Volume 59 · Issue 08 · 2023

This issue focuses on the research progress of ophthalmic epidemiology investigation. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Guan Huaijin.

Eye health is an essential component of physical and mental health, concerning the whole life cycle and all age groups, which is a major public health and social issue related to people′s livelihood. With 2020 being the final year of the 13th Five-Year National Eye Health Plan(2016-2020) and the VISION 2020 initiative, under the support of the Bureau of Medical Administration under the National Health Commission, the White Paper on Eye Health in China was prepared, aiming to comprehensively introduce the achievements of eye health in China, as well as the work experience and challenges in the development of eye health. Under the guidance of the "Healthy China 2030" and with the aim to further promote the high-quality development of eye health during the 14th Five-Year Plan period and further improve people′s eye health, the National Health Commission formulated the 14th Five-Year National Eye Health Plan (2021-2025). This paper focuses on the interpretation of the core content of the Plan, aiming to better implement the plan and achieve the goals.

Systematic errors and bias are common problems that affect the validity and reliability of epidemiological surveys of myopia among schoolchildren and adolescents worldwide. To provide guidance for standardization of such surveys, the perniciousness, causes and control measures of errors in surveying respondents and bias during the examination and diagnosis are discussed in this article. It is emphasized that controlling systematic errors and bias is the key to ensuring the quality of an epidemiological survey of pediatric and adolescent myopia.

Behcet′s disease is a chronic and recurrent multisystemic inflammatory disease, and its etiology and pathogenesis are not completely clarified. Behcet′s uveitis is one of the common types of uveitis with the highest rate of untreatable blindness among various uveitis entities in China. The blindness in patients with Behcet′s uveitis is commonly caused by retinal vascular occlusion, retinal atrophy and optic nerve atrophy. Early diagnosis and treatment are essential to preserve and improve visual function in these patients. To provide general guidance and reference in the diagnosis and treatment of Behcet′s uveitis, consensus opinions have been developed through an extensive investigation on this disease by the experts in the Uveitis and Ocular Immunology Group of Chinese Ophthalmologist Association and the Ocular Immunology Group of Ophthalmology Society of Chinese Medical Association.

To describe the distribution and establish reference intervals (RI) of daytime intraocular pressure (IOP) in the eye health screening population of Handan.

This cross-sectional study included subjects who participated in eye health screening at the Physical Examination Center of Handan First Hospital from May 2021 to June 2022. A complete general and ocular examination was performed, including measurements of visual acuity and IOP (using Goldmann tonometry), slit lamp microscopy, fundus photography, and anterior and posterior segment optical coherence tomography. Subjects with factors that could cause significant changes in IOP or affect the accuracy of IOP measurement, or with an inability to measure IOP were excluded. Simple random sampling was used to select participants, who were grouped by gender and age (18 to <30, 30 to <40, 40 to <50, 50 to <60, 60 to <70, and ≥70 years). Central corneal thickness and IOP at 8 to 11 o′clock in one eye of each participant were recorded. The independent sample t test and ANOVA were used for statistical analysis, and the RI of IOP values was calculated by x¯±1.96s.

A total of 9 310 subjects had their IOP measured, and 3 491 participants (3 491 eyes) were randomly selected from 7 886 healthy subjects. The age of the participants was (47.74±14.47) years old, ranging from 18 to 90 years old. There were 1 694 males and 1 797 females. The central corneal thickness of all participants was (525.56±49.39) μm. The daytime IOP of all participants was (15.40±2.54) mmHg (1 mmHg=0.133 kPa), and the RI was 10.42 to 20.39 mmHg. The IOP was (15.49±2.58) mmHg for males and (15.29±2.49) mmHg for females, and the gender difference was statistically significant (P<0.05). The RI of daytime IOP values was 10.43 to 20.54 mmHg for males and 10.41 to 20.18 mmHg for females. There were significant differences in daytime IOP [(15.13±2.58), (15.33±2.53), (15.49±2.50), (15.53±2.55), (15.39±2.62), and (15.28±2.52) mmHg] among 6 age groups (P<0.05).

The distribution of daytime IOP in different gender and age groups in the eye health screening population of Handan and the RIs derived from the distribution were roughly the same as the international normal IOP RI (10 to 21 mmHg). It is recommended to refer to the RI of daytime IOP values of different genders and ages for clinical decision.

This study aimed to analyze the trends and characteristics of early visual development in infants and young children.

A prospective cohort study was conducted, including full-term infants born between 2008 and 2013 at the Maternal and Child Health Hospital in Sanhe City, Hebei Province, China. Visual acuity was assessed at three time points 42 days after birth, 9 months of age, and 18 months of age, using the Teller Acuity Card Ⅱ (TAC Ⅱ) grating visual acuity test. At 3 years of age, visual acuity was assessed using the Lea Symbols chart and converted to grating visual acuity. Visual acuity of both eyes was measured at 42 days, 9 months, and 18 months. For children at 9 and 18 months, monocular visual acuity was also assessed, while at 3 years of age, monocular visual acuity was measured. Visual acuity measurements at different time points and changes in visual acuity within each period were recorded. The visual development of the participants was analyzed and compared with previous literature results.

A total of 1 496 children were included in the study, including 773 males (51.67%) and 723 females (48.33%). The binocular visual acuity at 42 days, 9 months, and 18 months was 0.9 (0.6, 1.1), 6.4 (6.4, 9.6), and 9.6 (9.6, 9.6) cycles per degree (cpd), respectively, with statistically significant differences (P<0.001). Visual acuity increased by a factor of 3.21±0.70 between 42 days and 9 months, and by a factor of 0.23±0.48 between 9 and 18 months. At 9 months of age, the monocular visual acuity in the right and left eyes was 6.4 (4.8, 6.4) cpd, which remained the same at 18 months, and the median visual acuity at 3 years of age for both eyes was 18.75 cpd, with a Snellen visual acuity of 20/32 (20/40, 20/32). The differences in binocular visual acuity at each time point were not statistically significant (all P>0.05). At 9 months of age, 68.7%(633/921) of children had visual acuity of ≥6.5 cpd, which increased to 92.7%(342/369) at 18 months. Monocular visual acuity increased by a factor of 0.26±0.46 between 9 and 18 months, and by a factor of 1.36±0.52 between 18 months and 3 years. At 9 months of age, 72.01% (921 out of 1 279) of children who completed binocular visual acuity testing also underwent monocular visual acuity testing, while this proportion decreased to 35.83% (369 out of 1 030) at 18 months. Visual acuity improved with increasing age (P<0.001). The visual acuity of children at each age group in this study was higher than that reported in the literature for children in Guangzhou (P<0.001).

The visual acuity of healthy infants and young children below 3 years of age improves with age. Visual development progresses rapidly before 9 months of age, slows down afterward, and then resumes rapid growth at 18 months of age.

To investigate the relationship between refractive status and ocular biometric parameters in preschool children in Shunyi District, Beijing.

This cross-sectional study employed a random cluster sampling method to measure the ocular axial length (AL), corneal curvature(CR), anterior chamber depth, and horizontal corneal diameter (WTW) using an optical biometer in 3-6-year-old children from 11 kindergartens in Shunyi District, Beijing. The ratio of AL to corneal curvature radius (AL/CR) was calculated. Cycloplegic refraction was performed using 1% cyclopentolate, and the equivalent spherical diopter (SE) was calculated. Ocular biometric parameters were compared among different age groups and refractive statuses. Correlation and regression analyses were conducted between SE and ocular biometric parameters.

A total of 1, 142 children completed the examination, with a mean age of (4.52±0.87) years, including 119 three-year-olds, 487 four-year-olds, 362 five-year-olds, and 174 six-year-olds. Among them, 554 were boys and 588 were girls. The mean SE of the examined children was (1.19±0.81) D, AL was (22.27±0.67) mm, corneal curvature radius was (7.73±0.25) mm, and the anterior chamber depth was (3.33±0.67) mm. The mean SE for three-, four-, five-, and six-year-old children was 1.18, 1.19, 1.21, and 1.13 D, respectively. SE showed correlations with AL, AL/CR, and anterior chamber depth (r=-0.350, -0.542, -0.083; all P<0.05), but no correlation with WTW or corneal curvature radius (P>0.05). Among children with different refractive statuses, SE showed stronger correlations with AL and AL/CR in myopic, hyperopic, and highly hyperopic children compared to emmetropic children, and the correlation tended to be stronger with increasing age. The linear regression equations for SE and AL, AL/CR were SE=10.64-0.42·AL and SE=21.48-7.043·AL/CR, respectively.

The refractive status of 3-6-year-old children in Shunyi District, Beijing, showed minimal changes. Myopic children had longer AL, deeper anterior chamber, and slightly steeper cornea.

To explore the risk factors for diabetic retinopathy (DR) in patients with diabetes and the mediating effect of insulin use on the relationship between glycated hemoglobin (HbA1c) and DR.

Cross-sectional study. Random cluster sampling was conducted using a random number table method. A total of 84 sampling points (including 2 pilot points) were selected from the registered population of patients with type 2 diabetes aged 50 years and above at the Disease Prevention and Control Center in Funing County, Jiangsu Province. Questionnaires and biochemical tests were performed to obtain information on the general characteristics of the participants, medical history, insulin use, and glycated hemoglobin (HbA1c) levels. Ocular examinations, including anterior segment and fundus examinations, were conducted. The participants were divided into two groups, DR (diabetic retinopathy) and non-DR, based on the presence or absence of retinal hemorrhages, hard exudates, cotton wool spots, neovascularization, preretinal or vitreous hemorrhage. Univariate and multivariate logistic regression analyses were performed to identify the influencing factors for DR. The Karlson-Holm-Breen analysis method was used for mediation effect analysis.

A total of 2 067 diabetic patients were enrolled, of whom 1 965 completed the survey and 1 802 were included in the statistical analysis, resulting in a response rate of 87.2%. Among them, 660 patients were diagnosed with DR, with a detection rate of 36.63%. The results of multivariate analysis showed that diabetes duration (OR=1.166, 95%CI: 1.138-1.196), family history of diabetes (OR=1.325, 95%CI: 1.001-1.755), insulin therapy (OR=1.995, 95%CI: 1.434-2.777), HbA1c level (OR=1.513, 95%CI: 1.189-1.925), and alcohol consumption (OR=0.712, 95%CI: 0.514-0.985) were independent risk factors for DR. The mediating effect of insulin use accounted for 13.67% of the total effect of HbA1c on DR (P<0.001).

The risk factors for DR in patients with diabetes include a history of insulin therapy, longer duration of diabetes, family history of diabetes, alcohol consumption, and high HbA1c levels. Insulin use increases the impact of HbA1c on DR and has a partial mediating effect on DR.

This study aims to analyze the incidence, disease burden, and trend of intraocular foreign bodies in China from 1990 to 2019, and to analyze the trend of changes in age, period, and cohort of Chinese men.

The data related to the incidence rate and disease burden of intraocular foreign bodies in China from 1990 to 2019 were obtained from the Global Burden of Disease Database (GBD database) on the website of the Institute for Health Indicators and Evaluation (IHME) of the University of Washington, United States, and the annual percentage rate change (AAPC) of intraocular foreign bodies in China was calculated using the Joinpoint software to describe the long-term trend of their incidence rate and disease burden over time. Using Stata17 software, an age period cohort model was constructed to analyze the age, period, and cohort factors affecting intraocular foreign bodies in men.

In 2019, the incidence rate of intraocular foreign bodies in China was 791.20/100 000, and the DALY rate was 10.32/100 000, with an average annual decline rate of 1.70% and 1.48% respectively. In 2019, the number of cases of intraocular foreign bodies in China was 11.253 6 million, and the DALY was 1 812.29 million person years. Among them, the incidence and disease burden of intraocular foreign bodies in men were more severe than those in women, and the incidence and disease burden risk of intraocular foreign bodies in men aged 30-35 and 45-50 were the highest. The incidence and disease burden risk of intraocular foreign bodies in elderly men gradually increased.

As a common ophthalmic disease, the incidence of intraocular foreign bodies and the DALY rate are declining, but the disease burden is increasing. With the aging of the population, the incidence of intraocular foreign bodies in the elderly will further increase in the future, which should be considered by policy makers. The findings of this study can help governments and healthcare planners formulate practical and targeted policy responses.

To analyze the clinical features of corneal interface infection.

A retrospective case series study was conducted to explore the clinical features of interstitial corneal infection. The data of eight patients (eight eyes) who were diagnosed with interstitial corneal infection after undergoing corneal transplant or corneal refractive surgery and visited Beijing Tongren Eye Center from January to December 2018 were collected, including two male and six female patients aged between 18 and 55 years (median age, 27 years). The patients′ general information, surgical type, onset time, and clinical manifestations were recorded. The lesions were examined by in vivo corneal laser confocal microscopy (IVCM), and microbial cultures and drug sensitivity tests were performed.

Among the 8 patients, 4 had undergone small-incision lenticule extraction (SMILE), 2 had undergone lamellar keratoplasty, and 2 had undergone endothelial keratoplasty. The onset of infection occurred between 2 and 30 days after surgery, with a mean of 9.8 days. Among the 3 patients who had undergone SMILE, the treatment outcome was corneal haze or opacity, while the remaining 5 cases required corneal transplantation for interstitial infections. The pathogens of the 4 cases of interstitial infection after corneal transplantation were all Candida species. Under the IVCM, patients with corneal interstitial bacterial infections showed a large amount of necrotic tissue with no normal tissue structure in the corneal stroma, with infiltration of inflammatory cells and local aggregation of inflammatory cells, but no typical pathogen was observed. Patients with fungal infections showed fungal hyphae under the corneal cap (filamentous fungal infection) or dense, punctate, high-reflection structures in the corneal interstitial space (yeast-like fungal infection).

Corneal interlayer infection is difficult to diagnose early and has a poor prognosis. IVCM can assist in early diagnosis. The pathogen spectrum of corneal interlayer infection may differ from that of corneal infection caused by trauma.

The patient was a 21-year-old male. Because of blurred vision in both eyes for 1 month, he went to the Department of Ophthalmology of PLA Army Characteristic Medical Center (Daping Hospital). No cold symptoms before the onset, no history of systemic disease, denial of medication or vaccine injection history. Eye examination: the corrected visual acuity of both eyes was 0.8; Anterior segment examination showed no abnormalities; The optic discs of both eyes were mildly congested, and multifocal, patchy yellow-white lesions of different sizes were seen in the retina, with pigment masses in some lesions (Essence Picture 1). Fundus autofluorescence examination: the lesions in both eyes showed low autofluorescence, and some lesions in the left eye were mixed with dot-like high autofluorescence (Essence Picture 2). Coherence light tomography examination: varying degrees of structural disorder and atrophy from the external plexiform layer to the retinal pigment epithelium (Quintessential Picture 2). Clinical diagnosis: Acute multiple squamous pigment epithelial lesions of the posterior pole in both eyes.

The child was a male, 8 years old. Because of an epileptic seizure, he was diagnosed as tuberous sclerosis in the Department of Neurology, the First Affiliated Hospital of the Air Force Medical University of the People's Liberation Army, and requested ophthalmic consultation to check the fundus. Eye examination: visual acuity was 0.6 for the right eye (correction did not improve) and 0.8 for the left eye; The intraocular pressure in both eyes was normal, and there was no abnormality in the anterior segment of the eye; A round gray-white bulge lesion with a diameter of about 1 optic disc was seen at the infratemporal retinal vascular arch in the right eye, but no obvious lesion was seen in the left eye (Quintessential Picture 1). optical coherence tomography (OCT) examination: the retina at the tumor under the optic disc of the right eye was dome-shaped, with enhanced reflection signal, slightly obscuring the underlying tissue, thickening of the nerve fiber layer on its surface, compressing the underlying retinal lining structure, partial detachment of the posterior vitreous cortex, and localized adhesion to the top of the tumor; Infrared light reflection shows that the retinal tumor body is weakly reflective (A in Quintessential Picture 2). The retinas of the left eye at the three tumors above the temporal optic disc, below the vascular arch above the macular area, and above the vascular arch below the macular area were dome-shaped, and the reflection signal was enhanced, and the nerve fiber layer on its surface was thickened, which compressed the inner layer structure of the lower retina, in which an optical cavity was visible in the tumor above the temporal optic disc; Infrared light reflection showed that the three tumors of the retina showed weak reflection (B ~ D in Quintessential Picture 2). Clinical diagnosis: Tuberous sclerosis with multiple retinal astrocytic hamartomas in both eyes. Different from the right eye, multiple retinal astrocytic hamartomas in the left eye are more insidious, and the color fundus image is not displayed, while OCT clearly shows the location and size of the lesion.

With the continual advancement of gene editing technology, gene therapy has been increasingly explored as a potential treatment option for both hereditary and acquired diseases. Due to its unique physiological and anatomical characteristics, the eye has emerged as an optimal target for gene therapy. In fact, ophthalmology was among the first clinical fields to obtain approval for in vivo gene therapy. Despite the widespread development of gene therapy targeting ocular surface and corneal diseases in recent years, a systematic review of these projects is still lacking. Thus, this review aims to comprehensively summarize the research progress and clinical application of gene therapy for ocular surface and corneal diseases, providing valuable guidance for future research and clinical translation.

Limbal stem cell deficiency (LSCD) is an ocular surface disease resulting from a reduction and/or dysfunction of limbal stem cells. The symptoms of LSCD are non-specific and can be difficult to distinguish from other ocular surface diseases through slit-lamp examination. Impression cytology is currently considered the gold standard for LSCD diagnosis; however,it is a qualitative method with low sensitivity. Nonetheless,emerging imaging techniques offer quantitative diagnosis and staging of LSCD. This review article examines four imaging methods and their associated parameters for diagnosing LSCD: optical coherence tomography,which measures corneal epithelial thickness; optical coherence tomography angiography,which detects corneal neovascularization; in vivo confocal microscopy,which measures corneal epithelial thickness,subbasal nerve density,and corneal basal cell density; and future applications of full-field/spectral-domain optical coherence tomography.

Non-infectious uveitis (NIU) is a challenging type of intraocular inflammatory disease that tends to recur and can be resistant to treatment. It can cause both transient and permanent pathological changes in the retina and choroid. Accurate diagnosis and monitoring of these changes rely heavily on ophthalmic imaging methods. In recent years, the enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT), swept-source optical coherence tomography (SS-OCT), and swept-source optical coherence tomography angiography (SS-OCTA) have emerged as rapidly evolving ophthalmic imaging techniques that offer significant advantages in evaluating choroidal thickness, displaying the whole choroid, and monitoring choroidal blood flow. This review provides an overview of the current research status of EDI-OCT, SS-OCT, and SS-OCTA in evaluating intraocular inflammation and other choroid-related complications in noninfectious intermediate uveitis, posterior uveitis, and panuveitis, and also highlights their future prospects.

In recent years, the physical concept of wavefront aberration has been popularized in ophthalmology clinical practice, guiding visual correction and its work closely related to visual quality, especially in the field of corneal refractive surgery, so it is very important to deeply understand and master the clinical application of basic concepts such as wavefront aberration. This paper summarizes the definition, commonly used expression methods, clinical significance, characteristics, detection methods and its application in corneal refractive surgery, aiming to help ophthalmologists improve their ability to solve clinical problems by applying wavefront aberration.