Ophthalmology (Eye & Ear Hospital) - Research Publications
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ItemRetinal age gap as a predictive biomarker of future risk of Parkinson's disease(OXFORD UNIV PRESS, 2022-03-01)INTRODUCTION: retinal age derived from fundus images using deep learning has been verified as a novel biomarker of ageing. We aim to investigate the association between retinal age gap (retinal age-chronological age) and incident Parkinson's disease (PD). METHODS: a deep learning (DL) model trained on 19,200 fundus images of 11,052 chronic disease-free participants was used to predict retinal age. Retinal age gap was generated by the trained DL model for the remaining 35,834 participants free of PD at the baseline assessment. Cox proportional hazards regression models were utilised to investigate the association between retinal age gap and incident PD. Multivariable logistic model was applied for prediction of 5-year PD risk and area under the receiver operator characteristic curves (AUC) was used to estimate the predictive value. RESULTS: a total of 35,834 participants (56.7 ± 8.04 years, 55.7% female) free of PD at baseline were included in the present analysis. After adjustment of confounding factors, 1-year increase in retinal age gap was associated with a 10% increase in risk of PD (hazard ratio [HR] = 1.10, 95% confidence interval [CI]: 1.01-1.20, P = 0.023). Compared with the lowest quartile of the retinal age gap, the risk of PD was significantly increased in the third and fourth quartiles (HR = 2.66, 95% CI: 1.13-6.22, P = 0.024; HR = 4.86, 95% CI: 1.59-14.8, P = 0.005, respectively). The predictive value of retinal age and established risk factors for 5-year PD risk were comparable (AUC = 0.708 and 0.717, P = 0.821). CONCLUSION: retinal age gap demonstrated a potential for identifying individuals at a high risk of developing future PD.
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ItemBody mass index is not associated with early onset cataract in the 45 and Up cohort study(AME PUBLISHING COMPANY, 2021-11)BACKGROUND: Body mass index (BMI) has been reported to be associated with age-related cataract, whereas its impact on early onset cataract (EOC) remains unknown. METHODS: A total of 73,007 individuals aged 45-55 years who had no previous cataract surgeries at baseline were enrolled from the population-based 45 and Up Study. BMI was calculated based on self-reported height and weight from the baseline questionnaire. Data on cataract surgeries were obtained from the Medicare Benefits Schedule database. EOC was defined as cataract surgically treated prior to 65 years of age. A Cox proportional hazards regression was used to assess the association between BMI and the incidence of EOC during the follow-up. RESULTS: A total of 1,764 participants underwent cataract surgery over 643,717 person-years of follow-up. No significant association was observed between BMI and EOC (P for trend 0.35). Among participants who drank 5 to 7 alcoholic drinks per week, a 73% and 27% reduction in the risk of EOC was observed in participants with a BMI of 18.5-19.99 and 25.0-27.49 kg/m2, respectively, compared to those with a BMI of 20.0-22.49 kg/m2. CONCLUSIONS: No association was identified between BMI and the incidence of EOC. Moderate alcohol intake may be protective against EOC.
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ItemImpact of Retinopathy and Systemic Vascular Comorbidities on All-Cause Mortality.(Frontiers Media SA, 2021)PURPOSE: To assess the impact of retinopathy and systemic vascular comorbidities on the all-cause mortality in a representative U.S. sample. METHODS: A total of 5703 participants (≥40 years old) from the 2005-2008 National Health and Nutrition Examination Survey. The Early Treatment Diabetic Retinopathy Study grading scale was used to evaluate the retinopathy status. Systemic vascular comorbidities included diabetes mellitus (DM), high blood pressure (HBP), chronic kidney disease (CKD) and cardiovascular disease (CVD). Time to death was calculated as the time from baseline to either the date of death or censoring (December 31st, 2015), whichever came first. Risks of mortality were estimated using Cox proportional hazards models after adjusting for confounders and vascular comorbidities. RESULTS: After a median follow-up of 8.33 years (IQR: 7.50-9.67 years), there were 949 (11.8%) deaths from all causes. After adjusting for confounders, the presence of retinopathy predicted higher all-cause mortality (hazard ratio (HR), 1.41; 95% confidence interval (CI), 1.08-1.83). The all-cause mortality among participants with both retinopathy and systemic vascular comorbidities including DM (HR, 1.72; 95% CI, 1.21-2.43), HBP (HR, 1.47; 95% CI, 1.03-2.10), CKD (HR, 1.73; 95% CI, 1.26-2.39) and CVD (HR, 1.92; 95% CI, 1.21-3.04) was significantly higher than that among those without either condition. When stratified by diabetic or hypertension status, the co-occurrence of retinopathy and CKD or CVD further increased the all-cause mortality compared to those without either condition. CONCLUSIONS: The co-occurrence of retinopathy and systemic vascular conditions predicted a further increase in the risk of mortality. More extensive vascular risk factor assessment and management are needed to detect the burden of vascular pathologies and improve long-term survival in individuals with retinopathy.
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ItemAssociation of visual impairment with risk for future Parkinson's disease(ELSEVIER, 2021-12)BACKGROUND: Although visual dysfunction is one of the most common non-motor symptoms among patients with Parkinson's disease (PD), it is not known whether visual impairment (VI) predates the onset of clinical PD. Therefore, we aim to examine the association of VI with the future development of PD in the UK Biobank Study. METHODS: The UK Biobank Study is one of the largest cohort studies of health, enrolling over 500,000 participants aged 40-69 years between 2006 and 2010 across the UK. VI was defined as a habitual distance visual acuity (VA) worse than 0·3 logarithm of the minimum angle of resolution (LogMAR) in the better-seeing eye. Incident cases of PD were determined by self report data, hospital admission records or death records, whichever came first. Multivariable Cox proportional hazard regression models were used to investigate the association between VI and the risk of incident PD. FINDINGS: A total of 117,050 participants were free of PD at the baseline assessment. During the median observation period of 5·96 (IQR: 5·77-6·23) years, PD occurred in 222 (0·19%) participants. Visually impaired participants were at a higher risk of developing PD than non-VI participants (p < 0·001). Compared with the non-VI group, the adjusted hazard ratio was 2·28 (95% CI 1·29-4·05, p = 0·005) in the VI group. These results were consistent in the sensitivity analysis, where incident PD cases diagnosed within one year after the baseline assessment were excluded. INTERPRETATION: This cohort study found that VI was associated with an increased risk of incident PD, suggesting that VI may serve as a modifiable risk factor for prevention of future PD.
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ItemReal-world assessment of topical glaucoma medication persistence rates based on national pharmaceutical claim data in a defined population(WILEY, 2019-09)IMPORTANCE: The rate and determinants of persistence to topical glaucoma medications are important for identifying patients at high risk of discontinuing medications and designing targeted approaches to improve persistence. BACKGROUND: To evaluate the rate and determinants of persistence to topical glaucoma medications among middle-aged and older Australian adults. DESIGN: Population-based cohort study. PARTICIPANTS: Participants in need of persistent topical glaucoma medications in the 45 and Up Study. METHODS: The 45 and Up Study is a large-scale population-based cohort study. Participants were classified as needing persistent topical glaucoma medications if at least three claims with related prescriptions were recorded. Persistence was defined as topical glaucoma medications were filled within 90 days. MAIN OUTCOME MEASURES: The rates and determinants of medication persistence at 2-year follow-up. RESULTS: A total of 12 899 patients requiring persistent topical glaucoma medications were identified. Among them, 9019 (69.9%) had persisted with their glaucoma medications for at least 2 years. Multiple logistic regression analysis documented significant effects of patient-related factors (gender, socioeconomic status, language spoken at home, lifestyle and comorbidities) and drug-related factors (total number and drug class) on the persistence rate. Those most at risk groups of non-persistence were those patients living in remote areas (odds ratio, OR: 0.59, 95% confidence interval, CI: 0.37-0.92), having family income over 70 000 AUD/year (OR: 0.53, 95% CI: 0.45-0.62), speaking other languages at home (OR: 0.61, 95% CI: 0.53-0.68), and using cholinergic classes of medications (OR: 0.55, 95% CI: 0.38-0.79). CONCLUSIONS AND RELEVANCE: Our data has shown a medium level of persistence to topical glaucoma medication among middle-aged and older Australian adults. However, efforts are still needed to improve the rate of persistence.