IMPORTANCESecondhand smoking is a risk to adult ocular health, but its effect on children's ocular development is not known.OBJECTIVE To assess the association between choroidal thickness and secondhand smoking exposure in children. DESIGN, SETTING, AND PARTICIPANTSChildren aged 6 to 8 years were consecutively recruited from January 2016 to July 2017 from the population-based Hong Kong Children Eye Study at the Chinese University of Hong Kong Eye Centre. All participants underwent detailed ophthalmic investigations. Choroidal thickness was measured by swept-source optical coherence tomography, with built-in software that automatically segmented the choroid layer to analyze its terrain imagery. History of secondhand smoking was obtained from a questionnaire. Multiple linear regression analyses were performed to assess the correlation between choroidal thickness and secondhand exposure when controlling for confounding factors. Analysis began July 2018 and ended in April 2019. MAIN OUTCOMES AND MEASUREMENTSThe association between children's choroidal thickness and their exposure to secondhand smoking. RESULTSOf 1400 children, 941 (67.2%) had no exposure to secondhand smoking, and 459 (32.8%) had exposure to secondhand smoking. The mean (SD) age was 7.65 (1.09) years for children in the nonexposure group and 7.54 (1.11) years for children in the exposure group. After adjustment for age, sex, body mass index, axial length, and birth weight, exposure to secondhand smoking was associated with a thinner choroid by 8.3 μm in the central subfield, 7.2 μm in the inner inferior, 6.4 μm in the outer inferior, 6.4 μm in the inner temporal, and 7.3 μm in the outer temporal. Choroidal thinning with also associated with increased number of family smokers and increased quantity of secondhand smoking. An increase of 1 family smoker was associated with choroidal thinning by 7.86 μm in the central subfield, 4.51 μm in the outer superior, 6.23 μm in the inner inferior, 5.59 μm in the outer inferior, 6.06 μm in the inner nasal, and 6.55 μm in the outer nasal. An increase of exposure to 1 secondhand cigarette smoke per day was associated with choroidal thinning by 0.54 μm in the central subfield, 0.42 μm in the inner temporal, and 0.47 μm in the outer temporal.CONCLUSIONS AND RELEVANCE This investigation showed that exposure to secondhand smoking in children was associated with choroidal thinning along with a dose-dependent effect. These results support evidence regarding the potential hazards of secondhand smoking to children.

Choroidal thickness is associated with many ocular conditions, interchangeability among different generations of optical coherence tomography is therefore important for both research purpose and clinical application. Hence, we compared choroidal thickness measurements between spectral-domain optical coherence tomography (SD-OCT) and swept-source optical coherence tomography (SS-OCT) in healthy paediatric eyes. A total of 114 children from the population-based Hong Kong Children Eye Study with mean age of 7.38 ± 0.82 years were included. Choroidal thickness of the right eye was measured by both devices. The central foveal choroidal thickness (CFCT) measured by SD-OCT and SS-OCT was 273.24 ± 54.29 μm and 251.84 ± 47.12 μm respectively. Inter-device correlation coefficient was 0.840 (95% CI 0.616–0.918). However, choroidal thickness obtained by SD-OCT was significantly thicker than that measured by SS-OCT with a mean difference of 21.40 ± 33.13 μm (P < 0.001). Bland–Altman limit of agreement on the relative difference scale for SD-OCT/SS-OCT was 86.33 μm. Validated conversion equation for translating SD-OCT CFCT measurement into SS-OCT was SS-OCT = 35.261 + 0.810 × SD-OCT. In conclusion, intra-class correlation coefficient (ICC) shows an acceptable agreement between SD-OCT and SS-OCT, however, there was a significant inter-device difference of choroidal thickness measurements in normal children eyes. Therefore, the measurements are not interchangeable.

Introduction: Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in the general population. How much it is a harbinger of cardiovascular disease (CVD) is controversial. We therefore analyzed the association of NAFLD with CVD in NHANES. Method: Data on 11,427 non-pregnant adult participants of NHANES 1999-2014 without viral hepatitis, diabetes on drug treatment and missing data in key variables were analyzed using the SPSS complex samples module. As ultrasound examination of the liver was not performed in NHANES, we used three non-invasive scores, fatty liver index (FLI), NAFLD liver fat score (LFS) and hepatic steatosis index (HSI) as markers of NAFLD. Logistic regression was used to examine their association, per standard deviation change, with CVD outcomes, namely, coronary heart disease (CHD), myocardial infarction (MI), heart failure (HF) and stroke. Results: 13.6% of participants had elevated LFS. The number of participants with self-reported CHD, MI, HF and stroke were 417 (3.1%), 430 (3.1%), 274 (1.8%) and 358 (2.4%), respectively. The main results are shown in the table. LFS was associated with increased risk of CHD, MI and HF with AUC of 0.595, 0.592, and 0.590, respectively (p<0.0001 for these outcomes). FLI was associated with increased risk of MI and HF with AUC of 0.594 (p=0.013) and 0.616 (p<0.0001), respectively. HSI was associated with increased risk of HF (AUC: 0.514). None of these scores was associated with stroke. Conclusion: With a large study population, we could discern a small but significant association of CHD, MI and HF with NAFLD. Although NAFLD is common in the general population, it is associated with only a slightly higher prevalence of CVD.

PURPOSE: Choroidal thickness is associated with many ocular conditions, interchangeability among different generations of optical coherence tomography is therefore important for both research purpose and clinical application. Hence, we compared choroidal thickness measurements between spectral-domain optical coherence tomography (SD-OCT) and swept-source optical coherence tomography (SS-OCT) in healthy pediatric eyes.METHODS: Children from the population–based Hong Kong Children Eye Study were recruited. Choroidal thickness was measured by both devices. Intra-class correlation coefficient (ICC) was used to compare the measurements.RESULTS: A total of 114 children with mean age of 7.38±0.82 years were included. The central foveal choroidal thickness (CFCT) measured by SD-OCT and SS-OCT was 273.24±54.29μm and 251.84±47.12μm respectively. Inter-device correlation coefficient was 0.840 (95%CI: 0.616-0.918). However, choroidal thickness obtained by SD-OCT was significantly thicker than that measured by SS-OCT with a mean difference of 21.40±33.13μm (P<0.001). Bland-Altman limit of agreement on the relative difference scale for SD-OCT/SS-OCT was 86.33μm. Validated conversion equation for translating SD-OCT CFCT measurement into SS-OCT was SS-OCT = 35.261 + 0.810 x SD-OCT. CONCLUSIONS: ICC shows an acceptable agreement between SD-OCT and SS-OCT, however, there was a significant inter-device difference of choroidal thickness measurements in normal children eyes. Therefore, the measurements are not interchangeable.