From Arterial to Cardiac Dysfunction

Zanoli, Luca; Gaudio, Agostino; Castellino, Pietro

doi:10.1177/0003319720971096

Cited by 4 publications

(6 citation statements)

References 12 publications

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“…Despite the rigorous selection criteria, the rates of progression we reported were comparable with those of patients from large population-based clinical studies. [2][3][4] This comparison also supports the generalizability of our results. 4.…”

Section: Rates Of Visual Field Change In Patients With Glaucoma and H...supporting

confidence: 88%

“…As noted previously, the time between COVID-19 and retinal vascular occlusion diagnoses likely represents an over-estimate given the expected delay between symptom onset and diagnosis. Nonetheless, other studies have found that post-COVID-19 vascular and thrombotic changes can persist for months after acute infection, [3][4][5][6] making it possible that a similar phenomenon could occur with retinal vascular disease.…”

Section: Correspondence Regarding Changes In the Incidence Of Retinal...mentioning

confidence: 99%

“…3,4 However, we avoided a need for continuity correction to stabilize variances in our meta-analyses by choosing to use the Freeman-Tukey double-arcsine transformation (FTT) method for our random-effects model. 4 We ran an additional generalized linear mixed model (GLMM), specifically, a random intercept mixed-effects logistic regression model to confirm and compare with our pooled estimates from the FTT method. In all but 1 outcome (progression from nonproliferative diabetic retinopathy to proliferative diabetic retinopathy), the 2 methods were comparable (eTable 8 in the Supplement).…”

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confidence: 99%

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Correspondence Regarding Changes in the Incidence of Retinal Vascular Occlusions After COVID-19 Diagnosis

Lin

Wei

2022

JAMA Ophthalmol

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topic 2 supporting these meta-analytic results (we observed lower diabetic retinopathy [DR] prevalence in pregnant women with T2D than those with type 1 diabetes [T1D]).We agree that our included studies had small sample sizes and this condition has been reported to cause bias. 3 Especially for studies with 0 events, we understand that continuity corrections in meta-analyses can be problematic, as mentioned by Zhou and Shen and the literature. 3,4 However, we avoided a need for continuity correction to stabilize variances in our meta-analyses by choosing to use the Freeman-Tukey double-arcsine transformation (FTT) method for our random-effects model. 4 We ran an additional generalized linear mixed model (GLMM), specifically, a random intercept mixed-effects logistic regression model to confirm and compare with our pooled estimates from the FTT method. In all but 1 outcome (progression from nonproliferative diabetic retinopathy to proliferative diabetic retinopathy), the 2 methods were comparable (eTable 8 in the Supplement). 1 Although we note that a GLMM method would remove much of the concern around sampling error and bias, one downside to the GLMM is a lack of transparency regarding the weights given to each study. Thus, we decided to present the FTT results and forest plots so that our readers can focus on the clinical message and not be distracted by methodological arguments. In that vein, while prediction intervals can provide a useful concept for interpreting published pooled estimates of effect size of one treatment compared with another in the context of clinical decision-making for an individual patient, 5 we omitted them because if a clinician wanted to predict their presentday patients' risk of developing DR or predict its progression in pregnancy, they may be better served to consider only studies with excellent quality, validated DR grading schemes, and consistent methodology in a population with the same type of diabetes and access to the same level of (present day) diabetes care. Using such criteria, this would limit the analysis to only 4 T1D studies (grand total of 82 participants). We plan to produce a table of meta-analysis results from FTT and GLMM methods that include prediction intervals and look forward to the opportunity to present these results.

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Section: Rates Of Visual Field Change In Patients With Glaucoma and H...supporting

confidence: 88%

Section: Correspondence Regarding Changes In the Incidence Of Retinal...mentioning

confidence: 99%

mentioning

confidence: 99%

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Correspondence Regarding Changes in the Incidence of Retinal Vascular Occlusions After COVID-19 Diagnosis

Lin

Wei

2022

JAMA Ophthalmol

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“…3 Especially for studies with 0 events, we understand that continuity corrections in meta-analyses can be problematic, as mentioned by Zhou and Shen and the literature. 3,4 However, we avoided a need for continuity correction to stabilize variances in our meta-analyses by choosing to use the Freeman-Tukey double-arcsine transformation (FTT) method for our random-effects model. 4 We ran an additional generalized linear mixed model (GLMM), specifically, a random intercept mixed-effects logistic regression model to confirm and compare with our pooled estimates from the FTT method.…”

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confidence: 99%

Correspondence Regarding Changes in the Incidence of Retinal Vascular Occlusions After COVID-19 Diagnosis—Reply

Modjtahedi

Do²,

Shaw

2022

JAMA Ophthalmol

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COMMENT & RESPONSEIn Reply We thank Li and colleagues for their interest in our study. 1 We elected to focus our attention on the most wellestablished risk factors for retinal vascular occlusion when including covariates. Li and colleagues identified other possible risk factors for retinal vascular disease; however, the nature of these associations is less certain. Given the known causative role of hypertension, hyperlipidemia, and diabetes with heart disease and peripheral vascular disease, the inclusion of these latter 2 variables would be anticipated to have a more limited impact on our results and may risk distorting our results by unblocking new confounding pathways. The desire to be complete in the inclusion of covariates must be weighed against the risks of overfitting, multicollinearity, and inflating the standard errors for regression coefficients. 2,3 As such, models with collinear covariates may bias against finding an independent association between COVID-19 diagnosis and retinal vascular occlusion. The goal of this study was to provide a focused evaluation of retinal vascular occlusions relative to COVID-19 diagnosis. Additional studies are needed to improve our understanding of the risk factors for retinal vascular disease outside of COVID-19; however, this is outside the scope of our current study.As noted previously, the time between COVID-19 and retinal vascular occlusion diagnoses likely represents an overestimate given the expected delay between symptom onset and diagnosis. Nonetheless, other studies have found that post-COVID-19 vascular and thrombotic changes can persist for months after acute infection, 3-6 making it possible that a similar phenomenon could occur with retinal vascular disease.Given the relative rarity of retinal vascular occlusions, it is not unexpected that some associations may fail to reach statistical significance and it is more important to analyze the general trends to ensure they make intuitive and clinical sense. Compared with those patients who did not have a retinal vascular occlusion (group 1), patients with occlusions before COVID-19 diagnosis (group 2), and those with occlusions after COVID-19 diagnosis (group 3) were more likely to have elevated BMI. Obese individuals were more likely to have a retinal vascular occlusion-the mean difference between group 2 and group 1 was 22.7; 95% CI, 10.4-35.0; P < .001. The same degree of difference was not seen between group 3 and group 1 (mean difference, 8.9; 95% CI, −1.3 to 19.0; P = .09) Overweight individuals were more likely to have retinal vascular occlusions when comparing group 3 vs group 1 (mean difference, 14.0; 95% CI, 5.2-22.8; P = .002); however, this degree of difference was not seen between group 2 and group 1 (mean difference, 4.9; 95% CI, −5.8 to 15.6; P = .37). It is important to view these results in the larger context that generally higher BMI was associated with an increased risk of retinal vascular occlusion.We appreciate Li and colleagues' thoughtful commentary. The purpose of our study was to quanti...

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“…As previously reported, 4 aPWV is a measure of the mean stiffness of the arterial segment (regional stiffness) and it does not include the ascending aorta which makes an important contribution to total aortic compliance. To overcome these limitations, at least in part, several methods and devices have been proposed.…”

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confidence: 99%