Incidence, causes and risk factors of vision loss in rural Southern China: 6-year follow-up of the Yangxi Eye Study

Zhao, Xinyu; Lin, Jianqiang; Yu, Shanshan; Xie, Liqiong; Liu, Jin; Xiong, Kaixin; Tsui, Ching-Kit; Yue, Xu; Wu, Benjuan; Liu, Bin; Wang, Wei; Congdon, Nathan; Huang, Wenyong; He, Mingguang; Liang, Xiaoling

doi:10.1136/bjophthalmol-2021-320892

Cited by 7 publications

(11 citation statements)

References 33 publications

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“…Medical AI models are developed mainly for clinical application to fulfill unmet clinical needs, especially in rural areas. Recently, a few studies have investigated the incidence and prevalence of vision loss in rural areas, such as the Yangxi Eye Study 18 and the Handan Eye Study 21 in China and the Andhra Pradesh Eye Disease Study in India. 22 They found that patients in rural areas have great health care demands but experience the consequences of a lack of health awareness and poor access to high-quality and affordable eye services.…”

Section: Discussionmentioning

confidence: 99%

“…Yangxi County roughly reflects the eye health condition of rural residents and medical resources in low-income rural areas in China . Participants in this study were enrolled from the 6-year follow-up study of the Yangxi Eye Study, which was initiated in 2014 .…”

Section: Methodsmentioning

confidence: 99%

“…Yangxi County roughly reflects the eye health condition of rural residents and medical resources in low-income rural areas in China. 17,18 Participants in this study were enrolled from the 6-year follow-up study of the Yangxi Eye Study, which was initiated in 2014. 19 Rural residents aged 50 years or older were selected by random cluster sampling from 268 geographically defined sampling units in Yangxi County.…”

Section: Study Setting and Participantsmentioning

confidence: 99%

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Deep Learning Performance of Ultra-Widefield Fundus Imaging for Screening Retinal Lesions in Rural Locales

Cui,

Lin,

et al. 2023

JAMA Ophthalmol

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ImportanceRetinal diseases are the leading cause of irreversible blindness worldwide, and timely detection contributes to prevention of permanent vision loss, especially for patients in rural areas with limited medical resources. Deep learning systems (DLSs) based on fundus images with a 45° field of view have been extensively applied in population screening, while the feasibility of using ultra-widefield (UWF) fundus image–based DLSs to detect retinal lesions in patients in rural areas warrants exploration.ObjectiveTo explore the performance of a DLS for multiple retinal lesion screening using UWF fundus images from patients in rural areas.Design, Setting, and ParticipantsIn this diagnostic study, a previously developed DLS based on UWF fundus images was used to screen for 5 retinal lesions (retinal exudates or drusen, glaucomatous optic neuropathy, retinal hemorrhage, lattice degeneration or retinal breaks, and retinal detachment) in 24 villages of Yangxi County, China, between November 17, 2020, and March 30, 2021.InterventionsThe captured images were analyzed by the DLS and ophthalmologists.Main Outcomes and MeasuresThe performance of the DLS in rural screening was compared with that of the internal validation in the previous model development stage. The image quality, lesion proportion, and complexity of lesion composition were compared between the model development stage and the rural screening stage.ResultsA total of 6222 eyes in 3149 participants (1685 women [53.5%]; mean [SD] age, 70.9 [9.1] years) were screened. The DLS achieved a mean (SD) area under the receiver operating characteristic curve (AUC) of 0.918 (0.021) (95% CI, 0.892-0.944) for detecting 5 retinal lesions in the entire data set when applied for patients in rural areas, which was lower than that reported at the model development stage (AUC, 0.998 [0.002] [95% CI, 0.995-1.000]; P &lt; .001). Compared with the fundus images in the model development stage, the fundus images in this rural screening study had an increased frequency of poor quality (13.8% [860 of 6222] vs 0%), increased variation in lesion proportions (0.1% [6 of 6222]-36.5% [2271 of 6222] vs 14.0% [2793 of 19 891]-21.3% [3433 of 16 138]), and an increased complexity of lesion composition.Conclusions and RelevanceThis diagnostic study suggests that the DLS exhibited excellent performance using UWF fundus images as a screening tool for 5 retinal lesions in patients in a rural setting. However, poor image quality, diverse lesion proportions, and a complex set of lesions may have reduced the performance of the DLS; these factors in targeted screening scenarios should be taken into consideration in the model development stage to ensure good performance.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Study Setting and Participantsmentioning

confidence: 99%

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Deep Learning Performance of Ultra-Widefield Fundus Imaging for Screening Retinal Lesions in Rural Locales

Cui,

Lin,

et al. 2023

JAMA Ophthalmol

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“…Matsuo et al 27 reported that family history was significantly higher in accommodative/partially accommodative esotropia and intermittent/constant exotropia than infantile esotropia. Also, probably because of the relatively inadequate eye care system in China, 28 potential patients with strabismus, especially older adults, are often undiagnosed.…”

Section: Discussionmentioning

confidence: 99%

Association between Gestational Age, Birth Weight, Parental Age at Childbirth, Mode of Delivery, and Infantile Esotropia

et al. 2022

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SIGNIFICANCE:This study investigated the potential perinatal risk factors associated with infantile esotropia in a Chinese population, including advanced parental age at childbirth and mode of delivery. The findings may be significant in developing better intervention strategies for infantile esotropia.PURPOSE: This study aimed to investigate the associations between gestational age, birth weight, parental age at childbirth, mode of delivery, family history of strabismus, and infantile esotropia in the Chinese population.METHODS: Ninety-nine patients with infantile esotropia and 117 control subjects were enrolled between March 2018 and March 2021. Detailed questionnaires were administered to parents to collect relevant information. Univariate and multivariate logistic regression models were used to identify possible risk factors of infantile esotropia. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. RESULTS:Infantile esotropia was associated with low birth weight (<2500 g; OR, 4.235; 95% CI, 1.460 to 12.287; P = .008) and emergency cesarean delivery (OR, 2.230; 95% CI, 1.127 to 4.413; P = .02). CONCLUSIONS:The findings suggest that low birth weight and emergency cesarean deliveries are risk factors for infantile esotropia, highlighting a need for collaborative care between obstetricians, pediatricians, and vision care providers.

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“…Participants were identified using random cluster sampling, details of which are described elsewhere. 18,19 Persons aged 50 years or older living in the catchment area for at least 6 months were considered eligible. Eligible persons were invited to a nearby temporary research clinic for comprehensive eye examinations, a physical examination, and questionnaires.…”

Section: Study Populationmentioning

confidence: 99%

Six-Year Change in Cataract Surgical Coverage and Postoperative Visual Outcomes in Rural Southern China: The Yangxi Eye Study

Gong,

Deng,

Yao

et al. 2023

Asia-Pacific Journal of Ophthalmology

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Purpose: The purpose of this study was to investigate a 6-year change in cataract surgical coverage (CSC), effective cataract surgical coverage (eCSC), and visual outcomes in an elderly population in rural southern China. Design: This is a prospective population-based study with a 6-year follow-up. Methods: The study included rural residents aged 50 years and above in southern China with comprehensive eye examinations at baseline and follow-up in 2014 and 2020, respectively. Results: Five thousand six hundred thirty-eight participants underwent baseline examinations (mean age 66.1±10.2 y, 50.8% women); and 3141 (64.9%) of 4841 eligible survivors attended the 6-year follow-up. Cataract surgical coverage was 41.7% and 40.6% at baseline and follow-up, respectively, while eCSC were 32.6% and 26.6%. In multivariate models, the 6-year likelihood of cataract surgery decreased with older age [odds ratio (OR)=0.97 per year, 95% confidence interval (CI): 0.94, 0.99, P=0.012] and worse baseline presenting uncorrected visual acuity (PVA) in the worse-seeing eye (OR=0.35 per unit logarithm of the minimum angle of resolution (logMAR), 95% CI: 0.25, 0.48, P<0.001), and increased with prior cataract surgical history at baseline (OR=3.88, 95% CI: 1.91, 7.09, P<0.001). The likelihood of receiving effective cataract surgery decreased with worse baseline PVA in the worse eye (OR=0.49 per unit logMAR, 95% CI: 0.24, 0.97, P=0.042) and better-seeing eye (OR=0.68 per unit logMAR, 95% CI: 0.48, 0.95, P=0.026). Posterior capsular opacification was the main reason for PVA <6/18, reporting it in logMAR (0.5) in operated eyes (38.4% at baseline; 28.1% at follow-up). Conclusions: World Health Organization has established a global target of increasing eCSC by 30% before 2030, but no increase was found in rural southern China between 2014 and 2020, let alone reaching the World Health Organization target of 56.3%. Strategies to improve surgery incidence should focus on older persons and those with worse preoperative PVA.

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Incidence, causes and risk factors of vision loss in rural Southern China: 6-year follow-up of the Yangxi Eye Study

Cited by 7 publications

References 33 publications

Deep Learning Performance of Ultra-Widefield Fundus Imaging for Screening Retinal Lesions in Rural Locales

Deep Learning Performance of Ultra-Widefield Fundus Imaging for Screening Retinal Lesions in Rural Locales

Association between Gestational Age, Birth Weight, Parental Age at Childbirth, Mode of Delivery, and Infantile Esotropia

Six-Year Change in Cataract Surgical Coverage and Postoperative Visual Outcomes in Rural Southern China: The Yangxi Eye Study

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