AMERICAN JOURNAL OF OPHTHALMOLOGY OCTOBER 2023

中文摘要

在過去一年中，需要但無法負擔醫療費用的人比起其他人更有可能報告由於白內障導致的視力喪失（ P < 0.001）。未投保醫療保險的參與者比起擁有私人保險的人更不可能報告接受了白內障手術（ P = 0.03）。收入較高的人（貧窮收入比：1.00-2.99 vs < 1.00）更有可能報告接受了白內障手術（ P = 0.04）。這些結果來自約翰霍普金斯大學醫學院威爾默眼科學院的研究。該研究強調眼科醫生在白內障患者中檢測社會風險的重要性，因為這些社會因素是影響接受就醫的重要障礙。視力障礙是一個重要的公共衛生問題，影響著超過340萬40歲以上的美國人，導致了巨大的經濟負擔。視力障礙對生活質量、心理社交健康和死亡率都有不良影響。白內障是美國領先的可逆視力喪失原因，負責50%的雙眼視力障礙。儘管白內障有有效的外科治療方法，但種族和族裔之間存在白內障相關視力障礙的差異，如巴爾的摩眼睛調查研究所發現，黑人患者的視力障礙因白內障而引起的年齡調整後患病率比白人患者高75%，接受白內障手術的比例較低。根據2016年的美國國家健康訪談調查（NHIS）分析，自報視覺障礙與具體的社會決定健康（social determinants of health, SDOH）指標（如教育水準較低、醫療保險、支付醫療費用困難等）明顯相關。本研究調查了2016年至2017年期間的NHIS數據集中的多個SDOH變數，發現與白內障相關的結果存在不平等，包括保險類型、收入水平、工作狀態、因時間問題延遲就醫和在過去一年需要但無法負擔醫療費用等。因此，研究提醒眼科醫生在白內障患者中應重視社會風險，並提醒醫療機構關注社會決定健康因素，以解決接受醫療的障礙。根據研究結果顯示，與高教育程度的人相比，教育程度較低的人在需要時購買眼鏡的能力較差。雖然之前的研究發現，教育程度較低的人患白內障的風險增加，但我們未在自報白內障和不同教育程度之間找到任何顯著關聯。此外，之前的研究指出教育程度較低的人視力損失率較高，但我們的研究未發現白內障導致的視力損失與教育程度之間的類似關聯。此外，在我們的研究中，即使在控制其他相關變量（如保險類型、年齡、種族和人均所得）後，教育程度較高的人接受白內障手術的可能性也顯著較低。未來的研究應該考慮到健康保險因素，並探討社會因素對於白內障相關結果的影響，例如醫療知識和語言障礙。此外，提供改善健康教育、保險覆蓋和幫助有社會風險的人連接眼科服務的資源，有助於解決這些健康差距。

English Abstract

The content discusses the association between social determinants of health (SDOH) factors and cataract-related outcomes. The study found that individuals who couldn’t afford medical care were more likely to report vision loss due to cataracts. Uninsured participants were less likely to undergo cataract surgery compared to those with private insurance. Higher income individuals were more likely to undergo cataract surgery. The study emphasizes the importance of ophthalmologists screening for social risks in patients with cataract, as social factors can be barriers to accessing care. Vision impairment due to cataracts is a significant public health issue, affecting millions of Americans. Racial and ethnic disparities in vision impairment have been documented, with Black individuals having a higher prevalence of visual impairment due to cataracts and lower rates of cataract surgery. Various SDOH factors, including income, insurance type, and access to healthcare, were examined in relation to cataract-related outcomes. The study used nationally representative data from three survey years.The content discusses a study that examines the relationship between education level and the affordability of eyeglasses and cataract-related outcomes. The study finds that individuals with lower educational attainment have a higher risk of cataracts but no significant association between education level and self-reported cataracts. It also explores the impact of health insurance on cataract-related outcomes, with uninsured individuals having the highest likelihood of vision loss due to cataracts. The study suggests that social factors such as insurance coverage, health literacy, and language barriers can serve as barriers to receiving cataract surgery and recommends improving health disparities through resources and assistance.

Ophthalmology Volume 130, Number 12, December 2023

中文摘要

本研究目的是檢測患有不確定小脈絡膜黑色素病變的患者循環腫瘤細胞（circulating tumor cells, CTCs)的存在。研究對象為47名患有2.5毫米或以下病變厚度和大基底直徑(largest basal diameter)的脈絡膜黑色素病變患者。結果發現CTCs的存在與病變的大基底直徑和厚度呈正相關。儘管觀察和等待可能會導致細胞持續傳播和預後惡化，但由於組織活檢具有很多限制和危險，因此流動生物(liquid biopsy)檢查是解決這些問題的替代方法。然而，目前對於CTCs檢測在不確定小脈絡膜黑色素病變中的敏感性和特異性的確定仍然是一個重要挑戰。因此，流動生物檢查需要進一步在臨床實踐中得到確定。在CTCs陽性患者中，亞視網膜下液(subretinal fluid)、橙色色素(orange pigment)、聲場中空(sonographic hollowness)和大基底直徑大於5毫米的風險因素明顯高於CTCs陰性患者。此外，對不確定小脈絡膜黑色素病變進行組織活檢的敏感性較低，而液體活檢的敏感性和特異性需要進一步研究。

English Abstract

The purpose of this study was to detect circulating tumor cells (CTCs) in patients with small choroidal melanocytic lesions. The study included 47 patients with lesions 2.5 mm or less in tumor thickness. The presence of CTCs was positively associated with both lesion thickness and largest basal diameter. Compared with the nCTC group,a higher percentage of the pCTC group exhibited LBD>5mm (36%vs.88%), subretinal fluid(9.1% vs.56%),orange pigment (4.5%vs.60%), sonographic hollowness (9.1%vs.60%),and the presence of multiple risk factors(0%vs.68% for 3 factors) with P<0.001 for all parameters.The study discusses the challenges in distinguishing between choroidal nevi and early-stage uveal melanoma and the limitations of current diagnostic techniques such as tissue biopsy. Liquid biopsy is proposed as an alternative method, and the study describes the procedure for isolating CTCs from peripheral blood. The sensitivity and specificity of liquid biopsy in detecting tumor cells in uveal melanoma remain important challenges. The study concludes that liquid biopsy has the potential to solve the limitations of current diagnostic techniques but further research is needed.

Ophthalmology Volume 130, Number 12, December 2023

中文摘要

這項研究旨在研究年齡相關眼病在診斷的流行率和發生率的當代趨勢。研究採用了每年的橫斷面診斷流行率和發生率進行計算，並按人口統計特徵（年齡、性別、種族和族裔）進行分層計算。研究發現，到2020年，所有疾病的診斷流行率和發生率均有所上升。總結來說，這項研究提供了Medicare FFS受益人年齡相關主要慢性眼疾診斷的流行率和發生率的最新數據。與較舊的流行病學估計相比，我們發現每個研究的疾病的診斷流行率在近年來有所提高。

English Abstract

This study aimed to examine trends in the diagnosed prevalence and incidence of age-related eye diseases, specifically age-related macular degeneration (AMD), diabetic retinopathy (DR), and glaucoma, among Medicare Fee-for-Service beneficiaries. The researchers analyzed annual cross-sectional data from 2005 to 2019 and also looked at the prevalence and incidence in 2020, which may have been impacted by the COVID-19 pandemic. The study found that the diagnosed prevalence of these eye diseases increased over the study period, with AMD showing a higher prevalence in more recent years. There were also differences in prevalence and incidence rates based on demographic factors such as age, sex, race, and ethnicity. The study notes that the findings may underestimate the true population differences, as the data is based on administrative claims from patients seeking eye care. Overall, the study provides updated data on the prevalence and incidence of major chronic age-related eye diseases among Medicare beneficiaries.

Ophthalmology Volume 130, Number 12, December 2023

中文摘要

本研究納入了2012年至2019年間在瑞典角膜移植紀錄登記中完成2年追蹤的一千六百七十七名接受內皮角膜移植手術的患者。根據視力、年齡、性別、手術年份和手術前炎症、血管生成和青光眼等風險因素進行傾向評分匹配，形成了三個可比較的組別(DMEK、DSAEK和 phacoemulsification plus DSAEK)每組216名患者。主要結果指標為2年追蹤時的最佳矯正視力和移植物存活頻率。結果顯示，三種手術方法中大多數患者(90%)的視力都有所提升。然而，DMEK和phacoemulsification plus DSAEK在手術後2年的視力水平更高，而phacoemulsification plus DSAEK在移植物存活率方面更優。三種手術方法都有優點和缺點，選擇手術方法應個體化，考慮到不僅僅是角膜，還有每位患者的完整醫療狀況以及手術後的全程醫療。

English Abstract

The study included 1,677 patients who underwent endothelial keratoplasty in Sweden from 2012 to 2019. Three groups (DMEK, DSAEK, and phacoemulsification plu sDSAEK) were compared based on surgical method and propensity score matching. The main outcome measures were Best-corrected visual acuity (BCVA) at the 2-year follow-up, frequency of graft dislocation,graft rejection episodes,and graft failure within 2 years including primary graft failure. The study found that visual acuity improved in 90% of patients with all three surgical methods, but DMEK and phacoemulsification plus DSAEK had higher levels of visual acuity after 2 years. The frequency of graft dislocation was higher among the patients undergoing phacoemulsification plus DSAEK, but the frequency of graft failure and primary graft failure was higher in the DMEK group.The study suggests that the choice of surgical method should be individualized based on the patient’s complete medical status.

Ophthalmology Volume 130, Number 12, December 2023

中文摘要

本研究旨在描述目前最大型、表現型和基因型多樣的 先天性視網膜疾病Inherited retinal diseases (IRD)相關 Coats-like vasculopathy (CLV) 患者群。通過回顧臨床記錄、眼科影像和分子診斷來進行研究。主要結果指標包括視覺功能、視網膜影像和治療反應。研究結果顯示，CLV診斷時的患者整體年齡為30.7（16.9）歲。81％的患者進行了基因檢測，其中40人進行了分子解決(molecularly solved)。最終最佳矯正視力明顯惡化（P = 0.002），60％的患者在視力規律檢查期間失去了15 ETDRS字母或更多，31％的患者進行了更進一步的視覺障礙治療。

English Abstract

The article describes a study on patients with Coats-like vasculopathy (CLV) associated with inherited retinal diseases (IRD). The study reviewed clinical notes, ophthalmic imaging, and molecular diagnosis from two international centers to describe the largest and most diverse cohort of patients with IRD-related CLV. The main findings of the study include:

• The overall age of patients at CLV diagnosis was 30.7 years.

• 81% of patients had genetic testing, and 60% of them lost 15 ETDRS letters or more over follow-up in one or both eyes.

• 31% of patients progressed to more advanced stages of visual impairment.

• IRD-related CLV is rare, sporadic, and mostly bilateral.

• Patients with decreased initial visual acuity, changes affecting 2 or more retinal quadrants, and CRB1-retinopathy may be at higher risk of a poor prognosis.