Background: To estimate the global disease burden of uncorrected refractive error (URE) among adolescents and assess the contributions of various risk factors to disability-adjusted life-years (DALYs) due to URE. Methods: Global, regional and country-level DALY numbers and rates due to URE among adolescents were acquired from the Global Burden of Disease Study 2019 database. Human Development Index (HDI), Socio-Demographic Index (SDI) and other country-level data were obtained from other open databases as potential indicators. Regression analysis was used to evaluate associations between DALY rates among adolescents and potential predictors. Results: Global DALYs due to URE among adolescents rose by 8% between 1990 and 2019 but moderately decreased by 4.8% during this period after adjusting for population size. Female adolescents showed higher DALY rates. DALY rates sharply increased from 5 to 9 years of age, then rose more slowly, reaching a plateau before 20 years of age. Country-level DALY rates in 2019 were positively associated with HDI, SDI, and urbanization rates but negatively correlated with primary school dropout rates. Higher disease burden of adolescents visually impaired from URE was associated with lower primary school dropout rates (β = − 0.257, 95% CI − 0.376 to − 0.138, P < 0.001) and higher urbanization rates (β = 0.257, 95% CI 0.067 to 0.256, P = 0.001). Conclusions: Higher socioeconomic status, urbanization rates and education levels are associated with a heavier disease burden of URE among adolescents. The findings of this study can provide a reference for policy making on resource allocation for URE prevention and control in teenagers.

Purpose. To study the clinical significance of the Graves’ orbitopathy-specific quality of life (GO-QOL) questionnaire in mainland Chinese patients. Methods. A cross-sectional study was performed at the Ophthalmology Department of the Sun Yat-sen Memorial Hospital from April 2017 to April 2018. Eighty-eight consecutive Graves’ orbitopathy (GO) patients completed the two subscales of the GO-QOL questionnaire: visual functioning and appearance. The disease severity of GO was measured by the European Group on Graves’ Orbitopathy (EUGOGO) classification, and clinical activity was evaluated by the clinical activity score (CAS). Results. The mean scores of GO-QOL questionnaire for the visual functioning and appearance subscales were 68.4 ± 31.2 and 62.0 ± 27.4, respectively. Lower QOL scores for the visual functioning subscale were significantly correlated with disease severity, the CAS and diplopia (all p<0.05). Lower QOL scores for appearance were significantly correlated with the CAS (p<0.05). Although no correlation was found between the appearance subscale scores and disease severity (p=0.407), a downward trend in the appearance subscale scores as the severity of GO increased from mild to sight-threatening GO was found. Conclusion. A strong correlation between disease severity and clinical activity has been shown in the GO-QOL questionnaire, suggested by the EUGOGO. The GO-QOL questionnaire is a simple and effective appraisal instrument in the evaluation of health-related QOL in the mainland Chinese patients with GO.

Purpose: To analyse the retinal vessel density and thickness characteristics of diabetic nephropathy (DN) individuals with preclinical diabetic retinopathy (DR) using optical coherence tomography angiography (OCTA).Methods: This retrospective case−control study included 88 eyes of 88 type 2 DM patients with preclinical DR [44 non-DN (NDN) and 44 DN]. OCTA images and data were acquired using AngioVue 2.0 of the spectral domain OCT device. The foveal avascular zone (FAZ) area, superficial capillary plexus (SCP) and deep capillary plexus vessel densities, ganglion cell complex (GCC) and full retinal thicknesses, peripapillary capillary density and nerve fibre layer (RNFL) thickness were compared between the NDN and DN groups. The relationship between each renal function parameter and each OCTA parameter was analysed.Results: SCP vessel density, GCC thickness and full retinal thickness were significantly reduced in DN individuals compared to NDN individuals [(NDN versus DN) SCP vessel density: 46.65 ± 3.84% versus 44.35 ± 5.25%, p=0.030; GCC thickness: 100.79 ± 5.92 μm versus 93.28 ± 8.66 μm, p<0.001; full retinal thickness: whole area: 287.04 ± 13.62 μm versus 277.71 ± 15.10 μm, p=0.005). Within the peripapillary area, capillary density was also significantly reduced in the whole area (50.19 ± 3.10% versus 47.46 ± 5.93%, p=0.016) and some sectors in the DN group, though RNFL thickness was only decreased in some sectors. For all individuals, estimated glomerular filtration rate (eGFR) correlated significantly with most OCTA parameters and then showed a significantly negative correlation with FAZ area (β=−16.43, p=0.039) in multivariate linear regression analysis. In the NDN group, eGFR showed a significantly negative correlation with FAZ area (β=−18.746, p=0.048) and a significantly positive correlation with SCP vessel density (β=0.580, p=0.036).Conclusion: Preclinical DR may be more severe in DN individuals than in NDN individuals with regard to microvascular and microstructural impairment. Moreover, eGFR may be a good indicator for retinal microvascular impairment.

Background. Compound Xueshuantong capsule (CXC) and Hexuemingmu tablet (HXMMT) are two important Chinese patent medicines (CPMs) frequently used to treat proliferative diabetic retinopathy (PDR), especially when complicated with vitreous hemorrhage (VH). However, a network pharmacology approach to understand the therapeutic mechanisms of these two CPMs in PDR has not been applied. Objective. To identify differences in the active ingredients between CXC and HXMMT and to comparatively predict and further analyze the molecular targets shared by these CPMs and PDR. Materials and methods. The differentially expressed messenger RNAs (mRNAs) between normal retinal tissues in healthy individuals and active fibrovascular membranes in PDR patients were retrieved from the Gene Expression Omnibus database. The active ingredients of CXC and HXMMT and the targets of these ingredients were retrieved from the Traditional Chinese Medicine Systems Pharmacology database. The intersections of the CPM (CXC and HXMMT) targets and PDR targets were determined. Then, Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed, and the ingredient-target networks, protein-protein interaction networks, and KEGG-target (KEGG-T) networks were constructed. Results. CXC contains 4 herbs, and HXMMT contains 19. Radix salviae is the only herb common to both. CXC had 34 potential therapeutic targets in PDR, while HXMMT had these 34 and 10 additional targets. Both CPMs shared the following main processes: response to reactive oxygen species and oxidative stress, regulation of blood vessel diameter and size, vasoconstriction, smooth muscle contraction, hemostasis, and blood coagulation. The shared pathways included the AGE-RAGE signaling pathway in diabetic complications, TNF signaling pathway, relaxin signaling pathway, and IL-17 signaling pathway. Conclusions. Both CXC and HXMMT include components effective at treating PDR and affect the following main processes: response to reactive oxygen species and oxidative stress, regulation of blood vessels, and blood coagulation. Radix salviae, the only herb common to both CPMs, contains many useful active ingredients. The PDR-CXC and PDR-HXMMT networks shared 34 common genes (RELA, HSPA8, HSP90AA, HSP90AB1, BRCA, EWSR1, CUL7, HNRNPU, MYC, CTNNB1, MDM2, YWHAZ, CDK2, AR, FN1, HUWE1, TP53, TUBB, EP300, GRB2, VCP, MCM2, EEF1A1, NTRK1, TRAF6, EGFR, PRKDC, SRC, HDAC5, APP, ESR1, AKT1, UBC, and COPS5), and the PDR-HXMMT network has 10 additional genes (RNF2, VNL, RPS27, COPS5, XPO1, PARP1, RACK1, YWHAB, and ITGA4). The top 5 pathways with the highest gene ratio in both networks were the AGE-RAGE signaling pathway in diabetic complications, TNF signaling pathway, relaxin signaling pathway, IL-17 signaling pathway, and focal adhesion. Additional pathways such as neuroactive ligand-receptor interaction, chemokine signaling pathway, and AMPK signaling pathway were enriched with HXMMT targets. Thus, HXMMT has more therapeutic targets shared by different active ingredients and more abundant gene functions than CXC, which may be two major reasons why HXMMT is more strongly recommended than CXC as an auxiliary treatment for new-onset VH secondary to PDR. However, the underlying mechanisms still need to be further explored.

Background . To investigate the clinical characteristics of Graves’ orbitopathy (GO) with elevated intraocular pressure (IOP) using the European Group of Graves’ Orbitopathy (EUGOGO) system. Methods . In this retrospective study, the clinical data of GO patients with elevated IOP (≥21 mmHg) were collected in Sun Yat‐sen Memorial Hospital from January 2010 to June 2016. The demographic characteristics, clinical history of thyroid disease and GO, and ocular examination data were evaluated, and the activity and severity of GO were classified. Results . Data were collected from 58 eyes of 39 patients. The durations of thyroid disease and GO were 15.9 ± 18.9 months and 7.5 ± 6.2 months, respectively. The average IOP was 24.8 ± 5.3 mmHg (range: 21–55 mmHg). No significant difference in IOP was observed between active and inactive eyes. Eight eyes (13.8%), 29 eyes (50.0%), and 21 eyes (36.2%) were graded as mild, moderate‐severe, and sight‐threatening disease, respectively, according to the EUGOGO classification. The IOP was not significantly different among the three EUGOGO grades. No glaucomatous optic nerve damage or visual field defects were found. Conclusion . Increased IOP was evident for every grade of GO severity and activity of the EUGOGO system. IOP, glaucomatous optic nerve damage, and visual fields must be evaluated regularly during follow‐up evaluations, regardless of the degree of activity and severity of GO.

Objectives: The aim of the study was to investigate the relationship between myopic severity and the retinal microvasculature based on quantitative variables using optical coherence tomography angiography (OCTA) and to identify OCTA indicators of microvascular network loss in myopia. Methods: This cross-sectional study included 123 eyes of 123 myopic subjects. The included eyes were divided into three groups according to the spherical equivalent (SE) and axial length (AL): low myopia (LM) (−3.00 D ≤ SE ≤ −0.50 D), moderate myopia (MM) (−6.00 D ≤ SE < −3.00 D), and high myopia (HM) (−9.00 D ≤ SE < −6.00 D or AL >26 mm). All the eyes underwent OCTA scans. The densities and thicknesses of the macular and peripapillary zones, including the foveal avascular zone (FAZ) area, superficial vascular plexus (SVP) density, deep vascular plexus (DVP) density, ganglion cell complex (GCC) thickness, full retinal thickness, radial peripapillary capillary plexus (RPCP) density, and retinal nerve fiber layer (RNFL) thickness, were automatically exported. Results: Compared to the LM or MM group, the HM group had a significantly reduced FAZ area (p < 0.05). In most sectors of the parafoveal and perifoveal areas, the HM group had significantly lower DVP density and higher retinal thickness than the LM and MM groups (all p < 0.05). However, significant differences among the three groups in only one or several sectors were observed with regard to SVP density, GCC thickness, and RNFL thickness, and no significant differences among the three groups in any sector were noticed in RPCP density. Perifoveal DVP density and perifoveal full retinal thickness were positively associated with SE and negatively associated with AL in stepwise multiple linear regression analyses adjusted for sex and age. Conclusion: DVP density was closely related to myopic severity. Reduced perifoveal DVP density may serve as an indicator of microvascular network loss in myopia. OCTA may provide useful and crucial information for monitoring the progression of myopia.