Visual acuity of urban and rural adults in a coastal province of southern China:the Fujian Eye Study

AIM:To evaluate the vision status and sociodemographic associations of visual acuity(VA)in an urban and rural population in a coastal province of southern China.METHODS:The Fujian Eye Study,a population-based cross-sectional study,was performed from May 2018 to October 2019.Totally 10044 participants over 50 years old from all nine cities in Fujian Province were enrolled,and underwent a questionnaire and a series of standard physical and ocular examinations.VA was measured by E Standard Logarithmic Visual Acuity Chart(GB 11533-1989).Data was double entered with Epi Data v3.1 for data collation and Stata/SE statistical software v15.1 was used to analyze the data.RESULTS:Totally 8211(81.8%)participants were finally included and were divided into urban populations(4678 subjects),rural populations(n=3533),coastal residents(n=6434),and inland residents(1777 subjects);4836 participants were female.The mean age was 64.39±8.87 y(median 64 y;range 50-98 y).The mean presenting VA was 0.61±0.30(0.23±0.27 log MAR),and the mean best correctedvisual acuity(BCVA)was 0.82±0.28(0.08±0.19 log MAR).In the multiple regression analysis,BCVA was significantly correlated with several socioeconomic and biologic factors,including age(P<0.001),education level(P<0.001),income(P=0.005),rural residency(P<0.001),inland residency(P=0.001)and refractive error(P<0.001),while sex(P=0.194)was independent with BCVA.CONCLUSION:Accessible services and eye health policies targeting the elderly,people with high myopia and people living in rural or inland areas are needed.

Morphological and functional changes in the macular area in diabetic macular edema after a single intravitreal injection of aflibercept

AIM:To evaluate the changes in macular morphology and function after a single intravitreal injection of aflibercept in diabetic macular edema(DME)using optical coherence tomography angiography(OCTA)and MP-3 microperimetry.METHODS:Twenty-eight patients(42 eyes)diagnosed with DME were treated with intravitreal injection of aflibercept.The changes in best corrected visual acuity(BCVA),central retinal thickness(CRT),foveal avascular zone(FAZ)area,vessel density of superficial retinal capillary plexus(SVD),vessel density of deep retinal capillary plexus(DVD),mean light sensitivity(MLS),2°fixation rate(P1),4°fixation rate(P2),and other indicators 1mo after treatment were compared;of these,BCVA was conver ted into logarithm of the minimum angle of resolution(logMAR),and the correlation among the factors was analyzed.RESULTS:After treatment,logMAR BCVA was 0.47±0.24,which was significantly better than that before treatment(0.63±0.28,P<0.001).The CRT was 359.21±107.87μm after treatment,which was significantly lower than before treatment(474.10±138.20μm,P<0.001).The FAZ area,SVD,and DVD were not significantly changed after treatment compared with the baseline.MLS was 22.16±4.20 dB after treatment,which was significantly higher than before treatment(19.63±4.23 dB,P<0.001).P2 significantly increased after treatment than before treatment(P=0.007).P1 had no significant change after treatment than before treatment(P=0.086).CONCLUSION:A single intravitreal injection of aflibercept effectively reduces macular edema and improves retinal sensitivity,fixation stability,and visual acuity,possibly without causing significant changes in the retinal vascular condition in a short time.

Cumulative sum analysis score and phacoemulsification competency learning curve

AIM： To use the cumulative sum analysis score（CUSUM） to construct objectively the learning curve of phacoemulsification competency.METHODS： Three second-year residents and an experienced consultant were monitored for a series of 70 phacoemulsification cases each and had their series analysed by CUSUM regarding posterior capsule rupture（PCR） and best-corrected visual acuity. The acceptable rate for PCR was 〈5%（lower limit h） and the unacceptable rate was 〉10%（upper limit h）. The acceptable rate for bestcorrected visual acuity worse than 20/40 was 〈10%（lower limit h） and the unacceptable rate was 〉20%（upper limit h）. The area between lower limit h and upper limit h is called the decision interval. RESULTS： There was no statistically significant difference in the mean age, sex or cataract grades between groups. The first trainee achieved PCR CUSUM competency at his 22 nd case. His best-corrected visual acuity CUSUM was in the decision interval from his third case and stayed there until the end, never reaching competency. The second trainee achieved PCR CUSUM competency at his 39^ th case. He could reach best-corrected visual acuity CUSUM competency at his 22 ^nd case. The third trainee achieved PCR CUSUM competency at his 41 st case. He reached bestcorrected visual acuity CUSUM competency at his 14 ^th case.CONCLUSION： The learning curve of competency in phacoemulsification is constructed by CUSUM and in average took 38 cases for each trainee to achieve it.