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Tien Yin Wong - One of the best experts on this subject based on the ideXlab platform.
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machine learning to determine relative contribution of modifiable and non modifiable risk factors of major Eye Diseases
British Journal of Ophthalmology, 2020Co-Authors: Simon Nusinovici, Yih-chung Tham, Charumathi Sabanayagam, Tien Yin Wong, Liang Zhang, Xiaoran Chai, Lei Zhou, Caroline Vasseneix, Shivani MajithiaAbstract:Aims To use machine learning (ML) to determine the relative contributions of modifiable and non-modifiable clinical, metabolic, genetic, lifestyle and socioeconomic factors on the risk of major Eye Diseases. Methods We conducted analyses in a cross-sectional multi-ethnic population-based study (n=10 033 participants) and determined a range of modifiable and non-modifiable risk factors of common Eye Diseases, including diabetic retinopathy (DR), non-diabetic-related retinopathy (NDR); early and late age-related macular degeneration (AMD); nuclear, cortical and posterior subcapsular (PSC) cataract; and primary open-angle (POAG) and primary angle-closure glaucoma (PACG). Risk factors included individual characteristics, metabolic profiles, genetic background, lifestyle patterns and socioeconomic status (n~100 risk factors). We used gradient boosting machine to estimate the relative influence (RI) of each risk factor. Results Among the range of risk factors studied, the highest contributions were duration of diabetes for DR (RI=22.1%), and alcohol consumption for NDR (RI=6.4%). For early and late AMD, genetic background (RI~20%) and age (RI~15%) contributed the most. Axial length was the main risk factor of PSC (RI=30.8%). For PACG, socioeconomic factor (mainly educational level) had the highest influence (20%). POAG was the disease with the highest contribution of modifiable risk factors (cumulative RI~35%), followed by PACG (cumulative RI ~30%), retinopathy (cumulative RI between 20% and 30%) and late AMD (cumulative RI ~20%). Conclusion This study illustrates the utility of ML in identifying factors with the highest contributions. Risk factors possibly amenable to interventions were intraocular pressure (IOP) and Body Mass Index (BMI) for glaucoma, alcohol consumption for NDR and levels of HbA1c for DR.
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profile of retinal nerve fibre layer symmetry in a multiethnic asian population the singapore epidemiology of Eye Diseases study
British Journal of Ophthalmology, 2020Co-Authors: Yijin Tao, Carol Y. Cheung, Yih-chung Tham, Charumathi Sabanayagam, Shivani Majithia, Miaoli Chee, Sahil Thakur, Zhi Da Soh, Tien Yin WongAbstract:Background To examine the normative profile and determinants of retinal nerve fibre layer (RNFL) symmetry in a non-glaucoma, multiethnic Asian population. Methods Chinese, Malay and Indian adults aged ≥40 years were recruited from the Singapore Epidemiology of Eye Diseases study. Participants underwent standardised systemic and ocular examinations. RNFL thickness was obtained using a spectral-domain optical coherence tomography (Cirrus HD-OCT). RNFL symmetry (in %) was calculated based on Pearson correlation coefficient between the RNFL thickness profiles of the right and left Eyes. Multivariable linear regression analysis was used to investigate the associations between ocular and systemic factors with RNFL symmetry. Results 4211 participants (1227 Chinese, 1245 Malays, 1739 Indians) were included. The mean RNFL symmetry was 86.7%±8.5% in Chinese, 84.7%±10.2% in Malays and 84.0%±10.7% in Indians. The fifth percentile limit of RNFL symmetry was 71.2% in Chinese, 65.0% in Malays and 62.0% in Indians. In multivariable analysis adjusting for age, gender, ethnicity, hypertension, diabetes, hyperlipidaemia, interEye absolute differences in intraocular pressure (IOP), axial length and disc area, Malays (β=−0.9; p=0.03) and Indians (β=−1.76; p Conclusions In non-glaucoma individuals, interEye RNFL profile is less symmetric in Malays and Indians than that in Chinese. This also suggests that current commercial optical coherence tomography’s deployment of a single, universal RNFL symmetry cut-off for glaucoma detection is flawed, and ethnic-specific cut-off is warranted.
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patterns and risk factor profiles of visual loss in a multiethnic asian population the singapore epidemiology of Eye Diseases study
American Journal of Ophthalmology, 2019Co-Authors: Tien Yin Wong, Yih-chung Tham, Charumathi Sabanayagam, Chingyu ChengAbstract:Purpose To describe the pattern and risk factor traits associated with visual loss (defined as either visual impairment [VI] or blindness) in a multiethnic Asian cohort of Malay, Indian, and Chinese individuals living in Singapore. Methods A total of 10 020 participants from the Singapore Epidemiology of Eye Diseases Study were examined between 2004 and 2011. All underwent standardized examinations. VI (visual acuity Results Malay individuals had higher age-standardized prevalence of best-corrected and presenting VI (5.4% and 19.9%, respectively) than Indian (3.6% and 18.0%) and Chinese individuals (3.3% and 17.2%). Cataract was the main cause for presenting and best-corrected blindness; cataract and diabetic retinopathy were the top causes for best-corrected VI, consistently observed across the 3 ethnic groups. Older age, female sex, lower socioeconomic status, diabetes, systemic comorbidities, and cognitive impairment were independently associated with increased risk of best-corrected visual loss (all P ≤ .027). Individuals aged ≥60 years with diabetes were 12.7 times (95% confidence interval, 8.39–19.23) likely to have best-corrected visual loss, compared with younger, nondiabetic individuals. Lower income and education explained 58.1% and 23.2% of best-corrected visual loss in this population, respectively. Conclusion In this urban multiethnic Asian population, we identified common traits associated with visual loss across Malay, Indian, and Chinese individuals. These results will be useful for the planning and designing of Eye health services and strategies for Asia's rapidly developing populations living in urban communities. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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direct and indirect associations between diabetes and intraocular pressure the singapore epidemiology of Eye Diseases study
Investigative Ophthalmology & Visual Science, 2018Co-Authors: Xiaoyang Luo, Nicholas Y Q Tan, Yih-chung Tham, Jie Jin Wang, Tien Yin Wong, Miaoli Chee, Yuan Shi, Chingyu ChengAbstract:Purpose The association between diabetes and IOP is controversial; diabetes is associated with thicker central corneal thickness (CCT), and thicker CCT is associated with higher IOP. We therefore aimed to clarify the diabetes-IOP association, considering CCT as a potential mediator. Methods We included 8636 participants from the Singapore Epidemiology of Eye Diseases (SEED) Study. Associations of diabetes, serum glucose, or HbA1c with IOP were assessed using regressions models, with adjustments for potential confounding factors. Regression-based mediation (path) analyses were further performed to evaluate the indirect effects of diabetes on IOP through the mediator (CCT), in addition to the direct effect of diabetes on IOP. Results Of the 8636 participants, 2524 (29.23%) had diabetes. Diabetes, higher serum glucose, or HbA1c levels were all associated with higher IOP (all P < 0.01). The effect of diabetes on IOP was partially and minimally mediated through CCT; the proportion of mediating effect of CCT was 11.09% of the total effect of diabetes on IOP. Axial length and spherical equivalent were not mediating variables in the diabetes-IOP association. Findings were consistent across three ethnicity groups. Conclusions Diabetes or higher long-term hyperglycemia was associated with higher IOP. CCT contributed a small proportion of mediating effect to the total effect of diabetes on IOP. We conclude that high IOP observed in diabetes is mainly due to the direct association of diabetes and IOP, and this finding may have pathophysiologic significance with respect to the risk of glaucoma among persons with diabetes.
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inter relationship between ocular perfusion pressure blood pressure intraocular pressure profiles and primary open angle glaucoma the singapore epidemiology of Eye Diseases study
British Journal of Ophthalmology, 2018Co-Authors: Yih-chung Tham, Tin Aung, Tien Yin Wong, Singhui Lim, Preeti Gupta, Chingyu ChengAbstract:Objective To elucidate the inter-relationship between ocular perfusion pressure (OPP), blood pressure (BP), intraocular pressure (IOP) profiles and primary open-angle glaucoma (POAG) in a multiethnic Asian population. Methods Participants were recruited from the Singapore Epidemiology of Eye Diseases Study and underwent standardised ocular and systemic examinations. POAG was defined according to the International Society for Geographical and Epidemiological Ophthalmology criteria. Logistic regression analyses with generalised estimating equation models were performed and used to account for correlation between Eyes. Results A total of 9877 participants (19 587 Eyes), including 213 POAG cases (293 Eyes) were included. Eyes with lowest quartile levels of systolic OPP (SOPP Conclusions In this population-based sample of nearly 10 000 Asian individuals, we showed that low SOPP was associated with POAG. This association was potentially in part secondary to low SBP and high IOP. Our findings provide further clarity on the roles of OPP surrogates and BP profiles in POAG.
Chingyu Cheng - One of the best experts on this subject based on the ideXlab platform.
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patterns and risk factor profiles of visual loss in a multiethnic asian population the singapore epidemiology of Eye Diseases study
American Journal of Ophthalmology, 2019Co-Authors: Tien Yin Wong, Yih-chung Tham, Charumathi Sabanayagam, Chingyu ChengAbstract:Purpose To describe the pattern and risk factor traits associated with visual loss (defined as either visual impairment [VI] or blindness) in a multiethnic Asian cohort of Malay, Indian, and Chinese individuals living in Singapore. Methods A total of 10 020 participants from the Singapore Epidemiology of Eye Diseases Study were examined between 2004 and 2011. All underwent standardized examinations. VI (visual acuity Results Malay individuals had higher age-standardized prevalence of best-corrected and presenting VI (5.4% and 19.9%, respectively) than Indian (3.6% and 18.0%) and Chinese individuals (3.3% and 17.2%). Cataract was the main cause for presenting and best-corrected blindness; cataract and diabetic retinopathy were the top causes for best-corrected VI, consistently observed across the 3 ethnic groups. Older age, female sex, lower socioeconomic status, diabetes, systemic comorbidities, and cognitive impairment were independently associated with increased risk of best-corrected visual loss (all P ≤ .027). Individuals aged ≥60 years with diabetes were 12.7 times (95% confidence interval, 8.39–19.23) likely to have best-corrected visual loss, compared with younger, nondiabetic individuals. Lower income and education explained 58.1% and 23.2% of best-corrected visual loss in this population, respectively. Conclusion In this urban multiethnic Asian population, we identified common traits associated with visual loss across Malay, Indian, and Chinese individuals. These results will be useful for the planning and designing of Eye health services and strategies for Asia's rapidly developing populations living in urban communities. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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direct and indirect associations between diabetes and intraocular pressure the singapore epidemiology of Eye Diseases study
Investigative Ophthalmology & Visual Science, 2018Co-Authors: Xiaoyang Luo, Nicholas Y Q Tan, Yih-chung Tham, Jie Jin Wang, Tien Yin Wong, Miaoli Chee, Yuan Shi, Chingyu ChengAbstract:Purpose The association between diabetes and IOP is controversial; diabetes is associated with thicker central corneal thickness (CCT), and thicker CCT is associated with higher IOP. We therefore aimed to clarify the diabetes-IOP association, considering CCT as a potential mediator. Methods We included 8636 participants from the Singapore Epidemiology of Eye Diseases (SEED) Study. Associations of diabetes, serum glucose, or HbA1c with IOP were assessed using regressions models, with adjustments for potential confounding factors. Regression-based mediation (path) analyses were further performed to evaluate the indirect effects of diabetes on IOP through the mediator (CCT), in addition to the direct effect of diabetes on IOP. Results Of the 8636 participants, 2524 (29.23%) had diabetes. Diabetes, higher serum glucose, or HbA1c levels were all associated with higher IOP (all P < 0.01). The effect of diabetes on IOP was partially and minimally mediated through CCT; the proportion of mediating effect of CCT was 11.09% of the total effect of diabetes on IOP. Axial length and spherical equivalent were not mediating variables in the diabetes-IOP association. Findings were consistent across three ethnicity groups. Conclusions Diabetes or higher long-term hyperglycemia was associated with higher IOP. CCT contributed a small proportion of mediating effect to the total effect of diabetes on IOP. We conclude that high IOP observed in diabetes is mainly due to the direct association of diabetes and IOP, and this finding may have pathophysiologic significance with respect to the risk of glaucoma among persons with diabetes.
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inter relationship between ocular perfusion pressure blood pressure intraocular pressure profiles and primary open angle glaucoma the singapore epidemiology of Eye Diseases study
British Journal of Ophthalmology, 2018Co-Authors: Yih-chung Tham, Tin Aung, Tien Yin Wong, Singhui Lim, Preeti Gupta, Chingyu ChengAbstract:Objective To elucidate the inter-relationship between ocular perfusion pressure (OPP), blood pressure (BP), intraocular pressure (IOP) profiles and primary open-angle glaucoma (POAG) in a multiethnic Asian population. Methods Participants were recruited from the Singapore Epidemiology of Eye Diseases Study and underwent standardised ocular and systemic examinations. POAG was defined according to the International Society for Geographical and Epidemiological Ophthalmology criteria. Logistic regression analyses with generalised estimating equation models were performed and used to account for correlation between Eyes. Results A total of 9877 participants (19 587 Eyes), including 213 POAG cases (293 Eyes) were included. Eyes with lowest quartile levels of systolic OPP (SOPP Conclusions In this population-based sample of nearly 10 000 Asian individuals, we showed that low SOPP was associated with POAG. This association was potentially in part secondary to low SBP and high IOP. Our findings provide further clarity on the roles of OPP surrogates and BP profiles in POAG.
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vision impairment and major Eye Diseases reduce vision specific emotional well being in a chinese population
British Journal of Ophthalmology, 2017Co-Authors: Charumathi Sabanayagam, Chingyu Cheng, Tien Yin Wong, Eva K Fenwick, Peng Guan Ong, Ryan E K Man, Ecosse L LamoureuxAbstract:Aims To assess the relationship between vision impairment (VI) and major Eye Diseases, with vision-specific emotional well-being in a Chinese population. Methods In this population-based cross-sectional study, 3353 Chinese participants aged 40–80 years answered the emotional well-being scale of the Impact of Vision Impairment questionnaire, validated using Rasch analysis. Participants underwent visual acuity testing and collection of sociodemographic and medical data from standardised questionnaires. The relationships between presenting bilateral VI, presence of major Eye Diseases (cataract, undercorrected refractive error, glaucoma, age-related macular degeneration and diabetic retinopathy) and emotional well-being were assessed using linear regression models. Stratified analyses for age, gender, education and immigration status were conducted to determine if change in β coefficients differed within each stratum. Results Approximately half of patients (n=1805) had normal vision, and 43% (n=1534) and 3.4% (n=114) had moderate and severe bilateral VI, respectively. Vision-specific emotional well-being systematically worsened as severity of bilateral VI increased (p Conclusions Severe VI and glaucoma are associated with substantial decrements in vision-specific emotional well-being, highlighting the importance of preventing progression of vision loss. Evidence-based interventions to improve vision-related coping skills and emotional management for patients with severe VI and glaucoma are warranted.
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association of vision impairment and major Eye Diseases with mobility and independence in a chinese population
JAMA Ophthalmology, 2016Co-Authors: Charumathi Sabanayagam, Chingyu Cheng, Tien Yin Wong, Eva K Fenwick, Peng Guan Ong, Ryan E K Man, Ecosse L LamoureuxAbstract:Importance Mobility limitations arising from vision impairment (VI) can result in loss of independence and reduced quality of life. However, few data are available on the association between VI and mobility limitations at a population-based level, particularly in Asian populations. Objective To assess the association of VI and major Eye Diseases with mobility and independence (MI higher scores indicate better MI β, –1.44; 95% CI, –1.75 to –1.13) and all 11 MI β, –0.94; 95% CI, –1.82 to –0.06) and cataract (6%; β, –0.43; 95% CI, –0.65 to –0.22) were independently associated with worse M&I, with patients with glaucoma particularly concerned about avoiding falling or tripping. Conclusions and Relevance Bilateral VI in this population was associated with substantial decrements in M&I, with glaucoma and cataract independently associated with worse M&I. Although these associations do not prove that preventing bilateral VI will improve M&I in this population, the results suggest that such interventions could be of tremendous value from this perspective.
Carol Y. Cheung - One of the best experts on this subject based on the ideXlab platform.
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profile of retinal nerve fibre layer symmetry in a multiethnic asian population the singapore epidemiology of Eye Diseases study
British Journal of Ophthalmology, 2020Co-Authors: Yijin Tao, Carol Y. Cheung, Yih-chung Tham, Charumathi Sabanayagam, Shivani Majithia, Miaoli Chee, Sahil Thakur, Zhi Da Soh, Tien Yin WongAbstract:Background To examine the normative profile and determinants of retinal nerve fibre layer (RNFL) symmetry in a non-glaucoma, multiethnic Asian population. Methods Chinese, Malay and Indian adults aged ≥40 years were recruited from the Singapore Epidemiology of Eye Diseases study. Participants underwent standardised systemic and ocular examinations. RNFL thickness was obtained using a spectral-domain optical coherence tomography (Cirrus HD-OCT). RNFL symmetry (in %) was calculated based on Pearson correlation coefficient between the RNFL thickness profiles of the right and left Eyes. Multivariable linear regression analysis was used to investigate the associations between ocular and systemic factors with RNFL symmetry. Results 4211 participants (1227 Chinese, 1245 Malays, 1739 Indians) were included. The mean RNFL symmetry was 86.7%±8.5% in Chinese, 84.7%±10.2% in Malays and 84.0%±10.7% in Indians. The fifth percentile limit of RNFL symmetry was 71.2% in Chinese, 65.0% in Malays and 62.0% in Indians. In multivariable analysis adjusting for age, gender, ethnicity, hypertension, diabetes, hyperlipidaemia, interEye absolute differences in intraocular pressure (IOP), axial length and disc area, Malays (β=−0.9; p=0.03) and Indians (β=−1.76; p Conclusions In non-glaucoma individuals, interEye RNFL profile is less symmetric in Malays and Indians than that in Chinese. This also suggests that current commercial optical coherence tomography’s deployment of a single, universal RNFL symmetry cut-off for glaucoma detection is flawed, and ethnic-specific cut-off is warranted.
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profiles of ganglion cell inner plexiform layer thickness in a multi ethnic asian population the singapore epidemiology of Eye Diseases study
Ophthalmology, 2020Co-Authors: Yih-chung Tham, Carol Y. Cheung, Wei Dai, Shivani Majithia, Rosalynn Siantar, Miaoli Chee, Sahil Thakur, Zhi Wei Lim, Tyler Hyungtaek Rim, Charumathi SabanayagamAbstract:Purpose To examine the normative profile and determinants of macular ganglion cell-inner plexiform layer (GCIPL) thickness based on spectral-domain OCT (SD-OCT) in a nonglaucoma, multi-ethnic Asian population. Design Population-based, cross-sectional study. Participants Ethnic Chinese, Malay, and Indian adults aged ≥40 years recruited from the Singapore Epidemiology of Eye Diseases Study. Methods All participants underwent standardized examinations. The GCIPL thickness was measured using Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA). Participants with glaucoma or poor-quality scans were excluded. Eye-specific data were used. Associations of ocular and systemic factors with GCIPL thickness parameters were investigated using multivariable linear regression with generalized estimating equation models to account for correlation between both Eyes. Main Outcome Measures GCIPL thickness. Results A total of 4464 participants (7520 Eyes) consisting of 1625 Chinese, 1212 Malay, and 1627 Indian adults contributed to this analysis. Average GCIPL thickness was 82.6±6.1 μm in Chinese, 81.5±6.8 μm in Malays, and 78.0±6.9 μm in Indians (P Conclusions GCIPL thickness profiles were significantly thinner in Indians compared with Chinese and Malays. Our findings further highlight the need of a more refined, ethnic-specific normative database for GCIPL thickness, which in turn may improve the detection and diagnosis of glaucoma in Asians.
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retinal nerve fiber layer thickness in a multiethnic normal asian population the singapore epidemiology of Eye Diseases study
Ophthalmology, 2019Co-Authors: Yih-chung Tham, Nicholas Y Q Tan, Carol Y. Cheung, Shivani Majithia, Miaoli Chee, Kahhie Wong, Yuan ShiAbstract:Purpose To describe variations in retinal nerve fiber layer (RNFL) thickness based on spectral-domain (SD) OCT in a multiethnic Asian population. Design Population-based, cross-sectional study. Participants Ethnic Chinese, Malay, and Indian adults older than 48 years without glaucoma who were recruited from the Singapore Epidemiology of Eye Diseases Study. Methods All participants underwent standardized systemic and ocular examinations. Retinal nerve fiber layer thickness was measured using SD OCT. Participants with poor-quality scans were excluded. Linear regression models were used to investigate the associations of ocular and systemic factors with average RNFL thickness. Generalized estimating equation models were used to account for correlation between both Eyes. Main Outcome Measure Average RNFL thickness. Results Four thousand four hundred seventy-five participants (8178 Eyes) consisting of 1371 Chinese, 1303 Malay, and 1801 Indian adults contributed to this analysis. Average RNFL thickness measured was 95.7±9.6 μm in Chinese participants, 94.9±10.6 μm in Malay participants, and 87.3±10.6 μm in Indian participants (P Conclusions Average and regional RNFL thicknesses were significantly thinner in Indian Eyes compared with Chinese and Malay Eyes. Results of the study highlight the need to acquire more refined normative data for the comparison of individual patients with others of similar ethnic background while accounting for ocular factors that could influence RNFL thickness. This in turn may improve the sensitivity and specificity of glaucoma detection.
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normative pattern and determinants of outer retinal thickness in an asian population the singapore epidemiology of Eye Diseases study
British Journal of Ophthalmology, 2019Co-Authors: Wei Dai, Nicholas Y Q Tan, Yih-chung Tham, Ning Cheung, Charumathi Sabanayagam, Shivani Majithia, Miaoli Chee, Kahhie Wong, Kumari Neelam, Carol Y. CheungAbstract:Background/aims To evaluate the distribution and determinants of outer retinal thickness in Eyes without retinal Diseases, using spectral-domain optical coherence tomography (SD-OCT). Methods Participants were recruited from the Singapore Epidemiology of Eye Diseases Study, a population-based study among Chinese, Malays and Indians in Singapore. A total of 5333 participants underwent SD-OCT imaging in which a 6×6 mm2 measurement area centred at the fovea. Outer retinal thickness was defined as the distance from the outer plexiform layer to the retinal pigment epithelium layer boundary. Results 7444 Eyes from 4454 participants were included in final analysis. Of them, mean age was 58.4 years (SD 8.3), and 2294 (51.5%) were women. Women (121.0±8.1 µm) had thinner average outer retinal thickness than men (125.6±8.2 µm) (p Conclusion In this large sample of Asian population, we provided normative SD-OCT data on outer retinal thickness in Eyes without retinal Diseases. Women had thinner outer retina than men. For the first time, these findings provide fundamental knowledge on normative profile of outer retinal thickness in Asians.
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development and validation of a deep learning system for diabetic retinopathy and related Eye Diseases using retinal images from multiethnic populations with diabetes
JAMA, 2017Co-Authors: Carol Y. Cheung, Daniel Shu Wei Ting, Gilbert Lim, Gavin Tan, Nguyen Duc Quang, Alfred Tau Liang Gan, Haslina HamzahAbstract:Importance A deep learning system (DLS) is a machine learning technology with potential for screening diabetic retinopathy and related Eye Diseases. Objective To evaluate the performance of a DLS in detecting referable diabetic retinopathy, vision-threatening diabetic retinopathy, possible glaucoma, and age-related macular degeneration (AMD) in community and clinic-based multiethnic populations with diabetes. Design, Setting, and Participants Diagnostic performance of a DLS for diabetic retinopathy and related Eye Diseases was evaluated using 494 661 retinal images. A DLS was trained for detecting diabetic retinopathy (using 76 370 images), possible glaucoma (125 189 images), and AMD (72 610 images), and performance of DLS was evaluated for detecting diabetic retinopathy (using 112 648 images), possible glaucoma (71 896 images), and AMD (35 948 images). Training of the DLS was completed in May 2016, and validation of the DLS was completed in May 2017 for detection of referable diabetic retinopathy (moderate nonproliferative diabetic retinopathy or worse) and vision-threatening diabetic retinopathy (severe nonproliferative diabetic retinopathy or worse) using a primary validation data set in the Singapore National Diabetic Retinopathy Screening Program and 10 multiethnic cohorts with diabetes. Exposures Use of a deep learning system. Main Outcomes and Measures Area under the receiver operating characteristic curve (AUC) and sensitivity and specificity of the DLS with professional graders (retinal specialists, general ophthalmologists, trained graders, or optometrists) as the reference standard. Results In the primary validation dataset (n = 14 880 patients; 71 896 images; mean [SD] age, 60.2 [2.2] years; 54.6% men), the prevalence of referable diabetic retinopathy was 3.0%; vision-threatening diabetic retinopathy, 0.6%; possible glaucoma, 0.1%; and AMD, 2.5%. The AUC of the DLS for referable diabetic retinopathy was 0.936 (95% CI, 0.925-0.943), sensitivity was 90.5% (95% CI, 87.3%-93.0%), and specificity was 91.6% (95% CI, 91.0%-92.2%). For vision-threatening diabetic retinopathy, AUC was 0.958 (95% CI, 0.956-0.961), sensitivity was 100% (95% CI, 94.1%-100.0%), and specificity was 91.1% (95% CI, 90.7%-91.4%). For possible glaucoma, AUC was 0.942 (95% CI, 0.929-0.954), sensitivity was 96.4% (95% CI, 81.7%-99.9%), and specificity was 87.2% (95% CI, 86.8%-87.5%). For AMD, AUC was 0.931 (95% CI, 0.928-0.935), sensitivity was 93.2% (95% CI, 91.1%-99.8%), and specificity was 88.7% (95% CI, 88.3%-89.0%). For referable diabetic retinopathy in the 10 additional datasets, AUC range was 0.889 to 0.983 (n = 40 752 images). Conclusions and Relevance In this evaluation of retinal images from multiethnic cohorts of patients with diabetes, the DLS had high sensitivity and specificity for identifying diabetic retinopathy and related Eye Diseases. Further research is necessary to evaluate the applicability of the DLS in health care settings and the utility of the DLS to improve vision outcomes.
Charumathi Sabanayagam - One of the best experts on this subject based on the ideXlab platform.
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machine learning to determine relative contribution of modifiable and non modifiable risk factors of major Eye Diseases
British Journal of Ophthalmology, 2020Co-Authors: Simon Nusinovici, Yih-chung Tham, Charumathi Sabanayagam, Tien Yin Wong, Liang Zhang, Xiaoran Chai, Lei Zhou, Caroline Vasseneix, Shivani MajithiaAbstract:Aims To use machine learning (ML) to determine the relative contributions of modifiable and non-modifiable clinical, metabolic, genetic, lifestyle and socioeconomic factors on the risk of major Eye Diseases. Methods We conducted analyses in a cross-sectional multi-ethnic population-based study (n=10 033 participants) and determined a range of modifiable and non-modifiable risk factors of common Eye Diseases, including diabetic retinopathy (DR), non-diabetic-related retinopathy (NDR); early and late age-related macular degeneration (AMD); nuclear, cortical and posterior subcapsular (PSC) cataract; and primary open-angle (POAG) and primary angle-closure glaucoma (PACG). Risk factors included individual characteristics, metabolic profiles, genetic background, lifestyle patterns and socioeconomic status (n~100 risk factors). We used gradient boosting machine to estimate the relative influence (RI) of each risk factor. Results Among the range of risk factors studied, the highest contributions were duration of diabetes for DR (RI=22.1%), and alcohol consumption for NDR (RI=6.4%). For early and late AMD, genetic background (RI~20%) and age (RI~15%) contributed the most. Axial length was the main risk factor of PSC (RI=30.8%). For PACG, socioeconomic factor (mainly educational level) had the highest influence (20%). POAG was the disease with the highest contribution of modifiable risk factors (cumulative RI~35%), followed by PACG (cumulative RI ~30%), retinopathy (cumulative RI between 20% and 30%) and late AMD (cumulative RI ~20%). Conclusion This study illustrates the utility of ML in identifying factors with the highest contributions. Risk factors possibly amenable to interventions were intraocular pressure (IOP) and Body Mass Index (BMI) for glaucoma, alcohol consumption for NDR and levels of HbA1c for DR.
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profile of retinal nerve fibre layer symmetry in a multiethnic asian population the singapore epidemiology of Eye Diseases study
British Journal of Ophthalmology, 2020Co-Authors: Yijin Tao, Carol Y. Cheung, Yih-chung Tham, Charumathi Sabanayagam, Shivani Majithia, Miaoli Chee, Sahil Thakur, Zhi Da Soh, Tien Yin WongAbstract:Background To examine the normative profile and determinants of retinal nerve fibre layer (RNFL) symmetry in a non-glaucoma, multiethnic Asian population. Methods Chinese, Malay and Indian adults aged ≥40 years were recruited from the Singapore Epidemiology of Eye Diseases study. Participants underwent standardised systemic and ocular examinations. RNFL thickness was obtained using a spectral-domain optical coherence tomography (Cirrus HD-OCT). RNFL symmetry (in %) was calculated based on Pearson correlation coefficient between the RNFL thickness profiles of the right and left Eyes. Multivariable linear regression analysis was used to investigate the associations between ocular and systemic factors with RNFL symmetry. Results 4211 participants (1227 Chinese, 1245 Malays, 1739 Indians) were included. The mean RNFL symmetry was 86.7%±8.5% in Chinese, 84.7%±10.2% in Malays and 84.0%±10.7% in Indians. The fifth percentile limit of RNFL symmetry was 71.2% in Chinese, 65.0% in Malays and 62.0% in Indians. In multivariable analysis adjusting for age, gender, ethnicity, hypertension, diabetes, hyperlipidaemia, interEye absolute differences in intraocular pressure (IOP), axial length and disc area, Malays (β=−0.9; p=0.03) and Indians (β=−1.76; p Conclusions In non-glaucoma individuals, interEye RNFL profile is less symmetric in Malays and Indians than that in Chinese. This also suggests that current commercial optical coherence tomography’s deployment of a single, universal RNFL symmetry cut-off for glaucoma detection is flawed, and ethnic-specific cut-off is warranted.
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six year changes in myopic macular degeneration in adults of the singapore epidemiology of Eye Diseases study
Investigative Ophthalmology & Visual Science, 2020Co-Authors: Charumathi Sabanayagam, Ryan E K Man, Yeeling Wong, Chee Wai Wong, Yin Bun Cheung, Anna Chweehong Yeo, Gemmy Cheung, Audrey Chia, Anthony N KuoAbstract:Purpose To examine the 6-year incidence, progression, associated risk factors, and impact of myopic macular degeneration (MMD) in a myopic population in Singapore. Methods We examined myopic (spherical equivalent ≤-0.5 diopters) adults (N = 2157 persons and 3661 Eyes) who were phakic at baseline and participated in both baseline and 6-year follow-up visits of the Singapore Epidemiology of Eye Diseases study. Eye examinations, including visual acuity, subjective refraction and axial length (AL) measurements, were performed. MMD was graded from fundus photographs following the META-PM classification. Vision-related quality of life was assessed with Rasch-transformed scores from reading, mobility, and emotional domains of the Impact of Vision Impairment questionnaire. Results The 6-year Eye-specific incidence of MMD among myopic Eyes was 1.2% (95% CI, 0.9%-1.6%). Older age, worse spherical equivalent, and longer AL at baseline were associated with MMD incidence (all P < 0.001). The 6-year Eye-specific progression of MMD in 288 Eyes with baseline MMD was 17.0% (95% CI, 12.6%-21.4%). More severe MMD at baseline, worse spherical equivalent, and longer AL (all P < 0.05) were associated with MMD progression. Patients with Meta-PM categories 3 and 4 had worse best-corrected visual acuity and poorer vision-related quality of life outcomes than those without MMD (all P < 0.05). Conclusions Over a 6-year period, one in 80 myopic Eyes developed MMD and one in six with existing MMD had MMD progression. Myopia severity and AL were strong predictors of MMD development and progression. Eyes with severe MMD were at higher risk of MMD progression than those with less severe MMD, and were associated with poorer visual acuity and vision-related quality of life.
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profiles of ganglion cell inner plexiform layer thickness in a multi ethnic asian population the singapore epidemiology of Eye Diseases study
Ophthalmology, 2020Co-Authors: Yih-chung Tham, Carol Y. Cheung, Wei Dai, Shivani Majithia, Rosalynn Siantar, Miaoli Chee, Sahil Thakur, Zhi Wei Lim, Tyler Hyungtaek Rim, Charumathi SabanayagamAbstract:Purpose To examine the normative profile and determinants of macular ganglion cell-inner plexiform layer (GCIPL) thickness based on spectral-domain OCT (SD-OCT) in a nonglaucoma, multi-ethnic Asian population. Design Population-based, cross-sectional study. Participants Ethnic Chinese, Malay, and Indian adults aged ≥40 years recruited from the Singapore Epidemiology of Eye Diseases Study. Methods All participants underwent standardized examinations. The GCIPL thickness was measured using Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA). Participants with glaucoma or poor-quality scans were excluded. Eye-specific data were used. Associations of ocular and systemic factors with GCIPL thickness parameters were investigated using multivariable linear regression with generalized estimating equation models to account for correlation between both Eyes. Main Outcome Measures GCIPL thickness. Results A total of 4464 participants (7520 Eyes) consisting of 1625 Chinese, 1212 Malay, and 1627 Indian adults contributed to this analysis. Average GCIPL thickness was 82.6±6.1 μm in Chinese, 81.5±6.8 μm in Malays, and 78.0±6.9 μm in Indians (P Conclusions GCIPL thickness profiles were significantly thinner in Indians compared with Chinese and Malays. Our findings further highlight the need of a more refined, ethnic-specific normative database for GCIPL thickness, which in turn may improve the detection and diagnosis of glaucoma in Asians.
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patterns and risk factor profiles of visual loss in a multiethnic asian population the singapore epidemiology of Eye Diseases study
American Journal of Ophthalmology, 2019Co-Authors: Tien Yin Wong, Yih-chung Tham, Charumathi Sabanayagam, Chingyu ChengAbstract:Purpose To describe the pattern and risk factor traits associated with visual loss (defined as either visual impairment [VI] or blindness) in a multiethnic Asian cohort of Malay, Indian, and Chinese individuals living in Singapore. Methods A total of 10 020 participants from the Singapore Epidemiology of Eye Diseases Study were examined between 2004 and 2011. All underwent standardized examinations. VI (visual acuity Results Malay individuals had higher age-standardized prevalence of best-corrected and presenting VI (5.4% and 19.9%, respectively) than Indian (3.6% and 18.0%) and Chinese individuals (3.3% and 17.2%). Cataract was the main cause for presenting and best-corrected blindness; cataract and diabetic retinopathy were the top causes for best-corrected VI, consistently observed across the 3 ethnic groups. Older age, female sex, lower socioeconomic status, diabetes, systemic comorbidities, and cognitive impairment were independently associated with increased risk of best-corrected visual loss (all P ≤ .027). Individuals aged ≥60 years with diabetes were 12.7 times (95% confidence interval, 8.39–19.23) likely to have best-corrected visual loss, compared with younger, nondiabetic individuals. Lower income and education explained 58.1% and 23.2% of best-corrected visual loss in this population, respectively. Conclusion In this urban multiethnic Asian population, we identified common traits associated with visual loss across Malay, Indian, and Chinese individuals. These results will be useful for the planning and designing of Eye health services and strategies for Asia's rapidly developing populations living in urban communities. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
Ecosse L Lamoureux - One of the best experts on this subject based on the ideXlab platform.
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vision impairment and major Eye Diseases reduce vision specific emotional well being in a chinese population
British Journal of Ophthalmology, 2017Co-Authors: Charumathi Sabanayagam, Chingyu Cheng, Tien Yin Wong, Eva K Fenwick, Peng Guan Ong, Ryan E K Man, Ecosse L LamoureuxAbstract:Aims To assess the relationship between vision impairment (VI) and major Eye Diseases, with vision-specific emotional well-being in a Chinese population. Methods In this population-based cross-sectional study, 3353 Chinese participants aged 40–80 years answered the emotional well-being scale of the Impact of Vision Impairment questionnaire, validated using Rasch analysis. Participants underwent visual acuity testing and collection of sociodemographic and medical data from standardised questionnaires. The relationships between presenting bilateral VI, presence of major Eye Diseases (cataract, undercorrected refractive error, glaucoma, age-related macular degeneration and diabetic retinopathy) and emotional well-being were assessed using linear regression models. Stratified analyses for age, gender, education and immigration status were conducted to determine if change in β coefficients differed within each stratum. Results Approximately half of patients (n=1805) had normal vision, and 43% (n=1534) and 3.4% (n=114) had moderate and severe bilateral VI, respectively. Vision-specific emotional well-being systematically worsened as severity of bilateral VI increased (p Conclusions Severe VI and glaucoma are associated with substantial decrements in vision-specific emotional well-being, highlighting the importance of preventing progression of vision loss. Evidence-based interventions to improve vision-related coping skills and emotional management for patients with severe VI and glaucoma are warranted.
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prevalence risk factors and impact of undiagnosed visually significant cataract the singapore epidemiology of Eye Diseases study
PLOS ONE, 2017Co-Authors: Jacqueline Chua, Jie Jin Wang, Paul Mitchell, Ecosse L Lamoureux, Eva K Fenwick, Alfred Tau Liang Gan, Ava Grace Tan, Blanche Lim, Tien Yin WongAbstract:Objective To determine the prevalence, risk factors, and impact of undiagnosed visually significant cataract in an Asian population. Methods The Singapore Epidemiology of Eye Diseases is a population-based study where 8,697 adults of Malay, Indian, and Chinese ethnicities aged > 40 years were invited for an Eye examination, including lens photograph, to establish cataract diagnosis. Visually significant cataract was defined by Wisconsin Cataract Grading System and a best-corrected visual acuity <20/40 with cataract as the primary cause of vision impairment. Participants were deemed ‘undiagnosed’ if they had visually significant cataract and reported no prior physician diagnosis of cataract. Visual functioning (VF) was assessed with the VF-11 questionnaire validated using Rasch analysis. Results Among the 925 participants with visually significant cataract, 636 (68.8%) were unaware of their cataract status. Age-standardized prevalence varied according to ethnicity, with Malays having higher rates than Chinese and Indians. Factors independently associated with having undiagnosed visually significant cataract were: Malay ethnicity, lower educational attainment, in employment, and without a history of diabetes (all P<0.05). In those with undiagnosed visually significant cataract, half had bilateral visual impairment, which was significantly associated with 24.8% poorer visual functioning compared to those with unilateral visual impairment (P<0.001). Conclusions Two-thirds of Singaporean adults with visually significant cataract were previously undiagnosed. Half of these cases had bilateral visual impairment and substantially reduced quality of life. Public health strategies targeting elderly patients, such as regular screening for visual impairment and timely referral to ophthalmologists in order to prevent progression to bilateral visual impairment when visual function is compromised are warranted.
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association of vision impairment and major Eye Diseases with mobility and independence in a chinese population
JAMA Ophthalmology, 2016Co-Authors: Charumathi Sabanayagam, Chingyu Cheng, Tien Yin Wong, Eva K Fenwick, Peng Guan Ong, Ryan E K Man, Ecosse L LamoureuxAbstract:Importance Mobility limitations arising from vision impairment (VI) can result in loss of independence and reduced quality of life. However, few data are available on the association between VI and mobility limitations at a population-based level, particularly in Asian populations. Objective To assess the association of VI and major Eye Diseases with mobility and independence (MI higher scores indicate better MI β, –1.44; 95% CI, –1.75 to –1.13) and all 11 MI β, –0.94; 95% CI, –1.82 to –0.06) and cataract (6%; β, –0.43; 95% CI, –0.65 to –0.22) were independently associated with worse M&I, with patients with glaucoma particularly concerned about avoiding falling or tripping. Conclusions and Relevance Bilateral VI in this population was associated with substantial decrements in M&I, with glaucoma and cataract independently associated with worse M&I. Although these associations do not prove that preventing bilateral VI will improve M&I in this population, the results suggest that such interventions could be of tremendous value from this perspective.
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Metabolic syndrome and Eye Diseases.
Diabetes Research and Clinical Practice, 2016Co-Authors: Stanley Poh, Tien Yin Wong, Ecosse L Lamoureux, Riswana Banu Binte Mohamed Abdul, Charumathi SabanayagamAbstract:Metabolic syndrome is becoming a worldwide medical and public health challenge as it has been seen increasing in prevalence over the years. Age-related Eye Diseases, the leading cause of blindness globally and visual impairment in developed countries, are also on the rise due to aging of the population. Many of the individual components of the metabolic syndrome have been shown to be associated with these Eye Diseases. However, the association of metabolic syndrome with Eye Diseases is not clear. In this review, we reviewed the evidence for associations between metabolic syndrome and certain ocular Diseases in populations. We also reviewed the association of individual metabolic syndrome components with ocular Diseases due to a paucity of research in this area. Besides, we also summarised the current understanding of etiological mechanisms of how metabolic syndrome or the individual components lead to these ocular Diseases. With increasing evidence of such associations, it may be important to identify patients who are at risk of developing metabolic syndrome as prompt treatment and intervention may potentially decrease the risk of developing certain ocular Diseases.
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impact of visual impairment and Eye Diseases on mortality the singapore malay Eye study simes
Scientific Reports, 2015Co-Authors: Rosalynn Siantar, Chingyu Cheng, Tin Aung, Paul Mitchell, Ecosse L Lamoureux, Tien Yin Wong, Peng Guan Ong, Chui Ming Gemmy Cheung, Khuan Yew Chow, Carol Y. CheungAbstract:We investigated the relationship of visual impairment (VI) and age-related Eye Diseases with mortality in a prospective, population-based cohort study of 3,280 Malay adults aged 40–80 years between 2004–2006. Participants underwent a full ophthalmic examination and standardized lens and fundus photographic grading. Visual acuity was measured using logMAR chart. VI was defined as presenting (PVA) and best-corrected (BCVA) visual acuity worse than 0.30 logMAR in the better-seeing Eye. Participants were linked with mortality records until 2012. During follow-up (median 7.24 years), 398 (12.2%) persons died. In Cox proportional-hazards models adjusting for relevant factors, participants with VI (PVA) had higher all-cause mortality (hazard ratio[HR], 1.57; 95% confidence interval[CI], 1.25–1.96) and cardiovascular (CVD) mortality (HR 1.75; 95% CI, 1.24–2.49) than participants without. Diabetic retinopathy (DR) was associated with increased all-cause (HR 1.70; 95% CI, 1.25–2.36) and CVD mortality (HR 1.57; 95% CI, 1.05–2.43). Retinal vein occlusion (RVO) was associated with increased CVD mortality (HR 3.14; 95% CI, 1.26–7.73). No significant associations were observed between cataract, glaucoma and age-related macular degeneration with mortality. We conclude that persons with VI were more likely to die than persons without. DR and RVO are markers of CVD mortality.
