Background: The retinal vasculature may be altered in multiple sclerosis (MS), potentially acting as a biomarker of disease processes. Objective: To compare retinal vascular plexus densities in people with MS (PwMS) and healthy controls (HCs), and examine correlations with visual function and global disability. Methods: In this cross-sectional study, 111 PwMS (201 eyes) and 50 HCs (97 eyes) underwent optical coherence tomography angiography (OCTA). Macular superficial vascular plexus (SVP) and deep vascular plexus (DVP) densities were quantified, and poor quality images were excluded according to an artifact-rating protocol. Results: Mean SVP density was 24.1% (SD = 5.5) in MS eyes (26.0% (SD = 4.7) in non-optic neuritis (ON) eyes vs. 21.7% (SD = 5.5) in ON eyes, p < 0.001), as compared to 29.2% (SD = 3.3) in HC eyes ( p < 0.001 for all MS eyes and multiple sclerosis optic neuritis (MSON) eyes vs. HC eyes, p = 0.03 for MS non-ON eyes vs. HC eyes). DVP density did not differ between groups. In PwMS, lower SVP density was associated with higher levels of disability (expanded disability status scale (EDSS): R2 = 0.26, p = 0.004; multiple sclerosis functional composite (MSFC): R2 = 0.27, p = 0.03) and lower letter acuity scores (100% contrast: R2 = 0.29; 2.5% contrast: R2 = 0.40; 1.25% contrast: R2 = 0.31; p < 0.001 for all). Conclusions: Retinal SVP density measured by OCTA is reduced across MS eyes, and correlates with visual function, EDSS, and MSFC scores.
IMPORTANCE Eye trauma is a common cause of vision loss and a substantial public health problem.OBJECTIVE To determine the changes in the incidence of eye trauma hospitalizations in the United States and compare the demographics of affected patients and outcomes of eye trauma as a primary or secondary admitting diagnosis. DESIGN, SETTING, AND PARTICIPANTSThis retrospective longitudinal cohort study used the National Inpatient Sample, a representative sample of all US community hospitals, to determine the incidence, characteristics, and causes of primary and secondary inpatient eye trauma admissions from 2001 through 2014. All inpatients with relevant diagnoses were included. Linear regression was used to estimate changes in incidence. Logistic regression was used to compare demographics and outcomes between primary and secondary diagnoses, including age, sex, race, income, primary payer, region, year of admission, length of stay, cost, and disposition at discharge. EXPOSURES Eye trauma.MAIN OUTCOMES AND MEASURES Incidence and characteristics of inpatient primary and secondary eye trauma. RESULTSFrom 2001 to 2014, there were an estimated 939 608 inpatient admissions (of whom 556 886 were male patients [59.3%]; overall mean [SD] age, 49.4 [25.2] years) in the United States because of eye trauma diagnoses, with 778 967 of these (82.9%) as a secondary diagnosis. The incidence of primary eye trauma decreased from 3.9 to 3.0 per 100 000 population (difference, 0.9 [95% CI, 0.2-1.6] per 100 000 population; P = .001). The incidence of eye trauma as a secondary admitting diagnosis increased from 14.5 to 19.0 per 100 000 population (difference, 4.5 [95% CI, 1.9-7.2] per 100 000 population; P = .004). This was largely attributed to an increasing number of falls in individuals older than 65 years. The most frequent diagnosis was orbital fracture (64 149 [39.9%]) for primary trauma and contusion of eye and adnexa (19 301 [37.8%]) for secondary trauma. Primary trauma was more common in children (adjusted odds ratio [aOR], 2.21 [95% CI, 2.09-2.32]) and adolescents (aOR, 1.25 [95% CI,) than adults (reference), African American individuals (aOR, 1.89 [95% CI, 1.81-1.97]) and Hispanic individuals (aOR, 1.52 [95% CI, 1.45-1.59]) than white individuals, and uninsured patients (aOR, 1.14 [95% CI, 1.07-1.22]) and those receiving Medicaid (aOR, 1.12 [95% CI, 1.05-1.19]) than Medicare beneficiaries. Patients with a primary diagnosis were more likely to have a stay of less than 3 days (patients with a primary diagnosis: 101 796 [63.4%]; secondary diagnosis: 274 538 [35.2%]), more likely to have costs in the lowest quartile (patients with a primary diagnosis: 51 212 [31.9%]; secondary diagnosis: 166 260 [21.3%]), and less likely to die (patients with a primary diagnosis: 526 [0.3%]; secondary diagnosis: 20 929 [2.7%]).CONCLUSIONS AND RELEVANCE These findings suggest that the increasing number of falls in individuals older than 65 years and the high risk of primary eye trauma in populations such as children and adolescents warrant the devel...
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