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Background Despite advancements in globe-preserving treatments, improvements in retinoblastoma outcomes are inconsistent across income levels and geographical locations. We aimed to investigate trends in global retinoblastoma survival and globe preservation during the past 40 years. We also examined associated socioeconomic and health-care factors and global survival disparity. MethodsWe did a systematic review and meta-analysis by screening articles in any language in nine databases (PubMed, Embase, ScienceDirect, Web of Science, OpenGrey, Global Burden of Disease, Global Health Data Exchange, Global Index Medicus, and International Agency for the Prevention of Blindness) published between Jan 1, 1981, and Oct 8, 2021. We screened for articles that described retinoblastoma overall survival or globe salvage, or both. All reported studies were subsequently stratified into four periods: 1980-89, 1990-99, 2000-09, and 2010-20. Indicators on socioeconomic and health-care factors were extracted from the World Bank and WHO. Ophthalmology-related indicators were further parsed from the International Agency for the Prevention of Blindness. Between-study heterogeneities by income level were assessed by mixed-effect meta-analysis. Associations of retinoblastoma outcome with socioeconomic and health-care factors and factors for survival prediction were investigated by multivariable linear regressions. This study is registered with PROSPERO, number CRD42020221556. Findings Our search identified 14 621 articles, of which 314 studies were included for analysis after screening, including 38 130 patients from 80 regions globally presenting during 1980-2020. 255 articles were entered for timetrend meta-analysis, covering 29 106 patients from 73 countries. Both overall survival (from 79% [95% CI 74-84] to 88% [83-93]; p=0•017) and globe salvage rate (from 22% [14-32] to 44% [36-52]; p=0•0003) improved significantly over the four decades. Wide disparities were observed between higher-income and lower-income countries. Overall survival, globe salvage, and globe salvage for advanced intraocular disease correlated positively with income level. Higher overall survival was associated with lower Gini index (p=0•0001) and with populations that had smaller percentages living in rural areas (p=0•0005). Higher globe salvage was associated with better health-care financing and accessibility (p=0•030). Overall survival (p=0•0024) and globe salvage (p=0•022) were both associated positively with education level. Survival gaps were observed in sub-Saharan Africa and southeast and southwest Asia.Interpretation Retinoblastoma treatment outcomes have improved globally over the past four decades but large disparities persist between higher-income and lower-income countries, with some areas having major survival gaps. Targeted health-care policy making with increased health-care financing and accessibility are needed in low-income and lower-middle-income countries to improve retinoblastoma outcomes worldwide.Funding Health and Medical Research Fund (H...

Male client of female sex workers (MCFSW) is a sizable population transmitting HIV from high-risk population to female general population in China. This study was to investigate the prevalence of taking up any forms of HIV testing in lifetime and in the past year among MCFSW in Hong Kong. Factors associated with uptake of any forms HIV testing in the past year were also investigated. A cross-sectional survey was conducted. Participants were Hong Kong Chinese males aged ≥18 years, and self-reported had patronized at least one female sex workers (FSW) in the last six months. A total of 303 MCFSW recruited online (n = 160) or from venues (n = 143) completed the self-administered questionnaire. Logistic regression was used for data analysis. The prevalence of taking up any forms of HIV testing in lifetime and last year was 49.2% and 23.8%, respectively. Adjusting for these background variables, scale scores representing perceived severity of HIV infection (AOR: 1.17), perceived benefits of HIV testing (AOR: 1.18) and perceived self-efficacy in taking up HIV testing (AOR: 1.36) were significantly and positively associated with uptake of any forms of HIV testing in the last year, while negative associations were found for the Perceived Psychological Barrier Scale (AOR= 0.88) and the Perceived Logistical Barrier Scale (AOR: 0.78). MCFSW in Hong Kong reported low uptake of HIV testing. Health promotion is urgently needed. Modifying perceptions related to the Health Belief Model are potential useful strategies. The potential of using HIV self-testing to increase HIV testing coverage among MCFSW should also be considered.

Background High blood pressure (BP) and obesity are becoming increasingly prevalent among children globally. Although prior studies have shown their adverse impacts on macrovascular health, less is known about their effects on microvascular heath. This study aims to evaluate the independent and synergistic effects of hypertensive BP and obesity on retinal vasculature in young children. Method and Results 1006 children aged 6 to 8 years were recruited from the Hong Kong Children Eye Study. Quantitative retinal vascular parameters, including central retinal arteriolar and venular equivalents and retinal arteriolar and venular fractal dimensions, were measured from retinal photographs following a standardized protocol. BP and body mass index were categorized according to reference values from American Academy of Pediatrics and International Obesity Task Force guidelines respectively. Children with hypertensive systolic BP had the narrowest central retinal arteriolar equivalents compared with children with either elevated or normotensive systolic BP (162.4, 164.6, and 167.1 µm; P ‐trend <0.001). Increased standardized systolic BP was associated with narrower central retinal arteriolar equivalents (β=−2.276 µm, P <0.001), wider central retinal venular equivalents (1.177, P =0.007), and decreased arteriolar fractal dimensions (β=−0.004, P =0.034). Children with obesity had the smallest arteriolar fractal dimensions compared with children with overweightness and normal weight (1.211, 1.234, and 1.240; P ‐trend=0.004). Children with both hypertensive BP and either overweightness or obesity had the narrowest central retinal arteriolar equivalents and smallest arteriolar D f ( P ‐trend<0.001 and P ‐trend=0.007). Conclusions Our findings demonstrate the potential synergistic or additive effects for both hypertensive BP and obesity on retinal vasculature in children.

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Background/aimsTo identify normative values and determinants for Bruch’s membrane opening (BMO) and the minimum rim width of BMO (BMO-MRW) among healthy children.MethodsA population-based cross-sectional study from the Hong Kong Children Eye Study, recruiting 1, 226 children aged 6–8 years. Spherical refractive error, axial length (AL), body mass index and intraocular pressure (IOP) were measured. The optic nerve head and the peripapillary retinal nerve fibre layer (p-RNFL) were imaged through spectral domain-optical coherence tomography, using 24 equally spaced radial B-scans. Global and sectoral BMO-MRW values, BMO area and fovea-to-BMO (FoBMO) angle were calculated. Multiple regression analysis was performed to define the determinants of BMO area and BMO-MRW in relation to demographic and ocular parameters.ResultsThe mean values for global BMO-MRW, BMO area and FoBMO angle among children were 345.76±54.08 µm, 2.34±0.49 mm2 and −5.45±4.36°, respectively. Global and sectoral values for BMO-MRW correlated with p-RNFL thickness (r=0.11–0.35, p<0.001). After adjusting for demographic and ocular parameters, global BMO-MRW increased with age (β=6.4, p<0.001) and greater global p-RNFL thickness (β=1.41, p<0.001), but decreased with larger BMO area (β=−47.46, p<0.001) and higher IOP (β=−1.73, p<0.001). Global BMO-MRW did not associate with AL, whereas both BMO area and FoBMO angle associated with AL (β=0.04, p=0.02 and β=0.31, p=0.03, respectively), but not with age.ConclusionWe observed that BMO-MRW increases with age among children. Our results provide normative values and the determinants of BMO parameters among Chinese children.