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ObjectiveThis study was to aggregate the prevalence and risks of epiretinal membranes (ERMs) and determine the possible causes of the varied estimates.DesignSystematic review and meta-analysis.Data sourcesThe search strategy was designed prospectively. We searched PubMed, Embase and Web of Science databases from inception to July 2016. Reference lists of the included literatures were reviewed as well.Study selectionSurveys published in English language from any population were included if they had a population-based design and reported the prevalence of ERM from retinal photography with or without optical coherence tomography. Eligibility and quality evaluation was conducted independently by two investigators.Data extractionThe literature search generated 2144 records, and 13 population-based studies comprising 49 697 subjects were finally included. The prevalence of ERM and the ORs of potential risk factors (age, sex, myopia, hypertension and so on) were extracted.ResultsThe pooled age-standardised prevalence estimates of earlier ERM (cellophane macular reflex (CMR)), advanced ERM (preretinal macular fibrosis (PMF)) and any ERM were 6.5% (95% CI 4.2% to 8.9%), 2.6% (95% CI 1.8% to 3.4%) and 9.1% (95% CI 6.0% to 12.2%), respectively. In the subgroup analysis, race and photography modality contributed to the variation in the prevalence estimates of PMF, while the WHO regions and image reading methods were associated with the varied prevalence of CMR and any ERM. Meta-analysis showed that only greater age and female significantly conferred a higher risk of ERMs.ConclusionsOur findings suggest that ERMs are relatively common among aged population. Race, image taking and reading methodology may play important roles in influencing the large variability of ERM prevalence estimates.

Background To evaluate the long‐term efficacy and safety of continued repeated low‐level red‐light (RLRL) therapy on myopia control over 2 years, and the potential rebound effect after treatment cessation. Methods The Chinese myopic children who originally completed the one‐year randomised controlled trial were enrolled. Children continued RLRL‐therapy were defined as RLRL‐RLRL group, while those who stopped and switched to single‐vision spectacle (SVS) in the second year were RLRL‐SVS group. Likewise, those who continued to merely wear SVS or received additional RLRL‐therapy were SVS‐SVS and SVS‐RLRL groups, respectively. RLRL‐therapy was provided by an at‐home desktop light device emitting red‐light of 650 nm and was administered for 3 min at a time, twice a day and 5 days per week. Changes in axial length (AL) and cycloplegic spherical equivalence refraction (SER) were measured. Results Among the 199 children who were eligible, 138 (69.3%) children attended the examination and 114 (57.3%) were analysed (SVS‐SVS: n = 41; SVS‐RLRL: n = 10; RLRL‐SVS: n = 52; RLRL‐RLRL: n = 11). The baseline characteristics were balanced among four groups. In the second year, the mean changes in AL were 0.28 ± 0.14 mm, 0.05 ± 0.24 mm, 0.42 ± 0.20 mm and 0.12 ± 0.16 mm in SVS‐SVS, SVS‐RLRL, RLRL‐SVS and RLRL‐RLRL group, respectively (p < 0.001). The respective mean SER changes were −0.54 ± 0.39D, −0.09 ± 0.55D, −0.91 ± 0.48D, and −0.20 ± 0.56D (p < 0.001). Over the 2‐year period, axial elongation and SER progression were smallest in RLRL‐RLRL group (AL: 0.16 ± 0.37 mm; SER: −0.31 ± 0.79D), followed by SVS‐RLRL (AL: 0.44 ± 0.37 mm; SER: −0.96 ± 0.70D), RLRL‐SVS (AL: 0.50 ± 0.28 mm; SER: −1.07 ± 0.69D) and SVS‐SVS group (AL: 0.64 ± 0.29 mm; SER: −1.24 ± 0.63D). No self‐reported adverse events, functional or structural damages were noted. Conclusions Continued RLRL therapy sustained promising efficacy and safety in slowing myopia progression over 2 years. A modest rebound effect was noted after treatment cessation.

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The CONSORT-EHEALTH checklist is intended for authors of randomized trials evaluating web-based and Internet-based applications/interventions, including mobile interventions, electronic games (incl multiplayer games), social media, certain telehealth applications, and other interactive and/or networked electronic applications. Some of the items (e.g. all subitems under item 5 -description of the intervention) may also be applicable for other study designs.The goal of the CONSORT EHEALTH checklist and guideline is to be a) a guide for reporting for authors of RCTs, b) to form a basis for appraisal of an ehealth trial (in terms of validity) CONSORT-EHEALTH items/subitems are MANDATORY reporting items for studies published in the Journal of Medical Internet Research and other journals / scientific societies endorsing the checklist.Items numbered 1., 2., 3., 4a., 4b etc are original CONSORT or CONSORT-NPT (nonpharmacologic treatment) items. Items with Roman numerals (i., ii, iii, iv etc.) are CONSORT-EHEALTH extensions/clarifications.As the CONSORT-EHEALTH checklist is still considered in a formative stage, we would ask that you also RATE ON A SCALE OF 1-5 how important/useful you feel each item is FOR THE PURPOSE OF THE CHECKLIST and reporting guideline (optional).Mandatory reporting items are marked with a red *.

AimTo develop a deep learning (DL) model that predicts age from fundus images (retinal age) and to investigate the association between retinal age gap (retinal age predicted by DL model minus chronological age) and mortality risk.MethodsA total of 80 169 fundus images taken from 46 969 participants in the UK Biobank with reasonable quality were included in this study. Of these, 19 200 fundus images from 11 052 participants without prior medical history at the baseline examination were used to train and validate the DL model for age prediction using fivefold cross-validation. A total of 35 913 of the remaining 35 917 participants had available mortality data and were used to investigate the association between retinal age gap and mortality.ResultsThe DL model achieved a strong correlation of 0.81 (p<0·001) between retinal age and chronological age, and an overall mean absolute error of 3.55 years. Cox regression models showed that each 1 year increase in the retinal age gap was associated with a 2% increase in risk of all-cause mortality (hazard ratio (HR)=1.02, 95% CI 1.00 to 1.03, p=0.020) and a 3% increase in risk of cause-specific mortality attributable to non-cardiovascular and non-cancer disease (HR=1.03, 95% CI 1.00 to 1.05, p=0.041) after multivariable adjustments. No significant association was identified between retinal age gap and cardiovascular- or cancer-related mortality.ConclusionsOur findings indicate that retinal age gap might be a potential biomarker of ageing that is closely related to risk of mortality, implying the potential of retinal image as a screening tool for risk stratification and delivery of tailored interventions.

The ensuing upward shift in demographic distribution due to the increase in life expectancy has resulted in a rising prevalence of Alzheimer’s disease (AD). The heavy public burden of AD, along with the urgent to prevent and treat the disease before the irreversible damage to the brain, calls for a sensitive and specific screening technology to identify high-risk individuals before cognitive symptoms arise. Even though current modalities, such as positron emission tomography (PET) and cerebrospinal fluid (CSF) biomarker, showed their potential clinical uses in early detection of AD, the high cost, narrow isotope availability of PET probes and invasive characteristics of CSF biomarker limited their broad utility. Therefore, additional tools for detection of AD are needed. As a projection of the central nervous system (CNS), the retina has been described as a “window to the brain” and a novel marker for AD. Low cost, easy accessibility and non-invasive features make retina tests suitable for large-scale population screening and investigations of preclinical AD. Furthermore, a number of novel approaches in retina imaging, such as optical coherence tomography (OCT), have been developed and made it possible to visualize changes in the retina at a very fine resolution. In this review, we outline the background for AD to accelerate the adoption of retina imaging for the diagnosis and management of AD in clinical practice. Then, we focus on recent findings on the application of retina imaging to investigate AD and provide suggestions for future research directions.

Topic: The magnitude and direction of the association between vision impairment and incident dementia and cognitive impairment in prospective cohort studies was estimated by systematic review and meta-analysis. The global burden of dementia associated with vision impairment then was estimated.Clinical Relevance: Because a predominant proportion of vision impairment is preventable or treatable, investigating its association with dementia may help to identify an important modifiable factor for the prevention of dementia.Methods: A literature search was conducted using PubMed, Embase, Web of Science, and Google Scholar on September 15, 2020. Relative risks (RRs) were pooled using random-effects models and stratified analyses for subgroups representing different study characteristics. Publication bias was evaluated with funnel plots and the Egger test. The global burden of dementia associated with vision impairment was estimated based on the Global Burden of Disease Study data on the prevalence of dementia and vision impairment.Results: In the meta-analysis of 14 prospective cohort studies with 6 204 827 participants and 171 888 dementia patients, the pooled RR associated with vision impairment was 1.47 (95% confidence interval [CI], 1.36e1.60). In the meta-analysis of 12 prospective cohort studies with 45 313 participants and 13 350 patients with cognitive impairment, the pooled RR was 1.35 (95% CI, 1.28e1.41). Stratified analyses showed that the associations of vision impairment with incident dementia and cognitive impairment were similar across methods of vision assessment, length of follow-up, and study quality. The global number of people with dementia associated with moderate or severe vision impairment in 2016 was 2.1 million (80% uncertainty interval, 1.0e3.3 million), which accounted for 4.7% (95% CI, 2.3%e7.5%) of the global burden of dementia. Economic inequality was significant for the burden of dementia associated with vision impairment.Discussion: The overall quality of the body evidence was low because of the observational design of the studies included in the analysis. Vision impairment is associated with an increased risk of both dementia and cognitive impairment in older adults. Screening and treating vision impairment, especially in low-and middleincome countries, may help to alleviate the global burden of dementia.