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BJO Online First, published on June 11, 2015 as 10.1136/bjophthalmol-2015-307050 Global issues
Prevalence and associations of epiretinal membrane in an elderly urban Chinese population in China: the Jiangning Eye Study Hehua Ye,1 Qi Zhang,1 Xiaohong Liu,1 Xuan Cai,1 Wenjing Yu,1 Siyi Yu,1 Tianyu Wang,1 Wuyi Lu,1 Xiang Li,1 Yiqian Hu,1 Bo Yang,2 Peiquan Zhao1 1
Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China 2 Department of Ophthalmology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People’s Republic of China Correspondence to Dr Peiquan Zhao, Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Rd, Shanghai 200092, People’s Republic of China; [email protected] HY and QZ contributed equally. Received 19 April 2015 Revised 18 May 2015 Accepted 27 May 2015
ABSTRACT Aims To describe the prevalence and associations of epiretinal membrane (ERM) in an elderly urban Chinese population in China. Methods A population-based cross-sectional study was conducted using a cluster random sample of residents aged 50 years or older living in the Jiangning Road Sub-district, Shanghai, China. All participants underwent a standardised interview and comprehensive eye examinations, including digital retinal photography and spectral domain optical coherence tomography (SD-OCT) examinations of both eyes between November 2012 and February 2013. ERM was identified and classified as either cellophane macular reflex (CMR) or preretinal macular fibrosis (PMF) based on the fundus photography and OCT features. Results Of the 2044 subjects who participated (82.5% response rate), 2005 had fundus photographs and OCT results of sufficient quality for grading of ERM signs. ERM was present in 8.4% of participants, including 5.0% with CMR and 3.4% with PMF. After age and gender standardisation to the 2010 Chinese census population, the prevalence rate of ERM in mainland Chinese individuals of 50 years of age or older was estimated to be 7.3%. After adjusting for age and/or gender, idiopathic ERM was positively associated with age (OR, 1.06; 95% CI 1.04 to 1.08), female gender (OR 1.67, 95% CI 1.16 to 2.40), myopia (OR 2.21, 95% CI 1.51 to 3.22) and hyperlipaemia (OR 1.80, 95% CI 1.04 to 3.12). Conclusions The prevalence of ERM in elderly urban Chinese was similar to that in Caucasians. Risk factors for idiopathic ERM were older age, female gender, myopia and hyperlipaemia.
INTRODUCTION
To cite: Ye H, Zhang Q, Liu X, et al. Br J Ophthalmol Published Online First: [please include Day Month Year] doi:10.1136/ bjophthalmol-2015-307050
Epiretinal membrane (ERM) is a condition characterised by the proliferation of abnormal tissues on the inner retinal surface.1 Studies have reported a great discrepancy in the prevalence of ERM, ranging from 1.0% to 28.9% among different ethnic groups.2–16 In relation to the prevalence of ERM in the Chinese population, three studies have provided population-based prevalence data on ERM, ranging from 1.0% to 3.4%.10 11 15 The results suggested that the prevalence of ERM is much lower in the Chinese population than in the Caucasian population. However, in another multi-ethnic population study, American of Chinese origin was identified as a risk factor for ERM.13 Additional population-based epidemiology studies should be conducted to better understand the epidemiology of ERM in China. Studies on ERM have traditionally relied on fundus photography for identifying and
characterising ERM. Recently, the development of spectral domain optical coherence tomography (SD-OCT) made it possible to obtain highresolution near-histologic images of the retina and epiretinal structure, and this has significantly increased the diagnostic capabilities, with some studies detecting ERM in up to 90% of cases.17 18 The purpose of the current study was to investigate the prevalence and factors associated with ERM in an elderly urban Chinese population, based on the fundus photography and SD-OCT.
METHODS Study population The Jiangning Eye Study, a population-based crosssectional study of Chinese urban elders aged 50 years and older, living in the Jiangning Road Sub-district, Shanghai, was conducted to investigate the prevalence and risk factors of eye disease. The study design and the details of the population sampling for the Jiangning Eye Study have been described elsewhere.19 Informed written consent was obtained from all participants before enrolment. The study complied with the guidelines in the Declaration of Helsinki, and ethical approval was received from the Medical Ethics Committee of the Xinhua Hospital, Shanghai Jiao Tong University School of Medicine.
Study procedures A detailed interviewer-administrated questionnaire was conducted to collect information about medical history, cigarette smoking, alcohol consumption, current medication use and socioeconomic status factors. The eye examinations were conducted according to a standardised protocol that included visual acuity measurement, autorefraction, noncontact tonometry, slit-lamp biomicroscopy, indirect ophthalmoscopy, axial length and SD-OCT (Topcon 3D OCT-2000; Topcon). Fundus photography was undertaken with a 45° 16.2-megapixel digital nonmydriatic fundus camera (integrated high-resolution fundus camera of Topcon 3D OCT-2000; Topcon) in a darkened room.
Definition and classification of ERM ERM was diagnosed based on the fundus photography and OCT images. For the photographic grading, ERM was classified into two forms.2 11 Earlier stage of ERM was defined as the presence of cellophane macular reflex (CMR) only, characterised by a patch or patches of irregular increased reflection from the inner surface of the retina. The
Ye H, et al. Br J Ophthalmol 2015;0:1–4. doi:10.1136/bjophthalmol-2015-307050
Copyright Article author (or their employer) 2015. Produced by BMJ Publishing Group Ltd under licence.
1
Downloaded from http://bjo.bmj.com/ on June 21, 2015 - Published by group.bmj.com
Global issues Package for Social Science (SPSS V.15.0, SPSS, Chicago, Illinois, USA). All p values were two-sided and were considered statistically significant when the values were
BJO Online First, published on June 11, 2015 as 10.1136/bjophthalmol-2015-307050 Global issues
Prevalence and associations of epiretinal membrane in an elderly urban Chinese population in China: the Jiangning Eye Study Hehua Ye,1 Qi Zhang,1 Xiaohong Liu,1 Xuan Cai,1 Wenjing Yu,1 Siyi Yu,1 Tianyu Wang,1 Wuyi Lu,1 Xiang Li,1 Yiqian Hu,1 Bo Yang,2 Peiquan Zhao1 1
Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China 2 Department of Ophthalmology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People’s Republic of China Correspondence to Dr Peiquan Zhao, Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Rd, Shanghai 200092, People’s Republic of China; [email protected] HY and QZ contributed equally. Received 19 April 2015 Revised 18 May 2015 Accepted 27 May 2015
ABSTRACT Aims To describe the prevalence and associations of epiretinal membrane (ERM) in an elderly urban Chinese population in China. Methods A population-based cross-sectional study was conducted using a cluster random sample of residents aged 50 years or older living in the Jiangning Road Sub-district, Shanghai, China. All participants underwent a standardised interview and comprehensive eye examinations, including digital retinal photography and spectral domain optical coherence tomography (SD-OCT) examinations of both eyes between November 2012 and February 2013. ERM was identified and classified as either cellophane macular reflex (CMR) or preretinal macular fibrosis (PMF) based on the fundus photography and OCT features. Results Of the 2044 subjects who participated (82.5% response rate), 2005 had fundus photographs and OCT results of sufficient quality for grading of ERM signs. ERM was present in 8.4% of participants, including 5.0% with CMR and 3.4% with PMF. After age and gender standardisation to the 2010 Chinese census population, the prevalence rate of ERM in mainland Chinese individuals of 50 years of age or older was estimated to be 7.3%. After adjusting for age and/or gender, idiopathic ERM was positively associated with age (OR, 1.06; 95% CI 1.04 to 1.08), female gender (OR 1.67, 95% CI 1.16 to 2.40), myopia (OR 2.21, 95% CI 1.51 to 3.22) and hyperlipaemia (OR 1.80, 95% CI 1.04 to 3.12). Conclusions The prevalence of ERM in elderly urban Chinese was similar to that in Caucasians. Risk factors for idiopathic ERM were older age, female gender, myopia and hyperlipaemia.
INTRODUCTION
To cite: Ye H, Zhang Q, Liu X, et al. Br J Ophthalmol Published Online First: [please include Day Month Year] doi:10.1136/ bjophthalmol-2015-307050
Epiretinal membrane (ERM) is a condition characterised by the proliferation of abnormal tissues on the inner retinal surface.1 Studies have reported a great discrepancy in the prevalence of ERM, ranging from 1.0% to 28.9% among different ethnic groups.2–16 In relation to the prevalence of ERM in the Chinese population, three studies have provided population-based prevalence data on ERM, ranging from 1.0% to 3.4%.10 11 15 The results suggested that the prevalence of ERM is much lower in the Chinese population than in the Caucasian population. However, in another multi-ethnic population study, American of Chinese origin was identified as a risk factor for ERM.13 Additional population-based epidemiology studies should be conducted to better understand the epidemiology of ERM in China. Studies on ERM have traditionally relied on fundus photography for identifying and
characterising ERM. Recently, the development of spectral domain optical coherence tomography (SD-OCT) made it possible to obtain highresolution near-histologic images of the retina and epiretinal structure, and this has significantly increased the diagnostic capabilities, with some studies detecting ERM in up to 90% of cases.17 18 The purpose of the current study was to investigate the prevalence and factors associated with ERM in an elderly urban Chinese population, based on the fundus photography and SD-OCT.
METHODS Study population The Jiangning Eye Study, a population-based crosssectional study of Chinese urban elders aged 50 years and older, living in the Jiangning Road Sub-district, Shanghai, was conducted to investigate the prevalence and risk factors of eye disease. The study design and the details of the population sampling for the Jiangning Eye Study have been described elsewhere.19 Informed written consent was obtained from all participants before enrolment. The study complied with the guidelines in the Declaration of Helsinki, and ethical approval was received from the Medical Ethics Committee of the Xinhua Hospital, Shanghai Jiao Tong University School of Medicine.
Study procedures A detailed interviewer-administrated questionnaire was conducted to collect information about medical history, cigarette smoking, alcohol consumption, current medication use and socioeconomic status factors. The eye examinations were conducted according to a standardised protocol that included visual acuity measurement, autorefraction, noncontact tonometry, slit-lamp biomicroscopy, indirect ophthalmoscopy, axial length and SD-OCT (Topcon 3D OCT-2000; Topcon). Fundus photography was undertaken with a 45° 16.2-megapixel digital nonmydriatic fundus camera (integrated high-resolution fundus camera of Topcon 3D OCT-2000; Topcon) in a darkened room.
Definition and classification of ERM ERM was diagnosed based on the fundus photography and OCT images. For the photographic grading, ERM was classified into two forms.2 11 Earlier stage of ERM was defined as the presence of cellophane macular reflex (CMR) only, characterised by a patch or patches of irregular increased reflection from the inner surface of the retina. The
Ye H, et al. Br J Ophthalmol 2015;0:1–4. doi:10.1136/bjophthalmol-2015-307050
Copyright Article author (or their employer) 2015. Produced by BMJ Publishing Group Ltd under licence.
1
Downloaded from http://bjo.bmj.com/ on June 21, 2015 - Published by group.bmj.com
Global issues Package for Social Science (SPSS V.15.0, SPSS, Chicago, Illinois, USA). All p values were two-sided and were considered statistically significant when the values were
