PURPOSE: The purpose of this study was to estimate the socioeconomic costs of glaucoma in Korea. It is to be used as an academic reference regarding policy making for the introduction of glaucoma screening tests in the national health check-ups. METHODS: We estimated the socioeconomic costs of glaucoma from a societal perspective, which included medical, nonmedical, and productivity costs. The medical costs consisted of official and nonofficial medical costs, and the nonmedical costs consisted of transportation, time, and nursing costs. We used the National Health Insurance Service-National Sample Cohort 2002–2013 and the Korea Health Panel study. RESULTS: The socioeconomic costs of glaucoma were estimated to be 3,000 billion Korean won (KRW) in 2013. These total costs were divided into 1,539 billion KRW (51.3%) for medical costs, 1,292 billion KRW (43.1%) for nonmedical costs, and 168 billion KRW (5.6%) for productivity costs. CONCLUSIONS: Glaucoma is a large economic burden from a societal perspective. The nonmedical and productivity costs, as well as the medical costs are especially high. Because the disease costs of glaucoma are expected to increase continuously, political support for early detection of glaucoma should be considered.
Cohort Studies ; Cost of Illness ; Efficiency ; Glaucoma ; Korea ; Mass Screening ; National Health Programs ; Nursing ; Policy Making ; Transportation

PURPOSE: To estimate the annual socioeconomic costs of age-related macular degeneration (AMD) in the Republic of Korea. METHODS: We estimated the costs of illness to society of AMD patients, including medical, nonmedical, and productivity costs. The medical costs included official and nonofficial medical costs, and the nonmedical costs consisted of transportation, time, and nursing costs. We used Korea National Health Insurance Claims Database, National Health Insurance Service-National Sample Cohort, and Korea Health Panel study data in the analysis. RESULTS: The socioeconomic costs of AMD were estimated to be 694 billion Korean won (KRW) in 2016. This figure was divided into 501 billion KRW (72.1%) for medical costs, 61 billion KRW (8.8%) for nonmedical costs, and 133 billion KRW (19.1%) for productivity costs. The annual per capita socioeconomic cost of AMD was 1.32 million KRW. CONCLUSIONS: We determined the scale and composition of the socioeconomic costs of AMD. Importantly, the productivity costs accounted for approximately 20% of all costs, suggesting that AMD had a significant impact on productivity. Because the disease costs of AMD are expected to increase continuously with the aging population, effective planning at the governmental level for prevention and treatment of AMD should be considered to reduce socioeconomic costs.
Aging ; Cohort Studies ; Cost of Illness ; Efficiency ; Humans ; Korea ; Macular Degeneration ; National Health Programs ; Nursing ; Republic of Korea ; Transportation

PURPOSE: To report a case of bilateral corneal wound dehiscence with iris prolapse after coronary artery bypass surgery. CASE SUMMARY: A 65-year-old woman complained of sudden bilateral vision loss. Slit lamp microscope examination showed bilateral corneal wound dehiscence, collapse of the anterior chamber and iris prolapse. The patient had a history of bilateral cataract surgery one-month earlier and a coronary artery bypass surgery one-day previously. The authors resutured the corneal wound and performed an emergency iris repositioning. Postoperative 1 day, the best corrected visual acuity (BCVA) was 0.3 in the right eye and hand motion in the left eye. Total hyphema was observed in the left eye. At postoperative 2 months, the right eye had a BCVA of 0.63 with a sutured state of the corneal wound, and the left eye had a BCVA of light perception with a clotted hemorrhage in the anterior chamber. CONCLUSIONS: When a patient with a history of a previous sutureless cataract surgery has a coronary bypass surgery under general anesthesia, corneal wound dehiscence and iris prolapse may occur. For those patients, the authors recommend suturing the corneal wound instead of sutureless cataract surgery.
Aged ; Anesthesia, General ; Anterior Chamber ; Cataract ; Coronary Artery Bypass ; Emergencies ; Eye ; Female ; Hand ; Hemorrhage ; Humans ; Hyphema ; Iris ; Light ; Prolapse ; Vision, Ocular ; Visual Acuity

Background: The prevalence of cataracts is steadily increasing among the middle-aged and elderly worldwide. We hypothesized that adults aged > 50 years with age-related cataracts (ARCs) have an association with metabolic syndrome (MS) and its components, and MS has interactions with different dietary patterns and lifestyles that affect ARC risk. We examined the hypothesis using the Korean Genome and Epidemiology Study (KoGES; a large-scale hospital-based cohort study), which collected data between 2004–2013. Methods: Participants ≥ 50 years old were classified as cases (1,972 ARC patients) and controls (38,290 healthy controls) based on a diagnosis of cataract by a physician. MS and its components were defined using WHO definitions for Asians. Dietary consumption was evaluated using a validated semi-quantitative food frequency questionnaire (SQFFQ), which contained 106 foods, and dietary patterns were analyzed by principal component analysis. After adjusting for potential covariates, logistic regression was used to investigate associations between MS and its components and between dietary patterns and a positive cataract history. Results: ARC had a positive association with MS after 1.32-fold adjusting for age, sex, residence area, body mass index, and energy intake. Plasma glucose and HbA1c concentrations exhibited an increased ARC risk in the participants with MS by 1.50- and 1.92-fold and without MS by 1.35 and 1.88-fold, respectively. Serum high-density lipoprotein (HDL) concentrations were negatively associated with ARC risk only in the MS patients, but not without MS. However, blood pressure, abdominal obesity, and serum triglyceride concentrations did not associate with ARC risk regardless of MS. High intake of a Koreanbalanced diet (KBD) containing fermented food exhibited a negative association with ARC risk (OR = 0.81) only in the MS group. The fat and coffee intake had a negative association with ARC only in the non-MS group. Current- and former-smokers were positively associated with ARC risk. Conclusion Persons who have hyperglycemia and low-HDL-cholesterolemia had increased susceptibility of ARC prevalence. A KBD with a proper amount of fat (≥ 15%) is recommended, and smoking should be prohibited.

Background: The prevalence of cataracts is steadily increasing among the middle-aged and elderly worldwide. We hypothesized that adults aged > 50 years with age-related cataracts (ARCs) have an association with metabolic syndrome (MS) and its components, and MS has interactions with different dietary patterns and lifestyles that affect ARC risk. We examined the hypothesis using the Korean Genome and Epidemiology Study (KoGES; a large-scale hospital-based cohort study), which collected data between 2004–2013. Methods: Participants ≥ 50 years old were classified as cases (1,972 ARC patients) and controls (38,290 healthy controls) based on a diagnosis of cataract by a physician. MS and its components were defined using WHO definitions for Asians. Dietary consumption was evaluated using a validated semi-quantitative food frequency questionnaire (SQFFQ), which contained 106 foods, and dietary patterns were analyzed by principal component analysis. After adjusting for potential covariates, logistic regression was used to investigate associations between MS and its components and between dietary patterns and a positive cataract history. Results: ARC had a positive association with MS after 1.32-fold adjusting for age, sex, residence area, body mass index, and energy intake. Plasma glucose and HbA1c concentrations exhibited an increased ARC risk in the participants with MS by 1.50- and 1.92-fold and without MS by 1.35 and 1.88-fold, respectively. Serum high-density lipoprotein (HDL) concentrations were negatively associated with ARC risk only in the MS patients, but not without MS. However, blood pressure, abdominal obesity, and serum triglyceride concentrations did not associate with ARC risk regardless of MS. High intake of a Koreanbalanced diet (KBD) containing fermented food exhibited a negative association with ARC risk (OR = 0.81) only in the MS group. The fat and coffee intake had a negative association with ARC only in the non-MS group. Current- and former-smokers were positively associated with ARC risk. Conclusion Persons who have hyperglycemia and low-HDL-cholesterolemia had increased susceptibility of ARC prevalence. A KBD with a proper amount of fat (≥ 15%) is recommended, and smoking should be prohibited.

Purpose: To investigate the refractive accuracy of intraocular lens (IOL) power calculation for biometric formulas in phacovitrectomy. Methods: This retrospective study included 357 eyes of 357 patients who underwent phacovitrectomy using four commonly available IOL power formulas: Hoffer Q (87 eyes), Holladay 1 (78 eyes), Holladay 2 (91 eyes), and SRK/T (101 eyes). The mean refractive error (ME) and the mean absolute refractive error (MAE) were calculated based on the predicted postoperative refraction error, and they were compared using analysis of variance test. Subjects were divided into high myopic eyes (axial length, ≥26 mm) and nonhigh myopic eyes (axial length, <26 mm). Results: The ME and the MAE after phacovitrectomy did not show a significant difference among the four IOL power formulas (p = 0.546 and p = 0.495, respectively). There was no significant statistical difference in formulas when the eyes were grouped into high myopia and nonhigh myopia (ME: p = 0.526 and p = 0.482, respectively; MAE: p = 0.715 and p = 0.627, respectively). The ME showed myopic shift in all formulas regardless of IOL formula used. The ME showed greater myopic shift in high myopia group than nonhigh myopia group in all formulas. Conclusions Our study did not find evidence for superiority of any formula in phacovitrectomy. However, in phacovitrectomy, possible myopic shift should be considered for IOL power calculation. Especially, in phacovitrecotmy in patients with high myopia, more myopic shift should be considered when selecting IOL.

PURPOSE: To examine the effects of panretinal photocoagulation (PRP) using a pattern scanning laser (PASCAL) system on the retinal nerve fiber layer (RNFL) thickness in patients with diabetic retinopathy. METHODS: This retrospective study included 105 eyes with diabetic retinopathy, which consisted of three groups: the PASCAL group that underwent PRP with the PASCAL method (33 eyes), the conventional group that underwent conventional PRP treatment (34 eyes), and the control group that did not receive PRP (38 eyes). The peripapillary RNFL thickness was measured by optical coherence tomography before, six months, and one year after PRP to evaluate the changes in peripapillary RNFL. RESULTS: The RNFL thickness in the PASCAL group did not show a significant difference after six months (average 3.7 times, p = 0.15) or one year after the PRP (average 3.7 times, p = 0.086), whereas that in the conventional group decreased significantly after six months (average 3.4 times, p < 0.001) and one year after PRP (average 3.4 times, p < 0.001). CONCLUSIONS: The results of this study suggest that the PASCAL system may protect against RNFL loss by using less energy than conventional PRP.
Diabetic Retinopathy/pathology/*surgery ; Disease Progression ; Female ; Fluorescein Angiography ; Fundus Oculi ; Humans ; Laser Coagulation/*methods ; Male ; Middle Aged ; Nerve Fibers/*pathology ; Retinal Ganglion Cells/*pathology ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity

PURPOSE: To evaluate the association between grape intake and diabetic retinopathy. METHODS: A population-based cross-sectional study using a nation-wide, stratified, multistage, clustered sampling method included 1,555 subjects aged > or =30 years who participated in the Korean National Health and Nutritional Examination Survey 2008-2011. All participants performed standardized interviews, food frequency questionnaires (FFQ), and comprehensive ophthalmic examinations. Grape intake was evaluated by an FFQ using 10 intervals of average frequency of grape intake during the past year. Diabetic retinopathy (DR) was evaluated by 7 standard retinal fundus photographs after pharmacological pupil dilatation. DR was classified as any DR, proliferative DR, or vision-threatening DR by the modified Air House classification system. RESULTS: The prevalence of diabetes was 16.9 +/- 1.2%. As the grape intake frequency increases in FFQ, the odds ratio (OR) for any DR, proliferative DR, and vision-threatening DR were 0.86 (95% confidence interval [CI], 0.75-0.98), 0.65 (95% CI, 0.48-0.88), and 0.77 (95% CI, 0.60-0.99) respectively. Compared to the group with a grape intake of less than once per month, the OR for any DR, proliferative DR, and vision-threatening DR in the group with a grape intake of more than 2-3 times per month were 0.54 (95% CI 0.33-0.89), 0.25 (95% CI 0.07-0.81), 0.36 (95% CI 0.13-0.95), respectively. CONCLUSIONS: The intake of grapes was inversely associated with the prevalence of DR.
Classification ; Cross-Sectional Studies ; Diabetic Retinopathy* ; Dilatation ; Odds Ratio ; Prevalence ; Pupil ; Retinaldehyde ; Vitis*

PURPOSE: To evaluate the possible association between psychological stress and glaucoma, given that there are emerging issues and controversy regarding whether psychological stress is one of contributing factors of glaucoma development. METHODS: We used the medical records of 16,426 patients from the Korean National Health and Nutritional Examination Survey 2008–2011. Glaucoma was defined based on examinations including the intraocular pressure, optic disc, visual field, and retinal nerve fiber layer. Stress was evaluated using five questionnaires regarding sustained stress, depression, feelings of suicide, history of suicide attempt/s, and history of psychological counseling. We used univariable and multivariable logistic regression analyses after adjusting confounding factors for glaucoma. RESULTS: Univariable logistic regression analysis revealed no significant association between glaucoma and psychological stress (odds ratio [OR] = 0.84; confidence interval [CI] = 0.70–1.01), depression (OR = 1.22; CI = 0.97–1.55), suicide attempt/s (OR = 0.73, CI = 0.33–1.59), and psychological counseling (OR = 0.72, CI = 0.43–1.21). Using univariate analysis, only the feelings of suicide factor (OR = 1.28, CI = 1.02–1.60) was significantly associated with glaucoma. Using multivariable analysis after adjusting for confounding factors, no significant association was found in any psychological stress factor. CONCLUSIONS: There was no significant association between psychological stress and glaucoma. The results of this study indicated that the pathogenesis of glaucoma is more consistent with the pathogenesis of physiological causes such as age or hypertension, rather than indirect causes such as stress.
Counseling ; Depression ; Glaucoma ; Humans ; Hypertension ; Intraocular Pressure ; Korea ; Logistic Models ; Medical Records ; Nerve Fibers ; Retinaldehyde ; Stress, Psychological ; Suicide ; Visual Fields

PURPOSE: To evaluate the cost-utility based on the quantitative relationship between glaucoma follow-up and glaucoma progression. METHODS: The Markov model was constructed and analyzed to determine the cost-effectiveness of primary open-angle glaucoma. The Markov model set up a virtual cohort of Korean over 40 years of age with early glaucoma. The costs associated with glaucoma treatment were assessed from a social point of view, and the utility was calculated using the quality adjusted life years according to the glaucoma states. Glaucoma health status was divided into 5 stages (early, middle, late, unilateral, bilateral blindness). The transition probability was set in one direction from mild to severe, and the length of each cycle was set at one year. The incremental cost effectiveness ratio (ICER) was calculated and compared with each other different follow-up periods. Sensitivity analysis was conducted to determine how the uncertainty of the variables used in this study affected the outcome. RESULTS: ICER of 3-month follow-up was 28,244,398 won/quality adjusted life years (QALY) compared 6-month follow-up, and ICER of 6-month follow-up was 13,615,443 won/QALY compared to 12-month follow-up. If the probability of progression of glaucoma in 6-months follow-up observations increases by more than 10% over 3-month periodic follow-up and the progression probability of 12-month follow-up increases by more than 15% follow-up compared to 3-months follow-up, 3-months follow-up was found to be a cost-effective strategy. On the other hand, 6-month follow-up was found to be cost-effective if probability of progression of 6-month follow-up was less than 10% increase of 3-month follow-up and 15% increase of 6-months follow-up. CONCLUSIONS: Cost-effective follow-up strategies differed according to the probability of progression of glaucoma, and 3-month or 6-month follow-up strategies were cost-effective and acceptable in Korea's health care system.
Cohort Studies ; Cost-Benefit Analysis ; Delivery of Health Care ; Follow-Up Studies ; Glaucoma ; Glaucoma, Open-Angle ; Hand ; Quality-Adjusted Life Years ; Uncertainty