Objective:To analyze the distribution of disease subtypes of primary open-angle glaucoma (POAG) in specialist clinics and carry out the follow-up survey.Methods:From January 2016 to January 2018, 621 patients with POAG diagnosed for the first time in the Glaucoma Clinic of Beijing Tongren Hospital affiliated to Capital Medical University were selected as the study subject by convenient sampling. We analyzed the disease subtype, age, sex, patient source and follow-up characteristics of POAG patients, and recorded the follow-up times of all patients. Logistic regression was used to explore the influencing factors of follow-up of patients with POAG.Results:Of the 621 patients with POAG, 568 had high intraocular pressure glaucoma and 53 had normal intraocular pressure glaucoma. Among the patients with different subtypes, there were statistical differences in the proportion of patients with no follow-up, three or more follow-up visits ( P<0.05) . Logistic regression showed that the young patient (β=-0.04, P<0.001) , source in Beijing (β=-1.20, P<0.001) and normal intraocular pressure glaucoma subtype (β=- 1.24, P<0.001) were the influencing factor that was conducive to the follow-up of 3 or more times. Conclusions:The sex, age and follow-up characteristics of POAG patients are similar to those reported in previous hospital-based studies. Follow-up compliance of POAG for all subtypes is low, especially in patients with high intraocular pressure glaucoma. Patients with low age, patient origin in Beijing, and subtype of normal intraocular pressure glaucoma are beneficial for POAG patients to meet the follow-up requirements.

Objective:To compare the change of macular microvasculature in early primary open-angle glaucoma (POAG) patients with central visual field defects (CVFDs) and peripheral visual field defects (PVFDs).Methods:A cross-sectional study was performed.Sixty-six eyes of 66 consecutive patients with early POAG were enrolled in Beijing Tongren Hospital from June to December 2020.The patients were divided into CVFDs group (25 eyes) and PVFDs group (41 eyes) according to their visual field defect.Another 55 eyes of 55 age-, gender- and spherical equivalent-matched healthy people were set as a normal control group.All subjects underwent routine ophthalmic examination.Humphrey 24-2 visual field test was carried out.Macular vessel density (VD) and perfusion density (PD) of an area of 6 mm×6 mm were measured by optical coherence tomography angiography (OCTA), and the area was divided into 3 rings and 9 zones, including center, inner ring (superior, inferior, temporal and nasal sectors), and outer ring (superior, inferior, temporal and nasal sectors) according to ETDRS ring.The relationship among VD, PD, and visual field defect was analyzed.This study adhered to the Declaration of Helsinki.The research protocol was approved by an Ethics Committee of Beijing Tongren Hospital, Capital Medical University (No.TRECKY2020-103). Written informed consent was obtained from each subject before any examination.Results:The total macular VD of normal control group, CVFDs group and PVFDs group was 18.20 (17.50, 18.50), 17.10 (16.30, 17.85), and 17.20 (16.25, 17.90)mm/mm 2, respectively, and there was a significant difference ( H=20.84; P<0.001). The total macular PD of normal control group, CVFDs group and PVFDs group was 0.45 (0.43, 0.46), 0.42 (0.40, 0.44), and 0.43 (0.40, 0.44)mm 2/mm 2, respectively, with a significant difference ( H=16.15; P<0.001). The total macular VD and PD of CVFDs and PVFDs groups were significantly lower than those of normal control group, with statistically significant differences (all at P<0.05). Significant differences were found in VD and PD of superior, inferior, temporal, and nasal sectors of the outer ring among three groups (all at P<0.05). VD of the outer ring and PD of superior, inferior, and nasal sectors of the outer ring were reduced in CVFDs group than normal control group, showing significant differences (all at P<0.05). VD and PD of the superior, inferior, and temporal sectors of the outer ring were reduced in PVFDs group compared with normal control group, with significant differences (all at P<0.05). A significant difference was found in macular PD of the outer-nasal sector between CVFDs and PVFDs groups ( P=0.035). Conclusions:Macular VD and PD are reduced in early POAG.Compared with POAG patients with CVFDs, the macular PD of the outer-nasal sector of POAG patients with CVFDs is lower.

Objective:To investigate the change regularity and influencing factors of subfoveal choroidal thickness (SFCT) with age among adults.Methods:A cross-sectional study was adopted.A total of 281 Chinese adults, aged between 21 and 90, were selected from working staff and retired staff of an institution who underwent routine physical examinations from June to October 2016 in Beijing Tongren Hospital.One eye of each subject was included in the study according to the random number table method.The subjects were divided into different age groups including 21-30 years group, 31-40 years group, 41-50 years group, 51-60 years group, 61-70 years group, 71-80 years group and 81-90 years group.The SFCT was measured at the fovea and at 500 μm, 1 000 μm and 2 000 μm nasal (N) and temporal (T) to fovea by high definition-optical coherence tomography.Multiple linear regression equation was used to analyze the influence of ages, gender, intraocular pressure (IOP), spherical equivalent (SE) and retinal thickness on SFCT.This study followed the Declaration of Helsinki and was approved by the Ethics Committee of Beijing Tongren Hospital, Capital Medical University (No.TRECKY2016-012). Written informed consent was obtained from each patient prior to any examination.Results:Mean SFCT of eligible 229 subjects (229 eyes) was (218.73±79.69)μm.Choroid became thinner gradually towards nasal and temporal part.There were significant differences in SFCT, N2 000, N1 000, N500, T500, T1 000 and T2 000 among all age groups ( F=27.05, 22.85, 25.38, 29.11, 32.55, 29.22, 28.70, all at P<0.01). Choroidal thicknesses of all locations showed age-related linear decrease with a steep drop after 50 years old ( R2ranged 0.35-0.47, all at P<0.01). SFCT was associated with SE (β=-10.07, P<0.01) and age (β=-2.43, P<0.01) but not related with gender (β=-19.69, P=0.057), foveal thickness (β=0.02, P=0.897) or IOP (β=-0.86, P=0.466). Conclusions:SFCT shows an age related linear decrease with a steep decline after 50 years old, which was associated with aging and higher SE in myopia, but not related with gender, foveal thickness or IOP within the normal range.

Objective:To analyze the change of intraocular pressure of normal adults measured by non-contact tonometer with age and to provide theoretical basis for health education of intraocular pressure.Methods:A total of 330 employed workers and retired employees (330 eyes, right eye) from a work unit who underwent physical examination in Beijing Tongren Hospital were selected from June to September 2019. According to the age of each 10 years, they were divided into 7 groups, including 31 cases in 20 to 29 years old group, 38 cases in 30 to 39 years old group, 32 cases in 40 to 49 years old group, 54 cases in 50 to 59 years old group, 43 cases in 60 to 69 years old group, 60 cases in 70 to 79 years old group and 71 cases in 80 to 90 years old group. The intraocular pressure was measured using a non-contact tonometer. Analysis of variance was used to compare the differences in intraocular pressure between different age groups and the effect of age on intraocular pressure was analyzed.Results:The age of the 330 subjects in this study ranged from 20 to 90 years old, and the intraocular pressure value was (13.57±3.42) mmHg. There were statistically significant differences in intraocular pressure among age groups ( F=4.36, P<0.01) . The 7 groups were regrouped into 20 to 59 years old group (155 eyes) and 60 to 90 years old group (175 eyes) , and intraocular pressure was respectively (14.53±3.18) mmHg and (12.72±3.41) mmHg, and the differences between the two groups were statistically significant ( t=4.98, P<0.01) . Simple linear regression analysis showed that the intraocular pressure decreased by 0.04 mmHg/year with the increasing age (95% CI -0.06- -0.02) . Conclusions:In normal people aged from 20 to 90 years old, the intraocular pressure drops after the age of 60. Therefore, determination of the normal range of intraocular pressure needs to be adjusted according to age so as to promote early detection, early diagnosis and early treatment of glaucoma.

Objective:To analyze the detection of myopic anisometropia in children of low and high age groups in a Class Ⅲ Grade A hospital to provide a theoretical basis for health promotion and education of myopia.Methods:A total of 217 children with myopia who were treated in the Ophthalmology Myopia Clinic of Beijing Tongren Hospital, Capital Medical University were selected from October to December 2020. According to age, they were divided into the low-age group (5-9 years old, 127 cases) and the high-age group (10-14 years old, 90 cases). The difference of spherical equivalent (SE) between left and right eyes of subjects was recorded, and the SE difference greater than or equal to 1.00d was defined as anisometropia. Non-parametric test was used to compare the difference of SE between the two groups, χ 2 test was used to compare the difference of gender and anisometropia detection rate between the two groups and multiple linear regression was used to analyze effects of age, gender and ocular axis difference on SE difference. Results:The binocular SE difference was 0.25 (0.00-0.50) D in the low age group and 0.50 (0.22-0.75) D in the high age group, and the difference between the two groups was statistically significant ( Z=2.75, P=0.006). The detection rates of anisometropia in the low-age group and the high-age group were respectively 9.45% and 20.00%, and the difference between the two groups was statistically significant (χ 2=4.92, P=0.027). Age had a significant effect on the SE difference. With the increase of age, the SE difference of both eyes increased 0.04 D/year (95% CI: 0.007-0.080, P=0.020). The binocular axial difference has a significant effect on the SE difference. For every 1 mm increased in the axial difference, the SE difference increased by 0.03 D (95% CI: 0.004-0.060, P=0.024). Gender had no effect on binocular SE difference ( P=0.382) . Conclusions:With the increase of age, the refractive difference of both eyes increases significantly, especially the incidence of anisometropia over 10 years old is higher than that under 10 years old. It is suggested that more attention should be paid to the occurrence of anisometropia in ophthalmology clinic, and to promote the early detection, intervention and control of anisometropia in children and adolescents.

The application of a specialized imaging data management system in ophthalmology not only improves clinical diagnosis and treatment, but also brings change to the traditional teaching of ophthalmology. Department of Ophthalmology in Beijing Tongren Hospital Affiliated to Capital Medical University applied the FORUM (Carl Zeiss, FORUM V4.0, Germany) imaging data management system in clinical practice and postgraduate teaching of ophthalmology. The imaging data management system can obtain the primary imaging data of patients and the data can be accessed at any time, which brings great convenience for teachers to show the cases. The imaging data management system can help clinical teachers to improve the teaching effect of direct teaching and cultivate students' clinical thinking to carry out case discussion, and it can also help to cultivate scientific thinking of postgraduates.

Objective To observe confocal scanning laser ophthalmoscope (cSLO) based retinal imaging and color fundus camera in pigment epithelial detachment (PED) of polypoidal choroidal vasculopathy (PCV).Methods PED of 30 patients (32 eyes) were recruited from June 2016 to June 2017 in the Beijing Tongren Hospital who were detected in high-definition OCT (HD-OCT) and diagnosed as PCV by FFA and ICGA.There were 16 males (17 eyes) and 14 females (15 eyes);aged from 50-83 years,with the mean age of 66.59 years.The photographs of ocular fundus including color fundus camera,cSLO imaging,HD-OCT,FFA and ICGA were analyzed.Multimodal imaging results were regarded as gold standard.Sensitivity and specificity were calculated in serous and hemorrhagic PED diagnosis using color fundus camera and cSLO imaging.The positive number of PED was used to compare between two modes fundus imaging by using x2 test.Results Twenty serous PED eyes,3 hemorrhagic PED eyes and 9 serous/hemorrhagic PED eyes were determined using multimodal imaging.The sensitivity and specificity of color fundus camera were 45％ and 100％ in detecting serous PED and 100％ and 91％ in detecting hemorrhagic PED.The sensitivity and specificity of cSLO imaging were 83％ and 100％ in detecting serous PED and 50％ and 86％ in detecting hemorrhagic PED.The positive number of serous PED in cSLO imaging was significantly higher than color fundus camera (x2=7.752,P=0.011).The positive number of hemorrhagic PED in cSLO imaging shows no obvious difference compared with color fundus camera (x2=1.164,P=0.419).Conclusion The sensitivity and positive number of detecting serous PED with PCV in cSLO fundus imaging were higher than the color fundus camera technology.

Objective To determine the difference of macular ganglion cell-inner plexiform layer (mGCIPL) thickness and peripapillary retinal nerve fiber layer (pRNFL) thickness using Cirrus HD-OCT between older and young people in order to provide information for glaucomatous progressive analysis.Methods A prospective case series study was adopted.Sixty-seven old persons (114 eyes) aged 60-80 years old were selected from retired staff of an institution who underwent routine physical examinations between June and July 2016 in Beijing Tongren Hospital as older group and 24 young persons(42 eyes) aged (20-40 years old) who underwent routine physical examination at the same period were selected as young group.The total superior,superonasal,inperonasal,inferior,inferotemporal and superotemporal mGCIPL thickness and PRNFL thickness were measured by Cirrus HD-OCT.The research followed the Declaration of Helsinki.The ethics committee of the Tongren Eye Center approved the study and all participants provided an informed consent.Results There were statistical differences in all measurement parameters (mGCIPL and pRNFL) between older and young people (all at P＜0.05) except nasal pRNFL thickness.Minimum mGCIPL thickness was significantly different between older and young group [(74.02±11.01) pm vs.(82.74 ±3.94) μm;t =-7.290,P＜0.001],while in the pRNFL parameters,temporal pRNFL thickness was siginicantly changed between older and young group [(70.83 ± 12.30) μm vs.(82.10 ± 17.02) μm;t =-3.930,P ＜ 0.001].The nasal pRNFL thickness showed no significant difference between the two groups.Conclusions All mGCIPL and most pRNFL parameters in older people were obviously thinner than young people except nasal pRNFL,age factor should be considered seriously in the progression analysis of glaucomatous neuropathy.

Background Glaucoma is characterized by loss of retinal ganglion cells (RGCs) followed by visual field defects.Spectral domain OCT(SD-OCT) enabled more precise and quantitative assessments of macular ganglion cell complex (GCC) thickness.Objective This study was to evaluate the diagnostic ability of GCC thickness in identifying primary open angle glaucoma (POAG).Methods A prospective study was performed.Seventy POAG patients and 30 healthy volunteers were enrolled in Beijing Tongren Hospital from November 2015 to April 2016.Macular GCC thickness and peripapillary retinal nerve fiber layer (RNFL) thickness were measured with RTVue SD-OCT,and Humphrey perimetry was performed on the eyes.The patients were assigned to the early stage POAG group,advanced POAG group and later stage POAG group based on the mean defect (MD) of visual field.The average,superior,inferior GCC and RNFL,focal loss volume (FLV),and global loss volume (GLV) were measured and compared among the groups.The correlations between GCC thickness or RNFL thickness with MD were evaluated in the POAG eyes.The discrimination capabilities of GCC thickness or RNFL thickness were assessed and compared by using areas under the receiver operating characteristic (ROC) curves (AUC).Results Compared with the normal control group,the average,superior,inferior GCC thickness and RNFL values were evidently reduced,the FLV and GLV were significantly increased in the early stage POAG group,advanced POAG group and later stage POAG group (all at P＜0.001).Compared with the early stage POAG group,the average GCC and RNFL thickness values were significantly reduced,and GLV was increased in the advanced POAG group and later stage POAG group (all at P＜0.05).In the later stage POAG group,superior RNFL was thinner than that in the early stage POAG group (P =0.003).The superior GCC value were lower in the later stage POAG group than that in the early stage POAG group and advanced POAG group (all at P＜0.001).Compared with the early stage POAG group,the inferior GCC and RNFL thicknesses were decreased and the FLV was increased in the advanced POAG group and the later stage POAG group (all at P≤0.01).Linear positive correlations were found between average GCC,superior GCC,inferior GCC,average RNFL,superior RNFL or inferior RNFL and MD (r =0.624,0.583,0.601,0.571,0.447,0.537,all at P＜0.001),and the positive correlations were also seen between average GCC and average RNFL,between superior GCC and superior RNFL or between inferior GCC and inferior RNFL (r =0.648,0.630,0.602,all at P＜0.001).The AUCs were 0.965,0.979,0.924,0.985,0.980,0.990,0.979 and 0.992 in the average GCC,superior GCC,inferior GCC,FLV,GLV,average RNFL,superior RNFL and inferior RNFL,with the largest AUCs in the FLV and inferior RNFL thickness.No significant difference was found in the AUC between FLV and inferior RNFL thickness (P＞0.05).Conclusions Inferior GCC is more susceptible to glaucomatous damage.FLV and GLV from GCC pattern parameters are sensitive indicators for diagnosis of POAG.GCC thickness could be a valid structural parameter for detecting glaucoma and can be used as a marker in glaucoma assessment.

Background Cystoid macular edema (CME) is caused by many fundus diseases.The noninvasive clinical diagnosis methods for CME are conventional color fundus photography up to now.However,these images can not display the CME range well.Confocal scanning laser ophthalmoscope (cSLO) based retinal imaging can provide clear picture with high contrast.However,whether cSLO imaging is feasible in the quantitative assessment of CME remains unclear.Objective This study was to image the boundary of CME and assess the quantification of CME image from cSLO imaging technology.Methods A series case-observational study was designed.This study protocal was approved by Ethic Committee of Beijing Tongren Hospital.cSLO based retinal imaging technology was carried out on consecutive 24 eyes of 24 patients with clinically diagnosed and OCT confirmed CME in Beijing Tongren Eye Center from August to December 2015 under the informed consent of each individual.The radial scan range was 45°× 45 ° and the line scan level was 49 at macula area.The pseudocolar image,green light reflective image (532 nm) and infrared reflective image (785 nm) were collected.The imaging was analyzed by EasyScan software (version 1.2.2).Fundus color photography and SD-OCT were carried out in each patient.The images were graded by specialists according to the SD-OCT cross sectional results.Results The primary causes of CME included epiretinal membrane (10 eyes),branch retinal vein occlusion (BRVO) (6 eyes),central retinal vein occlusion (CRVO) (4 eyes),diabetic retinopathy (DR) (3 eyes) and CRVO with BRVO (1 eye).A CME image was exhibited on the fundus color photogram with the obscure boundary;while the clear range of CME was displayed by the cSLO imaging.The mean score of CME from pseudocolar image,green light reflective image and infrared reflective image was 3.21±0.78,2.67±0.96 and 2.54±0.83,respectively,which was significantly higher than 1.33±0.82 from the fundus color photography (all at P＜0.01).Conclusions In CME patients,the imaging quality from cSLO-based retinal imaging technology is better than that from traditional fundus color photography.Combined with SD-OCT sectional scan analysis,cSLO-based retinal imaging technology may offer a method to observe and record more fundus details for CME diagnosis.