Tzyy-Chang Ho

Diabetes prevalence is increasing in Taiwan, raising concern over vision impairment among affected individuals. This study aimed to assess the burden of cause-specific vision impairment among individuals with diabetes, overall and stratified by age, sex, geographic region, and time, with a particular focus on diabetic retinopathy (DR). A cross-sectional, annual analysis was conducted from 2010 to 2020. Population prevalence of major eye diseases among adults aged ≥20 years with diabetes was obtained from the National Health Insurance Research Database. Ophthalmological data from a multicentre electronic medical record system across various hospital levels were used to characterise cause-specific vision impairment. Hierarchical Bayesian models integrated these datasets to estimate the prevalence of vision impairment and corresponding years lived with disability. In 2019, DR accounted for 1283.9 years lived with disability (95% credible interval: 992.9-1, 644.6), comprising 50.8% of the total vision impairment burden among individuals with diabetes, followed by glaucoma (11.7%) and cataract (9.9%). The age-standardised prevalence per 1000 individuals for DR-related vision impairment was 0.58 (0.43-0.76), 0.50 (0.36-0.67), 0.12 (0.06-0.20), and 0.09 (0.05-0.17) for mild, moderate, severe, and blindness, respectively. Higher burdens were observed in females, individuals aged 20-39, and residents of eastern Taiwan. Between 2010 and 2020, the prevalence of DR-related vision impairment decreased in the 55-69 age group and increased in the 20-39 age group. This study highlights high-risk subgroups for vision impairment among individuals with diabetes, providing evidence to inform targeted public health and diabetes eye-care strategies.

Purpose: This study aims to compare baseline characteristics and treatment outcomes of Type 1 and Type 2 myopic choroidal neovascularization (CNV) after 1 year of antivascular endothelial growth factors therapy and identify clinical factors associated with visual outcomes, recurrence rates, and injection numbers. Methods: In this retrospective study, we reviewed 171 patients with active myopic CNV treated with antivascular endothelial growth factors therapy and followed for at least 1 year. CNV types were classified using optical coherence tomography. Baseline characteristics, including best-corrected visual acuity, myopic maculopathy grade, and optical coherence tomography findings, were compared. Results: Type 1 CNVs (19.3% of cases) exhibited worse baseline best-corrected visual acuity and more advanced macular degeneration than Type 2 CNVs. Both types showed significant visual improvement equivalent to 2.2 lines post-therapy, with no difference in recurrence rates or injection numbers. Multivariate analysis revealed that baseline best-corrected visual acuity, severity of myopic macular degeneration, and presence of subretinal hyperreflective exudation were significant predictors of final best-corrected visual acuity, while CNV type was not an independent predictor. Conclusion: Despite more severe macular degeneration in Type 1 CNV, both types myopic CNVs benefit significantly from antivascular endothelial growth factors therapy. These findings support extending treatment to Type 1 CNVs and highlight the need for individualized management strategies.

Background Diabetes prevalence is increasing in Taiwan, raising concern over vision impairment among affected individuals. This study aimed to assess the burden of cause-specific vision impairment among individuals with diabetes, overall and stratified by age, sex, geographic region, and time, with a particular focus on diabetic retinopathy (DR). Methods A cross-sectional, annual analysis was conducted from 2010 to 2020. Population prevalence of major eye diseases among individuals with diabetes was obtained from the National Health Insurance Research Database. Ophthalmological data from a multicentre electronic medical record system across various hospital levels were used to characterise cause-specific vision impairment. Hierarchical Bayesian models integrated these datasets to estimate the prevalence of vision impairment and corresponding years lived with disability. Results In 2019, DR accounted for 1 283.9 years lived with disability (95% credible interval: 992.9–1 644.6), comprising 50.8% of the total vision impairment burden among individuals with diabetes, followed by glaucoma (11.7%) and cataract (9.9%). The age-standardised prevalence per 1 000 individuals for DR-related vision impairment was 0.58 (0.43–0.76), 0.50 (0.36–0.67), 0.12 (0.06–0.20), and 0.09 (0.05–0.17) for mild, moderate, severe, and blindness, respectively. Higher burdens were observed in females, individuals aged 20–39, and residents of eastern Taiwan. Between 2010 and 2020, the prevalence of DR-related vision impairment decreased in the 55–69 age group and increased in the 20–39 age group. Conclusions This study highlights high-risk subgroups for vision impairment among individuals with diabetes, providing evidence to inform targeted public health and diabetes eye-care strategies.

Introduction Neovascular age-related macular degeneration (nAMD) is a leading cause of vision loss, with some eyes showing recalcitrant disease despite standard anti-vascular endothelial growth factor (anti-VEGF) therapy. While clinical trials have demonstrated promising efficacy and safety of faricimab in treatment-naïve patients, only 9% of participants were Asian, and real-world data on its effectiveness in pretreated Asian populations remain limited. This study aims to evaluate the efficacy and longitudinal response of intravitreal faricimab in patients with recalcitrant nAMD in Taiwan by analyzing visual acuity, anatomical outcomes, and treatment interval extension over a 6-month period. Methods This was a retrospective observational study at National Taiwan University Hospital. Patients switched to intravitreal faricimab (6 mg/0.05 mL; Vabysmo™) from July 2023 to May 2024 with 6 months follow-up identified via electronic medical records. Injections were administered without a loading phase. Retreatment was guided by the presence of retinal fluid on optical coherence tomography (OCT), with or without visual decline. Results A total of 33 eyes from 28 patients were analyzed. Visual acuity remained stable over 6 months (p = 0.147). Central retinal thickness significantly improved from 267 to 235 μm at 3 months (p = 0.002) and remained stable at 6 months (p = 0.003). Subretinal fluid resolved in 36.4% of eyes at 3 months (p < 0.001) and 48.5% at 6 months (p = 0.002), while changes in intraretinal fluid (IRF) and pigment epithelial detachment (PED) height were not significant. Treatment intervals were extended in 52% of eyes, with 56% reaching ≥ 16 weeks (Q16W) intervals. No serious ocular or systemic adverse events were reported. Conclusions Intravitreal faricimab demonstrated improved anatomical outcomes with stable visual acuity and extended treatment intervals in patients with recalcitrant nAMD in Taiwan, addressing a key evidence gap. Future studies with longer follow-ups are needed to validate these findings.

Purpose: To investigate the surgical outcomes and intraoperative parameters of 3D visualization system for macular diseases in highly myopic eyes. Methods: In this single-center, prospective, randomized, comparative interventional study, 40 highly myopic eyes (axial length > 26 mm) were randomly assigned to either a 3D visualization system or a conventional microscope group. Surgical outcomes and intraoperative parameters, including the number of indocyanine green injections, surgical time, and epiretinal membrane/internal limiting membrane peeling time, were compared. Results: The 3D group required significantly fewer indocyanine green injections (1.3 ± 0.5 vs. 2.3 ± 0.7, P < 0.001), had shorter epiretinal membrane/internal limiting membrane peeling times (522.8 ± 258.0 vs. 751.8 ± 320.2 seconds, P < 0.05), and experienced fewer intraoperative retinal hemorrhages (0 vs. 7 cases, P < 0.05) compared with the conventional microscope group. Anatomical and functional outcomes were comparable between the two groups. Conclusion: The 3D system exhibited a lower number of indocyanine green injections, shorter epiretinal membrane/internal limiting membrane peeling times, and a reduced incidence of intraoperative retinal hemorrhages, suggesting the 3D visualization system may offer advantages for macular surgery in highly myopic eyes.

Background/Objectives: This study evaluates the impact of anti-vascular endothelial growth factor (anti-VEGF) treatment on neovascular age-related macular degeneration (nAMD) with and without pigment epithelial detachment (PED) over a one-year period. Methods: Conducted at a tertiary referral center in Taiwan, this retrospective analysis included 88 eyes treated with intravitreal aflibercept injections. Patients were categorized into four groups based on the presence or absence of PED at baseline and 12 months post-treatment. Results: Significant reductions in central macular thickness (CMT) and PED height were observed, although no statistical difference was found in best-corrected visual acuity (BCVA). The presence or type of PED did not negatively impact visual outcomes. Among nAMD patients with persistent PED throughout the first year of anti-VEGF treatment, linear regression analysis showed that mixed-type PED revealed poor final BCVA compared to those with serous PED. The analysis also identified older age and poorer initial BCVA as predictors of less favorable visual outcomes. Conclusions: This study highlights the effectiveness of anti-VEGF therapy in real-world settings and offers insights into factors influencing visual outcomes for nAMD patients with PED.

Background To elucidate the relationship between inherited retinal disease, visual acuity and refractive error development in Asian patients. Subjects Five hundred phakic eyes with refractive data were analysed in this retrospective cohort. Diseases were categorized by clinical phenotypes, and the prevalent genotypes identified in the Taiwan Inherited Retinal Degeneration Project were analysed. Consecutive surveys in Taiwan have provided the rates of myopia in the general population. Results No differences were observed among the disease phenotypes with respect to myopia (P = 0.098) and high myopia rates (P = 0.037). The comparison of refractive error between retinitis pigmentosa and diseases mainly affecting the central retina showed no difference, and the refraction analyses in diseases of different onset ages yielded no significance. Moreover, there was no difference in the myopia rate between the diseases and general population. Among the genotypes, a higher spherical equivalent was seen in RPGR and PROM1-related patients and emmetropic trends were observed in patients with CRB1 and PRPF31 mutations. Furthermore, significantly poorer visual acuity was found in ABCA4, CRB1 and PROM1-related patients, and more preserved visual acuity was seen in patients with EYS, USH2A, and RDH12 mutations. Conclusions No significant differences were observed in visual acuity, refractive state and myopia rate between patients with inherited retinal disease and the general population, and different subtypes of inherited retinal disease shared similar refractive state, except for higher cylindrical dioptres found in patients with Leber’s congenital amaurosis. The heterogeneity of disease-causing genes in Asian patients may lead to variable refractive state.

Purpose: To investigate the associations between fluid accumulation at different levels in the retina and visual outcome in polypoidal choroidal vasculopathy (PCV). Design: A retrospective observational study. Institutional setting. Study Population: A total of 91 eyes from 91 patients of PCV were included, with 65 receiving intravitreal aflibercept monotherapy and 26 receiving combined intravitreal ranibizumab and photodynamic therapy (PDT). Observation Procedures: Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) examination results were recorded at baseline and 3, 6, and 12 months after treatment. Main Outcome Measures: The correlations between visual outcomes and fluid biomarkers including intraretinal fluid (IRF), subretinal fluid (SRF), serous pigment epithelium detachment (PED), and hemorrhage at fovea were analyzed. Results: No differences in treatment outcomes were noted between patients receiving aflibercept and those receiving combined ranibizumab and PDT. IRF and hemorrhage at baseline predicted poorer vision at 3, 6, and 12 months. The presence of IRF was associated with poorer vision at 6 months and 12 months (p < 0.05 for all). The presence of SRF or PED was not associated with better vision at any time point. No differences in the correlations between fluid markers and visual outcomes were noted between thin and thick subfoveal choroidal thickness groups. Conclusions: For PCV, IRF and hemorrhage at baseline served as surrogates for poor visual prognosis after treatment, and IRF was a biomarker for poor vision during the treatment course. No fluid markers predicted good visual prognosis or had a positive impact on vision at any time point.

Background: To identify genotypes associated with neovascular age‐related macular degeneration (nAMD) and investigate the associations between genotype variations and anti‐vascular endothelial growth factor (VEGF) treatment response.Methods: This observational, retrospective, case series study enrolled patients diagnosed with nAMD who received anti‐VEGF treatment in National Taiwan University Hospital with at least one‐year follow‐up between 2012 and 2020. A genome‐wide association study (GWAS) was conducted on enrolled patients and controls. Correlations between the genotypes identified from GWAS and the treatment response of functional/anatomical biomarkers, including visual acuity (VA), presence of intraretinal or subretinal fluid (SRF), serous or fibrovascular pigmented epithelium detachment (PED), and disruption of the ellipsoid zone (EZ), were analysed.Results: In total, 182 patients with nAMD and 1748 controls were enrolled. GWAS revealed 16 single nucleotide polymorphisms (SNPs) as risk loci for nAMD, including seven loci in CFH and ARMS2/HTRA1 and nine novel loci, including rs117517872 and rs79835234(COPB2‐DT), rs7525578(RAP1A), rs2123738(LOC105376755), rs1374879(CNTN3), rs3812692(SAR1A), rs117501587(PRKCA), rs9965945(CNDP1), and rs189769231(MATK). Our study revealed rs800292(CFH), rs11200638(HTRA1), and rs2123738(LOC105376755) correlated with poor treatment response in VA (P = 0.005), SRF (P = 0.044), and fibrovascular PED (P = 0.007), respectively. Rs9965945(CNDP1) was correlated with poor response in disruption of EZ (P = 0.046) and serous PED (P = 0.049).Conclusions: Among the 16 SNPs found in the GWAS, four loci—CFH, ARMS2/HTRA1, and two novel loci—were correlated with the susceptibility of nAMD and anatomical/functional responses after anti‐VEGF treatment.