Mariko Sasaki

This study evaluated the association between systolic blood pressure (SBP) and diabetic retinopathy (DR) across different glycemic levels in a Japanese population. We analyzed data from 1,049 residents aged ≥ 40 years with diabetes who underwent ophthalmic screening in Chikusei City. Participants were stratified into four groups by glycated hemoglobin (HbA1c) level (< 7% or ≥ 7%) and SBP (< 140 or ≥ 140 mmHg). Logistic regression was used to examine associations between SBP and prevalent DR within HbA1c strata. DR was present in 136 participants (13.0%), including 82 (7.8%) with mild-to-moderate nonproliferative DR (NPDR) and 54 (5.1%) with severe NPDR or proliferative DR (PDR). Among participants with lower HbA1c levels, higher SBP was significantly associated with greater odds of DR (odds ratio, 2.21; 95% confidence interval, 1.16–4.23). A similar association was observed among those with mild-to-moderate NPDR, but not among participants with higher HbA1c levels. SBP was not significantly associated with severe NPDR or PDR in any group. These findings suggest that elevated SBP may contribute to the development of early-stage DR even in individuals with well-controlled blood glucose levels, underscoring the importance of blood pressure management in DR prevention strategies.

Purpose: To investigate the clinical significance of punctate hyperfluorescent spots (PHS) on indocyanine green angiography (ICGA) in patients with central serous chorioretinopathy (CSCR). Methods: In this retrospective study, 87 eyes of 87 patients diagnosed with CSCR through comprehensive multimodal imaging were analyzed. Eyes with a cluster of five or more PHS on ICGA were classified as PHS (+), and eyes with four or fewer as PHS (−). Clinical parameters, including age, blood pressure, visual acuity, and imaging features such as choroidal venous dilation, choroidal vascular hyperpermeability (CVH), pachydrusen, and the status of PHS in the CSCR-unaffected fellow eyes, were compared between the two groups. Logistic regression analysis was performed to identify independent factors associated with PHS (+) status. Results: The PHS (+) group consisted of 63 (72.4%) eyes and the PHS (−) group 24 (27.6%) eyes. In the PHS (+) group, patients were significantly older (p = 0.031) and had higher systolic blood pressure (p = 0.030) and worse best-corrected visual acuity (p = 0.040) than those in the PHS (−) group. Notably, the PHS (+) group showed a significantly higher prevalence of PHS clusters in the fellow eye than the PHS (−) group (81.7% vs. 34.8%, p < 0.001). In univariate analysis, age (p = 0.045), venous dilation (p = 0.041), CVH (p = 0.034), and PHS clusters in the fellow eye (p < 0.001) were significantly associated with PHS clusters in the study eye. In multivariate analysis adjusted for multiple confounders, venous dilation (p = 0.026) and the presence of cluster PHS in the fellow eye (p = 0.001) remained significantly associated, and CVH tended to be significant (p = 0.089). Conclusions: PHS clusters are a frequent finding in eyes with CSCR, associated with venous dilation, CVH, and PHS in the CSCR-unaffected fellow eye. These conditions may predispose eyes to pachychoroid diseases such as CSCR.

Background: Bacterial endophthalmitis is a rare but serious complication of intravitreal injections (IVIs). Prefilled syringes have been introduced to reduce contamination risk during drug preparation. However, whether they lower the incidence of bacterial endophthalmitis compared to vials remains unclear. Methods: This retrospective cohort study analyzed aflibercept IVIs performed at 17 clinical centers in Japan between 2015 and 2022. Patients aged ≥20 years who received aflibercept IVIs (vial or prefilled syringe) for age-related macular degeneration, diabetic macular edema, retinal vein occlusion, or myopic choroidal neovascularization were included. Bacterial endophthalmitis was diagnosed based on clinical signs (e.g., rapid vision loss, pain, hypopyon, vitreous opacity). Incidence rates were compared using Fisher’s exact test. Results: Among 152,039 injections (43,684 prefilled syringes; 108,355 vials), 12 cases of bacterial endophthalmitis were identified (0.0046% vs. 0.0092%, p = 0.53). Poor visual outcomes were associated with Enterococcus faecalis, Streptococcus spp., and diabetes. Conclusions: Although incidence was lower in the prefilled syringe group, the difference was not statistically significant. Detecting a significant difference requires a larger sample. Further studies are needed to confirm the potential benefits of prefilled syringes in reducing endophthalmitis risk.

Residents of Chikusei City, aged 40–74 years, underwent systemic and ophthalmological screening, and participants with diabetes were included in this analysis. Dietary intake was assessed using a food frequency questionnaire and calculated as a percentage of the total energy. The presence of diabetic retinopathy (DR) was defined as Early Treatment Diabetic Retinopathy Study levels ≥ 20 in either eye. The association between dietary fatty acid intake and DR has been examined in a cross-sectional study. Among the 647 diabetic participants, 100 had DR. The mean total fat and saturated fatty acid (SFA) intakes were 22.0% and 7.3% of the total energy intake, respectively. After adjusting for potential confounders, the highest quartiles of total fat and SFA intake were positively associated with the presence of DR compared with the lowest quartiles (odds ratios (95% confidence intervals), 2.61 (1.07–6.39), p for trend = 0.025, and 2.40 (1.12–5.17), p for trend = 0.013, respectively). No significant associations were found between DR prevalence and monounsaturated or unsaturated fatty acid intake. These results suggest that a high intake of fat and SFA may affect the development of DR, even in individuals whose total fat intake is generally much lower than that of Westerners.

Purpose: To determine the associations between fatty acid intakes and the prevalence of age-related macular degeneration (AMD) under a population-based cross-sectional study. Methods: Residents of Chikusei City aged ≥40 years underwent systemic and eye screening. AMD was graded according to a modified version of the Age-Related Eye Disease Study classification. Dietary intake was assessed using a food frequency questionnaire and was adjusted for total energy intake. Results: Altogether, 10,788 eyes of 5394 participants, 2116 men (mean [standard deviation (SD)] age, 62.4 [9.4] years) and 3278 women (60.6 [9.5] years), were included. The mean daily total fat intakes were 52.8 g and 59.0 g in men and women, respectively. After adjustments for potential confounders, saturated fatty acid (SFA) intake was inversely associated with the prevalence of any AMD in men (for each energy-adjusted 1-SD increase: odds ratio [OR], 0.86; 95% confidence interval [CI], 0.74–1.00). Significant trends were found for decreasing odds ratios of AMD with increasing SFA, monounsaturated fatty acid (MUFA), and polyunsaturated fatty acid (PUFA) intake (P for trend = 0.02, 0.04, and 0.04, respectively). In women, only a significant association was observed between the second quartile of linolenic acid intake and the prevalence of any AMD (OR, 0.78; 95% CI, 0.62–0.99). Conclusions: We found an inverse association of SFA intake and a weak inverse association of MUFA and PUFA intakes with the prevalence of any AMD in a Japanese population. Translational Relevance: Adequate fatty acid intake may be necessary to prevent or decelerate AMD.

The progression of age-related macular degeneration (AMD) is determined by environmental and genetic factors, and phenotypic or molecular risk factors have been investigated extensively. Interestingly, risk factor profiles for advanced AMD differ among individuals, and one of the causes of variation may be explained by their ethnic background. Recent advances in retinal imaging technology have led to the identification of previously unrecognized risk factors for advanced AMD on optical coherence tomography (OCT) and OCT angiography, which expands the concept of traditional imaging risk factors such as drusen and pigmentary abnormalities visible on color fundus photographs. This OCT imaging modality has identified novel pathognomonic changes for early AMD, including the associated photoreceptor, retinal pigment epithelium, and underlying choroidal changes. Regarding features of multimodal imaging associated with the presence or progression of geographic atrophy, there is an international expert consensus classification system; however, features associated with the progression of macular neovascularization (MNV) are still obscure. To make a consensus towards understanding features associated with the risk of MNV, this review focuses on the early stages of AMD by summarizing imaging characteristics and early signs and classifications in view of advanced multimodal imaging technology. Recent evidence suggests that neovascular AMD is not a single disease entity but a heterogeneous disease characterized by MNV. Besides drusen, OCT features associated with pigment abnormalities, such as shallow irregular RPE elevation (SIRE, also known as double-layer sign), pachychoroid pigment epitheliopathy, and choriocapillaris ischemia, seem to confer a high risk of MNV developing, especially for Asian populations.