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      Prevalence and associated factors of retinal vein occlusion in the Korean National Health and Nutritional Examination Survey, 2008–2012 : A cross-sectional observational study

      research-article
      , MD, PhD a , , MD, PhD a , , MD b , , MD b , , MD, PhD a , , MD, PhD c , , PhD d , , MD, PhD b
      Medicine
      Wolters Kluwer Health
      epidemiology, hypertension, Korean, retinal vein occlusion

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          Abstract

          Retinal vein occlusion (RVO) is the second most common retinal vascular diseases and there are only a few Asian population-based studies with small samples. Hypertension is one of a modifiable risk factor of RVO, but no recent studies have shown the relationship between RVO and hypertension control status. We aimed to investigate the prevalence of RVO and its associated factors in an adult Korean population.

          A nationwide population-based, cross-sectional study. We enrolled 37,982 participants from the Korea National Health and Nutrition Examination Survey who were 19 years or older and who had undergone ophthalmologic exams from 2008 through 2012. All participants underwent a comprehensive ophthalmic examination, standardized ophthalmic and health interviews, and laboratory investigations. Digital fundus photographs were interpreted by retinal specialists who investigated for the presence of RVO. The prevalence of RVO was then estimated. RVO-associated factors were determined using step-wise logistic regression analyses. We also performed a subgroup analysis to evaluate the association between hypertension and RVO according to hypertension control status and antihypertensive medication use.

          Of those enrolled participants, 25,765 participants met our study criteria and were included in the analyses. The overall RVO prevalence (n = 205) was 0.6 ± 0.1% (0.6 ± 0.1% for branch RVO and <0.1% for central RVO), and no sex differences were observed. In multivariate logistic regression analyses after adjusting for all potential risk factors, we found the following factors to be significantly associated with RVO: old age (odds ratio (OR) = 1.72, 95% CI: 1.27–2.34), hypertension (OR = 2.56, 95% CI: 1.31–5.08), history of stroke (OR = 2.08, 95% CI: 1.01–4.45), and hypercholesterolemia (OR = 1.84, 95% CI: 1.01–3.35). In a subset of participants with hypertension, participants with uncontrolled hypertension (OR = 3.46, 95% CI: 1.72–6.94) and unmedicated hypertension (OR = 4.12, 95% CI: 2.01–8.46) were more significantly associated with RVO than participants without hypertension.

          RVO prevalence in Korea was moderate relative to that in the rest of the world, and RVO-associated factors were similar to those identified in other population-based studies. Well-controlled hypertension and antihypertensive medication showed inverse association with RVO.

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          Most cited references25

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          Natural history of branch retinal vein occlusion: an evidence-based systematic review.

          To describe the natural history of branch retinal vein occlusion (BRVO) based on the best available evidence from the literature. Branch retinal vein occlusion is the second most frequent major retinal vascular disease. Although several new treatments for BRVO are currently being introduced, data on its natural history are sparse. English language articles were retrieved using a keyword search of MEDLINE, EMBASE, Current Contents, and the Cochrane Library to November 13, 2008, supplemented by manually searching the references of review articles published within the last 5 years. All relevant observational studies evaluating the natural history of BRVO and all clinical trials evaluating BRVO interventions with an untreated control arm were independently identified by 2 investigators. Of a total of 5965 citations retrieved, 24 eligible studies were identified and reviewed, providing 1608 eyes with BRVO with data on natural history. Visual acuity (VA) was moderately poor at baseline (<20/40). Although VA generally improved, with mean improvement ranging from 1 letter at 6 weeks to 28 letters up to 24 months, few studies reported improvement beyond 20/40. Over a 1-year period, 5% to 15% of eyes developed macular edema (ME), but of those with ME at baseline, 18% to 41% resolved. At baseline, 5% to 6% of eyes had bilateral BRVO, with 10% developing fellow eye involvement over time. There were few high-quality studies on other outcomes, including development of new vessels. Visual acuity generally improved in eyes with BRVO without intervention, although clinically significant improvement beyond 20/40 was uncommon. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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            The epidemiology of retinal vein occlusion: the Beaver Dam Eye Study.

            To describe the prevalence and the 5-year incidence of retinal central and branch vein occlusion and associated risk factors. The Beaver Dam Eye Study (n = 4,926) is a population-based study in which retinal vein occlusions were detected at baseline (1988-1990) and at a 5-year follow-up examination (1993-1995) by grading of 30 degrees color fundus photographs. The prevalence and 5-year incidence of retinal branch vein occlusion were each 0.6%. The prevalence of retinal central vein occlusion was 0.1%, and the 5-year incidence was 0.2%. While adjusting for age, the prevalence of branch vein occlusion was associated with hypertension (odds ratio [OR] 5.42, 95% confidence interval [CI] 2.18, 13.47), diabetes mellitus (OR 2.43, 95% CI 1.04, 5.70), pulse pressure (OR 1.24 for 10 mm Hg, 95% CI 1.03, 1.48), ocular perfusion pressure (OR 2.09 for 10 mm Hg, 95% CI 1.45, 3.01), arteriovenous nicking (OR 16.75, 95% CI 7.33, 38.24), and focal arteriolar narrowing (OR 22.86, 95% CI 8.43, 62.03). The age-adjusted incidence of retinal branch vein occlusion was associated with current smoking (OR 4.43 95%, CI 1.53, 12.84) compared with nonsmokers and to focal arteriolar narrowing (OR 5.24, 95% CI 1.97, 13.94) at baseline. While controlling for age, the incidence of branch vein occlusion was not associated with serum lipid levels, body mass index, white blood cell count, alcohol consumption, aspirin use, glaucoma, intraocular pressure, or ocular hypertension. Retinal vein occlusion is infrequent in the population. These data suggest a strong association between retinal branch vein occlusion and retinal arteriolar changes. Data from larger populations are needed to further assess associations between risk factors and the incidence of retinal vein occlusions.
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              • Abstract: found
              • Article: not found

              Natural history of central retinal vein occlusion: an evidence-based systematic review.

              To describe the natural history of central retinal vein occlusion (CRVO) based on the best available evidence from the literature. Central retinal vein occlusion is a common sight-threatening retinal vascular disease. Despite the introduction of new interventions, the natural history of CRVO is unclear. Systemic review of all English language articles retrieved using a keyword search of MEDLINE, EMBASE, Current Contents, and the Cochrane Library to November 13, 2008. This was supplemented by hand-searching references of review articles published within the last 5 years. Two investigators independently identified all relevant observational studies evaluating the natural history of RVO and all clinical trials evaluating interventions for CRVO; an untreated control arm was included. Of 5966 citations retrieved, 53 studies were reviewed, providing 3271 eyes with CRVO for analysis of its natural history. Visual acuity (VA) was generally poor at baseline (<20/40) and decreased further over time. Although 6 studies reported an improvement in VA, none of these improvements resulted in VA better than 20/40. Up to 34% of eyes with nonischemic CRVO converted to ischemic CRVO over a 3-year period. In ischemic CRVO cases, neovascular glaucoma developed in at least 23% of eyes within 15 months. In nonischemic CRVO cases, macular edema resolved in approximately 30% of eyes over time, and subsequent neovascular glaucoma was rare. Untreated eyes with CRVO generally had poor VA, which declined further over time. One quarter of eyes with nonischemic CRVO converted to ischemic CRVO. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                November 2016
                04 November 2016
                : 95
                : 44
                : e5185
                Affiliations
                [a ]Department of Ophthalmology, Hanyang University College of Medicine
                [b ]Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
                [c ]Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu
                [d ]Biostatistical Consulting and Research Lab, Hanyang University, Seoul, Korea.
                Author notes
                []Correspondence: Se Woong Kang, Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, #81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea (e-mail: swkang@ 123456skku.edu ).
                Article
                05185
                10.1097/MD.0000000000005185
                5591102
                27858854
                2e3cc192-9491-4c05-a5a5-f316440d4ca7
                Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved.

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                : 27 May 2016
                : 26 August 2016
                : 29 September 2016
                Categories
                5800
                Research Article
                Observational Study
                Custom metadata
                TRUE

                epidemiology,hypertension,korean,retinal vein occlusion
                epidemiology, hypertension, korean, retinal vein occlusion

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