Increased Prevalence of Pregestational Diabetes Mellitus Elevates Pregnancy Complications: Study

The prevalence of pregestational diabetes mellitus (PGDM) among women of reproductive age has increased globally by leading to a significant rise in adverse pregnancy outcomes. Hemoglobin A1c (HbA1c) is a critical marker for diagnosing and monitoring PGDM and plays a vital role in determining the risk of congenital anomalies and complications based on its levels during the periconceptional period.

A recent study published in The Israel Medical Association Journal evaluated the association between periconceptional HbA1c levels and perinatal complications in pregnant women with poorly controlled PGDM. This retrospective analysis covered pregnancies from 2010 to 2019 and focused on women with HbA1c levels greater than 6% three months prior to conception or during the first trimester.

The study cohort consisted of a total of 89 women divided into three groups based on their HbA1c levels; 49 women with HbA1c between 6-8%, 29 women with HbA1c between 8-10% and 11 women with HbA1c levels over 10%. It was observed that higher HbA1c levels were more prevalent among women with type 1 diabetes who also showed an elevated risk of end-organ damage.

Women with increased HbA1c levels underwent unbalanced glucose levels during pregnancy that contributes to various complications. The group expressed high rates of preterm delivery, hypertensive disorders, cesarean deliveries and neonatal intensive care unit (NICU) admissions. Despite these challenges, the overall live birth rate was close to 83%.

A significant correlation was found between higher HbA1c levels and preterm delivery. However, no consistent association was observed between HbA1c levels and other adverse outcomes like hypertensive disorders or NICU admissions. This suggests that while higher HbA1c levels are associated with certain risks, the escalation of complications does not always follow a proportional pattern beyond a specific HbA1c threshold.

The findings illuminate the importance of maintaining optimal glycemic control during the periconceptional period for women with PGDM. Increased HbA1c levels are associated with increased risks of adverse pregnancy outcomes that emphasizes the need for vigilant monitoring and management of blood glucose levels before and during pregnancy. Overall, the study highlights the major role of HbA1c as a predictive marker for pregnancy complications in women with PGDM ad clinicians are urged to prioritize glycemic control in reproductive-age women with diabetes to reduce the risks associated with high HbA1c levels.

Source:

Gelman, M., Galperin, T., Maor-Sagie, E., Yoeli, Y., Hallak, M., Gabbay-Benziv, R., & Naeh, A. (2024). Pregnancy Outcomes in Women with Poorly Controlled Pregestational Diabetes Mellitus. The Israel Medical Association Journal : IMAJ, 26(6), 376-382.

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PCSK9 Inhibitors May Reduce Risk of Vitiligo,Promising New Therapeutic Approach, reports study

Researchers have found that PCSK9 inhibitors, a class of lipid-lowering agents, may be associated with a sharply decreased incidence of developing vitiligo. The finding offers new avenues of therapeutic intervention in lipid metabolism-based therapies for the very disease-restricted options exist for. A study to this effect was just published in the Journal of Investigative Dermatology by Tae-Jong Kang and colleagues.

Vitiligo is a chronic, acquired skin disorder characterized by the loss of pigmenting agents in the skin and results in white patches of skin. The exact cause of vitiligo remains obscure, although several recent studies have suggested that lipid metabolism abnormalities may link with the state of the disease. Lipid-lowering agents have been proposed as potential therapeutic options, mainly PCSK9 inhibitors modulating the lipid profiles. The researchers investigated, in this paper, the genetically proxied effects of lipid-lowering agents on the risk of vitiligo and identified associated protein mediators that might further explain the protective effects observed.

In this study, genome-wide association study (GWAS) summary statistics were used for a large meta-analysis of vitiligo, along with data from the Global Lipids Genetics Consortium, the UK Biobank, and deCODE Genetics. These data were used to estimate the association of genetically proxied lipid-lowering agents with the risk of vitiligo. The MR analysis was performed to identify which lipid-lowering agents exerted protective effects against vitiligo, and multivariable and two-step MR analyses to explore the potential mediators between the lipid-lowering agents and the risk of vitiligo.

Key Findings

  • MR analysis found out genetic inhibition of PCSK9, a protein involved in cholesterol metabolism, was associated with a significantly reduced risk of developing vitiligo. The odds ratio was 0.71, which represented a 29 percent reduced risk of vitiligo with PCSK9 inhibition.

  • This protective effect was replicated in two independent biobank datasets: the UK Biobank (OR, 0.82; 95% CI, 0.71-0.96) and deCODE Genetics (OR, 0.78; 95% CI, 0.67-0.91).

  • These consistent results across the different populations further strengthen the evidence for the role of PCSK9 inhibitors in reducing the risk of vitiligo.

  • Further analysis was done to test whether the relationship between PCSK9 inhibition and vitiligo is driven by known lipid profiles.

  • We found no evidence for these lipid profiles mediating this protective effect in multivariable MR analyses. Two-step MR analyses identified five potential protein mediators—CCN5, CXCL12, FCRL1, LGMN, and FGF2—that may play a role in the link of PCSK9 inhibition with reduced vitiligo risk.

These findings suggest that PCSK9 inhibitors already licensed for the lowering of cholesterol levels could be repurposed as a new vitiligo treatment. The identification of possible protein mediators supplies additional objectives for the development of drugs in the future. The researchers and clinicians can target PCSK9 and these mediators in an effort to develop more effective therapies for vitiligo and give some hope to the patients who are living with this rather serious condition.

This research provides evidence based on data that PCSK9 inhibitors could be a new avenue of treatment against vitiligo, wherein multiple data sets showed reduced risk. The identification of protein mediators raises comprehension of how lipid-lowering agents would affect vitiligo, further opening up avenues for targeted and more effective treatments.

Reference:

Kang, T.-J., Lee, S. Y., Yoon, S., Kim, E. G., Kim, J. O., Kim, J.-S., Park, J., & Nam, K.-H. (2024). PCSK9 inhibitors and the risk of vitiligo: a Mendelian randomization study. The Journal of Investigative Dermatology. https://doi.org/10.1016/j.jid.2024.07.021

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Aceneuramic acid first approved drug for GNE myopathy treatment, report researchers

.In order to treat an underserved population of patients with a rare condition whose muscles gradually become weaker until they can no longer walk, a team of researchers across Japan have completed a clinical study to confirm the safety of long-term administration of a therapeutic drug.

Distal myopathy with rimmed vacuoles, or GNE myopathy, is a very rare disease in which muscle atrophy and degeneration occurs in the distal limbs (such as fingers and ankles). Symptoms typically begin from the teens to the early 30s. It gradually leads to a profound loss of motor control. This can greatly affect one’s quality of life as they slowly lose muscle strength, without any approved treatments available.

“Despite there being a demand from patients, developing a treatment to slow down symptom progression has been difficult due to the rarity of the disease,” remarks Masashi Aoki, a professor from Tohoku University, “For example, there are approximately 400 people with GNE myopathy in all of Japan.” A treatment for a population this size is considered an “ultra orphan drug” – because it is not profitable for pharmaceutical companies to develop treatment for such a small group. As a result, these patients are “orphaned” and left without any help.

Despite these hurdles, a team of researchers stepped in to develop a treatment. Patients with GNE myopathy have reduced functioning of an enzyme that produces sialic acid, so patients were given a drug containing aceneuramic acid (a type of sialic acid) to supplement this deficit.

Researchers conducted investigator-initiated phase I and phase II/III studies, and an efficacy confirmation study sponsored by Nobelpharma Co., Ltd. These studies demonstrated the treatment effects of an ultra-orphan drug, “Aceneuramic Acid (Acenobel®) Extended Release Tablets 500mg” for GNE myopathy.

In the current study, 19 patients with GNE myopathy completed a 72-week treatment plan without major adverse effects. These patients originally participated in a 48-week double-blind treatment study to compare the drug to a placebo, and treatment was extended to 72 weeks for this trial. The safety and efficacy of the treatment was confirmed in the current study, leading to Nobelpharma Co., Ltd. obtaining official manufacturing and marketing approval from the Ministry of Health, Labour and Welfare in Japan (March 2024). This approval is great news for patients, who finally have a safe, viable treatment option.

The research team plans to continue monitoring the efficacy of the treatment over even longer periods of time.

Reference:

Suzuki N, Mori-Yoshimura M, Katsuno M, et alSafety and efficacy of aceneuramic acid in GNE myopathy: open-label extension studyJournal of Neurology, Neurosurgery & Psychiatry Published Online First: 05 June 2024. doi: 10.1136/jnnp-2024-333853

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FDA Approves elimination of Aspirin use in HeartMate 3 LVAD Patients

The US Food and Drug Administration has approved a labeling change that eliminates aspirin from the antithrombotic regimen alongside use with heartmate 3 LVAD device.

FDA has approved a change to its label that will help patients who receive a HeartMate 3™ left ventricular assist device (LVAD, or heart pump) experience superior clinical outcomes by eliminating aspirin as part of routine patient management. The labeling update is exclusively for patients with an Abbott HeartMate 3 heart pump and has also been approved by regulatory agencies in Canada and the European Union.

Blood thinners have historically been used by patients receiving LVADs as a means to reduce the risk of blood clots associated with the use of a blood pump implant. The ARIES-HM3 study was designed to help clinicians understand whether aspirin is needed as part of a blood thinning regimen for HeartMate 3 patients. The ARIES-HM3 trial showed that patients who received an Abbott HeartMate 3 heart pump but didn’t take aspirin as part of their blood-thinning medication regimen had nearly 40% fewer complications from bleeding without increasing the risk of forming a blood clot compared to patients who also received a HeartMate 3 but did take aspirin. As a result of reduced bleeding risk, the ARIES-HM3 trial also found patients avoiding aspirin post-implant experienced reduced days in the hospital compared to patients who took aspirin daily.

“Aspirin, along with warfarin, has traditionally been mandated for advanced heart failure patients living with an LVAD, but whether it contributes to excessive bleeding has been uncertain. The ARIES-HM3 trial, in which aspirin was removed from the medication regimen, provided important data challenging the assumption that patients with a heart pump must take aspirin daily,” said Mandeep R. Mehra, M.D., executive director of the Center for Advanced Heart Disease and the William Harvey Distinguished Chair at Brigham and Women’s Hospital in Boston, MA and the principal investigator of the ARIES-HM3 trial. “With this labeling change, physicians can avoid using aspirin in patients receiving the HeartMate 3 LVAD, a decision that is safe, and decreases bleeding and its associated hospital visits.”

Abbott’s HeartMate 3 heart pump is an implantable device that pumps blood through the body in people whose heart is too weak to do so on its own. It is the only commercially approved heart pump with Full MagLev™ technology, which allows the device’s rotor to be “suspended” by magnetic forces, a unique design that has been proven to reduce trauma to blood passing through the pump, improving patient survival and quality of life. These factors have led to HeartMate 3 offering the lowest rate of pump-related complications of any other blood pump.

Advanced Heart Failure Patients Benefit From Going Aspirin-Free

Approximately 6.7 million Americans have heart failure, and that number is expected to rise to 8.5 million by 2030.1 Heart failure is a progressive condition that occurs when the heart can’t circulate blood efficiently, resulting in symptoms such as fatigue, breathlessness and swollen ankles. If not managed and treated, it can lead to poor quality of life, hospitalizations and death.

“Removing aspirin from the medication regimen for the HeartMate 3 is a simple change that means people with an Abbott LVAD can focus on the things they love and spend less time worrying about and tending to bleeding events,” said Keith Boettiger, vice president, Abbott’s heart failure business. “Through research such as the ARIES-HM3 trial, we continue to rewrite the book on the management of patients with advanced heart failure and focus on bringing life enhancing benefits to people who rely on our devices to survive.”

About the ARIES-HM3 Trial

The ARIES-HM3 trial was an international, randomized study of either aspirin (100mg/day) or placebo with vitamin-K antagonist (VKA) therapy in advanced heart failure patients newly implanted with Abbott’s HeartMate 3 LVAD (ages 18 and older). The study found that HeartMate 3 patients who didn’t receive aspirin but continued using the standard post-implant VKA treatment regimen met the primary endpoint by showing non-inferiority of no aspirin to aspirin. The HeartMate 3 patients who did not take aspirin spent 47% fewer days in the hospital due to a nearly 40% decrease in bleeding events compared to patients who continued to take aspirin daily. The data also found this same group had no elevated risk in developing thrombosis (a blood clot that increases the risk of stroke).

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USPSTF’s Latest Statement Highlights Gaps in Evidence for Iron Deficiency Screening During Pregnancy

USA: The US Preventive Services Task Force (USPSTF) has announced a new recommendation statement regarding the screening and routine supplementation for iron deficiency and iron deficiency anemia during pregnancy. The latest evaluation indicates insufficient evidence to definitively weigh the benefits and risks of these preventive measures for pregnant individuals.

The US Preventive Services Task Force Recommendation statement is published online in JAMA.
Iron deficiency remains a prominent issue in pregnancy, being the leading cause of anemia among this population. Historical data from surveys conducted between 1999 and 2006 reveals that approximately 18% of pregnant individuals experience iron deficiency, with prevalence rates increasing as pregnancy progresses through its three trimesters. Additionally, about 5% of pregnant individuals are affected by iron deficiency anemia.
Despite the recognized prevalence and potential impact of iron deficiency, the USPSTF’s current recommendation underscores a lack of clear evidence on the effectiveness of routine screening and supplementation in preventing adverse maternal and infant health outcomes. This recommendation aligns with the Task Force’s stance from 2015, reflecting the ongoing uncertainty in the field.
The USPSTF routinely assesses preventive care services and makes recommendations based on available evidence. Their latest statement suggests that while iron deficiency is a significant concern, the existing data does not sufficiently support a blanket approach to screening and supplementation for all pregnant individuals.
The USPSTF commissioned a systematic review to evaluate the evidence on the benefits and harms of screening and supplementation for iron deficiency with and without anemia on maternal and infant health outcomes in asymptomatic pregnant persons.
This recommendation applies specifically to asymptomatic pregnant adolescents and adults and does not extend to those with severe malnutrition, symptoms of iron deficiency, iron deficiency anemia, or specific hematologic conditions such as sickle cell anemia.
Iron is crucial for producing hemoglobin, which transports oxygen throughout the body, and for various metabolic functions. Iron deficiency, which can lead to iron deficiency anemia, is a common issue during pregnancy due to increased iron demands. Despite its prevalence, the exact definition of iron deficiency remains debated, and screening often involves measuring hematologic indices like hemoglobin levels. However, there is no consensus on the precise ferritin levels indicative of deficiency.
The USPSTF’s recommendation highlights a significant gap in evidence concerning the effectiveness of routine iron screening and supplementation. Although the prevalence of iron deficiency anemia increases throughout pregnancy, and certain groups, such as Black and Mexican American pregnant individuals are disproportionately affected, there is no universally accepted method to assess risk or effectiveness. Current practices in screening and supplementation vary, with some guidelines differing significantly. A recent survey showed that over half of pregnant participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) underwent hemoglobin testing during their first trimester. Additionally, data from NHANES indicated that a substantial portion of pregnant individuals use iron supplements.
The USPSTF’s review identified limited evidence on the benefits of screening asymptomatic pregnant individuals for iron deficiency or anemia. Potential harms from screening are minimal, but common side effects of iron supplementation include gastrointestinal issues such as nausea and constipation. There is also evidence of racial and ethnic disparities in screening and supplementation rates, highlighting a need for more equitable practices.
In conclusion, while iron deficiency remains a critical concern, the USPSTF’s latest recommendation underscores the need for more research to clarify the best practices for screening and supplementation during pregnancy.
Reference:
US Preventive Services Task Force. Screening and Supplementation for Iron Deficiency and Iron Deficiency Anemia During Pregnancy: US Preventive Services Task Force Recommendation Statement. JAMA. Published online August 20, 2024. doi:10.1001/jama.2024.15196

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Nonsurgical peri-implantitis treatment beneficial systemically regardless of adjunctive metronidazole: Study

Nonsurgical peri-implantitis treatment has beneficial systemic effects regardless of adjunctive use of systemic metronidazole, suggests a study published in the Clinical Oral Implants Research.

The aim of this study was to evaluate the systemic effect of non-surgical peri-implantitis treatment (NSPIT) with or without the administration of systemic metronidazole. In this secondary analysis from a previously published clinical trial (NCT03564301), peri-implantitis patients were randomized into two groups: test, receiving NSPIT plus 500 mg of oral systemic metronidazole three times a day for 7 days (n = 10); and control group, receiving NSPIT plus placebo (n = 11). Serum samples were obtained at baseline, 3 and 6 months after therapy to determine levels of inflammatory biomarkers, lipid fractions and complete blood counts.Results: Both treatment modalities produced improvements in clinical and radiographic parameters. After 6 months from NSPIT, a substantial reduction in C-reactive protein (6.9 mg/dL; 95% CI: 3.7 to 9.9, p < .001) and low-density lipoprotein cholesterol (21.8 mg/dL; 95% CI: −6.9 to 50.5, p = .013) as well as a modest increase in neutrophils counts (0.4 × 103/μL; 95% CI: −0.4 to 1.1, p = .010) was observed in the control group while the test group showed a significant reduction of TNF-α (110.1; 95% CI: 38.9 to 181.4, p = .004). NSPIT showed a short-term beneficial systemic effect regardless of adjunctive use of systemic metronidazole.

Reference:

Liñares, A., Dopico, J., Blanco, C., Pico, A., Sobrino, T., Blanco, J., & Leira, Y. (2024). The systemic impact of non-surgical treatment of peri-implantitis with or without adjunctive systemic metronidazole: Secondary analysis of a randomized clinical trial. Clinical Oral Implants Research, 00, 1–12. https://doi.org/10.1111/clr.14339

Keywords:

Nonsurgical, peri-implantitis, treatment, beneficial, systemic, effect, regardless, adjunctive, use, systemic, metronidazole, study, Clinical Oral Implants Research, Liñares, A., Dopico, J., Blanco, C., Pico, A., Sobrino, T., Blanco, J., & Leira, Y.

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Study finds no link between migraine and Parkinson’s disease

Contrary to previous research, a new study of female participants finds no link between migraine and the risk of developing Parkinson’s disease. The study is published in the August 21, 2024, online issue of Neurology®, the medical journal of the American Academy of Neurology.

“These results are reassuring for women who have migraine, which itself causes many burdens, that they don’t have to worry about an increased risk of Parkinson’s disease in the future,” said study author Tobias Kurth, MD, ScD, from the Institute of Public Health at Charité – Universitätsmedizin Berlin in Germany.

The study involved 39,312 female participants with an average age of 55 at the start of the study. A total of 7,321 of the participants reported current or past migraine at the start of the study. The participants were then followed for an average of 22 years. During that time, 685 people reported physician-diagnosed Parkinson’s disease. Of those, 128 were people who reported a history of migraine or active migraine, and 557 were people with no migraine.

After adjusting for other factors that could affect risk of developing Parkinson’s disease as well as migraine, such as age, physical activity, alcohol use and smoking status, researchers found that people with migraine were no more likely to develop Parkinson’s disease than those who did not have migraine.

This result did not change based on how frequently people had a migraine or whether they experienced an aura before the migraine. An aura is a visual or other sensory disturbance that occurs before the migraine starts, such as seeing bright lights.

“Since this study involved only female health professionals who were primarily white people, more research is needed to determine whether the results will apply to other groups, including men, women and other races, ethnicities and gender identities,” Kurth said.

Another limitation of the study is that participants self-reported information on migraine and Parkinson’s disease, so it is possible that some information was not accurate. In addition, since Parkinson’s disease is often not diagnosed until symptoms are advanced, it’s possible that some participants may have developed Parkinson’s disease after the end of the study.

Reference:

Ricarda S. Schulz, Toivo Glatz, Julie E. Buring, Pamela M. Rist. Migraine and Risk of Parkinson Disease in Women A Cohort Study. Neurology, 2024 DOI: 10.1212/WNL.0000000000209747.

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Inflammation during childhood linked to mental health issues in early adulthood – study reveals

Children who have persistently raised inflammation are at a higher risk of experiencing serious mental health disorders including psychosis and depression in early adulthood, according to a study published in JAMA Psychiatry.

The research lead by the University of Birmingham also found that those who had experienced inflammation at a young age were at a higher risk of developing cardiometabolic diseases such as insulin resistance – an early form of diabetes.

The study used data collected by the Avon Longitudinal Study of Parents and Children (ALSPAC) – also known as Children of the 90s – and included a total of 6,556 participants of whom 50.4% were female. Inflammation was identified by increased levels of the general inflammatory marker C-reactive protein (CRP) recorded in participants at ages 9, 15 and 17 years.

Of the two groups identified with persistently raised inflammation throughout their developing years, the researchers discovered that it was the group whose CRP levels peaked earlier in childhood, around age 9, that were most associated with subsequent higher risks of depression and psychosis at age 24.

Lead author on the study, Edward Palmer of the University of Birmingham said: “There’s growing evidence of an association between inflammation and psychotic, depressive and cardiometabolic disorders, however little has been done to explore the different trajectories of inflammation during childhood and the association between those and both mental and physical health outcomes in early adulthood.”

“When we look longitudinally, there is really strong evidence that inflammation earlier on in childhood is a significant risk factor for developing schizophrenia, depression and insulin resistance in later life. Some of the rates of developing these disorders within the group with inflammation who peaked around age 9 were four to five times the chances for those without inflammation.”

The results of the study have provided strong evidence needed to prompt further research that would seek to ascertain whether or not inflammation plays a causal role in such disorders or is merely an indicator.

Edward Palmer added: “We’re still a way off demonstrating whether raised inflammation plays a causal role in these disorders but it is clear that the inflammation pre-dates instances of mental illness and potentially related metabolic dysfunction, and as such further research needs to be done into the mechanisms driving it. This could ultimately lead to early life risk profiling, different kinds of early intervention and possible new treatment targets.” 

Reference:

Palmer ER, Morales-Muñoz I, Perry BI, et al. Trajectories of Inflammation in Youth and Risk of Mental and Cardiometabolic Disorders in Adulthood. JAMA Psychiatry. Published online August 21, 2024. doi:10.1001/jamapsychiatry.2024.2193

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Perimenopause closely associated with increased mania and depression risk: Study

A new study published in the recent issue of Nature Mental Health journal found an increased risk of mania and major depressive disorder (MDD) in perimenopause. Over 945 million women worldwide are projected to exist, where close to 80% of persons have neuropsychiatric symptoms during perimenopause, which is the time period surrounding the final menstrual period (FMP). Hot flashes, cognitive impairment, sleep issues, and mood-related symptoms are the most frequent neuropsychiatric symptoms at this time.

The researches so far has mostly examined solely depressive symptoms, it has been hypothesized that the perimenopause is also a high-risk time for the emergence or worsening of mental illnesses, including major depressive disorder, schizophrenia spectrum disorders, and bipolar disorder. While there is much evidence linking perimenopause to mood changes, less is known about the risk of a wide range of mental problems linked to aging reproductive systems. In this study, Lisa Shitomi-Jones and colleagues evaluated whether perimenopause is connected with a higher risk of acquiring mental illnesses than the late reproductive period.

The data on the time of menopause and mental health history were gathered by online questionnaires and interviews conducted by nurses with 128,294 female participants in the UK Biobank. The reference premenopausal era (6-10 years before the FMP) and the perimenopause (4 years around the FMP) were used to compare the incidence rates of mental illnesses. Major depressive disorder, schizophrenia spectrum disorders, mania, and other diagnoses were computed rates.

A total of 128,294 individuals were included in this study, where 753 (0.59%) had their first mental illness during the late reproductive period and 1,133 (0.88%) during the perimenopause. Incidence rates of mental illnesses increased dramatically during the perimenopause when compared with the reference reproductive period, and then reduced back to the premenopausal period during the postmenopause. With an incidence RR of 1.30, higher incidence rates of MDD were the main cause of the impact. But, mania was found to have the most impact size during the perimenopause. There was no correlation discovered between the incidence rates of schizophrenia spectrum diseases and perimenopause. Overall, the findings emphasize the significance of diagnostic accuracy in the evaluation of mental disorders related to aging.

Reference:

Shitomi-Jones, L. M., Dolman, C., Jones, I., Kirov, G., Escott-Price, V., Legge, S. E., & Di Florio, A. (2024). Exploration of first onsets of mania, schizophrenia spectrum disorders and major depressive disorder in perimenopause. In Nature Mental Health. Springer Science and Business Media LLC. https://doi.org/10.1038/s44220-024-00292-4

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Noncycloplegic autorefraction tied to more myopic refractive error than cycloplegic autorefraction in young adults: Study

Noncycloplegic autorefraction tied to more myopic refractive error than cycloplegic autorefraction in young adults suggests a study published in the Optometry and Vision Science.

This study explores the difference between cycloplegic and noncycloplegic refraction in young adult myopes. From the available literature, it is unclear whether cycloplegia is necessary when refracting young adults. This study investigates the agreement between noncycloplegic autorefraction and cycloplegic autorefraction and investigates factors affecting the agreement between the two methods. In total, 125 myopes with ages ranging between 18 and 26 years were included from Australia and Vietnam. Each participant underwent noncycloplegic autorefraction and cycloplegic autorefraction. Cycloplegia was induced with 1% ophthalmic tropicamide. RESULTS : The mean spherical equivalent difference (95% confidence interval) between noncycloplegic autorefraction and cycloplegic autorefraction was −0.20 D (−0.25 to −0.14 D; t124 = −7.18, p<0.0001). A mean difference of >0.25 D was seen in 46.8% of eyes. The lower and upper limits of agreement were −0.80 and 0.41 D, respectively. With univariate analysis, factors including age, degree of refractive error, accommodation amplitude, and distance phorias showed no impact on the average difference between cycloplegic autorefraction and noncycloplegic autorefraction. Yet, eyes with near exophoria (F2,120 = 6.63, p=0.0019) and Caucasian eyes (F3,121 = 2.85, p=0.040) exhibited the smallest paired differences. However, in the multivariate analysis, only near exophoria was associated with a lower mean difference. A significantly smaller proportion (34.9%) of eyes with near exophoria had a paired difference of −0.25 D or more compared with esophoria (50%) and orthophoria (65%; χ2 = 6.6, p=0.038). Noncycloplegic autorefraction results in more myopic refractive error than cycloplegic autorefraction in young adults.

Reference:

Khan, Hashim Ali OD, FAAO1,2∗; Tran, Huy MD, PhD2,3,4; Naduvilath, Thomas John PhD1,2; Tahhan, Nina BOptom, PhD1,2; Ha, Thao MD4; Sankaridurg, Padmaja BOptom, PhD2. Comparison between cycloplegic and noncycloplegic refraction in young adult myopes. Optometry and Vision Science 101(7):p 470-476, July 2024. | DOI: 10.1097/OPX.0000000000002169

Keywords:

Noncycloplegic, autorefraction, more, myopic, refractive, error, cycloplegic, autorefraction, young adults, Study, Optometry and Vision Science, Khan, Hashim Ali OD, FAAO1

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