Bio

Clinical Focus


  • Ophthalmology
  • Glaucoma
  • Cataract Extraction

Academic Appointments


Professional Education


  • Fellowship:Stanford University Glaucoma FellowshipCA
  • Internship:Kaiser Permanente Oakland Internal Medicine Residency (2014) CA
  • Board Certification: Ophthalmology, American Board of Ophthalmology (2018)
  • Residency:University of Michigan Ophthalmology ResidencyMI
  • Medical Education:University of California at San Francisco School of Medicine (2013) CA

Research & Scholarship

Current Research and Scholarly Interests


I use and integrate a wide variety of data sources in my research, spanning both structured and unstructured forms, including national survey datasets, health insurance claims data, patient generated online text, and electronic health records. I investigate outcomes of treatments for glaucoma and cataract, as well as other areas of ophthalmology, while developing and applying novel methods for automated extraction of ophthalmic data from free text.

Publications

All Publications


  • Understanding Patient Attitudes Toward Multifocal Intraocular Lenses in Online Medical Forums Through Sentiment Analysis. Studies in health technology and informatics Wang, S. Y., Hernandez-Boussard, T., Chang, R. T., Pershing, S. 2019; 264: 1378?82

    Abstract

    Multifocal intraocular lens implants (IOLs) are a premium option for cataract surgery which patients may purchase to achieve improved spectacle-independence for near vision but may have trade-offs with visual quality. We demonstrate the use of sentiment analysis to evaluate multifocal lenses discussed on MedHelp, a leading online health forum. A search for "multifocal IOL" was performed on MedHelp.org on November 1, 2016, yielding relevant patient posts. Sentiment analysis was performed using IBM's Watson, which extracted 30,066 unique keywords and their associated sentiment scores from 7495 posts written by 1474 unique patient users. Keywords associated with monovision, monofocal, and toric lenses had positive mean sentiment, significantly higher than for keywords associated with multifocals, which had negative mean sentiment (p < 0.001, ANOVA). Many keywords represented complaints and were associated with negative sentiment, including glare, halo, and ghosting. Sentiment analysis can provide insights into patient perspectives towards multifocal lenses by interpreting online patient posts.

    View details for DOI 10.3233/SHTI190453

    View details for PubMedID 31438152

  • Ocular Antihypertensive Medication Use After iStent Implantation Concurrent With Cataract Surgery vs Cataract Surgery Alone in a Large US Health Care Claims Database. JAMA ophthalmology Wang, S. Y., Singh, K., Stein, J. D., Chang, R. T. 2018

    Abstract

    Importance: The iStent Trabecular Micro-Bypass (Glaukos Corporation) is a minimally invasive glaucoma implant used in conjunction with cataract surgery to lower intraocular pressure.Objective: To determine whether implantation of the iStent concurrent with cataract surgery is associated with reduced use of ocular antihypertensive medications in a US health care claims database.Design, Setting, and Participants: Retrospective, observational longitudinal cohort study of individuals enrolled in a US managed care network who underwent iStent implantation with cataract surgery (iStent/CEIOL) from 2012 to 2016 (n=1509 bilateral and n=1462 unilateral surgery). A control group of individuals who underwent bilateral cataract surgery only (CEIOL) were matched 1:1 to patients undergoing bilateral iStent/CEIOL on baseline demographic and clinical factors. Data were analyzed between November 1, 2017, and January 31, 2018.Main Outcomes and Measures: The number of topical ocular antihypertensive agents used postoperatively by patients undergoing iStent/CEIOL compared with baseline and with matched CEIOL control individuals, and hazard ratios with 95% confidence intervals for sustained reduced use of at least 1 topical ocular antihypertensive agent postoperatively.Results: Of the 2971 eligible enrollees, mean age at first surgery was 74.3 years, and 1659 (55.8%) were women. Patients undergoing iStent/CEIOL had diagnoses that included primary open-angle glaucoma (n=2329; 78.4%), narrow angles (n=381; 12.8%), and secondary glaucomas (n=261; 8.8%). At baseline, 1223 (41.2%) were receiving no topical glaucoma agents; 876 (29.5%), 437 (14.7%), and 435 (14.6%) were receiving 1, 2, or at least 3 agents, respectively. Although only 678 persons (22.8%) completed at least 2 years of postoperative follow-up, the proportion of patients receiving no drops increased postoperatively (64.7%, 20-24 months, P<.001, chi2). Patients receiving at least 1 topical agent at baseline had mean reduction of 1.01 and 0.61 medications used at 20 to 24 months with bilateral or unilateral surgery, respectively (both P<.001, paired t). Sustained reduction in glaucoma medication use was more likely in patients receiving at least 3 vs 1 medication at baseline (hazard ratio, 1.68; 95% CI, 1.36-2.09). Compared with matched control individuals undergoing CEIOL, patients undergoing bilateral iStent/CEIOL had a greater mean reduction in drops used (0.99 vs 0.49; postoperative month 20-24; P<.001; paired t) and a higher proportion receiving no drops postoperatively (73.5% vs 55.3%, postoperative month 20-24; P<.001; chi2).Conclusions and Relevance: Implantation of the iStent trabecular micro-bypass stent concurrent with cataract surgery was associated with moderately reduced use of topical ocular antihypertensive medication. Reduction in the use of glaucoma medications may lessen the burden of medication adverse effects and promote better adherence.

    View details for PubMedID 30267072

  • Reduction of Ocular Antihypertensive Medication Use After IStent Implantation in a Large US Managed Care Network Wang, S., Chang, R. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018
  • Utilization of Ophthalmologist Consultation for Emergency Care at a University Hospital JAMA OPHTHALMOLOGY Wang, S. Y., Hamid, M. S., Musch, D. C., Woodward, M. A. 2018; 136 (4): 428?31

    Abstract

    Nearly 2 million patients visit emergency departments (EDs) because of eye concerns annually in the United States. How hospitals currently assign these patients to treatment is important for designing systems that equitably allocate resources for eye care in urgent settings.To investigate factors associated with ophthalmology consultation for eye-related adult ED encounters to assess possible disparities by sex, race/ethnicity, language preference, or residential distance from the medical center.Retrospective observational study of 13?361 adult ED encounters associated with an eye-related billing diagnosis between January 1, 2010, and September 30, 2015, at the University of Michigan Medical Center in Ann Arbor.Measures available from the University of Michigan clinical data warehouse included age, sex, race/ethnicity, preferred language, home distance from the ED, calendar year of encounter, and Charlson-Deyo Comorbidity Index score.Association of the ED encounter with ophthalmology consultation. An ophthalmology consultation was identified by cross-referencing ophthalmology faculty and clinical instructors from 2010 to 2015 against billing providers for consultations using the Charlson-Deyo Comorbidity Index score and billing codes. Measures included patient age, sex, race/ethnicity, home address, preferred language (English vs non-English), and calendar year of encounter.Among the 13 361 encounters, 6840 (51.2%) involved a female patient. Mean (SD) age at encounter was 50.7 (19.3) years; 10?033 patients (75.1%) were of white and 1969 (14.7%) of black race/ethnicity. English was the preferred language for 13 022 patients (97.5%). The ophthalmology service was consulted in 5289 encounters (39.6%). Black patients had significantly lower odds of an ophthalmology consultation than white patients (odds ratio [OR], 0.85; 95% CI, 0.75-0.96). Patients who preferred a non-English language had significantly lower odds of receiving an ophthalmology consultation (OR, 0.73; 95% CI, 0.55-0.98).Many of the 13?361 eye-related ED encounters were managed by ED clinicians with no ophthalmology consultation. Patients who were black or who preferred a language other than English were less likely to have an ophthalmologist involved in their care. The associations found in this observational study do not imply causation but suggest disparities in care that should be further investigated.

    View details for PubMedID 29543941

    View details for PubMedCentralID PMC5876882

  • Ophthalmic Screening Patterns Among Youths With Diabetes Enrolled in a Large US Managed Care Network JAMA OPHTHALMOLOGY Wang, S. Y., Andrews, C. A., Gardner, T. W., Wood, M., Singer, K., Stein, J. D. 2017; 135 (5): 432-438

    Abstract

    Ophthalmic screening to check for diabetic retinopathy (DR) is important to prevent vision loss in persons with diabetes. The American Academy of Ophthalmology recommends that ophthalmic screening for DR occur beginning at 5 years after initial diabetes diagnosis for youths with type 1 diabetes; the American Diabetes Association recommends screening of youths with type 2 diabetes at the time of initial diagnosis. To our knowledge, it is unknown to what extent youths with diabetes obtain eye examinations in accordance with these guidelines.To assess the rate of obtaining ophthalmic examinations and factors associated with receipt of eye examinations for youths with diabetes.This retrospective, longitudinal cohort study examined youths 21 years or younger with newly diagnosed diabetes enrolled in a US managed care network from January 1, 2001, through December 31, 2014.Kaplan-Meier survival curves estimated the time from initial diabetes diagnosis to first eye examination by an ophthalmologist or optometrist. Multivariable Cox proportional hazards regression models identified factors associated with receiving an ophthalmic examination after initial diabetes diagnosis.Among 5453 youths with type 1 diabetes (median age at initial diagnosis, 11 years; interquartile range, 8-15 years; 2972 male [54.5%]; 4505 white [82.6%]) and 7233 youths with type 2 diabetes (median age at initial diagnosis, 19 years; interquartile range, 16-22 years; 1196 male [16.5%]; 5052 white [69.9%]), 64.9% of patients with type 1 diabetes and 42.2% of patients with type 2 diabetes had undergone an eye examination by 6 years after initial diabetes diagnosis. Black youths (1367 [10.8%] of the sample) had an 11% and Latino youths (1450 [11.4%] of the sample) had an 18% decreased hazard of undergoing an eye examination by 6 years compared with white youths (black youths: adjusted hazard ratio [HR], 0.89; 95% CI, 0.79-0.99; Latino youths: HR, 0.82; 95% CI, 0.73-0.92). As household net worth increased, youths were increasingly more likely to undergo an eye examination by 6 years after initial diabetes diagnosis (net worth of ?$500?000 vs <$25?000: HR, 1.50; 95% CI, 1.34-1.68).Despite possessing health insurance, many youths with diabetes are not receiving eye examinations by 6 years after initial diagnosis to monitor for DR. These data suggest that adherence to clinical practice guidelines is particularly challenging for racial minorities and youths from less affluent families.

    View details for DOI 10.1001/jamaophthalmol.2017.0089

    View details for Web of Science ID 000401113400009

    View details for PubMedID 28334336

  • Patient-centered and visual quality outcomes of premium cataract surgery: a systematic review. European journal of ophthalmology Wang, S. Y., Stem, M. S., Oren, G., Shtein, R., Lichter, P. R. 2017: 0-?

    Abstract

    Over 8 million cataract surgeries are performed in the United States and the European Union annually, with many patients choosing to pay out of pocket for premium options including premium intraocular lens implants (IOLs) or laser-assisted cataract surgery (LACS). This report provides a systematic review evaluating patient-centered and visual quality outcomes comparing standard monofocal IOLs to premium cataract surgery options.PubMed and EMBASE were searched for publications published between January 1, 1980, and September 18, 2016, on multifocal, accommodative, and toric IOLs, monovision, and LACS, which reported on 1) dysphotopsias, 2) contrast sensitivity, 3) spectacle independence, 4) vision-related quality of life or patient satisfaction, and 5) IOL exchange.Multifocal lenses achieved higher rates of spectacle independence compared to monofocal lenses but also had higher reported frequency of dysphotopsia and worse contrast sensitivity, especially with low light or glare. Accommodative lenses were not associated with reduced contrast sensitivity or more dysphotopsia but had only modest improvements in spectacle independence compared to monofocal lenses. Studies of monovision did not target a sufficiently myopic outcome in the near-vision eye to achieve the full potential for spectacle independence. Patients reported high levels of overall satisfaction regardless of implanted IOL. No studies correlated patient-reported outcomes with patient expectations.Studies are needed to thoroughly compare patient-reported outcomes with concomitant patient expectations. In light of the substantial patient costs for premium options, patients and their surgeons will benefit from a better understanding of which surgical options best meet patients' expectations and how those expectations can be impacted by premium versus monofocal-including monovision-options.

    View details for DOI 10.5301/ejo.5000978

    View details for PubMedID 28574135

  • Incidence and Risk Factors for Developing Diabetic Retinopathy among Youths with Type 1 or Type 2 Diabetes throughout the United States. Ophthalmology Wang, S. Y., Andrews, C. A., Herman, W. H., Gardner, T. W., Stein, J. D. 2017; 124 (4): 424-430

    Abstract

    Despite the increasing prevalence of type 2 diabetes mellitus (T2DM) among children and adolescents, little is known about their risk of developing diabetic retinopathy (DR). We sought to identify risk factors for DR in youths with diabetes mellitus, to compare DR rates for youths with type 1 diabetes mellitus (T1DM) and those with T2DM, and to assess whether adherence to DR screening guidelines promoted by the American Academy of Ophthalmology, American Academy of Pediatrics, and American Diabetes Association adequately capture youths with DR.Retrospective observational longitudinal cohort study.Youths aged ?21 years with newly diagnosed T1DM or T2DM who were enrolled in a large US managed-care network.In this study of youths aged ?21 years with newly diagnosed T1DM or T2DM who were under ophthalmic surveillance, we identified the incidence and timing of DR onset. Kaplan-Meier survival curves assessed the timing of initial diagnosis of DR for participants. Multivariable Cox proportional hazard regression modeling identified factors associated with the hazard of developing DR. Model predictors were age and calendar year at initial diabetes mellitus diagnosis, sex, race/ethnicity, net worth, and glycated hemoglobin A1c fraction (HbA1c).Hazard ratios (HRs) with 95% confidence intervals (CIs) for developing DR.Among the 2240 youths with T1DM and 1768 youths with T2DM, 20.1% and 7.2% developed DR over a median follow-up time of 3.2 and 3.1 years, respectively. Survival curves demonstrated that youths with T1DM developed DR faster than youths with T2DM (P < 0.0001). For every 1-point increase in HbA1c, the hazard for DR increased by 20% (HR = 1.20; 95% CI 1.06-1.35) and 30% (HR = 1.30; 95% CI 1.08-1.56) among youths with T1DM and T2DM, respectively. Current guidelines suggest that ophthalmic screening begin 3 to 5 years after initial diabetes mellitus diagnosis, at which point in our study, >18% of youths with T1DM had already received ?1 DR diagnosis.Youths with T1DM or T2DM exhibit a considerable risk for DR and should undergo regular screenings by eye-care professionals to ensure timely DR diagnosis and limit progression to vision-threatening disease.

    View details for DOI 10.1016/j.ophtha.2016.10.031

    View details for PubMedID 27914837

  • Patient Attitudes Toward Telemedicine for Diabetic Retinopathy. Telemedicine journal and e-health Valikodath, N. G., Leveque, T. K., Wang, S. Y., Lee, P. P., Newman-Casey, P. A., Hansen, S. O., Woodward, M. A. 2017; 23 (3): 205-212

    Abstract

    Diabetic retinopathy (DR) is the leading cause of new-onset blindness in adults. Telemedicine is a validated, cost-effective method to improve monitoring. However, little is known of patients' attitudes toward telemedicine for DR. Our study explores factors that influence patients' attitudes toward participating in telemedicine.Ninety seven participants in a university and the Veterans Administration setting completed a survey. Only people with diabetes mellitus (DM) were included. The main outcome was willingness to participate in telemedicine. The other outcomes were perceived convenience and impact on the patient-physician relationship. Participants reported demographic information, comorbidities, and access to healthcare. Analysis was performed with t-tests and multivariable logistic regression.Demographic factors were not associated with the outcomes (all p?>?0.05). Patients had decreased odds of willingness if they valued the patient-physician relationship (adjusted odds ratio [OR]?=?0.08, confidence interval [CI]?=?0.02-0.35, p?=?0.001) or had a longer duration of diabetes (adjusted OR?=?0.93, CI?=?0.88-0.99, p?=?0.02). Patients had increased odds of willingness if they perceived increased convenience (adjusted OR?=?8.10, CI?=?1.77-36.97, p?=?0.01) or had more systemic comorbidities (adjusted OR?=?1.85, CI?=?1.10-3.11, p?=?0.02).It is critical to understand the attitudes of people with DM where telemedicine shows promise for disease management and end-organ damage prevention. Patients' attitudes are influenced by their health and perceptions, but not by their demographics. Receptive patients focus on convenience, whereas unreceptive patients strongly value their patient-physician relationships or have long-standing DM. Telemedicine monitoring should be designed for people who are in need and receptive to telemedicine.

    View details for DOI 10.1089/tmj.2016.0108

    View details for PubMedID 27336678

    View details for PubMedCentralID PMC5359684

  • The relation between exercise and glaucoma in a South Korean population-based sample PLOS ONE Lin, S., Wang, S. Y., Pasquale, L. R., Singh, K., Lin, S. C. 2017; 12 (2)

    Abstract

    To investigate the association between exercise and glaucoma in a South Korean population-based sample.Population-based, cross-sectional study.A total of 11,246 subjects, 40 years and older who underwent health care assessment as part of the 2008-2011 Korean National Health and Nutrition Examination Survey.Variables regarding the duration (total minutes per week), frequency (days per week), and intensity of exercise (vigorous, moderate exercise and walking) as well as glaucoma prevalence were ascertained for 11,246 survey participants. Demographic, comorbidity, and health-related behavior information was obtained via interview. Multivariable logistic regression analyses were performed to determine the association between the exercise-related parameters and odds of a glaucoma diagnosis.Glaucoma defined by International Society for Geographical and Epidemiological Ophthalmology criteria.Overall, 336 (2.7%) subjects met diagnostic criteria for glaucomatous disease. After adjustment for potential confounding variables, subjects engaged in vigorous exercise 7 days per week had higher odds of having glaucoma compared with those exercising 3 days per week (Odds Ratio [OR] 3.33, 95% confidence interval [CI] 1.16-9.54). High intensity of exercise, as categorized by the guidelines of the American College of Sports Medicine (ACSM), was also associated with greater glaucoma prevalence compared with moderate intensity of exercise (OR 1.55, 95% CI 1.03-2.33). There was no association between other exercise parameters including frequency of moderate exercise, walking, muscle strength exercise, flexibility training, or total minutes of exercise per week, and the prevalence of glaucoma. In sub-analyses stratifying by gender, the association between frequency of vigorous exercise 7 days per week and glaucoma diagnosis remained significant in men (OR 6.05, 95% CI 1.67-21.94) but not in women (OR 0.96 95% CI: 0.23-3.97). A U-shaped association between exercise intensity and glaucoma prevalence was noted in men (OR 1.71, 95% CI 1.09-2.69 for low intensity versus moderate intensity; OR 2.19, 95% CI 1.25-3.85 for high intensity versus moderate intensity).In a South Korean population sample, daily vigorous exercise was associated with higher glaucoma prevalence. In addition, the intensity of exercise was positively associated with glaucoma diagnosis in men but not women.

    View details for DOI 10.1371/journal.pone.0171441

    View details for PubMedID 28187143

  • Fungal Endophthalmitis Associated With DSAEK and Thermal Sclerostomy OPHTHALMIC SURGERY LASERS & IMAGING RETINA Wang, S. Y., Ghodasra, D. H., Amin, S. R., Mian, S. I., Jayasundera, K. T. 2016; 47 (7): 691-693

    Abstract

    An 85-year-old man with remote thermal sclerostomy and Descemet's stripping automated endothelial keratoplasty (DSAEK) in the right eye presented urgently for pain and blurred vision in that eye. Examination revealed bleb purulence and vitreous cellular aggregates concerning for endophthalmitis. Microscopy of a vitreous sample revealed yeast and pseudohyphae. He developed corneal infiltrates consistent with fungal infection. Therapy included topical, intravitreal, and systemic antifungals voriconazole and amphotericin. Fungal pathogens have very rarely been reported to cause bleb-associated endophthalmitis and should be considered in addition to bacterial pathogens. Vitreous aspiration should be performed in all cases of bleb-related endophthalmitis and include fungal studies. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:691-693.].

    View details for DOI 10.3928/23258160-20160707-15

    View details for Web of Science ID 000393098300015

    View details for PubMedID 27434905

  • Oral Contraceptive Use and Prevalence of Self-Reported Glaucoma or Ocular Hypertension in the United States OPHTHALMOLOGY Wang, Y. E., Kakigi, C., Barbosa, D., Porco, T., Chen, R., Wang, S., Li, Y., Singh, K., Pasquale, L. R., Lin, S. C. 2016; 123 (4): 729-736

    Abstract

    To investigate the association between oral contraceptive (OC) use and glaucoma prevalence in the United States.Cross-sectional study.A total of 3406 female participants, aged 40 years or older, from the 2005 to 2008 National Health and Nutrition Examination Survey, who reported a presence or absence of glaucoma or ocular hypertension completed both the vision and the reproductive health questionnaires and underwent eye examinations.Multivariate regression analysis was used to assess the correlation between OC use and self-reported glaucoma or ocular hypertension (n = 231 cases), controlling for potential confounders, including age, ethnicity, systemic comorbidities such as hypertension and stroke, ocular diseases such as cataract and diabetic retinopathy, and reproductive health factors, including age at menopause, age at menarche, history of hormone replacement therapy, and gynecological surgical history.The outcome variable was self-reported glaucoma or ocular hypertension.After adjusting for confounders, those with ?3 years of OC use had greater odds (odds ratio, 1.94; 95% confidence interval, 1.22-3.07) of self-reported glaucoma or ocular hypertension. Other factors associated with higher glaucoma or ocular hypertension prevalence included older age, African American race, and later age at menarche.Oral contraceptive use may be associated with increased risk of self-reported glaucoma or ocular hypertension.

    View details for DOI 10.1016/j.ophtha.2015.11.029

    View details for Web of Science ID 000372718300016

    View details for PubMedCentralID PMC4857187

  • Hospitalization after Cataract Surgery in a Nationwide Managed-Care Population PLOS ONE Wang, S. Y., Blachley, T. S., Andrews, C. A., Ayanian, J. Z., Lee, P. P., Stein, J. D. 2016; 11 (2)

    Abstract

    Little is known regarding the extent by which patients undergoing outpatient cataract surgery are at risk for postoperative hospitalization. We sought to determine the percentage of patients undergoing cataract surgery who were subsequently hospitalized, the patient characteristics associated with postoperative hospitalization, and the reasons for hospitalization.We identified all beneficiaries of a large U.S. managed care network age ?40 years old who underwent ?1 cataract surgery from 2001-2011. All enrollees who required inpatient hospitalization within 7, 14, 30, and 90 days following initial cataract surgery and the reasons for hospitalization were determined. Logistic regression was performed to assess factors that significantly impacted the odds of requiring postoperative hospitalization.Among the 64,981 patients who underwent cataract surgery, rates of hospitalization within 7, 14, 30, and 90 days were 0.3%, 0.5%, 1.3% and 4.2%, respectively. Among the 10,674 patients who had no major preexisting medical comorbidities, 0.1% were hospitalized within 7 days. The odds of hospitalization increased by 35% (OR = 1.35 [CI, 1.23-1.48]) with the presence of each additional comorbidity and by 14% with each additional hospitalization in the 3 years prior to cataract surgery (OR = 1.14 [CI, 1.10-1,18]). Those who were hospitalized in the 30 days prior to cataract surgery had 524% increased odds of being hospitalized within 7 days after cataract surgery (OR = 6.24, [CI, 3.37-11.57]) compared to those with no record of preoperative hospitalization. Postoperative hospitalizations were most commonly due to cardiovascular conditions, comprising over 25% of primary diagnoses associated with hospitalization.The risk of hospitalization after cataract surgery is low, and is very low among those with no major preexisting medical comorbidities. Opportunities may exist to limit comprehensive preoperative evaluation and testing to those who have serious pre-existing medical comorbidities.

    View details for DOI 10.1371/journal.pone.0149819

    View details for Web of Science ID 000371276100158

    View details for PubMedID 26901594

    View details for PubMedCentralID PMC4762614

  • Oral Contraceptive Use and Prevalence of Self-Reported Glaucoma or Ocular Hypertension in the United States. Ophthalmology Wang, Y. E., Kakigi, C., Barbosa, D., Porco, T., Chen, R., Wang, S., Li, Y., Singh, K., Pasquale, L. R., Lin, S. C. 2016; 123 (4): 729?36

    Abstract

    To investigate the association between oral contraceptive (OC) use and glaucoma prevalence in the United States.Cross-sectional study.A total of 3406 female participants, aged 40 years or older, from the 2005 to 2008 National Health and Nutrition Examination Survey, who reported a presence or absence of glaucoma or ocular hypertension completed both the vision and the reproductive health questionnaires and underwent eye examinations.Multivariate regression analysis was used to assess the correlation between OC use and self-reported glaucoma or ocular hypertension (n = 231 cases), controlling for potential confounders, including age, ethnicity, systemic comorbidities such as hypertension and stroke, ocular diseases such as cataract and diabetic retinopathy, and reproductive health factors, including age at menopause, age at menarche, history of hormone replacement therapy, and gynecological surgical history.The outcome variable was self-reported glaucoma or ocular hypertension.After adjusting for confounders, those with ?3 years of OC use had greater odds (odds ratio, 1.94; 95% confidence interval, 1.22-3.07) of self-reported glaucoma or ocular hypertension. Other factors associated with higher glaucoma or ocular hypertension prevalence included older age, African American race, and later age at menarche.Oral contraceptive use may be associated with increased risk of self-reported glaucoma or ocular hypertension.

    View details for PubMedID 26948305

  • Hypothyroidism and Glaucoma in The United States PLOS ONE Kakigi, C., Kasuga, T., Wang, S. Y., Singh, K., Hiratsuka, Y., Murakami, A., Lin, S. C. 2015; 10 (7)

    Abstract

    To investigate the association between hypothyroidism and glaucomatous disease.This cross-sectional study included all subjects above the age of 40 years from two nationwide surveys: the 2008 National Health Interview Survey (NHIS) as well as the 2007 and 2008 National Health and Nutrition Examination Survey (NHANES). The presence or absence of glaucoma, thyroid disease and other demographic and health-related information including comorbidities was ascertained via interview. Blood samples were collected from NHANES subjects and analyzed for thyrotropin (TSH).A total of 13,599 and 3,839 NHIS and NHANES participants respectively were analyzed to assess for a possible relationship between self-reported glaucoma, and self-reported hypothyroidism as well as self-reported thyroid disease. The unadjusted odds ratio (OR) for NHIS showed a significant association between self-reported glaucoma and self-reported hypothyroidism (OR 1.46, 95% confidence interval [CI] 1.07-1.99). Multivariate logistic regression analysis adjusted for age, gender, race, comorbidities, and health-related behavior, however, showed no association between self-reported glaucoma and hypothyroidism or thyroid disease in both surveys (OR 1.60, 95%CI 0.87-2.95 for NHIS; OR 1.05, 95%CI 0.59-1.88 for NHANES).A previously reported association between hypothyroidism and glaucomatous disease was not confirmed in two large U.S. health survey populations. While such an association was noted in the univariate analysis for the NHIS survey, such a relationship was not found in the multivariate analysis after adjustment for potential confounding variables.

    View details for DOI 10.1371/journal.pone.0133688

    View details for Web of Science ID 000358838400049

    View details for PubMedID 26230664

    View details for PubMedCentralID PMC4521841

  • Self-reported Calcium Supplementation and Age-Related Macular Degeneration JAMA OPHTHALMOLOGY Kakigi, C. L., Singh, K., Wang, S. Y., Enanoria, W. T., Lin, S. C. 2015; 133 (7): 746-754

    Abstract

    Despite widespread use of calcium supplementation among elderly people, little is known about the association between such consumption and the prevalence of age-related macular degeneration (AMD) in the United States.To investigate the association between self-reported supplementary calcium consumption and the prevalence of AMD in a representative US sample.This cross-sectional study included 3191 participants 40 years and older in the 2007-2008 National Health and Nutrition Examination Survey (NHANES) who were evaluated for the presence or absence of AMD by fundus photography. Participants were interviewed regarding use of dietary supplements and antacids during the 30-day period preceding enrollment. Self-reported supplementary intake of calcium was aggregated and divided into quintiles. Fundus photographs were graded for the presence or absence of AMD. Information regarding demographics, comorbidities, and health-related behaviors was obtained via interview. Multivariable logistic regression models were created to determine the odds of an AMD diagnosis among participants in each quintile of self-reported calcium vs participants not self-reporting supplementary calcium consumption after adjusting for confounders.Self-reported use of calcium supplements.Presence or absence of AMD by fundus photography.A total of 248 participants (7.8%) were diagnosed with AMD. Mean ages were 67.2 years for those with AMD and 55.8 for those without AMD. After adjustment for potential confounding variables, study participants who self-reported consumption of more than 800 mg/d of supplementary calcium were found to have higher odds of an AMD diagnosis based on fundus photography evaluation compared with those not self-reporting supplementary calcium consumption (odds ratio, 1.85; 95% CI, 1.25-2.75). The association between self-reported supplementary calcium intake and AMD was stronger in older than younger individuals (odds ratio, 2.63; 95% CI, 1.52-4.54). A clear dose-response association between the quintiles of self-reported supplementary calcium intake and AMD was not established.Self-reported supplementary calcium consumption is associated with increased prevalence of AMD, with the findings suggesting a threshold rather than a dose-response relationship. The stronger association in older individuals may be due to relatively longer duration of calcium supplementation in older individuals.

    View details for DOI 10.1001/jamaophthalmol.2015.0514

    View details for Web of Science ID 000357823100021

    View details for PubMedID 25856252

  • The Impact of Central Corneal Thickness on the Risk for Glaucoma in a Large Multiethnic Population JOURNAL OF GLAUCOMA Wang, S. Y., Melles, R., Lin, S. C. 2014; 23 (9): 606-612

    Abstract

    To investigate the relationship between central corneal thickness (CCT) and demographics, and determine whether CCT may be a substantial mediator of the relationships between glaucoma and its demographic risk factors.This cross-sectional study included patients in the Kaiser Permanente Northern California health plan from January 1, 2007 to December 31, 2011 who were 40 years and older and had a documented CCT measurement (N=81,082). Those with any cornea-related diagnoses or a history of corneal refractive surgery were excluded. Demographic characteristics, including age, sex, and race/ethnicity, as well as clinical information including glaucoma-related diagnosis, diabetic status, CCT, and intraocular pressure were gathered from the electronic medical record.Multivariate linear regression analysis indicated that female sex, increased age, and black race were significantly associated with thinner corneas. A subgroup analysis among Asians revealed that Chinese, Japanese, and Koreans had corneas 6 to 13 µm thicker than South and Southeast Asians, Filipinos, and Pacific Islanders for each diagnosis (P<0.001). In our population, 24.5% (N=19878) had some form of open-angle glaucoma; 21.9% (N=17,779) did not have any glaucoma-related diagnosis. Variation in CCT accounted for only 6.68% [95% confidence interval (CI), 6.14%-7.24%] of the increased risk of open-angle glaucoma seen with increasing age, but explained as much as 29.4% (95% CI, 27.0%-32.6%) of the increased risk of glaucoma seen among blacks, and 29.5% (95% CI, 23.5%-37.0%) of the increased risk of glaucoma seen among Hispanics.CCT seems to explain a substantial portion of the increased risk of glaucoma seen among blacks and Hispanics.

    View details for DOI 10.1097/IJG.0000000000000088

    View details for Web of Science ID 000345865000005

    View details for PubMedID 25055208

    View details for PubMedCentralID PMC4250426

  • Association Between Serum Ferritin and Glaucoma in the South Korean Population JAMA OPHTHALMOLOGY Lin, S., Wang, S. Y., Yoo, C., Singh, K., Lin, S. C. 2014; 132 (12): 1414-1420

    Abstract

    Evidence suggests that altered iron metabolism may be associated with oxidative damage to several organ systems, including the eye. Supplementary iron consumption is also associated with greater odds of self-reported glaucoma.To investigate the association between serum ferritin level and the likelihood of a glaucoma diagnosis in a cross-sectional, population-based study.Data were collected from 17,476 participants in the first and second years of the Fifth Korea National Health and Nutrition Examination Survey, a cross-sectional study of the South Korean population conducted from January 1, 2010, through December 31, 2011. Data pertaining to the serum ferritin level were aggregated and divided into quartiles. Demographic, comorbidity, and health-related behavior information was obtained via interview.The presence or absence of glaucoma. The definition of glaucoma was based on criteria established by the International Society of Geographical and Epidemiological Ophthalmology.Participants whose serum ferritin level was greater than 61 ng/mL (to convert to picomoles per liter, multiply by 2.247) had significantly higher odds of a glaucoma diagnosis when compared with those with a level less than 31 ng/mL, after adjustment for potential confounders (ferritin levels of 31-61 ng/mL: odds ratio [OR], 1.17; 95% CI, 0.84-1.62; ferritin levels of 62-112 ng/mL: OR, 1.60; 95% CI, 1.16-2.20; and ferritin levels of 113-3018 ng/mL: OR, 1.89; 95% CI, 1.32-2.72).Our study reveals that a higher serum ferritin level was associated with greater odds of glaucoma in a representative sample of the South Korean population, even at levels normally observed in the general population. This novel finding may help elucidate the pathogenesis and lead to novel therapeutic approaches for glaucomatous disease.

    View details for DOI 10.1001/jamaophthalmol.2014.2876

    View details for Web of Science ID 000346176400006

    View details for PubMedID 25171442

  • Racial Disparities in Uncorrected and Undercorrected Refractive Error in the United States INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Qiu, M., Wang, S. Y., Singh, K., Lin, S. C. 2014; 55 (10)

    Abstract

    To identify risk factors for inadequately corrected refractive error in the United States.This cross-sectional study included 12,758 participants 12 years of age and older from the 2005 to 2008 National Health and Nutrition Examination Survey. The primary outcome was the proportion of individuals with inadequate refractive correction for whom refractive correction would result in a visual acuity of 20/40 or better. The primary predictor was race/ethnicity. Secondary predictors included age, sex, annual household income, education, insurance, type of refractive error, current corrective lens use, presenting and best corrected visual acuity, cataract surgery, glaucoma, and age-related macular degeneration.Overall, 50.6% of subjects had a refractive error which was correctable to 20/40 or better with refraction. The percentage of subjects with correctable refractive error who were inadequately corrected was 11.7%. Odds of inadequate refractive correction were significantly greater in Mexican Americans and non-Hispanic blacks than in their non-Hispanic white counterparts in all age groups, with the greatest disparity in the 12- to 19-year-old group. Other risk factors associated with inadequate refractive correction in adults but not in teenagers included low annual household income, low education, and lack of health insurance.Racial disparities in refractive error correction were most pronounced in those under 20 years of age, as well as in adults with low annual household income, low education level, and lack of health insurance. Targeted efforts to provide culturally appropriate education, accessible vision screening, appropriate refractive correction, and routine follow-up to these medically underserved groups should be pursued as a public health strategy.

    View details for DOI 10.1167/iovs.13-12662

    View details for Web of Science ID 000344730500049

    View details for PubMedID 25249602

    View details for PubMedCentralID PMC4215743

  • Intraocular pressure reduction after cataract extraction in normal eyes: Influence of ethnicity and anterior segment parameters - response CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY Lee, R. Y., Kasuga, T., Cui, Q. N., Huang, G., Wang, S. Y., Lin, S. C. 2014; 42 (5): 508-508

    View details for Web of Science ID 000339952400022

    View details for PubMedID 24304665

    View details for PubMedCentralID PMC4004723

  • Age-related macular degeneration and protective effect of HMG Co-A reductase inhibitors (statins): results from the National Health and Nutrition Examination Survey 2005-2008 EYE Barbosa, D. T., Mendes, T. S., Cintron-Colon, H. R., Wang, S. Y., Bhisitkul, R. B., Singh, K., Lin, S. C. 2014; 28 (4): 472-480

    Abstract

    To determine the association of hydroxymethylglutarylcoenzyme A (HMG Co-A) reductase inhibitor (statin) use with the prevalence of age-related macular degeneration (AMD).This cross-sectional study included 5604 participants in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2008, ? 40 years of age, who were ascertained with regard to the diagnosis of AMD, the use of statins, and comorbidities and health-related behaviors such as smoking.The mean age of participants denying or confirming a history of AMD was 68 (SEM 0.90) and 55 (SEM 0.36) years, respectively. Individuals 68 years of age or older who were classified as long-term users of statins had statistically significant less self-reported AMD (odds ratio (OR) 0.64, 95% confidence interval (CI) 0.49-0.84; P=0.002), after adjusting for potential confounding variables. No significant association was found between the prevalence of AMD and statin consumption among subjects between 40 and 67 years of age (OR 1.61, 95% CI 0.85-3.03; P=0.137).Our results suggest a possible beneficial effect of statin intake for the prevention of AMD in individuals 68 years of age or older.

    View details for DOI 10.1038/eye.2014.8

    View details for Web of Science ID 000334360000016

    View details for PubMedID 24503725

    View details for PubMedCentralID PMC3983650

  • Association between Visual Field Defects and Quality of Life in the United States. Ophthalmology Qiu, M., Wang, S. Y., Singh, K., Lin, S. C. 2014; 121 (3): 733-740

    Abstract

    To investigate the association between visual field defects and quality of life in the United States population.Cross-sectional study.A total of 5186 participants in the 2005 through 2008 National Health and Nutrition Examination Survey 40 years of age and older without a self-reported history of age-related macular degeneration or prior refractive surgery who had undergone frequency doubling technology perimetric testing.Frequency doubling technology perimetry was performed in both eyes. Results from the better eye were used to categorize subjects as normal or having mild, moderate, or severe visual field loss. Subjects completed surveys about their visual and physical functioning ability.Disability pertaining to 6 vision-related activities, 2 visual function questions, and 5 physical functioning domains.Eighty-one percent of subjects had normal visual fields and 10%, 7%, and 2% demonstrated mild, moderate, and severe visual field defects, respectively. Subjects with greater severity of visual field defects had greater difficulty with vision-related activities. Subjects with severe visual field defects demonstrated the greatest odds of difficulty with all 6 activities. The 2 activities impacted most adversely were daytime driving in familiar places (odds ratio [OR], 12.4; 95% confidence interval [CI], 6.1-25.1) and noticing objects off to the side when walking (OR, 7.7; 95% CI, 4.7-12.7). Subjects with severe visual field defects had greater odds of worrying about eyesight (OR, 3.4; 95% CI, 2.0-5.8) and being limited by vision in the time spent on daily activities (OR, 5.1; 95% CI, 3.0-8.5). Subjects with severe visual field defects demonstrated the greatest odds of difficulty with 3 physical function domains, including activities of daily living (OR, 2.45; 95% CI, 1.37-4.38), instrumental activities of daily living (OR, 2.45; 95% CI, 1.37-4.38), as well as leisure and social activities (OR, 3.29; 95% CI, 1.87-5.77).Greater severity of visual field abnormality was associated with significantly greater odds of disability with vision-related function and physical function. These findings support the necessity of routine screening to find those who may benefit from therapy to prevent progressive glaucomatous vision loss.

    View details for DOI 10.1016/j.ophtha.2013.09.043

    View details for PubMedID 24342021

    View details for PubMedCentralID PMC3943627

  • Glaucoma Prevalence and the Intake of Iron and Calcium in a Population-based Study CURRENT EYE RESEARCH Wang, S. Y., Singh, K., Lin, S. C. 2013; 38 (10): 1049-1056

    Abstract

    Previous work has suggested a possible relationship between nutritional supplementation with iron and calcium, and a diagnosis of glaucoma. The present study investigates the association between dietary and total calcium and iron consumption with a diagnosis of glaucoma.This cross-sectional study included 6316 participants in the National Health and Nutrition Examination Survey (NHANES 2005-2008), age 40 or older, who participated in the dietary interview portion of NHANES. Intake of the oxidants calcium and iron was assessed using the National Cancer Institute Method of analyzing data from multiple 24-h dietary recall interviews. Participants self-reported the presence or absence of glaucoma as well as information pertaining to demographics, health-related behaviors and comorbidities.Adjusted odds of glaucoma increased with higher total consumption of calcium (p-trend <0.0001) and iron (p-trend <0.0001). Adjusted odds of glaucoma was significantly greater for total calcium intake at the third (OR 1.58, 95% CI 1.32-1.89) and fourth quintile levels (OR 1.21, 95% CI 1.03-1.43) and for total iron intake at the fourth (OR 2.95, 95% CI 2.52-3.45) and fifth quintile levels (OR 1.58, 95% CI 1.36-1.83), compared with the corresponding lowest quintile of intake. In contrast, a tendency towards decreased odds of glaucoma was observed with increasing dietary calcium (p-trend = 0.0008) and iron intake (p-trend = 0.0022).While greater total consumption of calcium and iron may be associated with increased odds of glaucoma, dietary rather than supplemental consumption of these oxidants was found to be associated with lower odds of glaucoma. Additional research is necessary to elucidate the relationship between glaucoma and oxidant intake from foods versus supplements, and to prospectively evaluate whether oxidant intake is related to glaucoma incidence and progression.

    View details for DOI 10.3109/02713683.2013.803124

    View details for Web of Science ID 000323719500006

    View details for PubMedID 23790096

  • Ethnic differences in intraocular pressure reduction and changes in anterior segment biometric parameters following cataract surgery by phacoemulsification CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY Lee, R. Y., Kasuga, T., Cui, Q. N., Huang, G., Wang, S. Y., Lin, S. C. 2013; 41 (5): 442-449

    Abstract

    To determine the association between ethnicity and changes in intraocular pressure and anterior segment biometric parameters following cataract surgery by phacoemulsification in nonglaucomatous subjects.Prospective clinical cohort study.Caucasian and Asian subjects.Customized software was used to calculate parameters from anterior segment optical coherence tomography images obtained preoperatively and at 3 months following cataract surgery by phacoemulsification. The percentage changes in intraocular pressure and anterior segment biometric parameters following cataract surgery by phacoemulsification were modelled as a function of ethnicity using linear mixed-effects regression, a likelihood ratio test function that adjusted for age, sex and the use of both eyes in the same subject, to determine the association between ethnicity and postoperative outcomes.Intraocular pressure, angle opening distance, anterior chamber depth, anterior chamber volume, and angle recess area.Fifty Asian and 23 Caucasian nonglaucomatous eyes were analysed. Postoperative decrease in intraocular pressure and increases in angle opening distance, anterior chamber depth, anterior chamber volume and angle recess area were observed within each ethnic group (P??0.05).In this study, regardless of ethnic classification, subjects who received cataract surgery by phacoemulsification experienced a significant postoperative decrease in intraocular pressure and increases in angle opening distance, anterior chamber depth, anterior chamber volume and angle recess area. The percent changes in postoperative outcomes did not differ significantly by ethnicity.

    View details for DOI 10.1111/ceo.12032

    View details for Web of Science ID 000320928600004

    View details for PubMedID 23146132

  • Glaucoma and vitamins A, C, and E supplement intake and serum levels in a population-based sample of the United States EYE Wang, S. Y., Singh, K., Lin, S. C. 2013; 27 (4): 487-494

    Abstract

    To investigate the potential association between glaucoma prevalence and supplemental intake, as well as serum levels of vitamins A, C and E.This cross-sectional study included 2912 participants in the 2005-2006 National Health and Nutrition Examination Survey, age ?40 years, who self-reported a presence or absence of glaucoma. Participants were interviewed regarding the use of dietary supplements during the preceding 30-day period. Participants also underwent serum measurements of vitamins A, C, and E (both alpha- and gamma-tocopherol). Information on the primary outcome measure, presence or absence of glaucoma, as well as demographic information, comorbidities and health-related behaviors, was assessed via interview.Multivariate odds ratios for self-reported glaucoma, comparing the highest quartile of consumption to no consumption, and adjusted for potential confounding variables were 0.48 (95% confidence interval (CI) 0.13-1.82) for vitamin A, 0.47 (95% CI 0.23-0.97) for vitamin C, and 2.59 (95% CI 0.89-7.56) for vitamin E. Adjusted odds ratios for self-reported glaucoma comparing the highest vs lowest quintiles of vitamin serum levels were 1.44 (95% CI 0.79-2.62) for vitamin A, 0.94 (95% CI 0.42-2.11) for vitamin C, 1.40 (95% CI 0.70-2.81) for alpha-tocopherol, and 0.64 (95% CI 0.24-1.70) for gamma-tocopherol.Neither supplementary consumption with nor serum levels of vitamins A and E were found to be associated with glaucoma prevalence. While low- and high-dose supplementary consumption of vitamin C was found to be associated with decreased odds of glaucoma, serum levels of vitamin C did not correlate with glaucoma prevalence.

    View details for DOI 10.1038/eye.2013.10

    View details for Web of Science ID 000317594000005

    View details for PubMedID 23429409

    View details for PubMedCentralID PMC3626010

  • Association between Myopia and Glaucoma in the United States Population INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Qiu, M., Wang, S. Y., Singh, K., Lin, S. C. 2013; 54 (1): 830-835

    Abstract

    To investigate the association between myopia and the prevalence of glaucoma.This cross-sectional study included 5277 participants from the 2005 to 2008 National Health and Nutrition Examination Survey, greater than or equal to 40 years old, without history of cataract or refractive surgery, who underwent auto-refraction measurement. The predictor was refractive status; emmetropia (-0.99 to +0.99 diopters [D]), mild myopia (-1.00 to -2.99 D), moderate myopia (-3.00 to -5.99 D), severe myopia (> -6.00 D), and hyperopia (> 1.00 D). The outcomes were self-reported glaucoma, vertical cup-to-disc ratio and visual field defects as found on frequency doubling technology (FDT) testingOdds of self-reported glaucoma were not significantly increased in mild (odds ratio [OR] 0.90, confidence interval [CI] 0.56-1.45), moderate (OR 1.40, CI 0.62-3.16), or severe (OR 0.26, CI 0.08-0.80) myopes compared with emmetropes. Odds of vertical cup-to-disc ratio greater than or equal to 0.7 were not significantly increased in mild (OR 0.84, CI 0.31-2.25), moderate (OR 0.37, CI 0.04-3.57), or severe (OR 0.85, CI 0.09-8.42) myopes compared with emmetropes. Odds of any visual field defects were significantly increased in mild (OR 2.02, CI 1.28-3.19), moderate (OR 3.09, CI 1.42-6.72), and severe (OR 14.43, CI 5.13-40.61) myopes compared with emmetropes. The ?(2) test indicated a significant difference (P = 0.001) in the distribution of subjects with each category of visual field status across subjects with each refractive status; the proportion of subjects with worse visual field defects increased with worsening myopia severity.The association between myopia and visual field defects may represent an increased risk of glaucoma among myopes, and the lack of association with self-reported glaucoma may suggest a need for greater glaucoma surveillance in this population.

    View details for DOI 10.1167/iovs.12-11158

    View details for Web of Science ID 000314338400109

    View details for PubMedID 23299483

    View details for PubMedCentralID PMC3562121

  • Prevalence and Predictors of Depression Among Participants With Glaucoma in a Nationally Representative Population Sample AMERICAN JOURNAL OF OPHTHALMOLOGY Wang, S. Y., Singh, K., Lin, S. C. 2012; 154 (3): 436-444

    Abstract

    To investigate the prevalence of and risk factors for depression among participants with glaucoma and the predictive value of glaucoma for depression.Cross-sectional study.This study included 6760 participants in the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2008, aged ?40 years, who reported a presence or absence of glaucoma. Demographic and disease-related information was obtained by interview. Self-reported measures of vision were ascertained via items from the Visual Function Questionnaire (VFQ-25). Participants underwent visual acuity examination, fundus photography, and visual field testing with screening frequency-doubling technology (FDT N-30-5). The main outcome was presence of depression, as determined by a score ?10 on the Patient Health Questionnaire-9 (PHQ-9).Prevalence of depression among participants with and without glaucoma was 10.9% (SEM 2.2%) and 6.9% (SEM 0.62%), respectively. While the presence of glaucoma was significantly associated with depression after adjustment for demographic factors (OR 1.80, 95% CI 1.16-2.79), this association was not significant after adjustment for self-reported general health condition (OR 1.35, 95% CI 0.822-2.23). Among participants with glaucoma, objective measures of glaucoma severity were not significant predictors for depression. However, several self-reported measures of visual function were significantly associated with depression.Glaucoma is a significant predictor of depression after adjustment for demographic factors and multiple comorbidities, but not after adjustment for self-reported general health condition. Among participants with glaucoma, self-reported measures of vision were significant risk factors for depression, whereas objective measures of vision were not.

    View details for DOI 10.1016/j.ajo.2012.03.039

    View details for Web of Science ID 000308115600005

    View details for PubMedID 22789562

    View details for PubMedCentralID PMC3422443

  • The Association between Glaucoma Prevalence and Supplementation with the Oxidants Calcium and Iron INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Wang, S. Y., Singh, K., Lin, S. C. 2012; 53 (2): 725-731

    Abstract

    To investigate the relationship between supplementary consumption of the oxidants calcium and iron and the prevalence of glaucoma.This cross-sectional study included 3833 participants in the National Health and Nutrition Examination Survey (NHANES) for 2007 and 2008, ? 40 years of age, who reported a presence or absence of glaucoma. Participants were interviewed regarding the use of dietary supplements and antacids during the preceding 30-day period. Data pertaining to the supplementary intake of calcium and iron was aggregated and divided into quintiles. Information regarding the presence or absence of glaucoma and demographics, comorbidities, and health-related behavior was obtained via interview.Participants who consumed ? 800 mg/d of supplementary calcium or ? 18 mg/d of supplementary iron had significantly higher odds of having been diagnosed with glaucoma than did those who had not consumed supplementary calcium or iron, after adjustment for potential confounders (odds ratio [OR] 2.44, 95% confidence interval [CI] 1.25-4.76 for calcium; OR 3.80, 95% CI 1.79-8.06 for iron). Concurrent consumption of both calcium and iron above these levels was associated with still greater odds of having been diagnosed with glaucoma (OR 7.24, 95% CI 2.42-21.62). A clear dose-response relationship between quintiles of supplementary calcium or iron intake and glaucoma prevalence was not found.These results suggest that there may be a threshold intake of iron and calcium above which there is an increased risk of development of glaucoma. Prospective longitudinal studies are needed, to assess whether oxidant intake is a risk factor for development and progression of glaucoma.

    View details for DOI 10.1167/iovs.11-9038

    View details for Web of Science ID 000302788600024

    View details for PubMedID 22247455

    View details for PubMedCentralID PMC3317417

  • Asian Americans and Obesity in California: A Protective Effect of Biculturalism JOURNAL OF IMMIGRANT AND MINORITY HEALTH Wang, S., Quan, J., Kanaya, A. M., Fernandez, A. 2011; 13 (2): 276-283

    Abstract

    Prior studies comparing US-born and foreign-born Asian Americans have shown that birth in the US conveys greater risk of obesity. Our study investigates whether retention of Asian culture might be protective for obesity despite acculturation to US lifestyle. We classified self-identified Asian American respondents of the California Health Interview Survey as traditional, bicultural, and acculturated using nativity and language proficiency in English and Asian language. We then examined the association of acculturation with overweight/obesity (BMI ? 25 kg/m˛) in a multivariate regression model. Acculturated respondents had higher adjusted odds of being overweight/obese than bicultural respondents (2.13 [1.40-3.23] for men, 3.28 [2.14-5.04] for women), but bicultural respondents had similar odds of being overweight/obese as traditional respondents (.98 [.69-1.41] for men, .72 [.50-1.05] for women). Among the bicultural, second and first generation respondents were equally likely to be overweight/obese. Biculturalism in Asian Americans as measured by Asian language retention appears protective against obesity. Further research is needed to understand the mechanisms underlying this association.

    View details for DOI 10.1007/s10903-010-9426-5

    View details for Web of Science ID 000288256800012

    View details for PubMedID 21153765

    View details for PubMedCentralID PMC3056137

  • Rapid deletional peripheral CD8 T cell tolerance induced by allogeneic bone marrow: Role of donor class II MHC and B cells JOURNAL OF IMMUNOLOGY Fehr, T., Wang, S., Haspot, F., Kurtz, J., Blaha, P., Hogan, T., Chittenden, M., Wekerle, T., Sykes, M. 2008; 181 (6): 4371-4380

    Abstract

    Mixed chimerism and donor-specific tolerance are achieved in mice receiving 3 Gy of total body irradiation and anti-CD154 mAb followed by allogeneic bone marrow (BM) transplantation. In this model, recipient CD4 cells are critically important for CD8 tolerance. To evaluate the role of CD4 cells recognizing donor MHC class II directly, we used class II-deficient donor marrow and were not able to achieve chimerism unless recipient CD8 cells were depleted, indicating that directly alloreactive CD4 cells were necessary for CD8 tolerance. To identify the MHC class II(+) donor cells promoting this tolerance, we used donor BM lacking certain cell populations or used positively selected cell populations. Neither donor CD11c(+) dendritic cells, B cells, T cells, nor donor-derived IL-10 were critical for chimerism induction. Purified donor B cells induced early chimerism and donor-specific cell-mediated lympholysis tolerance in both strain combinations tested. In contrast, positively selected CD11b(+) monocytes/myeloid cells did not induce early chimerism in either strain combination. Donor cell preparations containing B cells were able to induce early deletion of donor-reactive TCR-transgenic 2C CD8 T cells, whereas those devoid of B cells had reduced activity. Thus, induction of stable mixed chimerism depends on the expression of MHC class II on the donor marrow, but no requisite donor cell lineage was identified. Donor BM-derived B cells induced early chimerism, donor-specific cell-mediated lympholysis tolerance, and deletion of donor-reactive CD8 T cells, whereas CD11b(+) cells did not. Thus, BM-derived B cells are potent tolerogenic APCs for alloreactive CD8 cells.

    View details for Web of Science ID 000259250400076

    View details for PubMedID 18768896

    View details for PubMedCentralID PMC2628539

  • Protection against lethal Aspergillus fumigatus infection in mice by allogeneic myeloid progenitors is not major histocompatibility complex restricted 45th Annual Meeting and Exhibition of the American-Society-of-Hematology Arber, C., Bitmansour, A., Shashidhar, S., Wang, S., Tseng, B., Brown, J. M. UNIV CHICAGO PRESS. 2005: 1666?71

    Abstract

    Invasive fungal infections are a leading cause of morbidity and mortality after myelotoxic chemotherapy or radiation exposure. The resulting depletion of myeloid precursors under these conditions appears to be the factor that limits approaches to accelerate immune reconstitution. In a murine model of myeloablation after radiation exposure, we demonstrated that highly purified common myeloid and granulocyte-monocyte progenitors (CMPs/GMPs) accelerated myeloid recovery and, thus, enhanced innate immunity as measured by survival after a lethal challenge with Aspergillus fumigatus. Of greatest significance was the demonstration that the protection afforded by CMPs/GMPs was not major histocompatibility complex restricted. Furthermore, the effect of CMP/GMP cellular therapy was additive with that of liposomal amphotericin B treatment. These observations greatly expand the potential donor pool and, thus, the clinical utility of CMP/GMP cellular therapy in patients with myeloid depletion.

    View details for Web of Science ID 000232333000022

    View details for PubMedID 16206084

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