Adomfeh J, Jastrzembski BG, Oke I.
Association of Race, Ethnicity, and Socioeconomic Status With Visual Impairment in Adolescent Children in the US. JAMA Ophthalmol 2022;140(10):1006-1010.
AbstractImportance: Although racial, ethnic, and socioeconomic disparities in visual impairment have been described in adults, few studies have focused on the adolescent population, which may provide insight into the emergence of vision health inequities. Objective: To describe visual health disparities among adolescent children in the US. Design, Setting, and Participants: This was a cross-sectional study of adolescents from the 2005 to 2008 National Health and Nutrition Examination Survey. Participants were aged 12 to 18 years with a completed visual function questionnaire and eye examination. Data analyses were conducted from January 19 to July 20, 2022. Main Outcomes and Measures: Outcomes included subjective (self-reported poor vision) and objective (visual acuity worse than 20/40 in the better-seeing eye) measures of visual function. Multivariable logistic and linear regression analyses were conducted to examine the association between the sociodemographic risk factors and each outcome, adjusting for age, sex, and other covariates. Results: The 2833 included participants (mean [SD] age, 15.5 [2.0] years; 1407 female participants [49%]) represent a survey-weighted 57 million US adolescent children, of whom 14% were non-Hispanic Black participants (876), 11% were Mexican American participants (828), 63% were non-Hispanic White participants (816), and 11% were other race and ethnicity (313). A total of 5% of participants (266) were not US citizens, and 19% (773) had a family income below the poverty threshold. There were increased odds of self-reported poor vision among Black (odds ratio [OR], 2.85; 95% CI, 2.00-4.05; P < .001), Mexican American (OR, 2.83; 95% CI, 1.70-4.73; P < .001), and low-income (OR, 2.44; 95% CI, 1.63-3.65; P < .001) adolescent children. Similarly, there were increased odds of visual acuity worse than 20/40 in the better-seeing eye among Black (OR, 2.13; 95% CI, 1.41-3.24; P = .001), Mexican American (OR, 2.13; 95% CI, 1.39-3.26; P = .001), and non-US citizen (OR, 1.96; 95% CI, 1.10-3.49; P = .02) participants. Conclusions and Relevance: In this nationally representative sample from 2005 to 2008, adolescent children identifying as Black, Mexican American, low-income, or non-US citizen were more likely to report poor subjective visual function and perform worse on objective visual acuity testing. A greater understanding of the underlying etiology of these disparities may yield opportunities for improving vision at the population level.
Aleman TS, Huckfeldt RM, Serrano LW, Pearson DJ, Vergilio GK, McCague S, Marshall KA, Ashtari M, Doan TM, Weigel-DiFranco CA, Biron BS, Wen X-H, Chung DC, Liu E, Ferenchak K, Morgan JIW, Pierce EA, Eliott D, Bennett J, Comander J, Maguire AM.
Adeno-Associated Virus Serotype 2-hCHM Subretinal Delivery to the Macula in Choroideremia: Two-Year Interim Results of an Ongoing Phase I/II Gene Therapy Trial. Ophthalmology 2022;129(10):1177-1191.
AbstractPURPOSE: To assess the safety of the subretinal delivery of a recombinant adeno-associated virus serotype 2 (AAV2) vector carrying a human choroideremia (CHM)-encoding cDNA in CHM. DESIGN: Prospective, open-label, nonrandomized, dose-escalation, phase I/II clinical trial. PARTICIPANTS: Fifteen CHM patients (ages 20-57 years at dosing). METHODS: Patients received uniocular subfoveal injections of low-dose (up to 5 × 1010 vector genome [vg] per eye, n = 5) or high-dose (up to 1 × 1011 vg per eye, n = 10) of a recombinant adeno-associated virus serotype 2 (AAV2) vector carrying a human CHM-encoding cDNA (AAV2-hCHM). Patients were evaluated preoperatively and postoperatively for 2 years with ophthalmic examinations, multimodal retinal imaging, and psychophysical testing. MAIN OUTCOME MEASURES: Visual acuity, perimetry (10-2 protocol), spectral-domain OCT (SD-OCT), and short-wavelength fundus autofluorescence (SW-FAF). RESULTS: We detected no vector-related or systemic toxicities. Visual acuity returned to within 15 letters of baseline in all but 2 patients (1 developed acute foveal thinning, and 1 developed a macular hole); the rest showed no gross changes in foveal structure at 2 years. There were no significant differences between intervention and control eyes in mean light-adapted sensitivity by perimetry or in the lateral extent of retinal pigment epithelium relative preservation by SD-OCT and SW-FAF. Microperimetry showed nonsignificant (< 3 standard deviations of the intervisit variability) gains in sensitivity in some locations and participants in the intervention eye. There were no obvious dose-dependent relationships. CONCLUSIONS: Visual acuity was within 15 letters of baseline after the subfoveal AAV2-hCHM injections in 13 of 15 patients. Acute foveal thinning with unchanged perifoveal function in 1 patient and macular hole in 1 patient suggest foveal vulnerability to the subretinal injections. Longer observation intervals will help establish the significance of the minor differences in sensitivities and rate of disease progression observed between intervention and control eyes.