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Articles by T. Aung
Total Records ( 7 ) for T. Aung
  V. S. E Jeganathan , T. Y Wong , P. J Foster , J. G Crowston , W. T Tay , S. C Lim , S. M Saw , E. S Tai and T. Aung

Objective  To examine the relationship between peripheral artery disease (PAD) and glaucoma.

Methods  As part of a population-based study of 3280 persons of Malay descent (78.7% response) aged 40 to 80 years examined between August 1, 2004, and June 30, 2006, the ankle-brachial index (ABI) was assessed in all persons with known diabetes mellitus and every fifth systematically sampled participant without diabetes. Peripheral artery disease was deemed present if the ABI was 0.9 or less. Glaucoma was diagnosed using International Society of Geographical and Epidemiological Ophthalmology criteria.

Results  Of the 922 participants who had ABI measured, 79 (8.6%) had PAD and 42 (4.6%) had glaucoma. Persons with PAD were more likely to have glaucoma (11.4% vs 3.9%; age- and sex-adjusted odds ratio [OR], 2.80; 95% confidence interval [CI], 1.26-6.24), higher intraocular pressure (age- and sex-adjusted mean, 16.4 vs 15.5; P = .05), and a larger vertical cup-disc ratio (age- and sex-adjusted mean, 0.45 vs 0.40; P = .02). The association of PAD with glaucoma persisted while controlling for hypertension, diabetes, body mass index, serum triglyceride levels, and β-blocker use (multivariable-adjusted OR, 2.55; 95% CI, 1.09-5.98) and was stronger in people with diabetes (multivariable-adjusted OR, 2.91; 95% CI, 1.14-7.44).

Conclusions  Peripheral artery disease was related to glaucoma, supporting an association between large-vessel atherosclerotic disease and glaucoma. However, because the study sample included a high proportion of persons with diabetes, further research is needed to determine the relevance of these results to the general population.

  A. C. S How , G. S. W Tan , Y. H Chan , T. T. L Wong , S. K Seah , P. J Foster and T. Aung

Objective  To determine the prevalence of tilted and torted optic discs and associated risk factors among Chinese adults in Singapore.

Methods  As part of a population-based survey, optic disc stereophotographs of both eyes were obtained, and left eyes were analyzed using imaging software. A tilted optic disc was defined as an index of tilt (ratio of minimum to maximum optic disc diameter) less than 0.75. The angle of tilt was defined as the angle between the maximum and vertical optic disc diameter, and optic discs were graded as torted if the angle of tilt exceeded 15°.

Results  Twenty-six of 739 subjects (3.5%) had tilted optic discs, and 478 (64.7%) had torted optic discs. Myopia was present in 23 of 26 eyes (88.5% [95% confidence interval, 69.9%-97.6%]) with tilted optic discs and in 211 of 661 eyes (31.9% [28.4%-35.6%]) without tilted optic discs (P < .001). On multivariate analysis, myopia (spherical equivalent) was a significant risk factor for tilted optic discs (P < .001). Index of tilt was not associated with corneal astigmatism or with cylindrical refractive error. Seventeen eyes (65.4%) with tilted optic discs had an optic disc morphologic abnormality, but none were glaucomatous.

Conclusions  The prevalence of tilted optic discs among this Chinese population was 3.5%. Tilted optic discs were associated with myopia but not with glaucoma.

  R. S Kumar , V Tantisevi , M. H Wong , K Laohapojanart , O Chansanti , D. T Quek , V. T Koh , L. S MohanRam , K. Y Lee , P Rojanapongpun and T. Aung

Objective  To determine the prevalence of plateau iris in Asian eyes with primary angle closure glaucoma (PACG) using ultrasound biomicroscopy (UBM).

Methods  In this cross-sectional observational study, subjects older than 40 years with PACG who had a patent laser peripheral iridotomy underwent UBM in 1 eye. Ultrasound biomicroscopy images were qualitatively analyzed using standardized criteria. Plateau iris in a quadrant was defined by anteriorly directed ciliary body, absent ciliary sulcus, steep iris root from its point of insertion followed by a downward angulation, flat iris plane, and irido-angle contact. At least 2 quadrants had to fulfill these UBM criteria for an eye to be classified as having plateau iris.

Results  One hundred eleven subjects (70 from Singapore, 41 from Thailand) with PACG were recruited. The mean (SD) age was 65.6 (8.1) years, and 63.9% were female. Based on standardized UBM criteria, plateau iris was found in 36 of 111 eyes (32.4%; 95% confidence interval, 24.4%-41.6%). In these 36 eyes, quadrant-wise analysis showed 66.7% had plateau iris in 2 quadrants; 22.2%, in 3 quadrants; and 11.1%, in all quadrants.

Conclusions  About 30% of PACG eyes with a patent laser peripheral iridotomy were found to have plateau iris on UBM, highlighting the importance of non–pupil block mechanisms in Asian individuals.

  G. S Tan , T. Y Wong , C. W Fong and T. Aung

Objective  To examine the relationship of diabetes mellitus and metabolic abnormalities with intraocular pressure and glaucoma.

Methods  A population-based study was conducted in 3280 (78.7% response) Malay adults aged 40 to 80 years. Diabetes was defined as a random serum glucose level of 200 mg/dL or greater or physician diagnosis of diabetes mellitus. Metabolic abnormalities including body mass index, lipid levels, and blood pressure were measured. Glaucoma was defined from a standardized examination by means of the International Society for Geographical and Epidemiological Ophthalmology criteria.

Results  There were 764 persons (23.3%) who had diabetes. After controlling for age, sex, education, smoking, central corneal thickness, and diabetes treatment, intraocular pressure was higher in persons with than without diabetes (16.7 vs 15.0 mm Hg, P < .001) and in those with higher serum glucose levels (P < .001), glycosylated hemoglobin concentrations (P < .001), total cholesterol levels (P = .001), triglyceride levels (P = .002), and body mass index (P = .001). However, the prevalence of glaucoma was similar between persons with and without diabetes (4.7% vs 4.5%). In multivariate logistic regression models adjusting for age, sex, education, smoking, central corneal thickness, and diabetes treatment, diabetes was not associated with glaucoma (odds ratio, 1.00; 95% confidence interval, 0.63-1.61).

Conclusion  These data suggest that, although diabetes and metabolic abnormalities may be associated with a small increase in intraocular pressure, they are not significant risk factors for glaucomatous optic neuropathy.

  A Narayanaswamy , L. M Sakata , M. G He , D. S Friedman , Y. H Chan , R Lavanya , M Baskaran , P. J Foster and T. Aung

Objective  To assess the diagnostic performance of angle measurements from anterior segment optical coherence tomography (AS-OCT) images for identifying eyes with narrow angles.

Methods  We conducted a community-based cross-sectional study of individuals 50 years or older who had phakic eyes and who underwent AS-OCT imaging in the dark by a single operator and gonioscopy by an ophthalmologist masked to AS-OCT findings. An eye was considered to have narrow angles if the posterior pigmented trabecular meshwork was not visible for at least 180° on gonioscopy. Horizontal AS-OCT images were analyzed for the following measurements using customized software: angle opening distance (AOD) at 250, 500, and 750 µm from the scleral spur; trabecular-iris space area (TISA) at 500 and 750 µm; and angle recess area (ARA) at 750 µm. Areas under the receiver operating characteristic curves (AUCs) were generated for AOD, TISA, and ARA to assess the performance of these measurements in detecting eyes with narrow angles.

Results  Of 2047 individuals examined, 582 were excluded mostly because of poor image quality or inability to locate the scleral spur. Of the remaining 1465 participants, 315 (21.5%) had narrow angles on gonioscopy. Mean (SD) age was 62.7 (7.7) years, 54.1% were women, and 90.0% were Chinese. The AUCs were highest for AOD750 in the nasal (0.90 [95% confidence interval, 0.89-0.92]) and temporal (0.91 [0.90-0.93]) quadrants.

Conclusions  The AOD750 is the most useful angle measurement for identifying individuals with gonioscopic narrow angles in gradable AS-OCT images. Poor definition of the scleral spur precludes quantitative analysis in approximately 25% of AS-OCT images.

  R Wu , T. Y Wong , S. M Saw , H Cajucom Uy , M Rosman and T. Aung

Objectives  To examine the association of corneal arcus with central corneal thickness (CCT), intraocular pressure (IOP), and the prevalence of primary open-angle glaucoma.

Methods  This was a population-based cross-sectional study of Malay participants aged 40 to 80 years living in Singapore. Participants underwent a standardized interview and systemic and ocular examinations, including CCT, IOP, and corneal curvature radius measurements. Corneal arcus, assessed using a slitlamp, was defined as gray-white or yellow opacity located near the periphery of the cornea but separated from the limbus by a clear zone.

Results  Corneal arcus was found in right eyes among 1747 (57.9%) of 3015 participants. After adjusting for age, sex, and systemic factors, IOP was higher (15.87 vs 14.86 mm Hg, P < .001) and CCT was thinner (540.6 vs 543.4 µm, P = .03) in eyes with vs without corneal arcus. In multiple linear regression models, eyes with corneal arcus had on average 1.14 mm Hg higher IOP than eyes without corneal arcus. In the presence of corneal arcus, the linear correlations of CCT x IOP and of corneal curvature radius x IOP were altered. The prevalence of ocular hypertension, but not primary open-angle glaucoma, was significantly higher among participants with corneal arcus than among participants without corneal arcus (P = .02).

Conclusions  Corneal arcus was associated with higher IOP and lower CCT independent of age, sex, and systemic and ocular factors. Further research is required to investigate the clinical implications of these findings for IOP assessment in eyes with corneal arcus.

  J. P. New , T. Aung , P. G. Baker , G. Yongsheng , R. Pylypczuk , J. Houghton , A. Rudenski , R. P. New , J. Hegarty , J. M. Gibson , D. J. O`Donoghue and I. E. Buchan

Background Anaemia occurs early in the course of diabetes-related chronic kidney disease (CKD). There is little evidence about the prevalence of anaemia in people with diabetes. The aim of this study was to assess the prevalence of anaemia, by stage of CKD, in the general diabetic population.

Methods Haemoglobin (Hb) was measured on all glycated haemoglobin (HbA1c) samples and the most recent (<4months) estimated glomerular filtration rate (eGFR) was obtained. Anaemia (at treatment level) was defined as Hb<110g/l or the use of erythropoetic stimulating agents (ESA).

Results Twelve per cent (10–14%) of people had Hb<110g/l. The prevalence of anaemia increased progressively with worsening CKD. People with CKD stage3 accounted for the largest number of people with anaemia; 18% (95% CI 13–24%) had Hb<110g/l. Those with eGFR<60ml/min/1.73m2 and not on ESA or dialysis were four (2–7) times more likely than patients with better renal function to have Hb<110g/l. The relation between Hb and eGFR became approximately linear below an eGFR of 83ml/min/1.73m2, where, for every 1ml/min/1.73m2 fall in eGFR, there was a 0.4 (0.3–0.5)g/l fall in haemoglobin.

Conclusions This study demonstrates that anaemia, at levels where treatment is indicated, occurs commonly in people with diabetes and CKD stage3 or worse. The screening for anaemia in current diabetes management should be extended.

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