Association between vision impairment and mortality: protocol for a systematic review and meta-analysis.

Funder: Christian Blind MissionFunder: Queen Elizabeth Diamond Jubilee TrustFunder: Seva FoundationFunder: NIHR Moorfields Biomedical Research CentreFunder: British Council for the Prevention of BlindnessFunder: Sightsavers International; FundRef: http://dx.doi.org/10.13039/501100004324Funder: Fred Hollows Foundation; FundRef: http://dx.doi.org/10.13039/100014445INTRODUCTION: Due to growth and ageing of the world's population, the number of individuals worldwide with vision impairment (VI) and blindness is projected to increase rapidly over the coming decades. VI and blindness are an important cause of years lived with disability. However, the association of VI and blindness with mortality, including the risk of bias in published studies and certainty of the evidence, has not been adequately studied in an up-to-date systematic review and meta-analysis. METHODS AND ANALYSIS: The planned systematic review and meta-analysis will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases, including MEDLINE Ovid, Embase Ovid and Global Health, will be searched for relevant studies. Two reviewers will then screen studies and review full texts to identify studies for inclusion. Data extraction will be performed, and for included studies, the risk of bias and certainty of the evidence will be assessed using the Grades of Recommendation, Assessment, Development and Evaluation approach. The prognostic factor in this study is visual function, which must have been measured using a standard objective ophthalmic clinical or research instrument. We will use standard criteria from WHO to categorise VI and blindness. All-cause mortality may be assessed by any method one or more years after baseline assessment of vision. Results from included studies will be meta-analysed according to relevant sections of the Meta-analysis Of Observational Studies in Epidemiology checklist. ETHICS AND DISSEMINATION: This review will only include published data; therefore, ethics approval will not be sought. The findings of this review and meta-analysis will be published in an open-access, peer-reviewed journal and will be included in the ongoing Lancet Global Health Commission on Global Eye Health

Effects of paint-derived tributyltin on structure of estuarine nematode assemblages in experimental microcosms

A microcosm experiment was designed to evaluate the effects of different levels of paint-derived tributyltin (TBT), and different modes of exposure, on the diversity, feeding mode and assemblage structure of estuarine nematodes. Estuarine meiofauna were exposed to two types of treatments (mixture and deposit), containing uncontaminated sediment and sediment spiked with paint-derived TBT at 1 and 10 mg kg−1 for a duration of 4 and 8 weeks. In the mixture treatments, meiofauna assemblages were incubated in clean and contaminated sediments. In the deposit treatments meiofauna assemblages were exposed to the deposition of clean and contaminated sediments simulating the disposal of TBT-contaminated dredged material at sea. Effects of TBT on nematode species are likely to occur by (a) the uptake of leached TBT from the sediment pore water through their permeable cuticle, resulting in decreased diversity and increased changes in assemblage structure with increasing levels of TBT contamination, and (b) direct ingestion of paint-particles with food, resulting in a significant decline of nonselective deposit feeders in contaminated sediments. The numbers of many species differed greatly between mixture and deposit treatments. Results from multivariate analyses showed an immediate and dominant effect of burial on most nematode species in the deposit treatments compared to the longer-term effect of TBT contamination. The survival rates of nematode species in the top layer of these sediments depended on their ability to withstand TBT contamination as well as their potential to migrate, survive and reproduce in the deposit. This study unambiguously showed that the response of nematode species depended not only on the level of TBT contamination but also on the duration and mode of exposure to contaminated sediment, which should be taken into account when assessing the effects of TBT on aquatic communities

The Association Between Vision Impairment and Mortality: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis on the association between vision impairment and mortality is being carried out as part of the Lancet Global Health Commission on Global Eye Health

Association between vision impairment and mortality: a systematic review and meta-analysis

BACKGROUND: The number of individuals with vision impairment worldwide is increasing because of an ageing population. We aimed to systematically identify studies describing the association between vision impairment and mortality, and to assess the association between vision impairment and all-cause mortality. METHODS: For this systematic review and meta-analysis, we searched MEDLINE (Ovid), Embase, and Global Health database on Feb 1, 2020, for studies published in English between database inception and Feb 1, 2020. We included prospective and retrospective cohort studies that measured the association between vision impairment and all-cause mortality in people aged 40 years or older who were followed up for 1 year or more. In a protocol amendment, we also included randomised controlled trials that met the same criteria as for cohort studies, in which the association between visual impairment and mortality was independent of the study intervention. Studies that did not report age-adjusted mortality data, or that focused only on populations with specific health conditions were excluded. Two reviewers independently assessed study eligibility, extracted the data, and assessed risk of bias. We graded the overall certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations framework. We did a random-effects meta-analysis to calculate pooled maximally adjusted hazard ratios (HRs) for all-cause mortality for individuals with a visual acuity of <6/12 versus those with ≥6/12; <6/18 versus those with ≥6/18; <6/60 versus those with ≥6/18; and <6/60 versus those with ≥6/60. FINDINGS: Our searches identified 3845 articles, of which 28 studies, representing 30 cohorts (446 088 participants) from 12 countries, were included in the systematic review. The meta-analysis included 17 studies, representing 18 cohorts (47 998 participants). There was variability in the methods used to assess and report vision impairment. Pooled HRs for all-cause mortality were 1·29 (95% CI 1·20-1·39) for visual acuity <6/12 versus ≥6/12, with low heterogeneity between studies (n=15; τ2=0·01, I2=31·46%); 1·43 (1·22-1·68) for visual acuity <6/18 versus ≥6/18, with low heterogeneity between studies (n=2; τ2=0·0, I2=0·0%); 1·89 (1·45-2·47) for visual acuity <6/60 versus ≥6/18 (n=1); and 1·02 (0·79-1·32) for visual acuity <6/60 versus ≥6/60 (n=2; τ2=0·02, I2=25·04%). Three studies received an assessment of low risk of bias across all six domains, and six studies had a high risk of bias in one or more domains. Effect sizes were greater for studies that used best-corrected visual acuity compared with those that used presenting visual acuity as the vision assessment method (p=0·0055), but the effect sizes did not vary in terms of risk of bias, study design, or participant-level factors (ie, age). We judged the evidence to be of moderate certainty. INTERPRETATION: The hazard for all-cause mortality was higher in people with vision impairment compared with those that had normal vision or mild vision impairment, and the magnitude of this effect increased with more severe vision impairment. These findings have implications for promoting healthy longevity and achieving the Sustainable Development Goals. FUNDING: Wellcome Trust, Commonwealth Scholarship Commission, National Institutes of Health, Research to Prevent Blindness, the Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research, Moorfields Biomedical Research Centre, Sightsavers, the Fred Hollows Foundation, the Seva Foundation, the British Council for the Prevention of Blindness, and Christian Blind Mission

Association between vision impairment and mortality: protocol for a systematic review and meta-analysis

Funder: Christian Blind MissionFunder: Queen Elizabeth Diamond Jubilee TrustFunder: Seva FoundationFunder: NIHR Moorfields Biomedical Research CentreFunder: British Council for the Prevention of BlindnessFunder: Sightsavers International; FundRef: http://dx.doi.org/10.13039/501100004324Funder: Fred Hollows Foundation; FundRef: http://dx.doi.org/10.13039/100014445Introduction: Due to growth and ageing of the world’s population, the number of individuals worldwide with vision impairment (VI) and blindness is projected to increase rapidly over the coming decades. VI and blindness are an important cause of years lived with disability. However, the association of VI and blindness with mortality, including the risk of bias in published studies and certainty of the evidence, has not been adequately studied in an up-to-date systematic review and meta-analysis. Methods and analysis: The planned systematic review and meta-analysis will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases, including MEDLINE Ovid, Embase Ovid and Global Health, will be searched for relevant studies. Two reviewers will then screen studies and review full texts to identify studies for inclusion. Data extraction will be performed, and for included studies, the risk of bias and certainty of the evidence will be assessed using the Grades of Recommendation, Assessment, Development and Evaluation approach. The prognostic factor in this study is visual function, which must have been measured using a standard objective ophthalmic clinical or research instrument. We will use standard criteria from WHO to categorise VI and blindness. All-cause mortality may be assessed by any method one or more years after baseline assessment of vision. Results from included studies will be meta-analysed according to relevant sections of the Meta-analysis Of Observational Studies in Epidemiology checklist. Ethics and dissemination: This review will only include published data; therefore, ethics approval will not be sought. The findings of this review and meta-analysis will be published in an open-access, peer-reviewed journal and will be included in the ongoing Lancet Global Health Commission on Global Eye Health