Epidemiological survey of anterior segment diseases in Japanese isolated island using a portable slit-lamp device in home-based cases in Miyako Island

Eisuke Shimizu; Kazuhiro Hisajima; Shintaro Nakayama; Hiroki Nishimura; Rohan Jeetendra Khemlani; Ryota Yokoiwa; Yusuke Shimizu; Masato Kishimoto; Keigo Yasukawa

doi:10.1371/journal.pone.0306845

Peer Review History

Original SubmissionJune 24, 2024
1 Sep 2024 Decision Letter - Jiro Kogo, Editor PONE-D-24-24324Epidemiological Survey of Anterior Segment Diseases in Japanese Isolated Island Using a Portable Slit-Lamp Device in Home-Based Cases in Miyako IslandPLOS ONE Dear Dr. Shimizu, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Oct 16 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: Yes ****** 3. 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Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This study is an epidemiological investigation targeting an elderly population that faces significant barriers to accessing ophthalmic care and is consequently less likely to receive appropriate treatment. Given the isolated environment of the remote island and the limited number of home care patients, the sample size is considered appropriate when considering the average age of the patients. The portable slit-lamp microscope developed by the authors can evaluate a variety of anterior segment diseases. This study implies that visiting physicians who are not ophthalmologists can obtain critical information about anterior segment diseases. Previous reports have shown to have significant potential for widespread application beyond Japan. This study and portable slit-lamp microscope have the potential to benefit rural regions. However, some clarification on the discussion within this paper may be needed. The finding that many anterior segment diseases, particularly cataracts, remain untreated among patients on isolated islands is noteworthy. However, the current phrasing may need to establish whether the prevalence of untreated cataracts is indeed high. It might be more informative to compare the rate of previous cataract surgeries among patients over 80 years in this study with those in similar age groups in both developed and developing countries. Given that approximately half of the patients in this study underwent cataract surgery, it is possible that factors other than access to health care alone are involved. If the aim is to emphasize the high prevalence of cataracts in this population, referencing reports from comparable cohorts could provide a more compelling argument. The discussion suggests that the prevalence of pterygium is not high in this study compared to other reports. The authors show the reason could be the subjects' predominantly home-bound lifestyle, which reduces exposure to ultraviolet (UV). However, this contrasts with the explanation for the high prevalence of cataracts, which is attributed to increased UV exposure among the subjects. This hypothesis regarding UV exposure may create a potential inconsistency in the consideration. Because cataracts and pterygium have multifactorial etiologies, making definitive statements is challenging. If the intent is to emphasize the high prevalence of cataracts, it might be advisable to refrain from attributing the prevalence of pterygium to the home-bound lifestyle. Reviewer #2: The manuscript by Shimizu et al., titled "Epidemiological Survey of Anterior Segment Diseases in Japanese Isolated Island Using a Portable Slit-Lamp Device in Home-Based Cases in Miyako Island" is a report on epidemiological survey of anterior segment diseases amongst people living on Miyako island, which is a Japanese isolated island using a portable slit-lamp device. The study was a home-based survey. The report will be intereting to colleagues specialising in ophthalmology and public health. The manuscript is well-written and analysis properly done. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes: Professor Emmanuel oluwadare Balogun ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. 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Revision 1
29 Sep 2024 Author Response Response to the Reviewer 26th September, 2024 Dr. Eisuke Shimizu Reviewer #1: Comment: "The study finds that many anterior segment diseases, particularly cataracts, remain untreated among patients on isolated islands. However, the current phrasing may need to establish whether the prevalence of untreated cataracts is indeed high. It might be more informative to compare the rate of previous cataract surgeries among patients over 80 years in this study with those in similar age groups in both developed and developing countries. Given that approximately half of the patients in this study underwent cataract surgery, it is possible that factors other than access to healthcare alone are involved." Response: Thank you for this insightful suggestion. We agree that a direct comparison of cataract surgery rates in similar age groups across different regions could strengthen our argument. In the revised manuscript, we have included comparisons with data from developed countries as well as from developing regions where access to ophthalmic care is limited. We have modified the discussion to incorporate these multifactorial considerations. LINE 248 A comparison of untreated cataracts in developing countries reveals significant disparities in cataract surgery coverage. In Ghana, 55% of the population aged 60–69 has undergone cataract surgery [26]. However, in our study, only 9.52% of individuals within the same age group received the surgery (Fig 5). Cataract surgery coverage varies significantly across regions, with Western Europe and North America achieving coverage rates ten times higher than those in Africa [27]. This regional variability complicates direct comparisons. In contrast, data from developed nations such as Australia show that 30-45% of individuals aged 79–84 have already undergone cataract surgery [28, 29]. Similarly, in the United Kingdom, 42.3% of the population aged 80 and above has undergone cataract surgery [30]. In the current study, the proportion of individuals who had not received cataract surgery was 1.2 to 1.5 times higher, likely due to increased rates of bedridden status and reduced activities of daily living (Fig 5). Comment: "The discussion suggests that the prevalence of pterygium is not high in this study compared to other reports. The authors show the reason could be the subjects' predominantly home-bound lifestyle, which reduces exposure to ultraviolet (UV). However, this contrasts with the explanation for the high prevalence of cataracts, which is attributed to increased UV exposure among the subjects. This hypothesis regarding UV exposure may create a potential inconsistency." Response: We appreciate your observation regarding the apparent inconsistency in the explanation of UV exposure's role in cataracts and pterygium prevalence. To address this, we have revised the manuscript to clarify that while UV exposure is a significant risk factor for both conditions, the multifactorial nature of their etiology means that different factors might dominate in different settings. This updated explanation has been integrated into the discussion to present a more balanced and consistent interpretation. LINE 237 The prevalence observed in this study likely falls between the results of these previous studies due to the geographic location of Miyakojima Island, which is situated between the two regions under comparison. Reviewer #2: Comment: "The manuscript by Shimizu et al., titled 'Epidemiological Survey of Anterior Segment Diseases in Japanese Isolated Island Using a Portable Slit-Lamp Device in Home-Based Cases in Miyako Island,' is a report on an epidemiological survey of anterior segment diseases amongst people living on Miyako island. The report will be interesting to colleagues specializing in ophthalmology and public health. The manuscript is well-written and the analysis properly done." Response: Thank you for your positive feedback. We are grateful for your comment and we continued to refine the manuscript for clarity and precision as we finalize the revisions. LINE 237 The prevalence observed in this study likely falls between the results of these previous studies due to the geographic location of Miyakojima Island, which is situated between the two regions under comparison. LINE 248 A comparison of untreated cataracts in developing countries reveals significant disparities in cataract surgery coverage. In Ghana, 55% of the population aged 60–69 has undergone cataract surgery [26]. However, in our study, only 9.52% of individuals within the same age group received the surgery (Fig 5). Cataract surgery coverage varies significantly across regions, with Western Europe and North America achieving coverage rates ten times higher than those in Africa [27]. This regional variability complicates direct comparisons. In contrast, data from developed nations such as Australia show that 30-45% of individuals aged 79–84 have already undergone cataract surgery [28, 29]. Similarly, in the United Kingdom, 42.3% of the population aged 80 and above has undergone cataract surgery [30]. In the current study, the proportion of individuals who had not received cataract surgery was 1.2 to 1.5 times higher, likely due to increased rates of bedridden status and reduced activities of daily living (Fig 5). https://doi.org/10.1371/journal.pone.0306845.r002
4 Oct 2024 Decision Letter - Jiro Kogo, Editor Epidemiological Survey of Anterior Segment Diseases in Japanese Isolated Island Using a Portable Slit-Lamp Device in Home-Based Cases in Miyako Island PONE-D-24-24324R1 Dear Prof. Shimizu We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Jiro Kogo Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0306845.r003
Formally Accepted
13 Nov 2024 Acceptance Letter - Jiro Kogo, Editor PONE-D-24-24324R1 PLOS ONE Dear Dr. Shimizu, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Prof. Jiro Kogo Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0306845.r004

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