Wu et al (p. 1239) conducted a multi-area cluster randomized intervention trial to investigate the effectiveness of a school-based program in Taiwan that promotes outdoor time to prevent myopic changes. Six hundred ninety-three first grade schoolchildren in 16 schools participated from September 2013 to September 2014, with 267 schoolchildren in the intervention group and 426 in the control group. A Recess Outside Classroom Trial (ROCT711) program was implemented in the intervention group, with schoolchildren encouraged to go outdoors for up to 11 hours per week. The intervention group had significantly less myopic shift and axial length elongation, as well as a decreased risk of myopia onset and fast myopia shift, compared with the control group. The results suggest that the ROCT711 program reduced myopic changes in both nonmyopic and myopic children, and either brief periods of higher sunlight intensity or longer periods of moderate sunlight intensity may be sufficient for myopia prevention. Delcourt et al (p. 1149) conducted a meta-analysis to estimate the prevalence of nonrefractive visual impairment (best corrected better eye worse than 20/60) and blindness (worse than 20/400) in European subjects aged 55 years and older. The analysis was based on 14 European population-based studies participating in the European Eye Epidemiology (E3) consortium. The prevalence of nonrefractive visual impairment strongly increased with age in all studies. The age-standardized prevalence rate of nonrefractive visual impairment decreased from 2.22% in 1991-2006 to 0.83% in 2007-2012. Rates tended to be higher in women than men in 1991-2006, but not in 2007-2012. No differences were observed by geographical area. The projected number of older Europeans affected by nonrefractive visual impairment decreased from 2.5 million in 2000 to 1.2 million in 2010. The study provides evidence for a significant recent decrease in the prevalence of nonrefractive visual impairment and blindness in older Europeans, and the authors suggest that this may be due to major improvements in eye care and/or a decreased incidence of eye diseases. Xu et al (p. 1279) describe the presentation of patients developing endophthalmitis following intravitreal injection with vascular endothelial growth factor (VEGF) inhibitors. They conducted a retrospective, single-center, nonrandomized, interventional study of patients who developed endophthalmitis after receiving anti-VEGF injections between 2006 and 2016. Over the 10-year period, 258 357 intravitreal injections occurred and 40 patients (0.016%) had endophthalmitis within 3 weeks of injection. Of the endophthalmitis treatment group, 72.5% received intravitreal injection of antibiotics only (TAI group) and 27.5% had immediate pars plana vitrectomy with intraocular antibiotics (PPV group). The researchers found that a higher proportion of samples were culture positive in the PPV group compared with the TAI group. There was no statistically significant difference in best-corrected visual acuity at 6-month follow-up between TAI and PPV groups, and younger age and lower intraocular pressure at presentation were associated with better visual outcomes. Berk et al (p. 1172) conducted a comparative retrospective cohort analysis of postoperative refractive and visual outcomes in eyes receiving either femtosecond laser-assisted cataract surgery (FLACS) or manual cataract surgery (MCS). The researchers found that 82.6% of FLACS eyes and 78.8% of MCS eyes had ≤0.5 D of absolute error at 3 weeks, representing an adjusted odds ratio of 1.28 of FLACS relative to MCS being within target. Factors that predicted a favorable refractive outcome included an axial length between 22 and 24.8 mm, receiving a toric intraocular lens, less preoperative cylinder, and greater preoperative average keratometry. There was no significant difference in the percentage of patients targeted for distance who achieved uncorrected distance visual acuity of 20/20 or better, 20/25 or better, or 20/30 or better vision. The researchers conclude that there were no statistically significant postoperative visual or refractive advantages of FLACS relative to MCS. Li et al (p. 1199) assessed the efficacy of a deep learning algorithm for detecting referable glaucomatous optic neuropathy (GON) based on color fundus photographs. A total of 48 116 fundus photographs collected from various clinical settings in China were downloaded from an online dataset and classified by 21 trained ophthalmologists. In the validation dataset, the area under receiver operator characteristic curve of the deep learning algorithm was 0.986, with a sensitivity of 95.6% and specificity of 92.0% for the classification of referable GON. The most common reason for false negative classification was undetected GON with co-existing eye conditions, particularly pathologic or high myopia. Physiologic cupping and pathologic myopia were the most common reasons for false positive classification. The researchers conclude that their deep learning algorithm can detect referable GON with high sensitivity and specificity on a large dataset.

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