Change In Refractive Error Research Articles

Refractive changes after strabismus surgery in patients with intermittent exotropia.

To evaluate the long-term refractive changes after horizontal muscle surgery in patients with intermittent exotropia and investigate the correlation between changes in the postoperative refractive error and clinical factors. We retrospectively reviewed the clinical data of patients aged < 15 years who underwent unilateral strabismus surgery (lateral rectus recession and medial rectus resection [RR, n = 47], lateral rectus recession and medial rectus plication [RP, n = 81], or lateral rectus recession [LRc, n = 68]). Preoperative and postoperative refractive errors up to four years after surgery were recorded. A mixed model was applied to compare the refractive error between the operated and fellow eyes and identify the factors associated with postoperative refractive changes. The mean age at surgery was 7.5±2.4years, and girls accounted for 56.1% of the study population. There was no significant difference in the change in the spherical equivalent of refractive error between both eyes throughout the postoperative period. In contrast, the operated eyes consistently and significantly showed higher cylindrical power in with-the-rule astigmatism by 0.25D than in fellow eyes. Age, sex, and preoperative refractive error were not correlated with changes in postoperative astigmatism. Meanwhile, the type of surgery showed a significant interaction with the astigmatism changes. RP had less effect on the changes in astigmatism than RR and LRc (p = 0.001 and p = 0.022, respectively). Horizontal muscle surgery has no long-term effect on the change in the spherical equivalent. However, mild with-the-rule astigmatism is induced and sustained after surgery, and the type of surgery affects the postoperative change of astigmatism.

Changes in Stress-Strain Index in School-Aged Children: A 3-Year Longitudinal Study.

To determine three-year change of the corneal biomechanical parameter stress-strain index (SSI) in schoolchildren aged 7- 9 years and their correlation with refractive error and axial length (AL). This is a prospective cohort study. Data of the AL, refractive error, and corneal biomechanical parameter SSI were collected at baseline and a 3-year follow-up for 217 schoolchildren. SSI, AL, and refractive error were measured via corneal visualization Scheimpflug technology (Corvis ST), IOLMaster biometry, and cycloplegic refraction. Three years of changes in SSI and its association with refractive error and AL were analyzed. Participants were divided into persistent nonmyopia (PNM), newly developed myopia (NDM), and persistent myopia (PM). The three-year difference in SSI among the three groups was analyzed. After three years of follow-up, the corneal biomechanical parameter SSI decreased in all participants (P < 0.01). There was a negative correlation between the change in SSI and the change in AL (r = -0.205, P=0.002) and a positive correlation between the change in refractive error (r = 0.183, P=0.007). After three years of follow-up, there was a decrease in the SSI for the NDM, PM, and PNM participants, with a median change of -0.05 for PNM and -0.13 and -0.09 for the NDM and PM, respectively. There was a significant decrease in corneal biomechanical properties for NDM patients compared with PNM patients (P < 0.01). In 7- to 9-year-old schoolchildren, SSI decreased after three years of the longitudinal study, and the change in SSI was correlated with the change in AL and refractive error. There was a rapid decrease in corneal biomechanical properties among newly developed myopic patients.

The Relationship between Axis Length Difference and Refractive Error in Unilateral Myopic Anisometropic Children Treated with Orthokeratology.

To explore the correlation between the axial length (AL) difference (myopic and nonmyopic eye) and the refractive error in children with unilateral myopia anisometropia (UMA) and to elucidate its clinical application in the process of Ortho-K lenses review following nonstop wearing. This study retrospectively analyzed the data of 70 children with UMA (age, 8-15 years) whose myopic eyes were treated with Ortho-K lenses. The spherical equivalent refractive errors (SERE) of the myopic eye ranged from -0.75 D to -4.25 D, and astigmatism was no less than -1.50 D. In addition, SERE of nonmyopic eyes were no less than -0.50 D. AL, and the refractive data of both eyes were measured at baseline. A multivariate linear regression was used to analyze the relationship between the AL difference and refractive error, and paired t-test was used to analyze the changes in AL in both eyes. Every 1 mm axial length change corresponds to -1.627 D (95% CI: -1.921 D, -1.333 D; P < 0.001) change in refractive error in children. The association between the AL change and the degree of myopia did not change with age (P=0.751). Among the 70 subjects, 51 (72.86%) had myopia in the right eye, and the 95% confidence interval (CI) for myopia occurring in the right eye was 62.4%-83.3%. The paired t-test showed that the average AL growth was significantly slower in myopic eyes treated with Ortho-K lenses than in nonmyopic eyes (t = 9.805, P < 0.001). Every 1 mm AL change would cause an average refractive error increase. Age did not influence the association between AL changes and the degree of myopia. The right eye is more likely to be affected in children with UMA. The Ortho-K lens treatment slowed down the growth of AL in the myopic eye in children with UMA.

Evaluation of aberrometry changes following strabismus surgery in patients with horizontal strabismus.

The aim is to investigate the change in aberrations following strabismus surgery in patients with horizontal strabismus. This prospective study included patients who underwent surgery for horizontal strabismus. The patients were assessed preoperatively and 1 month and 3 months after the surgery, in terms of logMAR best-corrected visual acuity, eye deviation, spherical equivalent refractive error, tomographic and aberrometric corneal changes. Corneal tomography was performed using Orbscan II device. Wavefront analyses were performed using Bausch and Lomb Zywave II. A total of 25 patients (48 eyes) with exotropia or esotropia were entered in this study. Mean values of exotropia in the distance and near deviations were reported as 31.42 ± 7.13 and 28.82 ± 6.96 prism diopters (PD), respectively. Mean scores of esotropia in the distance and near deviations were 25.22 ± 5.41 and 30.45 ± 9.4 PD, respectively. Evaluation of irregularity in 5 mm zone, horizontal coma, spherical aberration changes, and root mean square of higher-order aberrations (HOAs) in 6 mm, and HOA w/o Z 400 changes showed that there was a significant difference before the intervention and 1 month after the surgery (P < 0.05). However, no difference was observed in the aforementioned variables before and 3 months after the intervention (P > 0.05). Results of the present study indicated a transient increase in HOAs and corneal irregularity following strabismus surgery on horizontal eye muscles that returned to the baseline after 3 months.

VISUAL AND CORNEAL CHANGES IN OVERNIGHT ORTHOKERATOLOGY USING MENICON Z LENSES – A MALAYSIAN STUDY

Reverse geometry lens is a specially designed orthokeratology (OK) lens used to treat myopia. Menicon Z night OK lens is unique because software supplied by the manufacturer generates its parameters. No reports have been published on its effectiveness in reducing myopia among young Malay adults. This prospective study involved young Malay adults 22.5 ± 1.2 years old. Participants who met the inclusion criteria were fitted with OK lenses and the following parameters were measured at baseline: Refractive errors, visual acuity and corneal curvatures. Participants were asked to sleep with the lenses and remove them in the morning before re-examining them at 24 hours, one week, one month and six months. Repeated measure analysis of variance was carried out to find any significant differences in the parameters measured over the six months. The correlation was also done between refractive error, corneal curvatures and visual acuity. Significant reductions in refractive error, corneal curvatures and improvement in visual acuity were found during the six months. The greatest change occurred after 24 hours of lens wear. There was no change in corneal toricity. Changes in refractive error correlated significantly with visual acuity and corneal curvatures. In conclusion, the OK lenses significantly flattened corneal curvature and reduced refractive power to almost zero, which improved visual acuity in young Malay adults. Myopes with low refractive power who want to be free from spectacles may benefit from this alternative myopic management.

Association between myopia progression and quantity of laser treatment for retinopathy of prematurity.

Previous studies found that infants with retinopathy of prematurity (ROP) who were treated for more posterior disease with a greater number of laser spots developed higher myopia. These studies included multiple physicians with variations in laser density. In treatments by a single physician, laser spot count is a better surrogate for area of avascular retina and anterior-posterior location of disease, so that the relationship with myopia can be better assessed. Our retrospective study included infants treated with laser for ROP by a single surgeon at a single center. Exclusion criteria were irregularities during laser and additional treatment for ROP. We assessed correlation between laser spot count and change in refractive error over time using a linear mixed effects model. We studied 153 eyes from 78 subjects treated with laser for ROP. The average gestational age at birth was 25.3±1.8 weeks, birth weight 737±248 grams, laser spot count 1793±728, and post-treatment follow up 37±29 months. Between corrected ages 0-1 years, the mean spherical equivalent was +0.4±2.3 diopters; between ages 1-2, it was -1.3±3.2D; and ages 2-3 was -0.8±3.1D. Eyes that received more laser spots had significantly greater change in refractive error over time (0.30D more myopia per year per 1000 spots). None of the eyes with hyperopia before 18 months developed myopia during the follow-up period. Greater myopia developed over time in infants with ROP treated by laser to a larger area of avascular retina.

Diurnal Variations of Exophoria in Subjects With Normal Vision

Background and Objectives: We aimed to investigate the variation of heterophoria during a day in students with a normal visual system. Methods: This cross-sectional observational study was conducted on 15 students aged 19 to 22 years with 20/20 visual acuity and normal binocular vision. Heterophoria was measured with a prism bar and alternate cover test at near and far distances (40 cm and 6 m). The measurement was performed from 8 to 10 PM in one day with 2 hours intervals. Results: The Mean±SD age of students was 21.6±0.87 years (63% women and 37% men). The mean deviation in far and near order was 1.93 and 3.75 prism diopter, respectively. The Greenhouse-Geisser test concluded no significant difference between the measurements of distant heterophoria during the day (F=1.362, df=3.066, P=0.267). However, the near-distance results were significant (F=15.17, df=7, P˂0.05). The paired t-test results showed that the highest amount of exophoria was observed near 4 PM, which was significantly different from the initial value, and the difference increases at the end of the day so that the mean difference of the initial near exophoria value from 4 to 10 PM reached from -1.254 to -3.508. Conclusion: Changes in refractive error or high order aberration increase near work and decrease the illumination during a day can induce force on accommodation and vergence. So, at the end of the day, the exophoria increases. Thus, it is preferable to perform eye examinations at the end of the day to make more accurate decisions about the diagnosis and treatment of patients.

Compensation for Vitreous Chamber Elongation in Infancy and Childhood.

The ratios of diopters of change in refractive error produced per millimeter of eye elongation (D/mm) are rarely those predicted from geometric optics because of changes in other ocular components. Quantifying this optical compensation in millimeters instead of ratios reveals some important principles about eye growth and refractive error. The study purpose was to sort total vitreous chamber elongation into millimeters that either contributed (uncompensated) or did not contribute to change in refractive error (compensated). Participants were infants in the Berkeley Infant Biometry Study (n = 271, ages 3 months to 6 years) or schoolchildren in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (n = 456 emmetropes and 522 myopes, ages 6 to 14 years). Refractive error was measured using cycloplegic retinoscopy in infants (cyclopentolate 1%) and cycloplegic autorefraction in schoolchildren (tropicamide 1% or combined with cyclopentolate 1%). Axial dimensions were assessed using A-scan ultrasonography. Uncompensated millimeters were estimated from ratios of change in refractive error per millimeter of elongation using Gullstrand eye models. Compensated millimeters were the difference between measured elongation and uncompensated millimeters. Compensated millimeters exceeded uncompensated millimeters in emmetropic children across ages, but uncompensated millimeters exceeded compensated millimeters in myopic children. Compensated millimeters were highest in infancy and decreased with age, reaching less than 0.10 mm per year by age 10 years in both myopic and emmetropic children. There were no statistically significant differences in compensated millimeters between myopic and emmetropic children between ages 8 and 14 years ( P values from .17 to .73). The ability of the ocular components, primarily crystalline lens, to compensate for vitreous elongation is independent of the higher demands of myopic eye growth. The limited compensation after age 10 years suggests the target for elongation in myopia control needed to arrest myopia progression may be that seen in emmetropes or less.

Does Central Fat Distribution Reduction After Bariatric Surgery Induce Ocular Refraction Change Independent of Body Mass Index?

The effect of body mass index (BMI) and central fat distribution (CFD) reduction after bariatric surgery on ocular refraction is not well established. We assessed association between anthropometric parameters and refraction errors with other ocular and metabolic parameters 1year after the surgery. This was a retrospective study with patients underwent bariatric surgery and had at least 1year follow-up. Data were extracted from the bariatric and ophthalmology outpatient clinic records of the participants. Measurements of metabolic, anthropometric, and ocular parameters including BMI, CFD, refraction status, visual acuity, intraocular pressure (IOP), optic coherence tomography (OCT), and biometry test of the eyes were evaluated. Seventy-four eyes of 37 patients had a mean follow-up of 14.4 ± 1.7months after the surgery. Mean BMI and percentage of CFD decreased from 47.5 ± 6.7 to 33.1 ± 5.2kg/m2 (p < 0.01) and 28.5 ± 5.74 to 17.8 ± 4.64 (p < 0.001) after 1year, respectively. Mean refractive errors of the right and left eyes changed from - 0.62 ± 1.23 D to - 0.17 ± 1.36 D and from - 0.79 ± 1.39 to - 0.34 ± 1.56 after 1year of the surgery (p < 0.001). Mean IOP was significantly reduced (p < 0.001). Unlike BMI, reduction in CFD was significantly correlated with refraction change in both eyes (right eyes; r = 0.783, left eyes; r = 0.791, p < 0.001) after 1year. No significant differences were found in the other parameters. Bariatric surgery induced significant refractive change in eyes, which is significantly associated with CFD reduction after 1year. Bariatric surgery should be considered as a risk factor in patients with unexpected refractive error changes.

Refraction development in anisometropic amblyopia with patching therapy.

To investigate the development of refraction in anisometropic amblyopia who had been with patching therapy. We retrospectively reviewed 37,528 medical records of the amblyopes who had been treated with patching therapy between July 2003 and January 2020 at the School of Optometry and Ophthalmology and Eye Hospital of Wenzhou Medical University. We included unilateral anisometropic amblyopia with a follow-up length of not < 2 years. In total, 371 cases were enrolled and followed up for a mean of 4.76 ± 2.11 years. The subjects were then divided into different groups and periods according to their initial spherical equivalent (SE) refractive error and best-corrected visual acuity (BCVA) of the amblyopic eye. Linear mixed-effects models were fitted to calculate the annual change of SE. The annual changes in SE were -0.32 (-0.35 to -0.30) and -0.16 (-0.19 to -0.14) D/yr for the amblyopic eye and the fellow eye, respectively. The annual changes in SE of amblyopic eyes during the treatment period and the successfully treated period were -0.36 (-0.43 to -0.29; 95% CI) and -0.27 (-0.32 to -0.23; 95% CI) D/yr, respectively; the annual SE changes of the fellow eye during the treatment period and the successfully-treated period were -0.07 (-0.14 to -0.01; 95% CI) and -0.18 (-0.22 to -0.14; 95% CI) D/yr, respectively. The amblyopic eye experienced a significantly greater degree of refractive error changes than the fellow eye and underwent a continuous refractive error reduction before and after 7 years old. After the patching therapy was terminated, emmetropization in the amblyopic eye remained synchronized, whereas the refractive error change was increased in the fellow eye.

Rehabilitative strategies after filtering procedure in glaucoma

Glaucoma is one of the leading causes of non-reversible blindness worldwide, and almost 6 million people are estimated to be impaired visually in advanced stage of glaucoma. Recently, several studies on glaucoma has been focused towards new therapeutic approaches based on mechanisms independent from IOP control. Effects of new therapeutic agents, visual psychophysical training, or complementary medications targeting optic pathways today seem to be a relevant and effervescent field of research. The goal of the study is to evaluate in glaucoma patients if a rehabilitative strategy with a biofeedback training with microperimetry may be useful after surgery in recovery visual performance even when visual field defects are present in IOP is well controlled environment. Were enrolled 24 patients (28 eyes) with Primary Open Angle Glaucoma (POAG) (mean 63 range: 49–75 years) from our Glaucoma Center after filtering surgery. All patients after one months from surgical intervention underwent to a complete ophthalmologic examination: IOP measurement, gonioscopy, visual field and SD-OCT at baseline of RNFL thickness. In some cases, were included in the study both eyes because in POAG frequently clinical conditions are different in each eye, and secondarily new fixation target retinal location (TRL) was chosen based on single eye retinal sensitivity. Best corrected visual acuity was significantly increased after the training from 0.61 to 0.479 (p = 0.00058) with no change in refractive error. After the biofeedback patients presented increased value in Mean retinal sensitivity from 14.91 to 15.96 (p = 0.0078).Fixation stabilitywas improved either according to Fuji classification (increased from 75.1 to 81.3% p = 0.0073) or BCEA value, reduced from 8.7 to 6.0 square degrees (p = 0.013) we noted a marked increase in this parameter with better performances and satisfaction by the patient. RFNL thickness: no change was noted (p = 0.505) in this value as an indicator of disease’s stability. Our data indicate that MP-3 Biofeedback may be a good strategy to reduce the impairment of the Glaucoma Patient.

Three-year change in refractive error and its risk factors: results from the Shahroud School Children Eye Cohort Study.

To determine spherical equivalent (SE) progression among children in the Shahroud School Children Eye Cohort Study. A prospective cohort study recruited children aged 6 to 12 years in 2015 (baseline) with a follow-up in 2018. Cycloplegic autorefraction and axial length (AL) measurements were included. SE progression over 3 years was analysed in non-myopic (SE ≥ + 0.76 D), pre-myopic (PM; SE between +0.75 D and -0.49 D), low myopic (LM; SE between -0.5 D and -5.99 D), and high myopic (HM; SE ≤ - 6 D) eyes. Age, sex, near work, outdoor time, living place, parental myopia, mother's education, and baseline SE were evaluated as risk factors for SE progression (≤ -0.50 D). Data were available for 3989 children (7945 eyes). At baseline, 40.3% (n = 3205), 3.4% (n = 274) and 0.1% (n = 7) eyes had PM, LM and HM, respectively. At the 3-year follow-up, 40.5% (n = 3216), 7.5% (n = 599) and 0.2% (n = 15) eyes had PM, LM, and HM, respectively. SE progression in eyes with LM and HM was -1.08 ± 0.76 D and -1.60 ± 1.19 D, respectively. SE progression was associated with age at baseline (Odds Ratio [OR] = 1.14; 95% confidence interval [CI], 1.08-1.21), female sex (OR = 1.80; 95% CI: 1.48-2.18), near work (OR = 1.08; 95% CI: 1.02-1.14), parental myopia (OR = 1.20; 95% CI: 1.01-1.42) and baseline SE (OR = 2.28; 95% CI: 1.88-2.78). A myopic shift was associated with older age, female sex, near work, parental myopia and greater myopic baseline SE. These results help identifying children at risk of progression that may benefit from treatment and lifestyle counselling.

Анализ цветовосприятия у студентов с нарушением рефракции

There are more than 1.6 billion people in the world with various types of refraction. Dysfunction of the eye color function is a consequence of the pathology of the retina and optic nerve. Myopia ranks first among the types of refractive errors, accompanied by a high probability of complications. Thanks to the early screening of students, we were able to identify changes in refractive errors, and as a result, to form an exemplary algorithm for preventive and typed treatment. Purpous.To assess the role of timely diagnosis in the detection of diseases of the organ of vision. Timely predict the likelihood of diseases of the optic nerve and retina. Material and methods. The study involved 53 people, 20 female students (79 %), 7 male students (21 %). In young men, the right eye is myopia 60 %, emmetropia 20 %, hyperopia 20 %, left eye myopia 60 %, emmetropia 20 %, hyperopia 20 %. In girls, the left eye: myopia 73 %, emmetropia 22 %, hyperopia 5 %, right eye: myopia 75 %, emmetropia 20 %, hyperopia 5 %. Results. The analysis showed that the number of errors (right eye) had no statistically significant changes (p = 0.686), visual acuity (right eye) showed statistically significant changes (p = 0.029), and visual acuity (left eye) had statistically significant changes (p = 0.008), the number of errors (left eye) did not show statistically significant changes (p = 0.154). Conclusions. Today, the problem of violation of refractive in young people is a significant problem. Introspection-based functional tests such as the FM 100 make it possible to monitor disorders at the retinal and optic nerve levels. Keywords: violation of refraction, color perception, Farnsworth-Munsell test (Farnsworth-Munsell 100 Hue Test).

Choroidal Thickening During Young Adulthood and Baseline Choroidal Thickness Predicts Refractive Error Change.

PurposeThe purpose of this study was to explore the age-related change in choroidal thickness (ChT) and test the hypothesis that baseline ChT is predictive of refractive error change in healthy young adults.MethodsParticipants underwent spectral-domain optical coherence tomography (SD-OCT) imaging and autorefraction at 20 (baseline) and 28 years old. The enhanced depth imaging mode on the SD-OCT was used to obtain images of the choroid. Scans were exported from the SD-OCT and analyzed with a custom software that automatically measures the central ChT. The longitudinal change in subfoveal ChT and association between baseline subfoveal ChT and 8-year change in refractive error (spherical equivalent) were determined using linear mixed models.ResultsIn total, 395 eyes of 198 participants (44% men; 18–22 years at baseline) were included. Over 8 years, mean spherical equivalent decreased by 0.25 diopters (D) and axial length increased by 0.09 mm. Subfoveal choroid thickened by 1.3 µm/year (95% confidence interval [CI] = 0.6–2.0), but this was reduced by 0.9 µm/year (95% CI = 1.6–0.2) for every 1 mm increase in axial length. For every 10 µm increase in baseline ChT, average annual change in spherical equivalent and axial length reduced by 0.006 D/year and 0.003 mm/year, respectively.ConclusionsIn a community-based cohort of young adults, the choroid continued to change during early adulthood. Choroidal thickening was less in eyes that were longer at baseline, and the choroid thinned in eyes that showed myopia progression. The association between baseline ChT and longitudinal changes in spherical equivalent and axial length supports the hypothesis that ChT may be predictive of refractive error development and/or myopia progression.

Scleral Cross-Linking in Form-Deprivation Myopic Guinea Pig Eyes Leads to Glaucomatous Changes.

PurposeTo investigate the potential glaucomatous changes caused by scleral cross-linking (CXL) in a guinea pig form-deprivation (FD) myopia model.MethodsEighty 4-week-old tricolor guinea pigs were divided into four groups: FD only, genipin CXL only, FD plus CXL, and control. Refractive error, axial length (AL), intraocular pressure (IOP), and structural and vasculature optic disc changes in optical coherence tomography (OCT) and OCT angiography (OCTA) were measured at baseline and day 21. CXL efficacy was evaluated by scleral rigidity Young's modulus values. Histological and molecular changes in the anterior chamber angle, retina, and sclera were assessed.ResultsBaseline parameters were similar among groups (P > 0.05). The FD plus CXL group at day 21 had the least increase of AL (0.14 ± 0.08 mm) and highest IOP elevation (31.5 ± 3.6 mmHg) compared with the FD-only group (AL: 0.68 ± 0.17 mm; IOP: 22.2 ± 2.6 mmHg) and the control group (AL: 0.24 ± 0.09 mm; IOP: 17.4 ± 1.8 mmHg) (all P < 0.001). OCT and OCTA parameters of the optic disc in the FD plus CXL group at day 21 showed glaucomatous changes and decreased blood flow signals. Sclera rigidity increased in the CXL and FD plus CXL groups. Advanced glycation end products deposited extensively in the retina, choroid, and sclera of FD plus CXL eyes.ConclusionsCXL causes increased IOP and subsequent optic disc, anterior segment, and scleral changes while inhibiting myopic progression and axial elongation in FD guinea pig eyes. Therefore, applying CXL to control myopia raises safety concerns.

Changes in Refractive Error Under COVID-19: A 3-Year Follow-up Study.

IntroductionTo investigate changes in refractive error in schoolchildren before and during the coronavirus disease 2019 (COVID-19) pandemic.MethodsThis study included 2792 students, who underwent a 3-year follow-up from 2018 to 2020. All participants underwent yearly noncycloplegic refraction and ocular examinations. Time-related changes in sphere, cylinder, and spherical equivalent (SE) measurements in both genders were analyzed.ResultsThe myopic sphere (− 0.78 ± 1.83 vs. − 1.03 ± 1.91 D; P = 0.025) and SE (− 1.04 ± 1.90 vs. − 1.32 ± 1.99 D; P = 0.015) progressed significantly from 2018 to 2019. Female participants had a significantly greater change in SE than male participants (P < 0.05), and the low hyperopia, emmetropia, and mild myopia groups significantly deteriorated (P < 0.001) from 2018 to 2019. Significant differences in sphere change (− 0.21 ± 0.97 vs. − 0.36 ± 0.96 D; P < 0.001) and SE change (− 0.23 ± 0.99 vs. − 0.38 ± 0.98 D; P < 0.001) were noted between 2019–2018 and 2020–2019, respectively. The respective changes in cylinder were statistically similar (− 0.03 ± 0.53 vs. − 0.05 ± 0.62 D; P = 0.400).ConclusionsThe refractive status of schoolchildren showed an increasing myopic shift trend before and during the COVID-19 pandemic. The low hyperopia, emmetropia, and mild myopia groups were more sensitive to environmental changes during COVID-19 than before. The myopic shift was greater in female participants than male participants.

Longitudinal Change of Refractive Error in Retinopathy of Prematurity Treated With Intravitreal Bevacizumab or Laser Photocoagulation

To compare progression of myopia and refractive error in former premature infants with retinopathy of prematurity (ROP) treated using intravitreal bevacizumab (IVB) or laser. Retrospective clinical cohort study. We identified premature infants with ROP treated using IVB from 2011 to 2020 and compared their longitudinal cycloplegic refraction data to that of infants with ROP treated using laser during the same timeframe. A subset of infants treated using IVB also underwent additional treatment using laser. We included cycloplegic refractions from 789 cumulative visits over a median 3.2 years. We used a linear mixed-effects model with a log decay function to evaluate how refraction changed with age after treatment. In aggregate, the model estimated a significant (P < .001) trend in refraction-from slight hyperopia to relatively more myopic states. However, progression in laser-treated eyes was significantly (P < .001) more rapid, regardless of treatment with IVB. The number of laser spots resulted in increased myopic progression by approximately 0.16 diopters per 100 laser spots. Both ROP stage and zone had a significant effect on myopic progression, with more severe disease resulting in faster myopic progression. Random effects, including individual subject variation with nested variance for left and right eye, accounted for 86.4% of the remaining variance not explained by age and treatment. Laser treatment for severe ROP increases the trend to severe myopia. In our sample, IVB did not affect myopic progression but did substantially reduce the amount of consequent laser required to treat ROP. The effect of laser persists after accounting for differences in ROP stage and zone.

Longitudinal Changes in Refractive Error Among Preschool Children Aged 1–6 Years: The Changsha Children Eye Study

PurposeTo investigate the longitudinal changes in refractive error of preschool children and explore the factors related to these changes and the timing of intervention.MethodsThe refractive data of preschool children aged 1–6 years were collected from 16 community Health Service Centers in Changsha during April 2016 to July 2019 for the retrospective cohort study. The refractive data of each participant was measured with a hand-held vision screener without cycloplegia. A follow-up for all the included participants was performed. The spherical equivalent change was calculated, subsequently, an analysis of risk factors related to the change was performed.ResultsFour thousand nine hundred twenty-one cases were included in the study with the follow-up for 1–2 years. The refractive status was found smoothly changed in 67.8% of children. The overall initial SE was 0.62 ± 1.13 D, and the average SE change was −0.20 ± 1.23 D per year. However, profound myopic shift was observed in 32.2% of children. The change of SE in 3-year-old group is most overt. The proportions of 1–6 years old who showed moderate and severe myopic shift (SE change ≥–1.00 D) were 21.6, 18.9, 28.2, 25.5, 13.4, and 10%, respectively. At the first visit, the younger children with greater hyperopic state exhibited more noticeable myopic shift, no significant difference was found in gender.ConclusionThe shift from hyperopia to myopia in preschool children is smooth, with −0.20D change on average per year. We suggest that an optometry screening should start at 3-year-old to track children's refractive status. We recommend that preschool children whose SE changes more than −1.00 D per year go to the ophthalmology department for further examination. Our study also found that at the first visit, the younger the child is and the more positive initial SE is, the degree of shift of myopia is greater.

Effect of Combining 0.01% Atropine with Soft Multifocal Contact Lenses on Myopia Progression in Children.

Combining 0.01% atropine with soft multifocal contact lenses (SMCLs) failed to demonstrate better myopia control than SMCLs alone. The Bifocal & Atropine in Myopia (BAM) Study investigated whether combining 0.01% atropine and SMCLs with +2.50-D add power leads to greater slowing of myopia progression and axial elongation than SMCLs alone. Participants of the BAM Study wore SMCLs with +2.50-D add power daily and administered 0.01% atropine eye drops nightly (n = 46). The BAM subjects (bifocal-atropine) were age-matched to 46 participants in the Bifocal Lenses in Nearsighted Kids Study who wore SMCLs with +2.50-D add power (bifocal) and 46 Bifocal Lenses in Nearsighted Kids participants who wore single-vision contact lenses (single vision). The primary outcome was the 3-year change in spherical equivalent refractive error determined by cycloplegic autorefraction, and the 3-year change in axial elongation was also evaluated. Of the total 138 subjects, the mean ± standard deviation age was 10.1 ± 1.2 years, and the mean ± standard deviation spherical equivalent was -2.28 ± 0.89 D. The 3-year adjusted mean myopia progression was -0.52 D for bifocal-atropine, -0.55 D for bifocal, and -1.09 D for single vision. The difference in myopia progression was 0.03 D (95% confidence interval [CI], -0.14 to 0.21 D) for bifocal-atropine versus bifocal and 0.57 D (95% CI, 0.38 to 0.77 D) for bifocal-atropine versus single vision. The 3-year adjusted axial elongation was 0.31 mm for bifocal-atropine, 0.39 mm for bifocal, and 0.68 mm for single vision. The difference in axial elongation was -0.08 mm (95% CI, -0.16 to 0.002 mm) for bifocal-atropine versus bifocal and -0.37 mm (95% CI, -0.46 to -0.28 mm) for bifocal-atropine versus single vision. Adding 0.01% atropine to SMCLs with +2.50-D add power failed to demonstrate better myopia control than SMCLs alone.

The Limited Value of Prior Change in Predicting Future Progression of Juvenile-onset Myopia.

Identifying children at highest risk for rapid myopia progression and/or rapid axial elongation could help prioritize who should receive clinical treatment or be enrolled in randomized clinical trials. Our models suggest that these goals are difficult to accomplish. This study aimed to develop models predicting future refractive error and axial length using children's baseline data and history of myopia progression and axial elongation. Models predicting refractive error and axial length were created using randomly assigned training and test data sets from 916 myopic participants in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study. Subjects were 7 to 14 years of age at study entry with three consecutive annual visits that included cycloplegic A-scan ultrasound and autorefraction. The effect of adding prior change in axial length and refractive error was evaluated for each model. Age, ethnicity, and greater myopia were significant predictors of future refractive error and axial length, whereas prior progression or elongation, near work, time outdoors, and parental myopia were not. The 95% limits for the difference between actual and predicted change were ±0.22 D and ±0.14 mm without prior change data compared with ±0.26 D and ±0.16 mm with prior change data. Sensitivity and specificity for identifying fast progressors were between 60.8 and 63.2%, respectively, when the cut points were close to the sample average. Positive predictive value and sample yield were even lower when the cut points were more extreme. Young, more myopic Asian American children in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study were the most likely to progress rapidly. Clinical trials should expect average progression rates that reflect sample demographics and may have difficulty recruiting generalizable samples that progress faster than that average. Knowing progression or elongation history does not seem to help the clinical decision regarding initiating myopia control.