Myopic Children Research Articles

Long-term Effects of Wearing Orthokeratology Lenses for More than 5 Years on the Progression of Childhood Myopia

Purpose: To investigate the long-term effects of wearing orthokeratology (OK) lenses for more than 5 years on the progression of myopia and the elongation of axial length in children.Methods: The study included patients aged 6-12 years with myopia ranging from -0.5 D to -5.0 D and astigmatism of ≤ 2.0 D who had worn lenses for ≥ 5 years. A retrospective analysis was conducted comparing with a control group of similar demographics who wore glasses. Spherical equivalent (SE) changes were compared between 28 subjects (56 eyes) in the OK lens group and 37 subjects (74 eyes) in the control group. Additionally, changes in axial length (AXL), anterior chamber depth, and central corneal thickness were compared between 23 subjects (46 eyes) in the lens group and 24 subjects (48 eyes) in the control group.Results: The annual changes in SE were -0.21 ± 0.18 D/year in the OK lens group and -0.38 ± 0.17 D/year in the control group. The annual changes in AXL were 0.13 ± 0.09 mm/year in the OK lens group and 0.21 ± 0.10 mm/year in the control group, both showing significant differences (<i>p</i> < 0.001, <i>p</i> < 0.001, respectively). Within the lens group, further analysis based on age 11 was conducted. SE changes were -0.23 ± 0.18 D/year in those age < 11 and -0.13 ± 0.18 D/year in those age ≥ 11. AXL changes were 0.15 ± 0.10 mm/year in the younger group and 0.06 ± 0.06 mm/year in the older group with both showing significant differences (<i>p</i> = 0.048, <i>p</i> = 0.012, respectively).Conclusions: The progression of myopia and elongation of AXL were significantly inhibited in the OK lens group compared to the control group. Additionally, younger age within the lens group was associated with greater myopia progression and AXL elongation.

Conjunctival ultraviolet autofluorescence as a biomarker of outdoor time in myopic children

IntroductionThe prevalence of myopia has increased significantly in recent years including an earlier onset of myopia development on the pediatric population. The main objective of the study is to compare CUVAF (Conjunctival Ultraviolet Autofluorescence) in children with and without myopia to validate its usefulness as an outdoor protective biomarker.MethodsA case–control observational study was conducted in a child cohort from subjects that attended to the Ophthalmology Department of Clínica Universidad de Navarra for an ophthalmological examination. The general exclusion criteria were (among others): amblyopia, congenital myopia, general ophthalmic disease, and any conjunctival alteration that might difficult the measurement of the CUVAF area. All participants underwent an automatic objective refraction under cycloplegic effect, biometry to measure axial length (AL) and central corneal radius (CCR), and completed a questionnaire about their lifestyle habits. A total of 4 images of the bulbar conjunctiva were taken with blue light in order to quantify the CUVAF area.ResultsA total of 263 subjects (6 to 17 years old) were analyzed with no significant differences in demographic data between case group and control group. There were 50 non-myopic subjects (19%) and 213 myopic subjects (81%). In relation to the outdoor activities (OA), myopic subjects spent significantly fewer hours per week outdoors than the control-group (p = 0.03). About the CUVAF area, the differences between groups were statistically significant, showing that the myopic group has a significantly smaller CUVAF area than the control-group (0.33 ± 0.72 mm2 vs. 0.78 ± 1.22 mm2; p = 0.0023), likewise, the frequency of CUVAF area absence between both groups showed an odds ratio (OR) of 2.52 (CI95% 1.33–4.74). A Pearson correlation test was done, obtaining a strong significant inverse correlation between myopia degree-CUVAF area (r = 0.1877; IC95% 0.068–0.302), and also ratio (AL/CCR)-CUVAF area (p = 0.002 and p = 0.04) respectively.ConclusionCUVAF is a useful biomarker for OA and it has an inverse relationship with myopia degree also in pediatric age, especially after the age of 12, so it could be useful to differentiate the risk of developing myopia. Having a CUVAF area greater than that corresponding to age, protect to myopia 2.5 times, being almost 5 times the protection in case of high myopia.

Impacts of environments on school myopia by spatial analysis techniques in Wuhan

The prevalence of myopia in China has increased significantly in recent years, and the age of onset has become younger. Previous studies have indicated that various environmental factors can influence the development of school myopia. However, the environmental impacts on school myopia remains to be investigated. Discoveries in this field may contribute to better urban planning. This study involved 7,610 students (aged 6–12 years, 4084 boys and 3526 girls) from six primary schools in Wuhan, China. We evaluated the associations between school myopia and the environment by analyzing the geographical distribution of myopic children. We utilized the spatial statistical analysis model. The Normalized Difference Vegetation Index (NDVI) risk coefficient for a 5,000-m radius around target schools was 0.379 (p = 0.008), while the NDVI risk coefficient for a 100-m radius around target schools was 0.241 (p = 0.047). The sports area risk coefficient for a 5,000-m radius around target schools was 0.234 (p = 0.016). We found that the specific buffers of NDVI and sports area around schools were associated with the prevalence of school myopia in schools, which worth further research to guide future initiatives on school myopia from an environmental perspective.

Longitudinal changes in choroidal structures among children with low to moderate myopia under orthokeratology treatment.

To explore the longitudinal changes in choroidal features in myopic children with low to moderate myopia under orthokeratology (ortho-k) treatment. Children (n=80) aged 8-12years with spherical equivalent refraction of -1.00 to -6.00D were randomly assigned to the control (single vision spectacles) (n=40) and ortho-k (n=40) groups. OCT images were collected at the baseline, 1-, 6-, 12-, 18-, and 24-month visits. Choroidal structure parameters, including choroidal total area (TA), luminal area (LA), stromal area (SA), and choroidal vascularity index (CVI) were calculated. Axial length (AL) was measured as the primary indicator for myopic progression. The analysis followed the intention-to-treat criteria. Compared to the control, ortho-k significantly improved the choroidal structures in choroidal TA and LA at all follow-up points (all P<0.05). Choroidal LA was the primary contributor to TA changes (85.8%[control], 91.4%[ortho-k]), with the most significant improvement within the first 6months. While, the changes in SA and CVI over time were not significantly different between the two groups (all P>0.05). Correlation matrices identified several noteworthy correlations between AL change and choroidal structure features. Further analysis showed a significant interaction effect between baseline choroidal LA and intervention type on subsequent AL change (P for interaction=0.005), suggesting that ortho-k might be more effective in children with larger baseline choroidal LA. This 2-year prospective study demonstrated that ortho-k can improve the choroidal structures, primarily manifested in choroidal LA, although this positive effect diminishes over time. Myopic children with larger baseline choroidal LA might benefit more from ortho-k.

Effect of school entrance age on myopia among primary schoolchildren using mixed-effect model: The Shantou Myopia Study (SMS).

To investigate the association between children's school entrance age and refractive status and prevalence of myopia in southern China. Population-based Cross-sectional study was conducted from September 2020 to June 2021 in Shantou, southern China, enrolling primary schoolchildren in the city. The school entrance age was calculated as the months from the birth date to the entrance date, divided by 12. Non-cycloplegic refraction and uncorrected visual acuity test were conducted. Myopia was defined as spherical equivalent refraction (SER) < -0.50D with an uncorrected distant visual acuity < Snellen 20/20. We explored the association between the SER and the school entrance age, with the clustering effect within schools adjusted by the linear mixed-model. We enrolled 410,080 primary schoolchildren, with a mean age of 9.8 ± 1.6 years. The overall prevalence of myopia was 42.04 %. The mean SER of myopic children was - 2.15 ± 1.70 D. The mixed-effects model revealed a significant correlation between the school entrance age and the SER and the prevalence of myopia. One year later for school entrance age would independently result in a less myopic SER of 0.352 D, and significantly decrease the prevalence of myopia. Children born before September 1st had significantly more myopic SER than those born after September 1st. Early school entrance, rather than age or prolonged exposure to schooling, was an independent risk factor for myopia. It is important to put forward some scientific and effective measures, preventing children from early exposure to task-heavy school life and near work.

Factors associated with myopia in the Portuguese child population: An epidemiological study.

Myopia, a leading cause of correctable visual impairment, is projected to affect nearly 50% of the global population by 2050, posing a significant public health challenge. Understanding its prevalence and associated factors, particularly in children, is crucial for devising prevention and intervention strategies. This study aims to determine the proportion of myopia in school-aged children in Portugal and to examine the correlation between myopia occurrence and various environmental and genetic factors. A cross-sectional epidemiological study was conducted on children aged from 5 to 17 years from nine schools in Lisbon, Portugal, between September 2020 and May 2021. It included optometric assessments to evaluate refractive status and binocular vision, as well as questionnaires about their lifestyles and parental myopia. Out of 1992 participants enrolled, 12.7% of the children were found to be myopic. The proportion of myopia increased with age and was higher in girls. A significant association was observed between myopia and parental history, with the likelihood being higher if one or both parents were myopic. Engaging in outdoor activities was associated with a lower likelihood of myopia. The study found that 12.7% of the children in the study sample, aged 5-17 years, were myopic, indicating a significant association with familial history and limited outdoor activities. These insights highlight the need for targeted myopia screening and prevention strategies in the paediatric population.

Myopia in Children: Epidemiology, Genetics, and Emerging Therapies for Treatment and Prevention

Refractive errors, particularly myopia, are among the most prevalent visual impairments globally, with rising incidence in children and adolescents. This review explores the epidemiology and risk factors associated with the development of refractive errors, focusing on the environmental and lifestyle factors contributing to the current surge in myopia. We provide an overview of key genetic factors and molecular pathways driving the pathogenesis of myopia and other refractive errors, emphasizing the complex interplay between genetic predisposition and environmental triggers. Understanding the underlying mechanisms is crucial for identifying new strategies for intervention. We discuss current approaches to slow myopia progression in pediatric populations, including pharmacological treatment regimens (low-dose atropine), optical interventions, and lifestyle modifications. In addition to established therapies, we highlight emerging innovations, including new pharmacological agents and advanced optical devices, and insights into potential future treatments. Cutting-edge research into gene therapy, molecular inhibitors, and neuroprotective strategies may yield novel therapeutic targets that address the root causes of refractive errors. This comprehensive review underscores the importance of early intervention and highlights promising avenues for future research, aiming to provide pediatricians with guidance to ultimately improve clinical outcomes in managing and preventing myopia progression in children and young adults.

Machine-learning models to predict myopia in children and adolescents.

To explore machine-learning applications in myopia prediction and analyze the influencing factors of myopia. Stratified cluster random sampling was used to select elementary school students in Shenzhen, China for inclusion in this case-control study. Myopia screening, ocular biological parameter measurements, and questionnaires were conducted. Random forest (RF), decision tree (DT), extreme gradient boosting trees (XGBoost), support vector machine (SVM), and logistic regression (LR) algorithms were used to construct five myopia prediction models using R software (version 4.3.0). These myopia prediction models were used to investigate the relationship between ocular biological parameters, environmental factors, behavioral factors, genetic factors, and myopia. This study included 2,947 elementary school students, with a myopia prevalence rate of 47.2%. All five prediction models had an area under the receiver operating characteristic curve (AUC) above 0.75, with prediction accuracy and precision exceeding 0.70. The AUCs in the testing set were 0.846, 0.837, 0.833, and 0.815 for SVM, LR, RF, and XGBoost, respectively, indicating their superior predictive performance to that of DT (0.791). In the RF model, the five most important variables were axial length, age, sex, maternal myopia, and feeding pattern. LR identified axial length was the most significant risk factor for myopia [odds ratio (OR) =8.203], followed by sex (OR = 2.349), maternal myopia (OR = 1.437), Reading and writing posture (OR = 1.270), infant feeding pattern (OR = 1.207), and age (OR = 1.168); corneal radius (OR = 0.034) and anterior chamber depth (OR = 0.516) served as protective factors. Myopia prediction models based on machine learning demonstrated favorable predictive performance and accurately identified myopia risk factors, and may therefore aid in the implementation of myopia prevention and control measures among high-risk individuals.

Parental awareness on myopia prevention and control among 350 children.

To understand the current situation of parental perspectives, knowledge, and practices concerning myopia prevention and control for both pre- and school-aged children. This study was a cross-sectional survey that involved children aged 0 to 15y and their parents. Participants were required to respond to an online questionnaire by scanning a quick response (QR) code. The questionnaire consisted of 25 tick-box questions and was open to response from December 22, 2022, to January 5, 2023. The dioptric traits of the children, the visual status and educational background of the parents, the parental perspectives towards myopia and its risks, and the parents' knowledge and practices related to myopia prevention and control were recorded and measured. The Chi-square test and binomial logistic regression were used for statistics. Totally 350 parents responded to the questionnaire. The prevalence and severity of myopia among the surveyed children exhibited a positive correlation with advancing age (P<0.001 and P=0.004, respectively). Nearly half of parents with myopic children considered myopia did not pose any health threat and could be effectively corrected (P<0.001). Parents who held master's or doctoral degree demonstrated a better understanding of children's vision standards for each age group (P=0.001), and 31.63% of them could undergo initial vision screening for their children during the age of 0 to 3y while parents with bachelor's degree (34.04%) and below (32.43%) mainly initiated the vision examination for their children at the age of 4 to 6y (P=0.05). Parents with master's or doctoral degree also exhibited more rational practices concerning outdoor time (P=0.048) and sleep time (P=0.044). No other significant discrepancy among the different educational groups in additional conceptions of myopia, such as hyperopia reserve, axis length, and corneal curvature alterations. Most parents preferred to employ conventional interventions, such as enhancing indoor lighting condition (80.00%) and ensuring appropriate reading posture and distance (71.71%). The current status of parental knowledge and practices about myopia prevention and control remains outdated and deficient. The administrative department should implement efficacious and adaptable measures to enhance parental awareness and foster their commitment towards myopia prevention and control.

Analysis of anterior corneal surface shape after replacing orthokeratology lenses carrying a small base curve diameter.

The study analyzed the changes in corneal surface shape after replacing orthokeratology lenses carrying a small base curve (BC) diameter. In this retrospective study, we included ~54 right eyes belonging to 54 myopic children who insisted on wearing an orthokeratology (ortho-k BC 6.0 mm) lens for more than 12 months and then replaced the second ortho-k (BC 6.0 mm or BC 5.0 mm) lens ~12 months. The children were categorized into two groups based on the design of the BC of the replaced ortho-k lens 6.0/5.0 and 6.0/6.0. The ratio of axial length (AL) elongation in the 6.0/5.0 group was significantly less than in the 6.0/6.0 group (-0.015 ± 0.014 mm/M vs. -0.005 ± 0.012 mm/M, t = -2.672, P = 0.010). After replacing the BC 5.0 ortho-k lens, the optical zone (8.19 ± 2.60 mm2 vs. 9.64 ± 1.57 mm2, t = -2.345, p = 0.023), reverse zone (31.64 ± 5.80 mm2 vs. 34.86 ± 4.61 mm2, t = -2.169, p = 0.035), and treatment zone (17.16 ± 3.94 mm2 vs. 22.96 ± 2.59 mm2, t = -6.049, p < 0.001) were all smaller than those in the 6.0/6.0 group. In the 6.0/5.0 group, the optical zone (wearing more than 1 month as first: 11.16 ± 2.12 mm2, the last inspection before replacing lens as before: 10.87 ± 1.90 mm2), reverse curve zone (first: 22.03 ± 3.11 mm2, before: 26.24 ± 5.06 mm2), and treatment zone (first: 35.97 ± 5.54 mm2, before: 37.11 ± 6.04 mm2) were all greater than these after replacing ortho-k lens (all P < 0.001). Replacing an ortho-k lens with a smaller BC resulted in a larger decrease in the mean central corneal zone and a substantial increase in the paracentral corneal zone. In addition, the ortho-k lens with a smaller BC does not increase the decentration distance and contributes to effective myopia control.

Refractive changes in children in the Chicago area during the COVID-19 pandemic: a retrospective observational study

BackgroundRemote learning during the COVID-19 pandemic caused behavioural changes such as increased screen time and decreased outdoor time. This study aimed to investigate myopia progression in children during the COVID-19...

Myopia Progression in School-Age Children During the COVID-19 Pandemic.

Objectives: This study aimed to investigate changes in refraction error in myopic school-age children during the COVID-19 pandemic. Methods: The data of 825 myopic children aged 7-18 years were retrospectively screened from the hospital data access system. The cycloplegic prescriptions of the patients in 2018, 2019, 2020, and 2021 were recorded. The patients were divided into three groups according to their ages: ≤10 years (Group A), 11-14 years (Group B), and ≥15 years (Group C). The mean refraction values and annual progression values were compared between the years and age groups. Results: The mean age of the patients was 13.8 ± 3.17 years. Statistical analysis for the overall sample indicated that the annual myopia progression significantly differed between 2018 and 2021 (-0.42 ± 0.37 and -0.53 ± 0.47, respectively) (p < 0.001), and there was also a significant difference in myopia progression observed in all years in the younger age group (-0.34 ± 0.44 for 2018, -0.50 ± 0.49 for 2019, and -0.76 ± 0.59 for 2020). The highest progression (-0.76 ± 0.59) was determined in the younger age group in 2020. Linear regression analysis showed a negative correlation between myopia progression from 2020 to 2021 and age (B = 0.049 and p < 0.001). Conclusions: Myopia progression has increased in school-age children during COVID-19, with the younger age group being more affected. During the COVID-19 pandemic, myopia progression in younger children has increased statistically significantly. Thus, at times when distance learning is required, it would be appropriate to plan by taking into account the myopia progression of children.

Research progress on the development of myopia prediction models and their predictive performance

The incidence of myopia is continuously increasing worldwide, especially in China, where the prevention and control of myopia is of great significance. Accurate prediction of myopia and early intervention are of great importance for slowing down the development of myopia and reducing the social burden. This article reviews the research progress of myopia prediction models and their predictive performance in recent years. It includes models based on refractive power and ocular biological characteristics, such as those using parameters such as refractive power, axial length, and percentile curves for prediction; models combined with environmental factors, which explore the relationship between myopia in school-age children and the age of onset, parents' myopia, education, and various living environmental factors; models based on genetic factors, which predict by evaluating parents' myopia status and single nucleotide polymorphisms discovered in genome-wide association studies. In addition, the article also introduces the application of artificial intelligence in myopia prediction, such as machine learning and deep learning algorithms that can predict changes in axial length growth and refractive power. These research advances provide a reference for establishing more accurate myopia prediction models and help achieve precise and personalized myopia prevention and control.

Four-Year Longitudinal Investigation of the Relationship Between Myopia and Retinal Shape in Chinese Children: The Anyang Childhood Eye Study

Purpose To investigate the longitudinal relationship between myopia and retinal shape in Chinese children. Methods A total of 2471 seven-year-old Chinese children were measured for axial length, anterior corneal radius of curvature, anterior chamber depth, lens thickness, central spherical equivalent, and peripheral refractions along the horizontal meridian (±15°, ±30°) under cycloplegia. Retinal shape was fitted using vertex radius of curvature, asphericity, and an offset. The areas under the horizontal retinal curve, the nasal side of areas under the horizontal retinal curve and the temporal side of areas under the horizontal retinal curve, were calculated. Children were tested annually for 5 years from year 0 to 4, with 1123 newly developed myopes divided into eight subgroups based on relative time to myopia onset. Results In follow-up subgroups, vertex radius of curvature showed positive correlations with central spherical equivalent from years 1 to 4. Smaller temporal side of areas under the horizontal retinal curve was associated with negative central spherical equivalent each year. Myopic shift (Δcentral spherical equivalent) was negatively correlated with baseline central spherical equivalent and with greater change in areas under the horizontal retinal curve from year 0 to 4. The absolute change in temporal side of areas under the horizontal retinal curve (0.39 ± 1.15 mm2) was significantly larger than the absolute change in nasal side of areas under the horizontal retinal curve (0.05 ± 1.11 mm2) over the 4 years. In myopia onset subgroups, temporal side of areas under the horizontal retinal curve was significantly smaller than nasal side of areas under the horizontal retinal curve. The ratio of temporal side of areas under the horizontal retinal curve/nasal side of areas under the horizontal retinal curve was closest to 1 in the year before myopia onset and decreased as myopia developed. Vertex radius of curvature, areas under the horizontal retinal curve, and temporal side of areas under the horizontal retinal curve decreased linearly as myopia progressed. Conclusion A progressive steepening of the horizontal posterior retina was associated with myopia progression. Myopia shift was negatively correlated with baseline central spherical equivalent and with greater change in posterior retinal shape. As myopia progressed, the horizontal retina shape displayed increased asymmetry.

Safety of and chorioretinal circulation during repeated low-level red-light therapy for myopic children.

To evaluate the safety of repeated low-level red-light (RLRL) therapy in children, and the dynamic evolution of choroidal and retinal blood flow. This is a single-centre, randomised, single-blind, parallel-group clinical trial. Seventy myopic children were randomly assigned to either the intervention group [receiving RLRL therapy plus single-vision spectacle (SVS)] or the control group (wearing SVS). Participants underwent comprehensive ophthalmic examinations following their first irradiation, 9 months continuous RLRL therapy and stop of treatment. Quantitative analyses of choroidal and retinal microcirculation were analysed via optical coherence tomography angiography. Over 9 months of treatment, while the RLRL treatment demonstrated significantly less increases in refractive error and axial length compared with the SVS treatment (ps < 0.05), no abnormalities in fundus structure or visual function (mfERG, VEP and microperimetry) were detected (ps > 0.05). A single red-light exposure did not exert a significant influence on choroidal thickness (ps > 0.05). Upon continuous treatment, the RLRL group achieved peak values in these circulations at 9 months (ps < 0.05). Following cessation of exposure, all circulations exhibited a declining trend, reaching similar levels in both groups (ps > 0.05). As the frequency of red-light exposures intensified, there was a consistent surge in these circulations (ps < 0.05). Nine months of continuous RLRL exposure does not cause toxic side effects on retinal or optic nerve functions, and there is a time-dependent cumulative response in choroidal and retinal circulation.

Genetic background of high myopia in children.

High myopia is a significant risk factor for irreversible vision loss and can occur in isolation or as a component of various syndromes. However, the genetic basis of early-onset high myopia remains poorly understood. We aimed to identify the causative genetic variants for high myopia in a cohort of Slovenian children. The study included children referred to a tertiary paediatric ophthalmology centre at the University Eye Clinic in Ljubljana between 2010 and 2022. The participants met the following inclusion criteria: age ≤ 15 years and high myopia ≤-5.0 D before the age of 10 years. Genetic analysis included exome sequencing and/or molecular karyotyping. Participants were categorized based on clinical presentation: high myopia with systemic involvement, high myopia with ocular involvement, and isolated high myopia. Genetic analysis of 36 probands revealed a genetic cause of high myopia in 22 (61.1%) children. Among those with systemic involvement (50.0%), genetic causes were identified in 13 out of 18 children, with Stickler's and Pitt-Hopkins being the most common syndromes. Among cases of high myopia with ocular involvement (38.9%), a genetic cause was found in 8 out of 14 probands, including (likely) pathogenic variants in genes related to retinal dystrophies (CACNA1F, RPGR, RP2, NDP). The non-syndromic ARR3- associated high myopia was identified in the isolated high myopia group. A genetic cause of high myopia was identified in 61.1% of children tested, demonstrating the value of genetic testing in this population for diagnosis and proactive counseling.

Assessing The Relationship Between Screen Time andMyopia In Children Aged 5-12 Ibadan South-West Local Governmen

This study investigated the relationship between screen time and myopia in children aged 5-12 years in Ibadan South-west Local Government, Nigeria. Guided by three specific purposes and research questions, the study examined how screen exposure, parental behaviors, and socioeconomic status influenced the development of myopia in young children. A descriptive survey research design was adopted. A sample of 300 children aged 5-12 years was selected from primary schools using a multistage sampling method. Two main instruments were used for data collection: a structured questionnaire for parents and an eye examination for children. The questionnaire was reviewed by experts in child health, education, and visual health to ensure content validity. The test-retest method was employed to establish reliability, with a Cronbach’s alpha coefficient of 0.70. Data were analyzed using descriptive statistics, including frequency counts, percentages, means, and standard deviations, to summarize demographic data, screen time duration, and the prevalence of myopia among participants. The findings revealed that prolonged screen time was significantly associated with higher rates of myopia among children. Children exposed to more than 2 hours of screen time daily had a higher prevalence of myopia. Passive screen activities, such as watching television, were found to have a stronger association with myopia than active screen use, like educational or interactive activities. Parental behaviors and lower socioeconomic status were also linked to increased screen exposure and higher rates of myopia. The study concluded that excessive screen time poses a significant risk for myopia in children and highlighted the need for public health interventions and parental education to manage screen time effectively and support healthier visual development.

Peripapillary hyperreflective ovoid mass-like structure (PHOMS): prevalence, risk factors, and development over time in Danish myopic children

BackgroundOn optical coherence tomography (OCT) scans of the optic nerve head, peripapillary hyperreflective ovoid mass-like structures (PHOMS) are sometimes seen as a sign of axonal distension. The phenomenon has been reported more frequently in myopic subjects. We investigated PHOMS-prevalence in a myopic pediatric cohort, associated risk factors, and PHOMS development over 18 months during low-dose atropine treatment. MethodsIn this post hoc analysis of an investigator-initiated, placebo-controlled, randomized clinical trial, 97 6- to 12-year-old myopic participants were randomized to 0.1% atropine for 6 months, then 0.01% for 18 months (N = 33), 0.01% for 24 months (N = 32) or placebo for 24 months (N = 32). Primary outcome was presence of PHOMS. Secondary outcome was mean nasal PHOMS diameter measured on OCT B-scan. Outcomes were reported at baseline, 6, and 18 months. Logistic regression and linear mixed modelling were performed. ResultsPHOMS were present in 26% of participants (n = 25), and 52% (n = 13) had bilateral presentation. Optic disk tilt (OR = 10.81; 95% CI, 3.58-32.58 [P < 0.001]) and longer axial length (AL) (OR = 2.06; 95% CI, 1.02-4.17 [P = 0.04]) increased the risk of having PHOMS. Greater increase in nasal peripapillary choroidal thickness over time was associated with smaller PHOMS diameter at 18 months (P = 0.05). ConclusionsPHOMS were common in our cohort of children with myopia. Longer AL increases the risk of, but not size of, PHOMS. The diameter of PHOMS seemed stable over time and unaffected by low-dose atropine.

Clinical Investigation of Short-Term Axial Elongation Control After Orthokeratology Lens Correction: Exploring Its Predictive Role in Long-Term Therapeutic Efficacy

Objective: This study was developed with the goal of exploring the efficacy of orthokeratology (OK) as an approach to controlling axial length (AL) growth and identifying factors predictive of the long-term efficacy of this approach. Methods: This was a retrospective study that enrolled 157 myopic children 7 to 15 years of age undergoing OK correction for over 3 years. The short- and long-term effectiveness of this approach at 1 and 3 years post-OK correction, respectively, was assessed. All participants were classified into two groups based on whether they exhibited good or poor long-term efficacy outcomes. Measurements of changes in AL were made at baseline and at 1 and 3 years post-OK. Univariate analyses and binary logistic regression approaches were used to evaluate baseline age, baseline spherical equivalent refraction, baseline keratometry (K) values of flat and steep meridians, and short-term effectiveness with the goal of identifying predictors of long-term efficacy. Results: Univariate analyses led to the identification of significant differences in baseline age, baseline spherical equivalent refraction, baseline AL, and short-term efficacy between these two groups (P&lt;0.05), whereas gender, baseline flat K, and baseline steep K did not differ significantly (P&gt;0.05). In binary logistic regression analyses, baseline AL (P=0.017) and short-term efficacy (P&lt;0.001) were both found to significantly influence long-term efficacy. Receiver operating characteristic curves demonstrated that short-term efficacy offered an area under the curve value &gt;0.8, consistent with its highly accurate performance as a predictor of long-term efficacy. Conclusion: These results suggest that short-term efficacy outcomes can feasibly be used to predict the long-term effectiveness of OK correction in children. In patients exhibiting poor short-term efficacy, timely replacement or the incorporation of additional treatment modalities may aid efforts to better control the progression of myopia.

Reduction of screen induced myopia by parental interventions

Abstract Background Excessive use of digital devices, including smartphones and tablets, has been shown to increase the risk of myopia in children. Gaps persist in understanding parental attitudes towards handheld screen use and effective interventions guiding eye health policies. This study examined the associations between parental behavior related to myopia and children’s handheld screen use. Methods Data obtained from 395 parents of pre-adolescents (Mean age 10.63; SD 1.09) were used, collected from an online community panel. Parents reported on various behavioral determinants related to myopia and their child’s screen time: knowledge, attitude, risk perception and self-efficacy. They reported on their child’s frequency and amount of screen use. Logistic regression analysis was used to assess associations between variables, using parental efforts to reduce screens as outcome measure. Results Of the 395 participating 9-12 year-olds, 73.4% of the children spent up to two hours a day on recreational handheld screens, 26% more than two hours. Of the parents surveyed, 28.1% perceived the risk of screen-induced myopia as significant, prompting 62.6% of them to take active measures to minimize screen time. The more knowledge parents had on child myopia the more they attempted to reduce screen time (OR = 2.57; 95% CI [1.57-4.19], p = &amp;lt;.001). Moreover, a more negative attitude towards screens was significantly related to attempting to reduce screen time (OR = 1.26; 95% CI[1.17-1.35],p = &amp;lt;.001). Key messages • These findings emphasize a need to address parental knowledge and attitude towards myopia and screen time reduction. • We recommend increasing knowledge, influencing attitude and searching for alternatives as a part of behavioral change strategies.