Lower Spherical Equivalent Research Articles

Combination Therapy with Atropine 0.05% and Myopi-X® Glasses: Is it Effective in Myopia Control?

To investigate whether the combination therapy of Myopi-X® peripheral progressive addition lenses (PAL; Novax®) and atropine 0.05% provides an additive effect compared to monotherapies with either Myopi-X® PAL or atropine 0.05%. This retrospective cross-sectional study reviewed the clinical records of 51 patients, categorized into three groups: 27 in the Myopi-X group, 13 in the atropine 0.05% group, and 11 in the combination therapy group using Myopi-X peripheral PAL with atropine 0.05%. Baseline characteristics, including age, cycloplegic spherical equivalent (SE), and axial length (AL), were compared between the groups. Twelve months after treatment initiation, changes in SE and AL were assessed and compared between the groups. Among the 51 patients analyzed, the baseline characteristics differed significantly between the groups, with the atropine 0.05% group showing a higher average age, longer AL, and lower SE compared to the other groups. After 12 months, no significant differences were found in SE changes between the treatment groups (p=0.35). Similarly, changes in AL did not significantly differ between the groups (p=0.10), although age had a significant impact on AL change (p=0.01). No significant differences were observed in pairwise comparisons of SE or AL changes between the groups. In this study, combining atropine 0.05% with Myopi-X PALs did not provide an additive benefit. The literature suggests that both treatments are effective in slowing myopia progression individually; however, in our study, their combination did not significantly improve SE progression or axial elongation compared to monotherapies. Further randomized studies with larger patient groups are needed to confirm these findings and assess long-term effects.

6/0 PROLENE DOUBLE-FLANGED INTRAOCULAR LENS SUTURELESS SCLERAL FIXATION WITH A 27-GAUGE NEEDLE FOR INTRAOCULAR LENS SURGERY.

To report the initial experience of a modified intraocular lens (IOL) scleral fixation technique using 6/0 prolene in a double-flanged sutureless technique with a 27-gauge needle. Twenty-nine consecutive patients with IOL surgery were retrospectively reviewed between December 2021 and October 2023. Early Treatment Diabetic Retinopathy Study letters, spherical equivalent (SE), astigmatism axial degree, and intraocular pressure were evaluated at baseline and 1, 2, 3, and 6 months postoperatively. Surgery-related complications were evaluated during follow-up. Early Treatment Diabetic Retinopathy Study letters or SE at 1, 2, 3, and 6 months postoperation was significantly improved compared with baseline levels. Patients with younger (estimate [SE] = 8.011 [2.485], P = 0.006), preoperative lens drop (estimate [SE] = 8.621 [2.906], P = 0.009), idiopathic cataract (estimate [SE] = 6.021 [2.099], P = 0.048), high baseline Early Treatment Diabetic Retinopathy Study letters (estimate [SE] = 15.449 [2.352], P < 0.001), or low baseline SE (estimate [SE] = 6.357 [2.406], P = 0.018) had the greatest improvement in Early Treatment Diabetic Retinopathy Study letters during follow-up. Patients with preoperative lens or IOL dislocation had a greater postoperative SE improvement than those with preoperative lens or IOL subluxation (dislocation vs. subluxation: estimate [SE] = -189.235 [70.692], P = 0.016). There were no cases of vitreous hemorrhage, cystoid macular edema, endophthalmitis, subluxation, or dislocation were observed during the 6-month follow-up. This modified IOL scleral fixation technique is a simple, safe, and efficient method that avoids haptic manipulation and slippage, reduces postoperative complications, achieves completely sutureless surgery, and results in an achievement of surgical refractive goals.

Excimer Laser-Assisted Deep Anterior Lamellar Keratoplasty Versus Penetrating Keratoplasty for Patients With Keratoconus: A Retrospective Analysis From the Homburg Keratoconus Center.

To evaluate the outcome of excimer laser-assisted deep anterior lamellar keratoplasty (Exc-DALK) and penetrating keratoplasty (Exc-PKP) for keratoconus (KC). We included 123 eyes and compared the outcome of 30 eyes undergoing big-bubble Exc-DALK after stromal debulking (G1) against a matched group of 83 eyes undergoing Exc-PKP (G2) in our department. G2 was created after performing a pseudorandom stratified bootstrapping of our PKP database starting with 2802 surgeries with removal of any bias. Main outcomes included best corrected visual acuity (BCVA), spherical equivalent (SE), tomographic changes, and endothelial cell density (ECD). Data were compared preoperatively, postoperatively with 2 double-running cross-stitch sutures according to Hoffmann [2 and 10 months postoperatively (T1 and T2)], after first suture removal [15 months postoperatively (T3)], and after final suture removal [26 months postoperatively (T4)]. Preoperatively, all parameters were comparable without significant differences. At T1, G1 showed significantly better BCVA (P = 0.01), lower SE (P = 0.04), lower anterior and posterior topographic astigmatism (ATA and PTA, P < 0.01), lower maximal keratometry (P = 0.02), and lower central corneal thickness (P < 0.01). At T2, G1 showed significantly better BCVA (P = 0.04), lower PTA (P < 0.01), and higher ECD (P < 0.01). At T3, G1 showed significantly lower ATA (P = 0.01) and PTA (P < 0.01) and higher ECD (P = 0.02). At T4, G1 showed significantly lower PTA and higher ECD (P < 0.01) but no significant difference in BCVA (P = 0.07). Exc-DALK provided faster visual rehabilitation and represented an endothelial cell-sparing method compared with Exc-PKP. After final suture removal, Exc-DALK showed noninferior outcomes compared with Exc-PKP if the graft was placed on naked Descemet membrane.

Refractive and ocular biometric characteristics of non-myopic and pseudomyopic eyes in mild hyperopic Chinese children aged 3–12 years

PurposeTo investigate the refractive and ocular biometric characteristics of children with mild hyperopia and distinguish between non-myopic and pseudomyopic eyes before cycloplegia. MethodsThe eligible children underwent refractive error measurements using a NIDEK autorefractor before and after the administration of 0.5 % tropicamide. Ocular biometric parameters, including axial length (AL), anterior chamber depth (ACD), and lens thickness (LT), were measured using the IOLMaster 700 before cycloplegia. We performed comparative analyses between the non-myopic and pseudomyopic groups, categorized based on whether the spherical equivalent (SE) before cycloplegia exceeded −0.50 diopters (D). Univariable and multivariable regression analyses were performed to control for confounding factors. ResultsThe final analysis included 968 eyes. The participants with pseudomyopia were more likely to be boys (P = 0.029), younger (P = 0.004), less hyperopic (P < 0.001) after cycloplegia, and exhibit a higher delta SE (P < 0.001) compared to the non-myopic participants. Pseudomyopic eyes were associated with a shallower ACD (P = 0.004) and thicker LT (P < 0.001) than non-myopic eyes. After adjusting for sex, age, and SE, pseudomyopic eyes showed increased AL (P = 0.001) and LT (P < 0.001) and decreased ACD (P = 0.005) compared with non-myopic eyes before cycloplegia. ConclusionsAmong the children with mild hyperopia, pseudomyopia was more common in younger boys with a lower cycloplegic SE and higher delta SE. A thicker LT, shallower ACD, and increased AL may indicate the presence of pseudomyopia, which may provide insights into the rapid progression of myopia in children with pseudomyopia.

Association Between Peripheral Retinal Defocus and Myopia by Multispectral Refraction Topography in Chinese Children.

To investigate the association between the peripheral refractive errors of the fundus in different regions and moderate and high myopia. In this case-control study, 320 children and adolescents aged 6 to 18 years were recruited. Peripheral refractive errors were measured using multispectral retinal refractive topography (MRT). Spherical equivalent (SE) and cylinder errors were classified into low, moderate, and high categories based on the magnitude range. Logistic regression was performed to test the factors associated with myopia. There were 152 participants with low myopia and 168 participants with moderate and high myopia included in the current study. Participants with moderate and high myopia were most likely to be older, with larger axial length (AL), lower SE, less time to watch electronic devices on the weekend, a higher difference between central refractive error and paracentral refractive error from the superior side of the retina (RDV-S), but a smaller difference between the central refractive error and paracentral refractive error from the inferior side of the retina (RDV-I) than those with low myopia (all P <0.05). After logistic analysis, female sex (odds ratio [OR] = 4.14; 95% confidence interval [CI] = 2.16-7.97, P <0.001), AL (OR = 6.88, 95% CI = 4.33-10.93, P <0.001), and RDV-I (OR = 0.52, 95% CI = 0.32-0.86, P = 0.010) were independent factors for moderate and high myopia. Our study demonstrated that the retina peripheral refraction of the eyes (RDV-I) was associated with moderate and high myopia, and RDV-S was only associated with high myopia.

Clinical Features of Fundus Tessellation and Its Relationship with Myopia: A Systematic Review and Meta-analysis.

This study aims to assess the existing literature on fundus tessellation (FT), focusing on its prevalence, associated factors, distribution, and progression. Systemic methods were employed to search and gather published literature on FT from databases such as the National Library of Medicine (PubMed), Web of Science (WOS), and Elsevier on July 1, 2023. The quality of the studies was evaluated using the Newcastle-Ottawa Scale (NOS) and the Healthcare Research and Quality (AHRQ) criteria. A meta-analysis was conducted to compare tessellated and normal fundus with respect to age, gender, axial length, and spherical equivalent. The systematic review included 23 articles, encompassing a total of 3053 eyes in the meta-analysis. The prevalence of FT varied from 43.00 to 94.35%. The severity of FT was significantly associated with older age, male sex, lower body weight index, longer axial length, larger peripapillary atrophy, thinner choroid, thinner sclera, and larger corneal radius of curvature, suggesting a potential progression pattern. Notably, FT was observed predominantly in the macular and peripapillary regions. The meta-analysis revealed that tessellated fundus tended to be associated with older age (mean difference [MD] 4.76, 95% confidence interval [CI] 1.71-7.80, P < 0.01), longer axial length (MD 0.86, 95% CI 0.70-1.02, P < 0.01), and a lower spherical equivalent (MD - 1.16, 95% CI - 1.68 to 0.65, P < 0.01) compared to normal fundus. However, there was no significant difference in the proportion of males between individuals with tessellated and normal fundus (odds ratio [OR] 1.12, 95% CI 0.89-1.42, P = 0.32). Overall, this systematic review and meta-analysis shed light on the prevalence, characteristics, and factors associated with FT, offering valuable insights for clinicians and researchers in the field of ophthalmology. The study protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023442486).

Myopia progression and associated factors of refractive status in children and adolescents in Tibet and Chongqing during the COVID-19 pandemic.

To investigate myopia progression and associated factors of refractive status among children and adolescents in Tibet and Chongqing in China during the COVID-19 pandemic. A population-based cross-sectional study was conducted to compare rates of myopia and high myopia, axial length (AL), spherical equivalent (SE), outdoor activity time, digital device use, and frequency of visual examinations for children and adolescents affected by myopia in Chongqing and Tibet in 2021. A total of 2,303 students from Chongqing and 1,687 students from Tibet were examined. The overall prevalence of myopia and high myopia in these two groups were 53.80 and 7.04% vs. 43.86 and 1.30%, respectively in each case. The Chongqing students had a longer AL than the group from Tibet (23.95 vs. 23.40 mm, respectively; p < 0.001). The mean SE of the students with myopic parents in Tibet was lower than that of the students in Chongqing with myopic parents (-2.57 ± 2.38 diopters (D) vs. -2.30 ± 2.34 D, respectively) (p < 0.001). Conversely, the mean SE of the students from urban areas in Chongqing was lower than that of the students in Tibet (-2.26 ± 2.25 D vs. -1.75 ± 1.96 D, respectively; p < 0.001). The Chongqing students exhibited lower SE (-2.44 ± 2.22 D) than their Tibetan counterparts (mean SE: -1.78 ± 1.65 D (p = 0.0001) when spending more than 2.5 h outdoors. For example, 61.35% of the students in Tibet spent more than 2.5 h outdoors daily, compared with 43.04% of the students in Chongqing. Correspondingly, the proportion of students using digital devices in Tibet (64.43%) was lower than that in Chongqing (100%). For the latter, 38.62% of the students in Chongqing spent more than 2.5 h online using digital devices compared to 10.49% of the students in Tibet. Greater monitoring of visual status was observed for the Chongqing students (mean SE: -1.90 ± 1.98 D) compared with students in Tibet (mean SE: -2.68 ± 1.85 D) (p = 0.0448), with the frequency of optimal examinations being every 6 months. Outdoor activity time was identified as a common risk factor for myopia in both of the populations examined, with odds ratios (ORs) of 1.84 (95% CI: 1.79-1.90) in Chongqing and 0.84 (95% CI: 0.73-0.96) in Tibet. Digital screen time was associated with myopia and high myopia in Chongqing, with ORs of 1.15 (95% CI: 1.08-1.22) and 1.06 (95% CI: 0.94-1.77), respectively. Digital screen time was also found to be a risk factor for high myopia in Tibet (OR: 1.21, 95% CI: 0.77-1.61). The type of digital devices used was also associated with myopia and high myopia in Tibet (OR: 1.33, 95% CI: 1.06-1.68 and OR: 1.49, 95% CI: 0.84-2.58, respectively). Finally, examination frequency was found to correlate with high myopia in the Tibet group (OR: 1.79, 95% CI: 0.66-2.71). Based on our data, we observed that the prevalence of refractive errors in children and adolescents was significantly lower in Tibet than in Chongqing. These results are potentially due to prolonged outdoor activity time, and the type and time of use for digital devices that characterize the group of children and adolescents from Tibet. It is recommended that parents and children in Chongqing would benefit from increased awareness regarding myopia progression and its prevention.

Comparison of the cycloplegic refractive measurements with handheld, table-mounted refractometers and retinoscopy in children

Background: Handheld autorefractometers are now widely used for screening refractive errors in children. The purpose of the study was to compare the refractive measurements from table-mounted, handheld autorefractometers and retinoscopy in children. Material and methods: Measurements in children with poor visual acuity and/or strabismus were obtained with the handheld 2WIN and the table-mounted Nidek ARK-1 refractometers and retinoscopy after the instillation of 0.5% atropine. Data on the sphere, spherical equivalent (SE), and cylindrical vectors at 0 degrees (J0) and 45 degrees (J45) were analysed. Results: Data were collected from 57 children (mean age, 4.3 years ± 2.0 years). The 2WIN refractometer measure statistically significantly lower SE mean values than the Nidek ARK-1 or retinoscopy (1.67 ± 1.48 D, 2.96 ± 1.95 D, 2.92 ± 1.93 D, respectively). The 95% LOA was the narrowest for sphere, SE, J0, and J45 vector for Nidek ARK-1 refractometer and retinoscopy. The difference between the measurements of 2WIN and retinoscopy and 2WIN and Nidek ARK-1 was more pronounced in higher refractive values for sphere, SE, J0, and J45. Conclusion: The table-mounted autorefractor provided a reading more similar to that of streak retinoscopy than to that of the handheld autorefractor. The differences between the 2WIN and the other two methods were more pronounced in the higher refractive values, so careful interpretation of the autorefraction results would be advised, especially in children with higher refractive values who are at most significant risk for amblyopia.

Analysis of factors associated with unintended initial dissection of the posterior plane during small incision lenticule extraction.

BackgroundTo investigate potential risk factors for unintended initial dissection of the posterior plane in the initial learning curve of small incision lenticule extraction (SMILE).MethodsData were derived from consecutive 263 eyes of 136 patients who underwent SMILE at the beginning of the surgeon’s learning curve. Probabilities of unintended initial dissection of the posterior plane in left and right eyes were analyzed. Preoperative sphere, cylinder, spherical equivalent (SE), J0, J45, lenticular diameter, lenticular thickness, corneal thickness, and axial length were assessed between eyes in which posterior plane dissection was unintended and those in which it was not.ResultsUnintended initial dissection of the posterior plane occurred in 29 eyes, corresponding to an incidence rate of 11.03%. The probability of difficulty in plane dissection in the left eye was significantly higher than that in the right eye (P=0.003). Significant differences were found in sphere (T =2.8, P=0.006), SE (T =2.37, P=0.019), J0 (T =2.05, P=0.043) and axial length (T =−2.79, P=0.006) between eyes with and without unintended initial dissection of the posterior plane.ConclusionsIn the present study, difficulty in plane dissection during SMILE was encountered significantly more often in left eyes for a right-hand doctor, and in eyes with low SE or high J0 values. Special attention should be paid to prevent unintended initial dissection of the posterior plane in such situations.

Outcome Predictors of SD-OCT-Driven Intravitreal Ranibizumab in Choroidal Neovascularization due to Myopia

Purpose: To analyze the efficacy and outcome predictors of SD-OCT (spectral-domain optical coherence tomography)-driven ranibizumab treatment in patients with choroidal neovascularization due to myopia (mCNV). Methods: This prospective investigator-initiated study includes 20 patients with treatment-naïve mCNV. Evaluation included best-corrected visual acuity (BCVA), morphological SD-OCT parameters, and treatment frequency. Results: From baseline to month 12, BCVA improved from 58.5 ± 16.9 to 66.1 ± 14.9 letters. Central retinal thickness (CRT) significantly decreased, and qualitative SD-OCT parameters improved. Better baseline visual acuity (VA), lower spherical equivalent, better inner/outer segment line and external limiting membrane integrity showed a significant positive effect on BCVA outcome. Less fluctuation in CRT (worst minus best CRT) indicated better BCVA at 12 months. No serious adverse events occurred. Conclusions: SD-OCT-guided intravitreal ranibizumab treatment in mCNV was efficient and safe. We determined useful predictive factors in regard to VA outcome after 12 months.

Role of Gender in the Prevalence of Myopia among Polish Schoolchildren.

Purpose The aim of the paper was to study the role of gender in the progression of myopia among Polish schoolchildren. Materials and Methods 4875 children from elementary schools and high schools were examined (2470 boys, aged 6–16 years, mean age 11.0, SD = 2.6 and 2405 girls, aged 6–16 years, mean age 11.1, SD = 2.6). The examined students were Caucasian and resided in and around Szczecin, Poland. The examination included retinoscopy under cycloplegia. The refractive error readings were reported as spherical equivalent (SE). Myopia was defined as SE of at least −0.5 D. Data analysis was performed using the Mann–Whitney U test and 2-sided Fisher's exact test. p values of less than 0.05 were considered statistically significant. Results It was found that the SE among Polish boys is similar to the SE among Polish girls before the age of 9 years. However, in older children, lower SE values and higher prevalence of myopia were found among girls than boys, both at 9–13 years range (0.45 ± 1.05 vs 0.55 ± 1.23 D, p=0.047 and 8.30% vs 5.71%, p=0.015, respectively) and at 13–16 years range (0.32 ± 1.14 vs 0.54 ± 1.08 D, p=0.0093 and 10.37% vs 5.96%, p=0.0050), respectively. Conclusions Gender is associated with the prevalence of myopia among Polish schoolchildren ranging from 9 to 16 years of age.

Factors That Influence Refractive Changes in the First Year of Myopia Development in Premature Infants.

Purpose To study the development of refractive status from 36 weeks to one year of postmenstrual age and to identify factors that contribute to development of myopia, including gender, birth weight, gestational age, and retinopathy of prematurity (ROP). Methods Premature infants underwent full cycloplegic retinoscopy at 36 weeks, 38 weeks, 40 weeks, 42 weeks, 44 weeks, 46 weeks, 48 weeks, 3 months, 6 months, 9 months, and 12 months of postmenstrual age. The infants were grouped by gender, birth weight, gestational age, and the severity of ROP to evaluate the correlation with refractive status at each postmenstrual age. Results A total of 942 infants were recruited in this study. A total of 2716 readings were obtained. Refractive state had a hyperopic shift until 46 weeks of postmenstrual age (r = 0.42, P < 0.0001). After that, the mean spherical equivalent (SE) gradually declined (r = −0.30, P < 0.0001). Boys had lower hyperopia than girls at nine months (t = 3.10, P=0.003) and one year (t = 3.34, P=0.001) of postmenstrual age. Premature infants with ROP had a lower average SE at most of the postmenstrual ages; however, this value did not vary significantly (P > 0.05). Premature infants with severe ROP were less hyperopic than those without it at every postmenstrual age, and the average SE differed significantly at one year of postmenstrual age (t = 2.60, P=0.011). There was no significant difference between each birth weight and gestational age (P > 0.05). Conclusions The dioptric value of premature infants within one year was generally hyperopic. Different gender, birth weight, gestational age, and ROP did not affect the overall development of refractive status. Females may have higher hyperopia at nine months of postmenstrual age. Birth weight and gestational age had little effect on change of refractive status. Severe ROP was an important contributing factor in myopia progression, which may be related to the treatment required. Further study may be carried out to understand the mechanism behind myopia progression in premature infants, including changes in refractive system parameters and emmetropization process.

Longitudinal Changes in Spherical Equivalent Refractive Error Among Children With Preschool Myopia.

Preschool myopia generally indicated a high risk of progression to high myopia. However, no previous study has reported its longitudinal evolution. This study aimed to investigate the longitudinal changes in preschool myopia and explore the associated key determinants. Medical records of patients seeking refractions at Zhongshan Ophthalmic Center between 2009 and 2017 were retrospectively reviewed. Mean rates of change in spherical equivalent (SE) refractive errors were evaluated in patients with preschool myopia. Association between the rate of change in SE and patient characteristics at the initial visit were examined using linear mixed-effect regression models. A total of 495 cases (median initial age: 5.12 years, interquartile range [IQR], 4.12-5.76 years) were assessed with at least 2-year follow-up. The initial median SE was -3.00 D (IQR, -5.25 to -1.75 D) and the median duration of follow-up was 3.69 years (IQR, 2.89-4.99 years). On average, myopia progressed by -0.59 ± 0.47 D/year. A total of 312 (63.0%) children demonstrated myopia progression (mean rate of change in SE ≤ -0.50 D/year in either eye) and 177 (35.8%) children demonstrated refraction stability (mean rate of change < ±0.50 D/year in both eyes). Older age (β = -0.06, P = 0.003), female sex (β = -0.09, P = 0.035), and initial lower myopic SE (β = -0.07, P < 0.001) were associated with faster myopia progression. Preschool myopia on average progresses, although considerable proportion of subjects demonstrates longitudinal refraction stability. The rate of myopia progression is associated with initial patient characteristics.

Predictive factors for efficacy and safety in refractive surgery for myopia.

PurposeTo evaluate the predictive factors for safety and efficacy in laser refractive surgery for myopiaSettingA singular refractive surgery center, at a University-affiliated tertiary medical center.DesignRetrospective cohort studyMethodsStudy population—A total 8,775 eyes having laser refractive laser procedures for myopia (in4,623 patients).Observation procedures–Using a prospective database of refractive procedures performed over the span of 13 years, variables such as gender, age, type of surgery, date of surgery, pre-operative corneal thickness and Spherical Equivalent (SEQ) were evaluated.Main outcome measures—Proportion of patients with Safety index higher than 0.85 and Efficacy index higher than 0.80.Results91.9% and 86.0% of all evaluated eyes were above the safety and efficacy cut-off levels, respectively. Younger age was significantly correlated with safety and efficacy indices above the cut-off levels (p<0.001). Male gender was significantly correlated with efficacy above the cut-off level (p<0.001). Myopic eyes with lower SEQ were associated with both safety (p = 0.002) and efficacy (p<0.001) indices above the cut-offs. The surgical procedure was found to significantly affect the outcome only using univariate analysis: Safety was higher in Photorefractive Keratectomy (PRK), while Efficacy was higher in Laser Assisted In Situ Keratomileusis (LASIK) (p<0.001, respectively) but no difference was found using multivariate analysis. Safety index above the cut-off level increased over the years (p<0.001).ConclusionsEfficacy in refractive surgery for myopia is correlated with younger age, male gender and low myopia. Safety is correlated with younger age, low myopia and increases over the years. Multivariate analysis found no differences between PRK and LASIK regarding safety and efficacy.

Minimum pupil in pupillary response to light and myopia affect disk halo size: a cross-sectional study

ObjectivesTo evaluate the relationship between pupillary response to light, myopia and disk halo size.DesignCross-sectional study.SettingSingle refractive surgery centre.ParticipantsIn this study, 197 right eyes of 197 patients between 20 and 35...

Long-term Visual Outcomes Comparing Descemet Stripping Automated Endothelial Keratoplasty and Penetrating Keratoplasty

To compare 5-year visual acuity and refraction outcome in Descemet stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) for Fuchs endothelial dystrophy (FED) or bullous keratopathy (BK) in Asian eyes. Prospective interventional case series. We analyzed 828 consecutive cases of DSAEK (423) or PK (405) for FED and BK from the Singapore Cornea Transplant Registry performed from 1991 to 2011. Our main outcome measures were best spectacle-corrected visual acuity (BSCVA) with astigmatism (cylinder) and spherical equivalent (SE) over 5 years of follow-up. Mean age was 67.5 ± 11.5 years (50.1% male, 49.9% female) and majority was Chinese (76.6%, n= 634) in our multiracial Asian population. DSAEK eyes had significantly better BSCVA (P < .001-.037) with lower SE (P < .001-.017) and cylinder (P < .001), independent of surgical indication, compared to PK over 5 years. DSAEK was superior to PK over 5 years (P < .001-.026) in FED, but only over 3 years in BK (P < .001-.031). DSAEK in FED eyes had significantly better BSCVA compared to BK eyes (P= .006 at 4-year follow-up). DSAEKs with preoperative BSCVA < 1.3 logMAR had significantly better visual outcomes than cases with ≥ 1.3 logMAR (P < .001-.042). PKs had significantly higher postoperative refractive correction than DSAEKs, with no significant influence of the surgery indication. In our study cohort, DSAEK provided significantly better long-term BSCVA and lower astigmatism than PK over 5 years of follow-up. Visual outcomes of DSAEK for FED were better than BK. In some analyses for years 1-3, analysis of covariance adjustment indicated that this DSAEK-associated better long-term BSCVA was independent of better preoperative vision in DSAEK eyes.

Evaluation of Refractive Errors and Ocular Biometric Outcomes after Intravitreal Bevacizumab for Retinopathy of Prematurity

ABSTRACTPurpose: To assess ocular biometric outcomes following intravitreal bevacizumab (IVB) monotherapy for retinopathy of prematurity (ROP) and compare these results with those of laser photocoagulated infants and with the ones with spontaneously regressed ROP.Materials and methods: Premature infants including those who underwent IVB monotherapy (Group 1) or laser photocoagulation (Group 2) for ROP and infants with spontaneously regressed ROP (Group 3) were recruited for the study. Refractive errors and ocular biometric parameters (Axial length [AL], anterior chamber depth [ACD], and lens thickness [LT]) were measured at adjusted 1 year of age in all subjects.Results: There was no significant difference of spherical equivalent (SE) value between the groups (P = 0.781). The incidence of high myopia was 7.4% in Group 1 and 12.7% in Group 2 (P = 0.081). No infants exhibited high myopia in Group 3. LT was greater in Group 2 when compared to Group 1 and Group 3 (P = 0.011). Lower SE was significantly correlated to longer AL in Group 1 (r = −0.656, P = 0.015). There was a significant positive correlation between SE and ACD values in Group 2 (r = 0.391, P = 0.005).Conclusion: The study showed no significant difference of SE between the groups. High myopia was only present among the treated infants either with IVB or laser. Infants who received laser treatment significantly had thicker lenses.

Refractive errors and refractive development in premature infants

To examine refractive errors and refractive development in premature infants. Premature infants in the retinopathy of prematurity (ROP) screening program were recruited and examined longitudinally between 28 and 58 weeks postmenstrual age. For performing cycloplegic retinoscopy, 1% tropicamide was administered, two drops with a 10-minute interval, in order to paralyze accommodation and to achieve cycloplegia. Birth weight, gestational age, gender and acute ROP disease were recorded. The relationship between spherical equivalent, astigmatism and postmenstrual age was evaluated. A total of 798 readings were obtained from 258 infants (131 females, 127 males) between 28 and 58 weeks postmenstrual age. The median number of examinations was 3 (minimum 1, maximum 7). In the comparisons of birth weight, gestational age, spherical equivalent and astigmatism between genders, there were no statistically significant differences (P>0.05). Gestational age (regression analysis, r(2)=0.30, P<0.01) and birth weight (regression analysis, r(2)=0.22, P<0.01) had a significant effect on refractive error development. Preterm babies with lower birth weight and those born more prematurely had lower spherical equivalent. The spherical equivalent of the eyes correlated significantly with the postmenstrual age of the infants (r=0.512, P<0.01). Infants with low gestational age and low birth weight also had low spherical equivalent. Moreover, spherical equivalent correlated with increasing postmenstrual age. However, astigmatism did not correlate with postmenstrual age and did not associate with gestational age or birth weight.

Central vault after phakic intraocular lens implantation: Correlation with anterior chamber depth, white-to-white distance, spherical equivalent, and patient age

To compare the central postoperative vault of a phakic intraocular lens (pIOL) to correct myopia, myopic astigmatism, and hyperopia and identify ocular and lens parameters that might predict the vault amount. Fernández-Vega Ophthalmological Institute, Oviedo, Spain. Cohort study. Three months after implantation of Implantable Collamer Lens pIOLs to correct myopia, hyperopia, and myopic astigmatism, central vault was measured using optical coherence tomography. Patients were divided into groups according to the preoperative anterior chamber depth (ACD) to compare the effects of ACD, white-to-white (WTW) distance, and lens diameter on postoperative pIOL vault. Hyperopic pIOLs had statistically significantly lower vault followed by myopic pIOLs and toric pIOLs, which had a higher mean value and narrower range (260 to 860 μm). Measured vaults had a positive correlation with preoperative ACD (r = .32, P<.001) and WTW (r = .29, P<.001) and a negative correlation with preoperative spherical equivalent (SE) (r = -0.21, P<.001) and patient age (r = -0.12, P=.025). Eyes with a vault of 250 μm or less had a shallower ACD than eyes with a vault between 250 μm and 750 μm (mean difference -0.11 mm; P=.012) and those with a vault greater than 750 μm (mean difference -0.25 mm; P<.001). Central vaulting was lower in hyperopic eyes. Current nomograms for pIOL diameter selection based on ACD and WTW might yield ideal vault and may have to be adjusted for older patients, shallower ACD, lower WTW, and lower SE.

Risk Factors for Decreased Visual Acuity in Preschool Children: The Multi-Ethnic Pediatric Eye Disease and Baltimore Pediatric Eye Disease Studies

To investigate risk factors associated with unilateral or bilateral decreased visual acuity (VA) in preschool children. Population-based, cross-sectional prevalence study. Population-based samples of 6504 children ages 30 to 72 months from California and Maryland. Participants were preschool African-American, Hispanic, and non-Hispanic white children from Los Angeles, California, and Baltimore, Maryland. Data were obtained by a parental interview and a detailed ocular examination. Logistic regression models were used to evaluate the independent associations between demographic, behavioral, and clinical risk factors with unilateral and bilateral decreased VA. Odds ratios (ORs) for various risk factors associated with interocular difference (IOD) in VA of ≥2 lines with ≤20/32 in the worse eye, or bilateral decreased VA <20/40 or <20/50 if <48 months of age. In multivariate logistic regression analysis, 2-line IOD with a VA of ≤20/32 was independently associated with Hispanic ethnicity (OR, 2.05), esotropia (OR, 8.98), spherical equivalent (SE) anisometropia (ORs ranging between 1.5 and 39.7 for SE anisometropia ranging between 0.50 to <1.00 diopters [D] and ≥2.00 D), and aniso-astigmatism in J0 or J45 (ORs ranging between 1.4 and ≥5.3 for J0 or J45 differences ranging between 0.25 to <0.50 D and ≥1.00 D). Bilateral decreased VA was independently associated with lack of health insurance (OR, 2.9), lower primary caregiver education (OR, 1.7), astigmatism (OR, 2.3 and 17.6 for astigmatism 1.00 to <2.00 D and ≥2.00 D), and SE hyperopia ≥4.00 D (OR, 10.8). Anisometropia and esotropia are risk factors for IOD in VA. Astigmatism and high hyperopia are risk factors for bilateral decreased VA. Guidelines for the screening and management of decreased VA in preschool children should be considered in light of these risk associations. The authors have no proprietary or commercial interest in any of the materials discussed in this article.