Mean Change In Refractive Error Research Articles

Pneumatic retinopexy preceded by drainage of subretinal fluid for the treatment of severe bullous retinal detachment.

To compare the efficacy and safety outcomes of scleral buckling (SB) and drainage-injection-pneumoretinopexy (DIP), a modified pneumatic retinopexy technique, in which, before gas injection, subretinal fluid is drained with a simultaneous injection of balanced salt solution (BSS) in the vitreous chamber, for the treatment of severe superior bullous rhegmatogenous retinal detachment (SBRD). This prospective, randomized, comparative study included 58 eyes with severe SBRD that were randomized 1:1 to undergo SB or DIP. The main outcome measures included success rate, visual acuity, mean change in refractive error and surgery duration. The primary anatomic success rate was 93% for both procedures. Both groups showed significantly improved visual acuity after surgery. The change in refractive error and surgery duration was significantly higher in the SB group. Drainage-injection-pneumoretinopexy (DIP) appeared to be less traumatic, but with a longer persistence of subretinal fluid in a greater number of patients. Our findings suggested that both SB and DIP are safe and effective treatments yielding functional and anatomical recovery in patients with severe SBRD. However, the DIP technique may be easier and less costly, with a success rate similar to that of SB.

The Myopic Shift in Aphakic Eyes in the Infant Aphakia Treatment Study After 10 Years of Follow-up.

To report the myopic shift in the aphakic eyes of a cohort of children who underwent unilateral cataract surgery during infancy and were then followed longitudinally for 10.5 years. One-half of the children enrolled in the Infant Aphakia Treatment Study (IATS) were randomized to aphakia and contact lens correction after unilateral cataract surgery. They then underwent ocular examinations using standardized protocols at prescribed time intervals until age 10.5 years. Thirty of 57 children randomized to aphakia remained aphakic at age 10.5, having undergone unilateral cataract surgery at a median age of 1.6 (IQR: 1.1-3.1) months. The median refractive error (RE) in the 57 eyes randomized to aphakia immediately after cataract surgery was 19.01 D (IQR: 16.98-20.49) compared to 10.38 D (IQR: 7.50-14.00) for the 30 eyes that remained aphakic at age 10.5 years. The mean change in RE in aphakic eyes was -2.11 D/year up to age 1.5 years, -0.68 D/year from 1.5 to 5.0 years, and -0.35 D/year from age 5 to 10.5 years. At age 10.5 years, 18 patients continued to wear a contact lens correction (silicone elastomer, n=6; gas permeable, n=6; hydrogel, n=5; and silicone hydrogel, n=1) (median RE, 12.50 D), 9 wore only spectacles (median RE, 4.00 D), and 4 wore no correction (median RE, 11.25 D) to correct their aphakic eye. The RE in aphakic eyes decreased by 44% from infancy to age 10.5 years. About two-thirds of children who remained aphakic at age 10.5 years continued to wear a contact lens.

Large Spot Laser for Treatment of Retinopathy of Prematurity.

To compare large spot versus standard spot laser for treatment of retinopathy of prematurity (ROP). Eighty eyes of 40 infants with bilateral type 1 ROP were randomized for laser photocoagulation using laser indirect ophthalmoscope with either standard spot or large spot size laser. During the procedure, total time taken and Premature Infant Pain Profile (PIPP) scores were noted. Regression of disease and refractive error were noted on follow-up. The infants were randomized into two groups. All infants in both groups had regression of ROP. Large spot laser significantly reduced total treatment duration in zone I by 32% (P = .005) and zone II by 63.4% (P = .0006). Moderate-to-severe pain occurred in PIPP scores in both groups throughout the procedure (under topical anesthesia) and was comparable between the groups. Mean change in refractive error (myopia) from pre-laser (2.090 diopters [D] ± 1.345 D) to 3 months' post-laser (2.465 D ± 1.399 D) was not statistically significant between the groups. Large spot laser significantly reduced total duration of laser treatment in zone I/II ROP. Large spot laser is a useful alternative for treatment of ROP in terms of faster procedure, lesser total duration of pain, and similar regression profile. It does not cause additional myopia and can be performed without additional training. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e233-e239.].

Acquired myopia in Vogt-Koyanagi-Harada disease.

To analyze the change in refractive error and the axial length of chronic Vogt-Koyanagi-Harada (VKH) disease. Medical records of 106 eyes of 54 adult VKH patients were analyzed. The refractive error and the axial length were compared between the baseline (defined as the time point at least 2weeks after acute stage of VKH) and the final visit. The rate of the eyes with significant myopia progression [defined as refraction change toward myopia >1 diopter (D)] was examined. The correlation of the degree of sunset glow fundus/choroidal thickness with the change in refractive error was also evaluated. At the final visit, the mean refractive error was more myopic and the axial length was longer than at baseline. Seventeen of the 106 eyes (16.0%) showed significant myopia progression. The mean change in refractive error during a follow-up in these 17 eyes was -2.7D (range -7.5 to -1.1D). The axial length data both at baseline and at the final visit were obtained only in 8 eyes. The mean change in axial length during a follow-up in these 8 eyes was 1.3mm (range 0-3.7mm). In the cases with myopia progression, sunset glow fundus was more frequent and subfoveal choroid was thinner than those without myopia progression. Myopia progression as well as increase in axial length occurs in VKH disease. The link between choroidal thinning and axial length elongation in VKH patients gives some insights into axial length increase of pathologic myopia.

Interventions to control myopia progression in children: protocol for an overview of systematic reviews and meta-analyses

BackgroundMyopia is a common visual disorder with increasing prevalence among developed countries of the world. Myopia constitutes a substantial risk factor for several ocular conditions that can lead to blindness. The purpose of this study is to conduct an overview of systematic reviews and meta-analyses in order to identify and appraise robust research evidence regarding the management of myopia progression in children and adolescents.MethodsA literature search will be conducted in MEDLINE, EMBASE, The Cochrane Database of Systematic Reviews (CDSR), Database of s of Reviews of Effects (DARE), and Health Technology Assessment (HTA) Database via Centre for Reviews and Dissemination (CRD). We will search for systematic reviews or meta-analyses that examine optical or pharmaceutical modalities for myopia control. Two independent overview authors will screen the titles and abstracts against the eligibility criteria. Individual study’s methodological quality and quality of evidence for each outcome of interest will be assessed by two independent authors using the ROBIS tool and GRADE rating, respectively. In cases of disagreement, consensus will be reached with the help of a third author. Our primary outcomes will be the mean change in refractive error, mean axial length change, and adverse events. A citation matrix will be generated, and the corrected covered area (CCA) will be estimated, in order to identify overlapping primary studies. Possible meta-biases and measures of heterogeneity will be described, and cases of dual co-authorship will be identified and discussed. If any recently published randomized controlled trials (RCTs) are detected, these will be appraised and their findings will be presented. An overall summary of outcomes will be provided using descriptive statistics and will be supplemented by narrative synthesis.DiscussionThis overview will examine the high level of existing evidence for treatment of myopia progression. Efficient interventions will be identified, and side effects will be reported. The expected benefit is that all robust recent research evidence will be compiled in a single study. The results may inform future research in this area, which should provide insight into the appropriate regimes for the administration of these modalities and contribute to future guideline development.Systematic review registrationPROSPERO CRD42017068204

Five-Year Progression of Refractive Errors and Incidence of Myopia in School-Aged Children in Western China.

BackgroundTo determine the change in refractive error and the incidence of myopia among school-aged children in the Yongchuan District of Chongqing City, Western China.MethodsA population-based cross-sectional survey was initially conducted in 2006 among 3070 children aged 6 to 15 years. A longitudinal follow-up study was then conducted 5 years later between November 2011 and March 2012. Refractive error was measured under cycloplegia with autorefraction. Age, sex, and baseline refractive error were evaluated as risk factors for progression of refractive error and incidence of myopia.ResultsLongitudinal data were available for 1858 children (60.5%). The cumulative mean change in refractive error was −2.21 (standard deviation [SD], 1.87) diopters (D) for the entire study population, with an annual progression of refraction in a myopic direction of −0.43 D. Myopic progression of refractive error was associated with younger age, female sex, and higher myopic or hyperopic refractive error at baseline. The cumulative incidence of myopia, defined as a spherical equivalent refractive error of −0.50 D or more, among initial emmetropes and hyperopes was 54.9% (95% confidence interval [CI], 45.2%–63.5%), with an annual incidence of 10.6% (95% CI, 8.7%–13.1%). Myopia was found more likely to happen in female and older children.ConclusionsIn Western China, both myopic progression and incidence of myopia were higher than those of children from most other locations in China and from the European Caucasian population. Compared with a previous study in China, there was a relative increase in annual myopia progression and annual myopia incidence, a finding which is consistent with the increasing trend on prevalence of myopia in China.

The effect on refractive error of unilateral atropine as compared with patching for the treatment of amblyopia

Our objective was to determine whether the use of unilateral atropine as amblyopia therapy leads to an asymmetric change in refractive error compared with patching. Patients were enrolled in a clinical trial in which atropine 1% solution or occlusion with an adhesive patch was administered daily to the sound eye of children 3 to less than 7 years of age for a period of at least 6 months to a maximum of 2 years. Refractive error at entry and at 2 years was determined with cycloplegic retinoscopy for 282 of 419 patients enrolled. The baseline mean refractive error was + 3.13 diopters (D) in patients assigned randomly to receive atropine and + 2.58 D in patients assigned randomly to wear the patch. The mean change in refractive error of the sound eye was + 0.10 D in the atropine group (N = 134) and + 0.08 D in the patch group (N = 148). Patients also were subdivided into those treated with atropine only (n = 41) and patching only (n = 64) because some children changed treatments during their study participation. The mean change for the sound eyes was -0.21 D for the patients receiving only atropine and -0.06 D for the patients receiving only patching. Unilateral atropine applied to the sound eye compared with occlusion was not associated with any adverse effect on refractive error following up to 2 years of treatment.

Functional and anatomic outcome of scleral buckling versus primary vitrectomy in pseudophakic retinal detachment

To conduct a randomized prospective clinical trial to compare primary vitrectomy without scleral buckling versus conventional scleral buckling surgery in pseudophakic primary retinal detachment (PPRD) in terms of anatomic attachment rate, functional outcome and complications. Fifty consecutive eyes of 50 patients with PPRD were randomized into two groups, with 25 patients in each of group 1 (scleral buckling group) and group 2 (pars plana vitrectomy without buckling group) in a hospital setting and followed up at 1 week, 2 weeks, 6 weeks and 6 months. A primary reattachment rate of 76% (19 retinas) was obtained in group 1, while a reattachment rate of 84% (21 retinas) was achieved in group 2. The final anatomic reattachment rate was 100% in both groups. The causes of failure in group 1 were proliferative vitreoretinopathy in five eyes and open break/missed break in one eye. The causes of failure in group 2 were missed break/open break in three eyes and proliferative vitreoretinopathy in one eye. Best corrected visual acuity (BCVA) at 2 weeks was better in group 1, while the final BCVA at end of 6 months was two lines better in group 2. The mean change in refractive error was -- 1.38 D in group 1 and -- 0.85 D in group 2. Pars plana vitrectomy without buckling provides an effective treatment for PPRD and results in better longterm visual and anatomic outcomes than conventional scleral buckling.

Five-year refractive changes in an older population: the Blue Mountains Eye Study

Purpose To examine 5-year changes in refractive error and astigmatism in an older population. Design Population-based cohort study. Participants The Blue Mountains Eye Study examined 3654 residents aged 49 years or older from 1992 to 1994. After excluding 543 persons who died since baseline, 2335 (75.1%) attended 5-year examinations from 1997 to 1999. Methods Both examinations included a detailed eye assessment, with subjective refraction performed according to a modified Early Treatment of Diabetic Retinopathy Study protocol. Main outcome measures Spherical equivalent (sum of sphere + 1 2 cylinder) was used as the measure of refractive error. Only phakic eyes with best-corrected visual acuity >20/40 were included (n = 3701). Results Similar changes in refractive error were observed for the two eyes. Symmetric changes were found in 72% of participants when the difference between eyes was within 0.5 diopters (D) and in 91% when the difference was within 1.0 D. The 5-year change in spherical power was in a hyperopic direction for younger age groups and in a myopic direction for older subjects, P < 0.0001. The gender-adjusted mean change in refractive error in right eyes of persons aged 49 to 54, 55 to 64, 65 to 74, and 75 years or older at baseline was +0.41 D, +0.30 D, +0.05 D, and −0.22D, respectively. Refractive change was strongly related to baseline nuclear cataract severity; grades 4 to 5 were associated with a myopic shift (−0.33 D, P < 0.0001). Education level and age of onset of myopia, but not gender or diabetes, also predicted refractive change. The mean age-adjusted change in refraction was +0.14 D for hyperopic eyes, +0.32 D for emmetropic eyes, and +0.15 D for myopic eyes. The mean change in cylinder power over the 5-year period was small, irrespective of baseline refraction. The axis of astigmatism remained stable in most cases (64%), whereas 12% changed to “against the rule” and 11% to “with the rule.” Conclusions This report has documented refractive error changes in an older population and confirmed reported trends of a hyperopic shift before age 65 years and a myopic shift thereafter associated with the development of nuclear cataract.

Minimal myopic shift in pseudophakic versus aphakic pediatric cataract patients

Purpose: To evaluate postoperative refractive changes in aphakic and pseudophakic children in a comparative case series. Methods: The medical records of pediatric patients with aphakia and pseudophakia were reviewed retrospectively. The mean change in refractive error from one postoperative examination to the next was calculated at each age to give aggregate curves of postoperative refractive change for each group. Results: A total of 233 aphakic and 92 pseudophakic eyes were studied. The median age at the time of surgery was 0.8 years (range, 0.0-16 years) for patients with aphakia and 7.3 years (range, 1.5-19.9 years) for patients with pseudophakia (P <.0001). The postoperative refraction curves at comparable ages of 2 to 20 years showed a total mean myopic shift of 1.5 D for patients with pseudophakia and 7.8 D for patients with aphakia. An age-matched subset of patients with aphakia also showed more myopic shift than those with pseudophakia. Conclusions: Pseudophakic eyes show less postoperative myopic shift than aphakic eyes. Selecting intraocular lens powers aimed at producing initial emmetropic refractions has been a good strategy in our cohort of patients with pseudophakia. However, our data are insufficient for conclusions regarding children with pseudophakia younger than 2 years, in whom larger myopic shifts may occur. (J AAPOS 2002;6:271-6)

Pars plana vitrectomy without scleral buckle for pseudophakic retinal detachments

Objective To report the anatomic and visual results of primary pars plana vitrectomy (PPV) without scleral buckling to repair primary rhegmatogenous retinal detachments in pseudophakic eyes. Design Nonrandomized, prospective, comparative clinical trial. Participants Two hundred eighty-three consecutive patients (294 eyes) with pseudophakia, peripheral retinal tears, and new rhegmatogenous retinal detachments were treated according to the surgery protocol. Intervention Patients underwent PPV with fluid-gas exchange and endolaser to repair the retinal detachment. Two hundred sixty-four patients (275 eyes) were followed from 6 months to 6 years and 8 months with an average follow-up of 19 months. Main outcome measures Reattachment of the retina and visual outcome were compared to previously published studies. Results Of 97 eyes with a macula-attached rhegmatogenous retinal detachment, 88 eyes (91%) were reattached with a single operation, and of the 178 eyes with a macula-detached retinal detachment, 153 (86%) eyes were reattached with a single operation. In 241 (88%) of 275 eyes, the retina was reattached with a single operation, and in 265 (96%) of 275 eyes, the retina was ultimately reattached with subsequent operations. The median initial visual acuity was 20/300, and the median final visual acuity was 20/40. The rate of reattachment with one operation was similar for eyes with an anterior chamber intraocular lens (91%) and for eyes with a posterior chamber intraocular lens (88%). Refractive error measurements obtained in 81 eyes were essentially unchanged. The mean change in refractive error was −0.15 diopter. Seventeen eyes (6%) developed macular puckers requiring surgery, 46 eyes (17%) developed cystoid macular edema, and 6 eyes (2%) developed full-thickness macular holes. Conclusion Primary PPV with fluid-gas exchange and laser is a safe, effective method to repair primary pseudophakic retinal detachments. The anatomic reattachment rate and the visual acuity obtained with this technique appear to be at least as good as those reported in the literature for scleral buckling, PPV with scleral buckling, and pneumatic retinopexy.

Does Overcorrecting Minus Lens Therapy for Intermittent Exotropia Cause Myopia?

Overcorrecting minus lens therapy has been used as a treatment for intermittent exotropia. It is based on the principle that an exotropic deviation will be decreased by stimulating accommodative convergence with additional minus power in spectacles. Because excessive accommodation has been implicated as a cause of myopia, there is theoretical concern that overcorrecting minus lens therapy for exotropia may cause myopia. To investigate the effect of overcorrecting minus lens therapy for exotropia on the progression of myopia. A retrospective chart review. Seventy-four patients with intermittent exotropia were treated with overcorrecting minus lens therapy for at least 6 months (6-month treatment group), and a 34-patient subset of them received overcorrecting minus lens therapy for 5 years (5-year treatment group). The mean change in refractive error (spherical equivalent of the fixing eye) of these 2 groups 5 years after initial examination was compared with the mean change in refractive error of a control group of 45 patients with intermittent exotropia who did not receive overcorrecting minus lens therapy. At the time of initial examination, the mean (+/-SD) refractive error was 0.00 +/- 1.40 diopters (D) in the control group, 0.00 +/- 1.50 D in the study group, and -0.10 +/- 1.50 D in the 5-year study group, all of which were essentially identical. Five years after initial examination, the mean change in refractive error was -1.40 +/- 2.80 D in the control group, -1.52 +/- 1.80 D in the 6-month treatment group, and -1.54 +/- 1.80 D in the 5-year treatment group. These differences in the change in refractive error (myopic shift) were not statistically significant (t test), and the differences are clinically unimportant. Overcorrecting minus lens therapy for intermittent exotropia does not appear to cause myopia.

Resource management of cataract patients: Can visual rehabilitation be achieved in three visits?

Abstract Purpose: To assess the feasibility and acceptability of reduced postoperative follow-up after phaccemulsification using a scleral tunnel technique. Setting: Cataract service of a large free-standing eye hospital in a capital city. Methods: In this pilot study, patients with age-related cataract requiring surgery were prospectively recruited to a standardized management protocol, the three-episode model, with assessment by an independent observer. Main outcome measures were number of postoperative visits, patient satisfaction, and refractive error at 2 and 6 weeks postoperatively. Results: Almost 90% of patients could be managed within this model of care. Patient satisfaction was high; no patient requested further hospital visits. Mean change in refractive error between 2 and 6 weeks was 0.34 diopters (D), with a modal value of 0 D. Patients were able to obtain spectacles 2 weeks postoperatively because little change in refraction occurs over the next month. Conclusion: The three-episode model for the management of patients with cataract could result in significant financial savings. Such savings could be used to treat patients with cataract who otherwise would not have treatment or would have their surgery delayed.

Resource management of cataract patients: Can visual rehabilitation be achieved in three visits?

Purpose: To assess the feasibility and acceptability of reduced postoperative follow-up after phaccemulsification using a scleral tunnel technique.Setting: Cataract service of a large free-standing eye hospital in a capital city.Methods: In this pilot study, patients with age-related cataract requiring surgery were prospectively recruited to a standardized management protocol, the three-episode model, with assessment by an independent observer. Main outcome measures were number of postoperative visits, patient satisfaction, and refractive error at 2 and 6 weeks postoperatively.Results: Almost 90% of patients could be managed within this model of care. Patient satisfaction was high; no patient requested further hospital visits. Mean change in refractive error between 2 and 6 weeks was 0.34 diopters (D), with a modal value of 0 D. Patients were able to obtain spectacles 2 weeks postoperatively because little change in refraction occurs over the next month.Conclusion: The three-episode model for the management of patients with cataract could result in significant financial savings. Such savings could be used to treat patients with cataract who otherwise would not have treatment or would have their surgery delayed.