Mean Spherical Equivalent Refraction Research Articles

Evaluating a web-based visual acuity and refractive error self-assessment tool in myopic children.

Demands for myopia management are rising. A web-based tool that allows home-performed self-assessments of visual acuity (VA) and refractive error may enable hybrid care pathways and aid in identifying those with deteriorating visual performance. The tool has been validated in adult populations, but has yet to be evaluated in children. This study compared home-performed VA and refraction self-assessments to conventional measurements obtained at the clinic in a population of myopic children. Myopic children aged ≥6 years old were invited to perform web-based eye tests at home, assisted by a parent. At two myopia control clinics, they also underwent measurements of VA using a Snellen chart and refractive error using cycloplegic autorefraction. Agreement between the tests, repeatability of the web-based test and associations between clinical characteristics and web-based test accuracy were evaluated. A total of 147 children were enrolled, of whom 116 (51% male; mean age 13 ± 3 years; mean spherical equivalent refraction (SEQ) -5.58 ± 3.05) performed the web-based tests at home. Overall, the home-performed VA self-assessment and the Snellen chart assessment at the clinic agreed well (mean difference 0.03 ± 0.11 logMAR). A significant proportional bias was identified (β 0.65, p < 0.001), indicating underestimated web-based VA scores when the child's vision declined. The sensitivity to detect VA poorer than 0.10 logMAR was 94%; the specificity was 71%. The web-based refractive error algorithm measured more myopia progression compared to clinic observations (mean difference SEQ 0.40 ± 0.51 dioptres). Age, sex or use of atropine drops were not significantly associated with test accuracy. The web-based test for self-assessing vision, performed at home by children with assistance from their parents, yielded VA scores with a precision similar to Snellen chart testing conducted in a clinical setting. However, the web-based refractive error algorithm overestimated myopia progression and requires recalibration for this specific age group.

Visual outcomes following bilateral implantation of a non-diffractive extended depth of focus toric intraocular lens using a mini-monovision approach.

To evaluate the clinical outcomes following bilateral implantation of the AcrySof™ IQ Vivity™ toric extended depth of focus (EDOF) intraocular lens (IOL). Prospective interventional case series. Patients with bilateral significant cataracts and pre-existing corneal astigmatism underwent cataract surgery and implantation with the AcrySof™ IQ Vivity™ toric IOL. Dominant eyes were targeted at emmetropia and non-dominant eyes at -0.50D. Primary endpoints were binocular uncorrected distance (UDVA), intermediate (UIVA at 66cm) and near (UNVA at 40cm) acuities at 3months. Secondary outcomes were corrected distance (CDVA), distance corrected intermediate (DCIVA) and distance corrected near (DCNVA), refractive predictability, rotational stability, binocular defocus curve, contrast sensitivity, Questionnaire for Visual Disturbances (QUVID) and Visual Function Index (VF-14) questionnaire scores. All visual acuities were converted to logarithm of minimum angle of resolution (logMAR) for analysis. 30 patients underwent uneventful phacoemulsification. The mean binocular UDVA, UIVA and UNVA were 0.06 ± 0.12, 0.11 ± 0.10 and 0.26 ± 0.10 respectively. The mean refractive spherical equivalent (MRSE) for dominant and non-dominant eyes were - 0.07D ± 0.27 and - 0.12D ± 0.54 respectively. 92.4% of dominant eyes and 84.6% of non-dominant eyes within 0.50D of target. The mean IOL rotation was 3.85° ± 5.09 with 86.7% of eyes with less than 5° of rotation. 26.7%, 20% and 36.7% of patients reported starbursts, haloes and glare respectively. The mean VF-14 score was 91.77. Bilateral implantation of the AcrySof™ IQ Vivity™ Toric IOL resulted in very good unaided visual acuities for far and intermediate distance with functional near vision. Dysphotopsias were reported but despite this, a high level of visual function was achieved.

Repeated Low-Level Red Light Therapy for Myopia Control in High Myopia Children and Adolescents: A Randomized Clinical Trial

To assess the effectiveness and safety of repeated low-level red light (RLRL), which is a newly available treatment for myopia control in children and adolescents with high myopia. Multicenter, randomized, parallel-group, single-blind clinical trial (randomized controlled trial; NCT05184621). Between February 2021 and April 2022, 192 children aged 6 to 16 years were enrolled. Each child had at least 1 eye with myopia of cycloplegic spherical equivalent refraction (SER) at least -4.0 diopters (D), astigmatism of ≤2.0 D, anisometropia of ≤3.0 D, and best-corrected visual acuity (BCVA) of 0.2 logarithm of the minimum angle of resolution or better. Follow-up was completed by April2023. Participants were randomly assigned at a 1:1 ratio to intervention (RLRL treatment plus single-vision spectacles) or control (single-vision spectacles) groups. The RLRL treatment was administered for 3 minutes per session, twice daily with a minimum interval of 4 hours, 7 days per week. The primary outcome and key secondary outcome were changes in axial length (AL) and cycloplegic SER measured at baseline and the 12-month follow-up visit. Participants who had at least 1 postrandomization follow-up visit were analyzed for treatment efficacy. Among 192 randomized participants, 188 (97.91%) were included in the analyses (96 in the RLRL group and 92 in the control group). After 12 months, the adjusted mean change in AL was -0.06 mm (95% confidence interval [CI], -0.10 to -0.02 mm) and 0.34 mm (95% CI, 0.30 to 0.39 mm) in the intervention andcontrol groups, respectively. A total of 48 participants (53.3%) in the intervention group were still experiencing axial shortening >0.05 mm at the 12-month follow-up. The mean SER change after 12 months was 0.11 D (95% CI, 0.02to 0.19 D) and -0.75 D (95% CI, -0.88 to -0.62 D) in the intervention and control groups, respectively. Repeated low-level red light demonstrates stronger treatment efficacy among those with high myopia, with 53.3% experiencing substantial axial shortening. Repeated low-level red light provides an excellent solution for the management of high myopia progression, a significant challenge in ophthalmology practice. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Atropine 0.01% Eye Drops for Myopia Control in a tertiary care center of Pakistan: An interventional case series

Purpose: To evaluate the real time results of once-dailyAtropine 0.01% eye drops in controlling myopia. Study Design: Interventional case series. Place and Duration of Study: The Eye Centre, South City Hospital, Karachi from September 2020 to August 2021. Methods: One hundred(both) eyes of 50 children were included in the study using non-probability consecutive sampling technique. Baseline spherical equivalent refraction(SER) was recorded at the initiation of treatment.The endpoint was measuring the rate of progression in SER at one year after treatment. Responders weredefined as the ones with either no progression of myopia or worsening of myopia of ≤ -0.50 SER and non-responders were defined as ones with a progression rate of myopia of greater than0.50 SER. Results: The baseline means SER for 100 eyes was 3.25±1.37 D. On follow-up after 12 months of treatment with Atropine 0.01% eye drops, the mean SER was -3.74 ± 1.34 D. The rate of SER progression was significantly lower at one year follow-up (p-value&lt;0.001). The percentage of responders was84%. Conclusion: Significant reduction in myopia progression occurred after treatment with Atropine 0.01% eye drops in a greater percentage of children. This has led us to be confident in providing Atropine 0.01% eye drops along with simple spectacles as an effective treatment strategy to control myopia progression.

Surgical outcomes of intraocular lens iris suture fixation in eyes with residual capsule support

Purpose: To evaluate the safety and refractive outcomes of eyes after intraocular lens (IOL) iris suture fixation (ISF). Setting: Private practice, Los Angeles, California. Design: Nonrandomized and unmasked retrospective chart review. Methods: Eyes that underwent IOL exchange or repositioning with ISF with at least 270 degrees of capsular support were included. Eyes with less than 270 degrees of capsular support and eyes with iris damage were excluded. The primary outcome measures included incidence of cystoid macular edema (CME), IOL dislocation requiring refixation, and chronic inflammation. Secondary outcome measures included worsening intraocular pressure (IOP) control, retinal tear or detachment, worsening of corrected distance visual acuity (CDVA), and corneal decompensation. Refractive outcomes for 26 subgrouped eyes included mean and median spherical equivalent refraction accuracy (SERA), and percentage of eyes within 0.5 diopter (D) and 1 D of the refractive target. Results: The study included 53 eyes of 50 patients. CME: 2/53 (3.8%), IOL dislocation requiring refixation: 2/53 (3.8%), chronic inflammation: 1/53 (1.9%), worsening IOP control: 5/53 (9.4%), retinal tear or detachment: 2/53 (3.8%). No patient experienced worsening of CDVA from baseline or corneal decompensation. Mean SERA ± SD −0.35 ± 0.29 D, median SERA −0.37 D. Of the 26 eyes subgrouped for refractive analysis, 73% were within 0.5 D and 100% were within 1 D of the desired refractive outcome. Conclusions: ISF can offer stability for sulcus-fixated IOLs provided there is some residual capsule support. Although there are measurable complications, there is a relatively low side effect profile. The refractive error tended to be myopic, indicating the need for further refinement of IOL power predictive formulas.

Peripheral and posterior pole retinal changes in highly myopic Chinese children and adolescents

PurposeThis study was conducted to evaluate the prevalence and related factors of peripheral and posterior pole retinal changes in highly myopic Chinese children and adolescents.MethodsA hospital-based cross-sectional study was designed. A total of 120 subjects with high myopia were recruited and underwent cycloplegic refraction, dilated fundus examination, and optical coherence tomography. A statistical analysis was performed to evaluate the factors associated with peripheral and posterior pole retinal changes.ResultsThe mean spherical equivalent refraction of the subjects was − 8.74 ± 2.86 D, and the mean age was 11.45 ± 3.02 years. Snowflake retinal degeneration (27.5%), white without pressure (27.5%), snail-track degeneration (15%), and lattice degeneration (15%) were the most common peripheral retinal changes, while tessellated fundus (84.17%), optic nerve crescents (78.3%), and posterior staphyloma (11.7%) were the most common posterior changes. Subjects with peripheral changes were significantly older, with thinner choroids (OR = 1.194, 95% CI: 1.045–1.363, p = 0.009; OR = 0.993, 95% CI: 0.987–0.999, p = 0.022, respectively). Optic nerve crescents, tessellated fundus, and posterior scleral staphyloma were all associated with thin choroids (OR = 0.990, 95% CI: 0.983–0.997, p = 0.008; OR = 0.983, 95% CI: 0.974–0.991, p < 0.001; OR = 0.974, 95% CI: 0.960–0.987, p < 0.001, respectively).ConclusionA substantial proportion of the subjects had peripheral and posterior retinal changes. An increased risk of retinal changes was associated with high degrees of myopia, long axial lengths, thin choroids, and older ages among 7–16-year-old individuals.

VISUAL AND REFRACTIVE OUTCOME OF NEW GENERATION SMALL INCISION LENTICULE EXTRACTION (SMILE) IN MYOPIA AND MYOPIC ASTIGMATISM

Introduction: Two main options for the surgical correction of high myopia and myopic astigmatism are corneal refractive surgery and implantation of phakic intraocular lens (IOL). Small Incision Lenticule Extraction (SMILE) is becoming more popular technique which includes a minimally invasive flap-free procedure. The aim of this study is to evaluate the visual and refractive outcome of New Generation SMILE in myopia and myopic astigmatism. Methods: This is an observational retrospective study in patients who underwent SMILE using Visumax 800 Femtosecond laser procedure at Undaan Eye Hospital in period December 2022 to February 2023. Pre and post operative uncorrected visual acuity (UCVA), spherical equivalent (SE), astigmatism value, keratometry and intra ocular pressure (IOP) were evaluated at 1 day, 1 week and 1 month follow-up. Results: The study comprised 30 eyes of 15 patients age from 18 to 32 years old. The mean post operative UCVA was significantly improved to 0.03 ± 0.06 logMAR at 1-day, 0.02 ± 0.04 logMAR at 1-week and -0.01 ± 0.02 logMAR at 1-month follow-up compared to preoperative UCVA 1.35 ± 0.23 logMAR (p&lt;0.001). The mean refractive spherical equivalent was significantly changed from -4.60 ± 1.47 D preoperatively to -0.57 ± 0.38 D at 1-month follow up (p &lt; 0.001). The mean refractive astigmatism decreased from -1.02 ± 0.66 D preoperatively to -0.34 ± 0.25 D at 1- month follow up (p&lt;0.001). Conclusion: New Generation of SMILE has shown good visual and refractive outcome for the correction of myopia and myopic astigmatic eyes since the early phase after surgery.

Characterization the corneal transparency profile in SMILE-treated myopic patients with densitometry: A 7-year cohort study.

To investigate 7-year changes in corneal densitometry (CD) and its influencing factors following small incision lenticule extraction (SMILE) for moderate to high myopia. A total of 32 patients (52 eyes) with a mean spherical equivalent (SE) refraction of -6.30 ± 1.30 D who underwent SMILE were recruited for this prospective study. Pre- and postoperative CD and corneal aberrations were measured by an oculus Pentacam system, and patients were followed up to 7 years. The CD evolution over time and its influencing factors were explored. No complications were observed after SMILE. There was a significant time effect on postoperative CD ( P < 0.05). The CD values at the 0-to-2 and 2-to-6 mm of the anterior layer increased at the first day ( P < 0.05) and declined to baselines at 1 year postoperatively; after that, CD values at any zone and any corneal layer presented a decreasing trend over time (all P < 0.05). Multivariate analysis showed that postoperative CD was positively correlated with age and optical zone (OZ), whereas negatively correlated with SE, corrected distance visual acuity (CDVA), and corneal aberrations (higher-order aberrations, Coma0 and Coma90) (all P < 0.05). Generalized estimating equation revealed that age, SE, CDVA, OZ, and Coma0 were the main factors influencing postoperative CD values (all P < 0.05). CD manifested a long-term decreasing trend in moderate to high myopia treated with SMILE. Its main influencing factors are age, SE, CDVA, OZ, and Coma0.

Two-Year Results of 0.01% Atropine Eye Drops and 0.1% Loading Dose for Myopia Progression Reduction in Danish Children: A Placebo-Controlled, Randomized Clinical Trial.

We investigated the two-year safety and efficacy of 0.1% loading dose and 0.01% low-dose atropine eye drops in Danish children for reduction in myopia progression in an investigator-initiated, placebo-controlled, double-masked, randomized clinical trial. Ninety-seven six- to twelve-year old myopic participants were randomized to 0.1% loading dose for six months and then 0.01% for eighteen months (loading dose group, N = 33), 0.01% for two years (0.01% group, N = 32) or placebo for two years (placebo, N = 32). Axial length (AL) and spherical equivalent refraction (SER) were primary outcomes. Secondary outcomes included adverse events and reactions, choroidal thickness, and other ocular biometrical measures. Outcomes were measured from baseline and at six-month intervals. Individual eyes nested by participant ID were analyzed with linear-mixed model analysis. Data were analyzed with intention-to-treat. Mean AL was 0.08 mm less (95% confidence interval (CI): -0.01; 0.17, p-value = 0.08) in the 0.1% loading dose and 0.10 mm less (95% CI: 0.01; 0.19, p-value = 0.02) in the 0.01% group after two years of treatment compared to placebo. Mean SER progression was 0.12 D (95% CI: -0.10; 0.33) less in the loading dose and 0.26 D (95% CI: 0.04; 0.48) less in the 0.01% groups after two years of treatment compared to placebo (p-value = 0.30 and 0.02, respectively). In total, 17 adverse events were reported in the second-year follow-up, and all were rated as mild. Adjusting for iris color did not affect treatment effect estimates. Intra-ocular pressure increased over two years comparably between all groups but remained within normal limits. Two-year treatment with 0.01% low-dose atropine eye drops is a safe and moderately efficacious intervention in Danish children for reducing myopia progression.

Refractive outcomes following silicone oil tamponade in vitreoretinal surgery.

To evaluate the factors influencing the refractive outcomes following silicone oil tamponade (SOT) and silicone oil removal (SOR) in different lens statuses post-vitreoretinal surgery. Retrospective analysis of three different lens statuses. This was a descriptive study that included 150 eyes of 147 patients who had undergone pars plana vitrectomy with SOT and SOR between January 2017 and June 2021. Demographic profile, spherical equivalent refraction (SER), and its association with clinical features were evaluated with SOT and post-SOR. The mean (±standard deviation [SD]) age was 47 ± 17.8 years, including all three groups. SER was represented in diopters (D). The mean ± SD refraction with SOT in phakic, pseudophakic, and aphakic was 4.28 ± 2.59 D, 2.94 ± 2.58 D, and 3.98 ± 4.82 D. The mean SER post-SOR in phakic, pseudophakic, and aphakic was -2.72 ± 2.03 D, -1.12 ± 1.41 D, and 8.22 ± 3.70 D. The diagnosis of rhegmatogenous retinal detachment (RRD) among 96 eyes (64%) is the common indicator to perform vitreoretinal (VR) surgery. A minority of subjects were managed with retinal lasers before VR surgery (14%). The macula was attached in 100 eyes (67.6%), the belt buckle was done in 37 eyes (24.7%), and the silicone oil viscosity with 1000 centistoke was chosen in 129 eyes (86%). SOT was used as a tamponade in VR surgeries irrespective of lens status. The significant predictor for post-SOR refraction in phakic and aphakic is post-SOT refraction. In pseudophakic, gender and diagnosis of RRD are the predictors of SOR refraction.

Whole-Exome Sequencing Among School-Aged Children With High Myopia

High myopia (HM) is one of the leading causes of visual impairment worldwide. Genetic factors are known to play an important role in the development of HM. To identify risk variants in a large HM cohort and to examine the implications of genetic testing of schoolchildren with HM. This cohort study retrospectively reviewed whole-exome sequencing (WES) results in 6215 schoolchildren with HM who underwent genetic testing between September 2019 and July 2020 in Wenzhou City, China. HM is defined as a spherical equivalent refraction (SER) of -6.00 diopters (D) or less. The study setting was a genetic testing laboratory and a multicenter school census. Data were analyzed from July 2021 to June 2022. The frequency and distribution of positive germline variants, the percentage of individuals with HM in both eyes, and subsequent variant yield for common high myopia (CHM; -8.00 D ≤ SER ≤ -6.00 D), ultra myopia (UM; -10.00 D ≤ SER < -8.00 D), and extreme myopia (EM; SER < -10.00 D). Of the 6215 schoolchildren with HM, 3278 (52.74%) were male. Their mean (SD) age was 14.87 (2.02) years, including 355 students in primary school, 1970 in junior high school, and 3890 in senior high school. The mean (SD) SER was -7.51 (-1.36) D for the right eye and -7.46 (-1.34) D for the left eye. Among schoolchildren with HM, genetic testing yielded 271 potential pathogenic variants in 75 HM candidate genes in 964 diagnoses (15.52%). A total of 36 known variants were found in 490 HM participants (7.88%) and 235 protein-truncating variants (PTVs) in 506 participants (8.14%). Involved variant yield was significantly positively associated with SER (Cochran-Armitage test for trend Z = 2.5492; P = .01), which ranged from 7.66% in the CHM group, 8.70% in the UM group, to 11.90% in the EM group. We also found that primary school students with EM had the highest variant yield of PTVs (8 of 35 students [22.86%]), which was 1.77 and 4.78 times that of the UM and CHM, respectively. In this cohort study of WES for HM, several potential pathogenic variants were identified in a substantial number of schoolchildren with HM. The high variation frequency in younger students with EM can provide clues for genetic screening and clinical examinations of HM to promote long-term follow-up assessment.

Clinical Outcomes of Femtosecond Laser-assisted Implantation of 325-Degree Versus 340-Degree Arc Length Intracorneal Ring Segments in Naive Keratoconic Eyes.

To evaluate and compare clinical outcomes after femtosecond laser-assisted implantation of 325-degree versus 340-degree arc length intracorneal ring segments (ICRS) in eyes with keratoconus (KCN). In this prospective non-randomized interventional case series, 23 eyes of 21 patients diagnosed with KCN, underwent femtosecond laser-assisted implantation of two types of ICRS, which included a 325-degree ICRS (Group 325) and a 340-degree ICRS (Group 340). The primary outcome measures were uncorrected distance visual acuity (UDVA), and the secondary outcome measures included corrected distance visual acuity (CDVA), sphere, cylinder, mean refractive spherical equivalent (MRSE), keratometry, vectorial change in corneal astigmatism, and the location of maximum keratometry relative to the corneal apex. The study groups were compared using the primary and secondary outcome measures obtained at postoperative months six and 12. Groups 325 and 340 consisted of 10 and 13 eyes, respectively. The two groups were comparable in terms of parameters measured preoperatively. On comparison to the baseline values, both study groups exhibited a significant increase in UDVA and CDVA measured at postoperative month six (Ps 0.05) and a significant decrease in the sphere, cylinder, spherical equivalent refraction, and keratometry readings measured at postoperative months six and 12 (Ps 0.05). No significant differences were observed between the two groups in terms of visual, refractive, and keratometric outcomes at any time point. No intraoperative or postoperative complications were observed in any of the study groups. Both the 325-degree ICRS and the 340-degree ICRS effectively and equally improved visual, refractive, and keratometric outcomes in keratoconic eyes.

The Impact of Parental Myopia and High Myopia on the Hyperopia Reserve of Preschool Children

Introduction: The aim of this study was to explore the association between parental myopia and high myopia with children’s refraction and ocular biometry in large-scale Chinese preschool children from the Beijing Hyperopia Reserve Study. Subjects/Methods: This cross-sectional kindergarten-based study enrolled children aged 3–6 years. Cycloplegic refraction, axial length (AL), and corneal radius (CR) were measured for all children. Parents were asked to complete a questionnaire about refractive status (no myopia, mild myopia <−3 D, moderate myopia ≥−3 D and ≤−6, and high myopia >−6 D). Results: The study enrolled 2,053 children (1,069 boys and 984 girls), with a mean age of 4.26 ± 0.96 years and mean spherical equivalent refraction (SER) of 1.11 ± 0.97 diopter. Of the children, 90.7% had at least one myopic parent, and 511 children (24.9%) had at least one highly myopic parent. SER decreased significantly with increasing severity of parental myopia (p < 0.001). Preschool children’s myopia was independently associated with parental myopia (OR, 10.4 and 11.5 for one and two highly myopic parent[s]). Age (OR = 1.1), gender (OR = 1.7; girls as references), near work time (OR = 1.2), and both maternal (OR, 1.4 and 2.0 for moderate and high myopia) and paternal myopia (OR, 1.6 and 1.9 for moderate and high myopia) were independent risk factors for lacking hyperopia reserve. Conclusion: Severe parental myopia was associated with a lower SER, longer AL, and higher AL/CR ratio in preschool children. Parental myopia and near work may predispose children to faster elimination of hyperopia reserves before exposure to higher educational stress.

Safety and efficacy of 0.01% and 0.1% low-dose atropine eye drop regimens for reduction of myopia progression in Danish children: a randomized clinical trial examining one-year effect and safety

BackgroundTo investigate the efficacy and safety of 0.1% and 0.01% low-dose atropine eye drops in reducing myopia progression in Danish children.MethodsInvestigator-initiated, placebo-controlled, double-masked, randomized clinical trial. Ninety-seven six- to twelve-year old myopic participants were randomized to 0.1% loading dose for six months followed by 0.01% for six months (loading dose group, Number (N) = 33), 0.01% for twelve months (0.01% group, N = 32) or vehicle for twelve months (placebo, N = 32). Primary outcomes were axial length and spherical equivalent refraction. Secondary outcomes included adverse events and reactions, choroidal thickness and ocular biometry. Outcomes were measured at baseline and three-month intervals. Data was analyzed with linear-mixed model analysis according to intention-to-treat.ResultsMean axial elongation was 0.10 mm less (95% confidence interval (CI): 0.17; 0.02, adjusted-p = 0.06) in the 0.1% loading dose and 0.07 mm less (95% CI: 0.15; 0.00, adjusted-p = 0.16) in the 0.01% group at twelve months compared to placebo. Mean spherical equivalent refraction progression was 0.24 D (95% CI: 0.05; 0.42) less in the loading dose and 0.19 D (95% CI: 0.00; 0.38) less in the 0.01% groups at twelve months, compared to placebo (adjusted-p = 0.06 and 0.14, respectively). A total of 108 adverse events were reported during the initial six-month loading dose period, primarily in the loading dose group, and 14 were reported in the six months following dose switching, all deemed mild except two serious adverse events, unrelated to the intervention.ConclusionsLow-dose atropine eye drops are safe over twelve months in otherwise healthy children. There may be a modest but clinically relevant reduction in myopia progression in Danish children after twelve months treatment, but the effect was statistically non-significant after multiple comparisons adjustment. After dose-switching at six months the loading dose group approached the 0.01% group, potentially indicating an early “rebound-effect”.Trial registrationthis study was registered in the European Clinical Trials Database (EudraCT, number: 2018-001286-16) 05/11/2018 and first posted at www.clinicaltrials.gov (NCT03911271) 11/04/2019, prior to initiation.

Prevalence Trend of Myopia during the Post-COVID-19 Epidemic Period among Preschoolers: A Prospective School-based Study.

Changes in behavior and lifestyle during the post-COVID-19 epidemic may have some impact on myopia rates in preschoolers, and exploring the changes in myopia rates in preschool children may inform the formulation of myopia prevention and control policies. To investigate the prevalence of myopia in preschool children during the post-COVID-19 epidemic period in Xuzhou, China. A series of cross-sectional school-based studies was conducted. A total of 117,632 preschool children aged 3 to 6 years were subjected to annual vision screening from 2019 to 2021. Spot photo screening was used to record the spherical equivalent refraction for each child and to analyze the prevalence of myopia by age, sex, and region during the post-COVID-19 epidemic period. A total of 113,979 preschool children were included in the analysis, of whom 60784 (53.3%) were males and 53195 (46.7%) were females. For all children, the mean spherical equivalent refraction in 2019, 2020 and 2021 was +0.32 ± 0.50 D, +0.34 ± 0.55 D, and + 0.34 ± 0.54 D, respectively (all P < .05), indicative of a very slight hyperopic shift. In all age groups, the change in mean spherical equivalent refraction and its distribution were relatively stable. From 2019 to 2021, the overall prevalence of myopia in preschool children was 3.1%, 3.3%, and 3.5%, respectively. The rise in myopia rates was minimal. The largest increase in the annual prevalence of myopia was seen among children aged 6, at 0.5%, followed by those aged 5 (0.4%) and aged 3 (0.4%). The prevalence was higher in males than females, and in urban versus rural areas. During the post-COVID-19 epidemic period, the refractive status of Xuzhou preschool children remained stable.

Refractive Profile of Surgical Patients with Intermittent Exotropia: A Large-Sample Cross-Sectional Study in Southern China

Purpose To describe the refractive profile of surgical patients with intermittent exotropia (IXT) residing in southern China. Methods Medical records of patients who received strabismus surgery between June 2014 and August 2020 were retrospectively reviewed. Clinical data, including age, sex, refractive errors, preoperative angle of deviation, types of exotropia, accommodative convergence to accommodation ratio (AC/A ratio) and stereopsis, were investigated. Results A total of 2250 patients were included, and 93.6% of patients were younger than 30 years of age. The mean angle of exodeviation was 37.0 ± 14.7 prism degree (PD) and 37.5 ± 15.8 PD at distance and near, respectively. Mean spherical equivalent refraction (SER) values were -0.7 ± 2.4 D and −0.8 ± 2.5 D in the dominant eye and nondominant eye, respectively. Significant differences in SER were observed between the dominant eye and nondominant eye among children at 6 years old or younger. The percentage of myopia increased from 11.0% in children (≤6 years old) to 77.9% in teenagers (13-18 years of age). Significant positive associations between the magnitude of exodeviation and the magnitude of myopia were observed (p < 0.0001). Patients with convergence insufficiency type IXT (p < 0.0001) or AC/A < 2 (p < 0.05) showed a greater magnitude of myopia. The mild hyperopia group included a larger proportion of subjects showing a certain degree of stereopsis (p < 0.05). Conclusions Myopia was present in more than half of our patients (51.2%), which is much higher than the percentage in the general population of southern China. Patients with convergence insufficiency, an AC/A ratio < 2, or a larger angle of deviation tended to have a greater magnitude of myopia.

Retrospective Analysis of Axial Length Changes in Overnight Orthokeratology in an Academic Myopia Control Clinic.

Although the myopia control efficacy of orthokeratology lenses has been established with clinical trials, reports of axial length change in non-study-based patient care are scarce. This study investigates the use of orthokeratology lenses for myopia control in a clinical population and compares axial elongation against those published in recent clinical investigations. This study aimed to investigate factors affecting axial elongation during use of orthokeratology lenses for myopia control in an academic clinical setting. This study was a retrospective consecutive case series from the Myopia Control Clinic at the Herbert Wertheim School of Optometry at the University of California, Berkeley (Berkeley, CA). Patients ranging from 5 to 18 years old using orthokeratology for at least 1 year were included in the study. Data from 102 patients' eyes were analyzed at baseline (before the initiation of treatment) and after 1 year of wear (12 ± 3 months). Multivariate analysis was undertaken to identify factors significantly associated with axial elongation over this period. Mean (±standard deviation) spherical equivalent refraction and axial length at baseline were -2.54 (±1.21) D and 24.53 (±0.82) mm, respectively. By the 1-year follow-up, eyes had shown significant axial elongation (0.18 ± 0.24 mm; P < .001), which was found to be inversely correlated with age ( P < .001). Race, sex, baseline axial length, and baseline refraction were not significantly associated with axial elongation. Factors influencing axial length and the magnitude of axial elongation in our orthokeratology patient population are consistent with orthokeratology treatment groups from published randomized clinical trials and support the use of these lenses for myopia control in a clinical practice setting.

Development and progression of myopia in children during the COVID-19 pandemic in urban area in Turkey.

To investigate the relationship between digital screen time and the development and progression of myopia during the 2019 coronavirus disease (COVID-19) pandemic. Children aged 7-18years who had regular refractive measurement follow-ups before and after the COVID-19 pandemic were included in the study. They were divided into two groups according to their initial refractive status, emmetropic and myopic. The relationship between spherical equivalent refraction (SER) changes and digital screen time before and after the pandemic was analyzed. A total of 255 children were included in the study. During the pandemic in the emmetropic group, digital screen time increased by 5.98 ± 2.13h/day, and the mean SER decreased from - 0.02 to - 0.55 D (p < 0.001). During the pandemic in the myopic group, the digital screen time increased by 6.25 ± 2.36h, and the mean SER decreased from - 1.82 to - 2.72 D (p < 0.001). A significant correlation was found between the increase in digital screen time and the change in SER in the emmetropic and myopic groups (r = - 0.261, p = 0.015, r = - 0.269, p = 0.001, respectively). Increased digital screen time during the COVID-19 pandemic is associated with a myopic shift in emmetropic children and myopic progression in myopic children. As a result of COVID-19, increasing cases of myopia should be addressed as a public health concern.

Influence of a long-distance optical imaging workbench on accommodation and choroidal response in myopic children

ABSTRACT Clinical relevance Optical approaches to modulating near work may be beneficial in arresting the progression of myopia Background To explore whether a long-distance optical image workbench (LOIW) can replace traditional near-distance reading and has beneficial influences on accommodation and choroidal parameters. Methods This self-control study included two sessions. In session 1, an open-field autorefractor measured sustained accommodative response and pupil diameter when participants viewed virtual images from 3.42 m away through LOIW with + 0.50 D over-correction lenses (3.42 m/+0.50 D), LOIW with full-correction lenses (3.42 m/FC), or the visual target at a given distance of 0.33 m with + 0.50 D over-correction lenses (0.33 m/+0.50 D), with full-correction lenses (0.33 m/FC). In session 2, swept-source optical coherence tomography angiography assessed subfoveal choroidal thickness (SFChT), choroidal volume (CV), and choriocapillaris flow void percentage (FV%) at baseline and before and after reading via LOIW with + 0.50 D over-correction lenses (Far/+0.50 D) or in habitual near distance with full-correction (Near/FC) for a sustained 30-min period. Results Thirty-five myopic (mean spherical equivalent refraction: −1.11 ± 0.78 D) children (median [range] age: 8.36 [8–10] years) were analysed. Children viewing virtual images in 3.42 m/+0.50 D exhibited mild-degree accommodative leads (−0.54 ± 0.17 D), much smaller pupil diameter (3.39 ± 0.63 mm) and microfluctuations (0.13 ± 0.04 D); accommodative lags (0.88 ± 0.04 D), larger pupil diameter (5.05 ± 0.75 mm) and microfluctuations (0.88 ± 0.16 D) were observed in 0.33 m/+0.50 D, and the microfluctuations were unstable (F = 2.185, p = 0.038). Compared with baseline data, SFChT, CV, and FV% changed by 13.40 ± 4.71 μm, 0.26 ± 0.21 mm3, and − 0.14%±3.66% in Far/+0.50 D, respectively, while changes under Near/FC were − 10.19 ± 7.48 μm, −0.15 ± 0.22 mm3 and 1.95%±2.92%, respectively. All changes differed significantly between these two conditions (all p < 0.001). Conclusion The long-distance working mode may exert beneficial effects on accommodative and choroidal parameters in myopic children compared with traditional near work.

Multiple segment spectacle lenses for myopia control. Part 2: Impact on myopia progression.

Initial studies have suggested that multiple segment (MS) spectacle lenses can reduce the progression rate of childhood myopia and axial eye growth. This paper aimed to compare the effectiveness of two different available designs of MS lens and to explore the nature of their control effect. Published data from the only two clinical trials in which changes in mean spherical equivalent refraction (SER) and axial length (AL) for matched groups of myopic children wearing either MS or single-vision (SV) spectacle corrections, recorded over a period of at least 2 years, were further analysed and compared. Both trials involved Chinese children of similar ages and visual characteristics, but the trials were located in different cities. The two MS lenses examined were MiyoSmart or DIMS (Hoya) and Stellest (Essilor). Absolute changes in SER and AL differed over time during the two trials. However, if the results were expressed in terms of efficacy over successive 6-month periods, then the two MS lenses produced broadly similar results (initial efficacy for the control of myopia progression of about 60%-80%, declining over 2 years to about 35%-55%). Control appears to be absolute rather than proportional. Myopia control may be due to either the additional myopic defocus induced by the MS lenses (i.e., asymmetry of the through-focus image changes about the distance focus) or to the general reduction in image contrast that the lenslets create in the peripheral field. Multiple segment spectacle lenses offer a valuable new approach to the control of myopia progression in children. Further work is required to clarify their mechanism of action and to optimise their design parameters.