Myopic Macular Degeneration Research Articles

Privacy Preserving Technology using Federated Learning and Blockchain in protecting against Adversarial Attacks for Retinal Imaging

PurposeCollaboration provides valuable data for robust artificial intelligence (AI) model development. Federated learning (FL) is a privacy enhancing technology that allows collaboration while respecting privacy via the development of models without raw data transfer. However state-of-the-art FL models still face challenges in non-independent and identically distributed (non-i.i.d.) health care settings and remain susceptible to privacy breaches. We propose a novel FL framework coupled with blockchain technology to address these challenges. DesignRetrospective multicohort study Subjects and Methods27,145 images from Singapore, China and Taiwan were used to design a novel FL aggregation method for the detection of myopic macular degeneration (MMD) from fundus photographs and macular disease from optical coherence tomography (OCT) scans in feature distribution skew and label distribution imbalance scenarios. We further performed adversarial attacks (label flipping and clean label). As proof of concept, blockchain was incorporated into FL to demonstrate secure transfer of model updates across collaborating sites. Main Outcome MeasuresWe evaluated our FL model performance in MMD and OCT classification and compared our model against state-of the-art FL and centralized models. ResultsOur FL model showed robust performance with areas under the receiving operating characteristic curves (AUC) of 0.868±0.009 for MMD detection and 0.970±0.012 for OCT macular disease classification. In label flipping attack, our FL model had an AUC of 0.861±0.019, similar to the centralized model (AUC 0.856± 0.015) and higher than other FL models (AUC 0.578–0.819) In clean label attack, our FL model had an AUC of 0.878±0.006 which was comparable to the centralized model (AUC 0.878±0.001) and superior to other state-of-the-art FL models with AUC of 0.529-0.838. Simulation showed that the additional time with blockchain in one global epoch was around 5 seconds. The addition of blockchain to the FL framework was feasible with a minimal impact on model development time. ConclusionsOur proposed FL algorithm overcomes the shortcoming of the traditional FL in non i.i.d. situations and remains robust to against adversarial attacks. The integration of blockchain adds further security during the transfer of model updates. Blockchain-enabled FL can be a trusted platform for collaborative health AI research.

Prevalence and associations of dome-shaped maculas. The Beijing Eye Study.

To explore the prevalence and associated factors of a dome-shaped macula (DSM) in a general population. Out of the population-based Beijing Eye Study cohort (n = 3468 participants), the investigation included all eyes with an axial length of ≥25 mm, and a randomized sample of eyes with an axial length of <25 mm. Using optical coherence tomographic (OCT) images, we examined presence and height of DSMs, defined as an inward convexity of the foveal retinal pigment epithelium (RPE)/Bruch's membrane (BM) line, detectable in at least two OCT scans perpendicularly orientated to each other. The study cohort consisted of 366 eyes (314 individuals) with a mean age of 63.7 ± 9.7 years and a mean axial length of 24.8 ± 2.1 mm (median: 25.1 mm; range: 18.96-30.88 mm). Prevalence of DSMs (found in 6/366 eyes; 1.9%; 95%CI: 1.0, 3.0) increased from 0/125 (0%) in non-myopic eyes to 1/152 (0.7%; 95%CI: 0.0, 2.0) in moderately myopic eyes, and to 6/83 (7.2%; 95%CI: 1.7, 12.7) in the highly myopic group. In multivariable analysis, higher DSM prevalence corelated with longer axial length (OR: 2.05; 95%CI: 1.36, 3.08; p < 0.001) and higher stage of myopic macular degeneration (OR: 1.08; 95%CI: 1.01, 1.16; p = 0.03). The mean maximal DSM height was 139 ± 107 μm (median: 100 μm; range: 25-350 μm). It was associated with higher stage of myopic macular degeneration (beta: 0.24; p < 0.001) and higher prevalence of macular BM defects (beta: 0.17; p < 0.001). None of the DSMs showed a serous retinal detachment or relative choroidal thickening. Higher DSM prevalence correlated non-linearly with longer axial length, with DSM height increasing with the presence of a BM defect. DSMs may be associated with an axial elongation-related BM overproduction in the fundus midperiphery in all meridians.

Lacquer cracks in pathological myopia: a clinical review.

Lacquer cracks, described as breaks in the Bruch's membrane, are unique lesions in the spectrum of fundus changes associated with pathological myopia. Lacquer cracks are generally believed to be relatively innocuous lesions by themselves; however, progression to other features of myopic macular degeneration, such as patchy chorioretinal atrophy and choroidal neovascularization, may result in irreversible visual impairment. With the rising prevalence of pathological myopia to epidemic proportions, particularly in the Asian countries, ophthalmologists expect to encounter lacquer cracks more frequently in clinical practice. Therefore, it is crucial for the ophthalmic community to be aware of lacquer cracks and to actively look for these lesions in myopic patients so that early detection and close monitoring can help prevent blinding complications. This article provides a comprehensive review on lacquer cracks in eyes with pathological myopia from a clinical perspective.

High myopia: Reviews of myopia control strategies and myopia complications.

Myopia and especially high myopia are recognised as major public health concerns. Although the prevalence of high myopia in young children is low, 10-20% of high school children in Asia have high myopia, with many still progressing, and one in three patients with high myopia develop visual impairment with age. Most participants in myopia control studies have low and moderate myopia; relatively little is known about myopia control in high myopia. Literature searches were undertaken in MEDLINE and EMBASE to identify publications in English, investigating (Aim 1) the efficacy of myopia control strategies (environmental, pharmacological and optical) in high myopia (≤-6.00 D) and (Aim 2) the complications of high myopia using keywords. Outcomes included change in spherical equivalent refractive error (SE) and/or axial length (AL) to evaluate progression in high myopia. Aim 1: Twelve studies were identified that reported the efficacy of optical and pharmacological (none on environmental) interventions on AL and SE for high myopia control. A statistically significant reduction in progression of SE and AL in high myopes was reported with 1% and 0.5% atropine. Defocus Incorporated Multiple Segment spectacle lenses had lower efficacy in slowing high myopia progression compared to moderate and low myopia. Ortho-K lenses were equally effective in reducing myopia progression in low, moderate and high myopia. Aim 2: Myopic patients have an increased risk of myopic macular degeneration, retinal detachment, cataract and glaucoma, with the risk increasing with the level of myopia. High myopia has significant effects on quality of life, risk of pathological complications and vision impairment. Young children, excluding those with some syndromic associations, who are fast progressing moderate and high myopes require early intervention and close monitoring. Further research investigating the efficacy of myopia control strategies in highly myopic patients, both independently and through combination treatments, are necessary.

Bruch's Membrane Opening Changes in Eyes With Myopic Macular Degeneration: AIER-SERI Adult High Myopia Study.

The purpose of this study was to assess the choroidal thickness and the Bruch's membrane opening size and their relationship to visual acuity in eyes with myopic macular degeneration (MMD). This was a population-based, cross-sectional study. Patients over the age of 30years with high myopia (spherical equivalent ≤-5 diopters [D]) were recruited. The eyes were grouped according to the International Meta-Analysis for Pathologic Myopia (META-PM) classification based on fundus photographs and diffuse atrophy was subdivided into peripapillary diffuse choroidal atrophy (PDCA) or macular diffuse choroidal atrophy (MDCA). Swept-source optical coherence tomography imaging was performed and then the subfoveal choroidal thickness (SFCT) and Bruch's membrane opening diameter (BMOD) were measured. Of the 470 study participants recruited, 373 patients (691 eyes), with a mean age of 42.8 ± 7.2years, were eligible for the study and included in the analysis. There was no significant difference in SFCT between MDCA and patchy atrophy (M3) groups (P = 1.000), and the BMOD enlarged significantly from no myopic macular lesions to M3 (the P values of multiple comparison tests were all <0.005). Simple linear regression analysis showed that BMOD correlated positively with age (P < 0.001) and axial length (P < 0.001). Multiple linear regression analysis showed that best corrected visual acuity (BCVA) was significantly correlated with age (P = 0.041), axial length (P = 0.001), and BMOD (P = 0.017), but not with SFCT (P = 0.231). The significant variation of BMOD among MMD groups and the correlation between BMOD and BCVA in MMD eyes suggest that BMOD may be an imaging biomarker for monitoring MMD.

Myopic Macular Atrophy in the Two-Continent Population-Based Study.

To examine the prevalence of Bruch's membrane defects (BMDs) and subretinal proliferations (SRPs) in highly myopic eyes with myopic macular atrophy (myopic macular degeneration [MMD] stage 4) and myopic patchy atrophies (MMD stage 3) in three ethnically different cohorts recruited in a population-based manner. The Ural Eye and Medical Study (UEMS) and Beijing Eye Study (BES) included individuals aged 40+years, and the Ural Very Old Study (UVOS) examined individuals aged 85+years. Main outcome measures were the prevalence of BMDs and SRPs. Among 5794 UEMS participants, 19 eyes had MMD stage 4, with 17 (89%) eyes showing a foveal BMD; two eyes could not fully be explored. All 19 eyes showed localized SRPs. Among 21 eyes with MMD stage 3, BMD and SRP prevalence was 9 of 21 (44%) and 7 of 21 (33%), respectively. Among 930 UVOS participants, 17 eyes had MMD stage 4, with 16 (94%) eyes showing foveal BMDs and SRPs; one eye could not be assessed. Among 18 eyes with MMD stage 3, BMD and SRP prevalence was 3 of 18 (17%) and 2 of 18 (11%), respectively. Among 3468 BES participants, 8 eyes had MMD stage 4, with all eyes showing foveal BMDs and SRPs. Among 14 eyes with MMD stage 3, BMD and SRP prevalence was 10 of 14 (71%) and 7 of 21 (33%), respectively. All eyes with assessable myopic macular atrophy showed foveal BMDs associated with SRPs, while patchy atrophies could be differentiated into those with BMDs and SRPs and those without BMDs and without SRPs. Independent of the MMD stage, the prevalences of BMDs and SRPs were highly significantly associated with each other.

Positive and Negative Associations of Myopia with Ocular Diseases in Population-Based Studies

ObjectivePrevalence of myopia and vision impairment due to myopic macular degeneration and myopia-related optic neuropathies have markedly increased worldwide. We evaluated whether myopia is associated with the prevalence of other ocular disorders in a positive or negative sense. DesignPopulation-based studies conducted in Russia, China and India. ParticipantsThe Russian Ural Eye and Medical Study (UEMS) and the Beijing Eye Study (BES) included 5899 individuals and 4439 individuals (all aged 40+ years), respectively, and the Central India Eye and Medical Study (CIEMS) consisted of 4711 individuals, aged 30+ years. The studies were conducted in rural and urban regions in Bashkortostan/Russia, Nagpur/India, and Beijing/China. MethodsThe participants underwent a series of ophthalmological and general medical examinations. Main Outcome MeasuresAxial length as surrogate for myopia, and prevalence of diabetic retinopathy (DR), age-related macular degeneration (AMD), angle-closure glaucoma (ACG), and open-angle glaucoma (OAG). ResultsIn the UEMS, DR prevalence (OR:0.73;95%CI:0.56,0.96), AMD prevalence (OR:0.85;95%CI:0.74,0.98) and ACG prevalence (OR:0.72;95%CI:0.55,0.95) decreased, and OAG prevalence (OR:1.65;95%CI:1.45,1.88) increased with longer axial length in multivariable analyses. In the CIEMS, lower AMD prevalence (OR:0.81;95%CI:0.69,0.95) and lower ACG prevalence (OR:0.55;95%CI:0.36,0.83), and higher OAG prevalence (OR:1.45;95%CI:1.15,1.83) were associated with longer axial length. DR prevalence (0.33%;95%CI:0.16,0.50) was too low for statistical analysis in the CIEMS. In the BES, prevalence (OR:0.64;95%CI:0.50,0.81) and 10-year incidence of DR (OR:0.48;95%CI:0.33,0.71) and prevalence (OR:0.83;95%CI:0.77,0.89) and 5-year incidence of AMD (OR:0.996;95%CI:0.993,0.999) decreased, and prevalence (OR:1.35;95% CI:1.17,1.56) and 10-year incidence of OAG (OR:1.40;95%CI:1.22,1.61) increased with longer axial length. In all three studies, the association between higher OAG prevalence and longer axial length was nonlinear with a slight increase for the moderate myopia range, and a steep increase in the highly myopic range. Conclusions and RelevanceMyopia is associated with a lower prevalence of DR, AMD and ACG and lower incidence of DR and AMD, while high myopia more than moderate myopia is associated with a higher prevalence and incidence of OAG. Future studies may assess whether in myopia, in particular in moderate myopia, the myopia-related advantages, i.e., lower prevalence of DR, AMD and ACG, may outweigh the increased risks for OAG and other myopia-related disorders.

Clinical features of primary and compound forms of wide macular posterior staphyloma in high myopia

BackgroundTo compare the ocular features of highly myopic eyes with posterior staphyloma of wide macular type according to its morphological complexity.MethodsIn this cross-sectional study, wide macular posterior staphyloma (WMPS) was classified into the primary (Curtin type I) and the compound (Curtin types VI to X) forms based on the configuration within the staphyloma. The grades of myopic maculopathy and the thicknesses of choroid and sclera were compared between the primary and compound forms of WMPS.ResultsA total of 154 eyes (103 patients) with primary WMPS and 65 eyes (49 patients) with compound WMPS were included. Eyes with compound WMPS had worse visual acuity (P = 0.001) and greater axial length (P < 0.001) than those with primary WMPS. Compared to primary WMPS, compound WMPS had a higher grade of myopic macular degeneration (P < 0.001) and a higher frequency of lamellar or full-thickness macular hole associated with myopic traction (21.5% vs. 10.4%; P = 0.028) and active or scarred myopic choroidal neovascularization (33.8% vs. 20.1%; P = 0.030). On swept-source optical coherence tomography, eyes with compound WMPS had significantly thinner choroid and sclera.ConclusionsThe compound form of WMPS had more severe myopic macular changes and worse visual prognosis compared to the primary form of WMPS, and these were associated with more structural deformation in the posterior eyeball. Compound WMPS should be considered as an advanced form of staphyloma.

Circulating Autoantibody Profiling Identifies LIMS1 as a Potential Target for Pathogenic Autoimmunity in pathologic Myopia

High myopia is a leading cause of blindness worldwide, among which pathologic myopia, characterized by typical myopic macular degeneration, is the most detrimental. However, its pathogenesis remains largely unknown. Here, using a HuProt array, we first initiated a serological autoantibody profiling of high myopia and identified 18 potential autoantibodies, of which anti-LIMS1 autoantibody was validated by a customized focused microarray. Further subgroup analysis revealed its actual relevance to pathologic myopia, rather than simple high myopia without myopic macular degeneration. Mechanistically, anti-LIMS1 autoantibody predominantly belonged to IgG1/IgG2/IgG3 subclasses. Serum IgG obtained from patients with pathologic myopia could disrupt the barrier function of retinal pigment epithelial cells via cytoskeleton disorganization and tight junction component reduction, and also trigger a pro-inflammatory mediator cascade in retinal pigment epithelial cells, which were all attenuated by depletion of anti-LIMS1 autoantibody. Together, these data uncover a previously unrecognized autoimmune etiology of myopic macular degeneration in pathologic myopia.

Prevalence and Associated Factors of Cataract, Cataract Surgery and Postoperative Outcome in an Old Population in Russia: The Ural Very Old Study

PurposeTo assess prevalence of cataract and cataract surgery in a very old population in Russia. DesignPopulation-based study. ParticipantsThe Ural Very Old Study included 1526 (81.1%) participants out of 1882 eligible individuals aged 85+ years. MethodsBased on anterior and posterior segment imaging, we assessed the prevalence of cataract, cataract surgery and other ocular disorders affecting best corrected visual acuity (BCVA). Main outcome measuresPrevalence of cataract and cataract surgery. ResultsThe study included 1163 (76.3%) individuals with lens information. Cataract surgery had been performed in 469 right eyes (41.0%;95%CI:38.1,43.9) (92.1% with posterior chamber IOL; 4.7% with multifocal IOL) and 479 left eyes (41.6%;95%CI:38.7,44.4) (92.7% with posterior chamber IOL; 4.2% with multifocal IOL). Among the 1163 study participants, 610 (52.5%) individuals had undergone cataract surgery in at least one eye. Higher prevalence of previous cataract surgery correlated (multivariable analysis) with lower IOP (OR:0.92;95%CI:0.88,0.95;P<0.001), glaucomatous optic nerve damage stage (OR:1.20;95%CI:1.05,1.36;P=0.006), and better visual acuity (OR:0.67;95%CI:0.51,0.89;P=0.005). Postoperative BCVA (mean:0.83±1.43logMAR) was reduced to moderate-to-severe vision impairment (MSVI) in 202 eyes (44.6%;95%CI:40.0,49.2) and to blindness in 53 eyes (11.7%;95%CI:8.7,14.7). Causes of postoperative MSVI were age-related macular degeneration (AMD) (34.2%), glaucoma (13.9%), and secondary cataract (5.4%). Causes for blindness were AMD (24.5%), glaucoma (18.9%), corneal opacifications (15.8%) and myopic macular degeneration (11.3%). YAG-laser capsulotomy had been performed in 6 (1.3%) out 469 right eyes after cataract surgery and in 12 (2.5%) out of 479 left eyes after cataract surgery. Prevalence of nuclear cataract and cortical cataract was 604/671 (90.0% in phakic eyes 51.9% in the whole study population) and 97.9% eyes (48.4% in total study population). Cataract caused bilateral MSVI and blindness in 28.2% (95%CI:25.6,30) and 2.9% (95%CI:1.9,3.9), respectively, of all study participants. ConclusionsDespite a relatively high prevalence of cataract surgery, this multiethnic cohort aged 85+ years from Russia showed a high prevalence of cataract-related MSVI and blindness, due to the old age of the participants. After cataract surgery, main causes for MSVI (prevalence:44.6%) and blindness (prevalence:11.7%) were AMD, glaucoma, corneal opacifications, and myopic macular degeneration. Almost all individuals aged 85+ years need cataract surgery, despite limited chance of postoperative good vision.

Prevalence of Myopic Maculopathy Among the Very Old: The Ural Very Old Study.

To assess the prevalence of myopic macular degeneration (MMD) in very old individuals. The population-based Ural Very Old Study (UVOS) included 1526 (81.1%) of 1882 eligible inhabitants aged ≥85 years. Assessable fundus images were available for 930 (60.9%) individuals (mean age, 88.6 ± 2.7years). MMD was defined by macular patchy atrophies (i.e., MMD stage 3 and 4 as defined by the Pathologic Myopia Study Group). MMD prevalence was 21 of 930 (2.3%; 95% CI, 1.3-3.3), with 10 individuals (1.1%; 95% CI, 0.4-1.7) having MMD stage 3 and 11 participants (1.2%; 95% CI, 0.5-1.9) MMD stage 4 disease. Within MMD stage 3 and 4, prevalence of binocular moderate to severe vision impairment was 4 of 10 (40%; 95% CI, 31-77) and 7 of 11 (64%; 95% CI, 30-98), respectively, and the prevalence of binocular blindness was 2 of 10 (20%; 95% CI, 0-50) and 3 of 11 (27%; 95% CI, 0-59), respectively. In minor myopia (axial length, 24.0 to <24.5 mm), moderate myopia (axial length, 24.5 to <26.5 mm), and high myopia (axial length, ≥26.5 mm), MMD prevalence in the right eyes was 0 of 46 eyes (0%), 3 of 40 eyes (8%; 95% CI, 0-16), and 7 of 9 (78%; 95% CI, 44-100), respectively; MMD prevalence in the left eyes was 1 in 48 eyes (2%; 95% CI, 0-6), 4 of 36 eyes (11%; 95% CI, 0-22), and 3 of 4 eyes (75%; 95% CI, 0-100), respectively. In multivariable analysis, a higher MMD prevalence (odds ratio, 8.89; 95% CI, 3.43-23.0; P < 0.001) and higher MMD stage (beta, 0.45; B, 19; 95% CI, 0.16-0.22; P < 0.001) were correlated with longer axial length but not with any other ocular or systemic parameter. MMD prevalence (stages 3 and 4) in very old individuals increased 8.89-fold for each mm axial length increase, with a prevalence of ≥75% in highly myopic eyes. In old age, highly myopic individuals have a high risk of eventually developing MMD with marked vision impairment.

Using choroidal thickness to detect myopic macular degeneration.

To explore the usage of choroidal thickness measured by swept-source optical coherence tomography (SS-OCT) to detect myopic macular degeneration (MMD) in high myopic participants. Participants with bilateral high myopia (≤-6 diopters) were recruited from a subset of the Guangzhou Zhongshan Ophthalmic Center-Brien Holden Vision Institute High Myopia Cohort Study. SS-OCT was performed to determine the choroidal thickness, and myopic maculopathy was graded by the International Meta-Analysis for Pathologic Myopia (META-PM) Classification. Presence of MMD was defined as META-PM category 2 or above. A total of 568 right eyes were included for analysis. Eyes with MMD (n=106, 18.7%) were found to have older age, longer axial lengths (AL), higher myopic spherical equivalents (SE), and reduced choroidal thickness in each Early Treatment Diabetic Retinopathy Study (ETDRS) grid sector (P<0.001). The area under the receiver operating characteristic (ROC) curves (AUC) for subfoveal choroidal thickness (0.907) was greater than that of the model, including age, AL, and SE at 0.6249, 0.8208, and 0.8205, respectively. The choroidal thickness of the inner and outer nasal sectors was the most accurate indicator of MMD (AUC of 0.928 and 0.923, respectively). An outer nasal sector choroidal thickness of less than 74 µm demonstrated the highest odds of predicting MMD (OR=33.8). Choroidal thickness detects the presence of MMD with high agreement, particularly of the inner and outer nasal sectors of the posterior pole, which appears to be a biometric parameter more precise than age, AL, or SE.

Low vision rehabilitation program in patients with myopic macular degeneration: A case series

Aims/Purpose: Patients with pathologic myopia are at risk of developing myopic macular degeneration (MMD) that leads to vision loss and irreversible visual impairment. Working age and elderly populations are affected by loss of productivity and quality of life. Low vision services should offer specialized training programs to help patients to overcome the difficulties in daily living activities. The aim of this study was to describe the results of a low vision rehabilitation program (LVR) in patients with MMD.Methods: Five patients (8 eyes) with MMD were included in the LVR at an ophthalmology clinic in Portugal. The LVR had a length of 8 weeks and was divided into two phases. The first phase included the use of prisms for image relocation (IR) with eccentric viewing exercises to stabilize the preferred retinal locus. At the second phase, training with low vision aids was performed. Best corrected visual acuity (BCVA) for distance and near, contrast sensitivity (CS), reading speed (RS) and face recognition were compared pre and post rehabilitation.Results: Patients had MMD category 3 (patchy chorioretinal atrophy) and 4 (macular atrophy) in the best eye. Vision impairment varied between mild and severe. The IR prisms varied from 2 to 6 prism dioptres. Electronic devices were the most prescribed low vision aids. At the end of the LVR, the outcomes were good in all patients. BCVA increased by two to three lines, CS increased by two to four lines, RS increased by 40 to 60 words per minute and face recognition improved in all patients.Conclusions: The LVR was beneficial, improving visual function and functional vision outcomes in all patients. LVR programs seem to be effective in patients with pathologic myopia. Longitudinal studies are necessary to ascertain the long‐term efficacy of LVR.

AI‐based studies using fundus images

The artificial intelligence (AI)/deep learning (DL) algorithms were shown to detect diseases based on image analysis, including retinal diseases from fundus photos and optical coherence tomography (OCT) scans, lung diseases from chest radiographs, and skin disorders from skin photos. It was also shown that retinal photos can be used to identify risk factors related with cardiovascular disorders, including blood pressure, smoking and body mass index.The fundus picture was shown to source data for developing AI/DL algorithms detecting many ophthalmic diseases and pathologies, including diabetic retinopathy, diabetic macular edema, retinal artery and vein occlusion, macular hole, epiretinal membrane, AMD, glaucoma, retinopathy of prematurity, myopia, myopic macular degeneration, hyperopia, optic disc edema, optic nerve atrophy, central serous retinopathy, myelinated nerve fibres, and retinitis pigmentosa. Moreover, fundus pictures were also used to develop many AI/DL algorithms detecting non ophthalmic diseases and pathologies, including Alzheimer and Parkinson disease, risk of stroke, risk of cardiac infarction, systemic hypertension, chronic renal disease, peripheral arterial disease, and anaemia.

Axial Elongation Trajectories in Chinese Children and Adults With High Myopia

Understanding the long-term axial elongation trajectory in high myopia is important to prevent blindness. To evaluate axial elongation trajectories and related visual outcomes in children and adults with high myopia. In this cohort study, participants in the Zhongshan Ophthalmic Centre-Brien Holden Vision Institute high myopia cohort were followed up every other year for 8 years. Participants with axial length measurements at baseline (2011 or 2012) and at least 1 follow-up visit were included. Participants were grouped according to baseline age as children and adolescents (7 to <18 years), young adults (18 to <40 years), and older adults (≥40 to 70 years). Data were analyzed from November 1, 2022, to June 1, 2023. High myopia (spherical power ≤-6.00 diopters). Longitudinal axial elongation trajectories were identified by cluster analysis. Axial elongation rates were calculated by linear mixed-effects models. A 2-sided P < .05 was defined as statistically significant. A total of 793 participants (median [range] age, 17.8 [6.8-69.7] years; 418 females [52.7%]) and 1586 eyes were included in the analyses. Mean axial elongation rates were 0.46 mm/y (95% CI, 0.44-0.48 mm/y) for children and adolescents, 0.07 mm/y (95% CI, 0.06-0.09 mm/y) for young adults, and 0.13 mm/y (95% CI, 0.07-0.19 mm/y) for older adults. Cluster analysis identified 3 axial elongation trajectories, with the stable, moderate, and rapid progression trajectories having mean axial elongation rates of 0.02 mm/y (95% CI, 0.01-0.02 mm/y), 0.12 mm/y (95% CI, 0.11-0.13 mm/y), and 0.38 mm/y (95% CI, 0.35-0.42 mm/y), respectively. At 8 years of follow-up, compared with the stable progression trajectory, the rapid progression trajectory was associated with a 6.92 times higher risk of developing pathological myopic macular degeneration (defined as diffuse or patchy chorioretinal atrophy or macular atrophy; odds ratio, 6.92 [95% CI, 1.07-44.60]; P = .04), and it was associated with a 0.032 logMAR decrease in best-corrected visual acuity (β = 0.032 [95% CI, 0.001-0.063]; P = .04). The findings of this 8-year follow-up study suggest that axial length in high myopia continues to increase from childhood to late adulthood following 3 distinct trajectories. At 8 years of follow-up, the rapid progression trajectory was associated with a higher risk of developing pathological myopic macular degeneration and poorer best-corrected visual acuity compared with the stable progression trajectory. These distinct axial elongation trajectories could prove valuable for early identification and intervention for high-risk individuals.

Characterizing Macular Neovascularization in Myopic Macular Degeneration and Age-Related Macular Degeneration Using Swept Source OCTA.

Visual prognosis and treatment burden for macular neovascularization (MNV) can differ between myopic macular degeneration (MMD) and age-related macular degeneration (AMD). We describe and compare MNV associated with MMD and AMD using swept-source (SS)-OCTA. Adult patients with documented MNV associated with MMD or AMD were consecutively recruited. Qualitative and quantitative features were assessed from 6x6mm angiograms, including the MNV area and vessel density (VD). Descriptive statistics and linear regression analyses were carried out. Out of 75 enrolled eyes with diagnosed MNV (30 MMD-MNV and 45 AMD-MNV; mean age 55±19 and 75±8 years, respectively), 44 eyes had discernible MNV (11 MMD-MNV and 33 AMD-MNV) on SS-OCTA at the time of the study and were included in the analysis. The MMD-MNV group exhibited a three-fold smaller sized MNV (p=0.001), lower greatest linear dimension (p=0.009) and greatest vascular caliber (p<0.001) compared to AMD-MNVs, and had a higher prevalence of tree-in-bud pattern. Eyes with AMD showed a higher prevalence of type 1 MNVs with medusa pattern. There was no difference in the location of the MNV, shape's regularity, margins, presence of core vessel, capillary fringe, peripheral loops, or perilesional dark halo (p>0.05) between both conditions. After adjustment, decreased MNV area and increased VD were associated with the tree-in-bud pattern, whereas the diagnosis did not significantly influence those parameters. While larger studies are warranted, this study is the first to describe and compare MMD-MNV and AMD-MNV using SS-OCTA, providing relevant clinical insight on MNV secondary to MMD and AMD. These findings also further validate OCTA as a powerful tool to detect and characterize MNV non-invasively.

Topical Atropine for Childhood Myopia Control

Clinical trial results of topical atropine eye drops for childhood myopia control have shown inconsistent outcomes across short-term studies, with little long-term safety or other outcomes reported. To report the long-term safety and outcomes of topical atropine for childhood myopia control. This prospective, double-masked observational study of the Atropine for the Treatment of Myopia (ATOM) 1 and ATOM2 randomized clinical trials took place at 2 single centers and included adults reviewed in 2021 through 2022 from the ATOM1 study (atropine 1% vs placebo; 1999 through 2003) and the ATOM2 study (atropine 0.01% vs 0.1% vs 0.5%; 2006 through 2012). Change in cycloplegic spherical equivalent (SE) with axial length (AL); incidence of ocular complications. Among the original 400 participants in each original cohort, the study team evaluated 71 of 400 ATOM1 adult participants (17.8% of original cohort; study age, mean [SD] 30.5 [1.2] years; 40.6% female) and 158 of 400 ATOM2 adult participants (39.5% of original cohort; study age, mean [SD], 24.5 [1.5] years; 42.9% female) whose baseline characteristics (SE and AL) were representative of the original cohort. In this study, evaluating ATOM1 participants, the mean (SD) SE and AL were -5.20 (2.46) diopters (D), 25.87 (1.23) mm and -6.00 (1.63) D, 25.90 (1.21) mm in the 1% atropine-treated and placebo groups, respectively (difference of SE, 0.80 D; 95% CI, -0.25 to 1.85 D; P = .13; difference of AL, -0.03 mm; 95% CI, -0.65 to 0.58 mm; P = .92). In ATOM2 participants, the mean (SD) SE and AL was -6.40 (2.21) D; 26.25 (1.34) mm; -6.81 (1.92) D, 26.28 (0.99) mm; and -7.19 (2.87) D, 26.31 (1.31) mm in the 0.01%, 0.1%, and 0.5% atropine groups, respectively. There was no difference in the 20-year incidence of cataract/lens opacities, myopic macular degeneration, or parapapillary atrophy (β/γ zone) comparing the 1% atropine-treated group vs the placebo group. Among approximately one-quarter of the original participants, use of short-term topical atropine eye drops ranging from 0.01% to 1.0% for a duration of 2 to 4 years during childhood was not associated with differences in final refractive errors 10 to 20 years after treatment. There was no increased incidence of treatment or myopia-related ocular complications in the 1% atropine-treated group vs the placebo group. These findings may affect the design of future clinical trials, as further studies are required to investigate the duration and concentration of atropine for childhood myopia control.

Prevalence and causes of vision impairment in elderly Chinese people living in suburban Shanghai

PurposeTo investigate the current prevalence and causes of moderate and severe visual impairment (MSVI) and blindness in elderly people in suburban Shanghai, China. MethodsA cross-sectional study based on the population was conducted, which involved 5846 individuals (11,692 eyes) aged 65 years or older. Thorough eye examinations were performed to assess the prevalence and leading factors of MSVI (BCVA <20/63 to ≥20/400) and blindness (BCVA <20/400). ResultsThe standardized prevalence of bilateral MSVI and blindness was 3.3% and 0.6%, correspondingly. The standardized prevalence of monocular MSVI and blindness was 7.4% and 2.0%, correspondingly. Cataract (47.9% and 20.7%, correspondingly) and myopic macular degeneration (MMD, 25.7% and 31.1%, correspondingly) were the principal causes of bilateral MSVI and blindness. As for monocular MSVI, the primary causes were cataract (39.4%), age-related macular degeneration (AMD, 16.6%), and MMD (16.6%). The primary causes of monocular blindness were other posterior segment eye diseases (30.1%) and MMD (14.2%). In adults aged 65–74 years, MMD was the foremost factor causing bilateral vision impairment. Conversely, cataract was identified as the primary cause of bilateral and monocular vision impairment among adults aged ≥ 75 years. AMD accounts for a significant proportion of individuals across all age groups. ConclusionsThe significant prevalence of MSVI and blindness among Chinese adults represents a critical public health issue. In addition to cataract, the vision impairment caused by MMD and AMD become an important issue in the elderly Chinese people.

Additional degradants in the impurity profile of atropine low-dose ophthalmic solution

WHO has identified the increase in myopia as the world's greatest threat to vision health due to its association with vision-threatening complications like myopic macular degeneration, retinal detachment, cataract and open angle glaucoma. Pharmacological treatment with atropine is assessed as one of the best option in op-tical approaches to the control and inhibit of myopia progression. The aim of this study was to develop analytical method for quality control of 0.1 mg/mL atropine ophthalmic solution. UPLC analytical method for simultaneous determination of atropine sulfate monohydrate and its related substances described in Eur. Ph. and for additional impurities was developed. For method development low-dose of atropine formulations with a wide range of pH 4.5-6.6 were tested and the impact of formulation pH on the impurity profile was noted. The ionized form of tropic acid was observed in our studies in all buffered formulations with pH above 5. Additionally two isomers of atropine N-oxide were observed in the tested preparation with pH 6.6 in the presence of an oxidizing agent and were just possible to integrate with our new developed UPLC method. The ionized form of tropic acid was already defined in Berton et al. publication (1) and observed in the buffered formulation with pH 6.0. Our result complement and extend the impurity profile of atropine in wider pH range of atropine ophthalmic solutions.

Juvenile-onset myopia-who to treat and how to evaluate success.

The risk of eye diseases such as myopic macular degeneration increases with the level of myopia, but there is no safe level of myopia and the burden of lower degrees of myopia remains considerable. Effective treatments are available that slow progression and thus limit the final degree of myopia. In this review, the rationale for slowing progression is summarized, and a case made for treating all myopic children. Measurement of refractive error and axial length is reviewed, stressing the precision of optical biometry, but also the need for cycloplegic autorefraction. The factors influencing progression are considered and the available tools for interpretation of progression rate are discussed. Finally, the need to set attainable treatment goals is emphasized.