Refraction In Children Research Articles

Comp arison of c yclop legic refraction in ch i ldren w i th different iris c olou r cat eg ories: A cross- sec tio na l survey.

To compare the cycloplegic refraction in children with different iris colour categories and age groups. The cross -sectional study was conducted from December 2 022 to June 2023 at the Eye Clinic of Sehat Medical Complex, Hanjarwal, Lahore, and Khizar Eye Centre, Lahore, Pakistan, and comprised hyperopic children aged 5-12 years of either gender. Data regarding age, gender, iris colour, auto -refraction and retinoscopy before and after cycloplegic refraction was collected using a structured proforma. Data was analysed using SPSS 21. Of the 139 subjects, 73(52.5%) were males and 60(47.5%) were females. There were 79(56.8%) subjects aged 5-8 ye ars and 60(43.2%) aged 9 -12 years. The iris colour dis tribution was 23(16.5%) light, 80(57.6%) med ium and 36(25 . 9%) da r k, w ith a mean visual acuity of 0.7 ±0.6. There wa s a signi ficant differe nce in non - cyclopleg ic and cycloplegic refraction for different iris colours and age groups (p<0.05). Children with light iris colour accommodated more and needed a low concentration of cyclopentolate compared to those with m edi u m and dark ir is col ours. More accomm odation was noted among child ren ag ed 9-12 years.

Comparison of Different Cycloplegic Refraction Regimens for Children

In the process of a pediatric eye exam, cycloplegic refraction is a crucial step. Since no single cycloplegic drug is ideal, a combination regimen is employed. This study compares the ocular (refractive power and pupil diameter) and systemic (blood pressure and heart rate) effects of administering a combination of 1% cyclopentolate and 2.5% phenylephrine, with or without 1% tropicamide, to children with refractive errors. This study aimed to discover a more feasible regimen for children. This was a single-blind study, a randomized clinical trial conducted from November–December 2020 in children with mild to moderate refractive errors. Group A received 1% cyclopentolate, 2.5% phenylephrine, and 1% tropicamide (SFT), whereas group B received 1% cyclopentolate and 2.5% phenylephrine (SF). The outcomes were measured using an auto refractometer and IOL Master® 700. Before and 60 minutes after medication was administered, blood pressure and heart rate were measured. There were 54 participants (108 eyes) with an average age of 12.85± 2.84 years. Although the SFT group's refractive power and pupil width were greater than those of the SF group, the differences were not statistically significant (p=0.271 and p=0.088). Heart rate (p=0.521) and blood pressure (systolic p=0.201; diastolic p=0.950) did not significantly differ between the two groups. Despite mydriasis manifested more rapidly in the SFT group, there was no discernible difference in the cycloplegic effects between those groups. SF might be a more feasible regimen for cycloplegic refraction in children with refractive errors.

ASSOCIATION OF TESSELLATION DENSITY WITH PROGRESSION OF AXIAL LENGTH AND REFRACTION IN CHILDREN: An Artificial Intelligence-Assisted 4-Year Study.

To investigate fundus tessellation density (TD) and its association with axial length (AL) elongation and spherical equivalent (SE) progression in children. The school-based prospective cohort study enrolled 1,997 individuals aged 7 to 9 years in 11 elementary schools in Mojiang, China. Cycloplegic refraction and biometry were performed at baseline and 4-year visits. The baseline fundus photographs were taken, and TD, defined as the percentage of exposed choroidal vessel area in the photographs, was quantified using an artificial intelligence-assisted semiautomatic labeling approach. After the exclusion of 330 ineligible participants because of loss to follow-up or ineligible fundus photographs, logistic models were used to assess the association of TD with rapid AL elongation (>0.36 mm/year) and SE progression (>1.00 D/year). The prevalence of tessellation was 477 of 1,667 (28.6%) and mean TD was 0.008 ± 0.019. The mean AL elongation and SE progression in 4 years were 0.90 ± 0.58 mm and -1.09 ± 1.25 D. Higher TD was associated with longer baseline AL (β, 0.030; 95% confidence interval: 0.015-0.046; P < 0.001) and more myopic baseline SE (β, -0.017; 95% confidence interval: -0.032 to -0.002; P = 0.029). Higher TD was associated with rapid AL elongation (odds ratio, 1.128; 95% confidence interval: 1.055-1.207; P < 0.001) and SE progression (odds ratio, 1.123; 95% confidence interval: 1.020-1.237; P = 0.018). Tessellation density is a potential indicator of rapid AL elongation and refractive progression in children. TD measurement could be a routine to monitor AL elongation.

Relative Myopic Defocus in the Superior Retina as an Indicator of Myopia Development in Children.

To investigate the role of peripheral refraction in children's myopization. This 2-year study included 214 children (8-15 years old). Refraction across the retina (field of view: 60° × 36°) was measured with a custom-made aberrometer every year. Three datasets were established: dataset 1, 214 subjects from baseline to the first-year visit; dataset 2, 152 subjects from baseline to the second-year visit; and dataset 3, 59 initial emmetropes from baseline to the second-year visit. The baseline refraction of different retina regions was correlated with the central myopic shift, and was compared among groups with different levels of myopic shift. In datasets 1 and 2, the refraction distribution across the retina was significantly different among the subjects who were initially emmetropes but not among those who were initially hyperopic or myopic. Refraction in the central vertical retina, especially in the superior retina (r = -0.5, P < 0.001), was significantly correlated with the myopic shift for emmetropes in that subjects with more relative myopia in the superior retina manifested greater central myopic shifts. In dataset 3, 21 subjects remained emmetropic after 2 years, 15 subjects became myopic at the 1-year visit, and 23 subjects became myopic at the 2-year visit. No difference was found for the relative peripheral refraction in all of the peripheral regions between the stage prior to and after the onset of myopia. Relative myopic defocus in the superior retina could be a predictor of central myopia shift. Changes in relative peripheral refraction are more likely a consequence of myopia progression rather than a cause.

Clinical efficacy of individual intraocular lens calculation in children with congenital cataract at risk of abnormal refraction

Purpose. To assess the clinical efficacy of the SRK II formula with a correction factor Rm in children with congenital cataracts who are at risk of pseudophakic myopia. Material and methods. A complex examination of 48 children (86 eyes) with congenital cataracts involved visometrics, tonometry, tonography, biomicroscopy, keratorefractometry, ophthalmoscopy, ultrasonography, and pachymetry. To determine the IOL power, we used the SRK II formula supplemented with the individual correction factor Rm, proposed by the authors. The examined children were divided into 2 groups. The main group 1 included 22 patients (42 eyes), for which the IOL power was calculated with the Rm factor. The control group 2 consisted of 26 patients (44 eyes) for which the IOL power was calculated according to the traditional SRK II formula using age-related hypocorrection of refraction but without the Rm coefficient. Results. The correction factor Rm, allowed us to achieve the targeted refraction in children who were at risk of developing pseudophakic myopia in 83.3 % of cases of the main group (versus 45.4 % of the control group cases) and reduce the development of high age-related refraction) by 37.9 %. In children of the main group, visual acuity reached, on average, 0.5 ± 0.001, while in the control group it was also higher but only reached 0.200 ± 0.001. Conclusion. The method of calculating the IOL optical power involving an individual correction factor Rm, according to the formula: SRK II – R – Rm can be recommended for clinical practice focused on children at risk of abnormal refractogenesis.

A Cross-sectional Observational Study to Assess the Influence of 1% Cyclopentolate and 1% Tropicamide on Intraocular Pressure in Children Undergoing Cycloplegic Refraction at a Tertiary Care Hospital in Southern India

Introduction: Cycloplegic refraction is necessary in children due to their high amplitude of accommodation. A combination of Tropicamide and Cyclopentolate is commonly used as cycloplegics in children. These medications can cause a substantial elevation in Intraocular Pressure (IOP) in a few susceptible children. Therefore, the present study was conducted to investigate the changes in IOP when 1% Cyclopentolate and 1% Tropicamide were used for cycloplegic refraction in children. Aim: To assess the influence of 1% Cyclopentolate eyedrops and 1% Tropicamide eyedrops on IOP in children undergoing cycloplegic refraction and to compare the changes in IOP between the hypermetropic and myopic groups before and after cycloplegia. Materials and Methods: This cross-sectional hospital-based study was conducted in the Outpatient Department (OPD) of Ophthalmology at KLE’s Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, in Northern Karnataka, India over a duration of six months. The study included 55 children in the age group of 5-15 years who met the inclusion criteria. All children underwent visual acuity assessment and a detailed examination of the anterior and posterior segments of the eye. Refraction was expressed in terms of Spherical Equivalence (SE), calculated as sphere plus half of the cylinder. Based on the SE calculated after refraction, children were diagnosed as having either myopia or hypermetropia as types of refractive error. Data were analysed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) Statistics (Version 25.0, Chicago, IL, USA). Categorical variables were represented as frequency and percentages, while continuous variables were represented as Mean±Standard Deviation (SD). A p-value ≤0.05 was considered statistically significant. Results: Out of the 55 children included in the study, 25 children were hypermetropic, and 30 children were myopic based on the calculated SE. Among the total of 55 children, 34 were girls, and 21 were boys. The mean age of the 55 children was 10.98±2.4 years. The mean age of the myopic group was 11.97±2.21 years, while the hypermetropic group had a mean age of 9.74±3.29 years. The mean precycloplegic IOP was 14.21±2.76 mmHg, and the mean postcycloplegic IOP was 15.19±3.25 mmHg. The change in IOP was statistically significant (p≤0.0001). In the hypermetropic group of 25 children, the mean precycloplegic IOP was 13.74±2.55 mmHg, while the mean postcycloplegic IOP was 15.10±3.65 mmHg. There was a significant difference in IOP (p=0.0242). In the myopic group of 30, the mean precycloplegic IOP was 14.47±2.86 mmHg, while the postcycloplegic IOP was 15.08±2.86 mmHg. There was no statistically significant change in IOP in the myopic group (p=0.0669). After cycloplegic mydriasis, 2 eyes (3.7%) experienced an increase in IOP greater than 7 mmHg. Conclusion: Cycloplegic mydriasis using 1% Cyclopentolate and 0.8% Tropicamide caused a significant increase in IOP in a few children, with a higher increase observed in hypermetropic children compared to myopic children. Therefore, ophthalmologists should exercise caution and monitor IOP changes in children undergoing cycloplegic refraction to manage any transient rise in IOP and prevent damage to the optic nerve.

Systematic review and meta-analysis on the agreement of non-cycloplegic and cycloplegic refraction in children.

To determine the diagnostic agreement of non-cycloplegic and cycloplegic refraction in children. The study methodology followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases were searched for comparative studies exploring refraction performed on children under non-cycloplegic and cycloplegic conditions. There was no restriction on the year of publication; however, only publications in the English language were eligible. Inclusion criteria consisted of children aged ≤12 years, any degree or type of refractive error, either sex and no ocular or binocular co-morbidities. The QUADAS-2 tool was used to evaluate the risk of bias. Meta-analysis was conducted to synthesise data from all included studies. Subgroup and sensitivity analyses were undertaken for those studies with a risk of bias. Ten studies consisting of 2724 participants were eligible and included in the meta-analysis. The test for overall effect was not significant when comparing non-cycloplegic Plusoptix and cycloplegic autorefractors (Z = 0.34, p = 0.74). The pooled mean difference (MD) was -0.08 D (95% CI -0.54 D, +0.38 D) with a prediction interval of -1.72 D to +1.56 D. At less than 0.25 D, this indicates marginal overestimation of myopia and underestimation of hyperopia under non-cycloplegic conditions. When comparing non-cycloplegic autorefraction with a Retinomax and Canon autorefractor to cycloplegic refraction, a significant difference was found (Z=9.79, p < 0.001) and (Z=4.61, p < 0.001), respectively. Non-cycloplegic Plusoptix is the most useful autorefractor for estimating refractive error in young children with low to moderate levels of hyperopia. Results also suggest that cycloplegic refraction must remain the test of choice when measuring refractive error ≤12 years of age. There were insufficient data to explore possible reasons for heterogeneity. Further research is needed to investigate the agreement between non-cycloplegic and cycloplegic refraction in relation to the type and level of refractive error at different ages.

Changes in the Axial Length of the Eye and Refraction in Children with Progressive Myopia while Wearing Defocused Contact Lenses

Progressive myopia remains one of the urgent problems in modern ophthalmology. Optical methods for controlling progressive myopia suggest the formation of peripheral myopic defocus, which has a stabilizing effect on the axial length of the eye and, as a result, the degree of myopia. One option for optical control of myopia is defocus soft contact lenses.Purpose: to evaluate the growth of axial length and changes in the spherical equivalent of clinical refraction in users of defocus (bifocal) contact lenses and monofocal glasses expressed in diopters, against the background of the correction of progressive myopia with defocus (bifocal) contact lenses and monofocal glasses.Materials and methods. The study involved 256 patients with bilateral mild to moderate and high myopia in the range from (–)0.5 to (–) 7.75 D in spherical equivalent and an annual progression gradient from 0.65 to 1.5 D in the age categories 7–10, 11–14, 15–18 years old. Depending on the degree of myopia and the method of correction, the patients were divided into main and control groups. For correction in the main groups, defocused (with an addition of +4.0 D) soft contact lenses (SCLs) were used. In the control groups monofocal glasses were used. All patients underwent a standard ophthalmological examination. Clinical refraction data and axial length of the eye were used as criteria for evaluating the results. The follow-up period was 3, 6, 12 months.Results. After 12 months of wearing bifocal soft contact lenses, there was a statistically significant slowdown in the growth of the axial length and the spherical equivalent of refraction Higher rates of progression of myopia were in young children (7–10 years). Myopia at the age of 15–18 years is characterized by a decrease in the rate of progression with any type of optical correction and in most cases does not require the appointment of correction with the formation of peripheral myopic defocus.Conclusion. The results obtained indicate the effectiveness of the use of bifocal SCLs in the control of progressive mild, moderate and high myopia. The main stabilization factor is the formation of peripheral myopic defocus on the retina, followed by a slowdown in the growth of the axial length of the eye and the degree of myopia (spherical equivalent of clinical refraction).

Comparative Study of Relative Peripheral Refraction in Children With Different Degrees of Myopia.

PurposeTo investigate the difference in the retinal refraction difference value (RDV) using multispectral refractive topography (MRT).MethodsNinety myopic participants, who met the enrolment requirements, were examined with an automatic optometer after mydriasis. According to the value of the spherical equivalent (SE), the participants were divided into Emmetropia group (E, +0.5D < SE < −0.5D), Low Myopia (LM, −0.5D < SE ≤ −3D), and Moderate and high Myopia (MM, −3D < SE ≤ −10D). The ocular biological parameters were detected by optical biometrics (Lenstar 900, Switzerland), including axial length (AL), lens thickness (LT), and keratometry (K1, K2). Furthermore, the MRT was used to measure the retinal RDV at three concentric areas, with 15-degree intervals from fovea into 45 degrees (RDV-15, RDV 15–30, and RDV 30–45), and four sectors, including RDV-S (RDV-Superior), RDV-I (RDV-Inferior), RDV-T (RDV-Temporal), and RDV-N (RDV-Nasal).ResultsIn the range of RDV-15, there was a significant difference in the value of RDV-15 between Group E (−0.007 ± 0.148) vs. Group LM (−0.212 ± 0.399), and Group E vs. Group MM (0.019 ± 0.106) (P < 0.05); In the range of RDV 15–30, there was a significant difference in the value of RDV 15–30 between Group E (0.114 ± 0.219) vs. Group LM (−0.106 ± 0.332), and Group LM vs. Group MM (0.177 ± 0.209; P < 0.05); In the range of RDV 30–45, there was a significant difference in the value of RDV 30–45 between Group E (0.366 ± 0.339) vs. Group LM (0.461 ± 0.304), and Group E vs. Group MM (0.845 ± 0.415; P < 0.05); In the RDV-S position, there was a significant difference in the value of RDV-S between Group LM (−0.038 ± 0.636) and Group MM (0.526 ± 0.540) (P < 0.05); In the RDV-I position, there was a significant difference in the value of RDV-I between Group E (0.276 ± 0.530) vs. Group LM (0.594 ± 0.513), and Group E vs. Group MM (0.679 ± 0.589; P < 0.05). In the RDV-T position, there was no significant difference in the value of RDV-T among the three groups. In the RDV-N position, there was a significant difference in the value of RDV-N between Group E (0.352 ± 0.623) vs. Group LM (0.464 ± 0.724), and Group E vs. Group MM (1.078 ± 0.627; P < 0.05). The RDV analysis in all directions among the three groups showed a significant difference between RDV-S and RDV-I in Group LM (P < 0.05). Moreover, the correlation analysis showed that SE negatively correlated with AL, RDV 30–45, RDV-S, RDV-I, and RDV-N.ConclusionsIn this study, there was a significant difference in the value of RDV among Group E, Group LM, and Group MM, and the value of RDV in Group MM was the highest on the whole. In the range of RDV 30–45, there was a growing trend with the increase in the degree of myopia among the three groups. Furthermore, the SE negatively correlated with AL, RDV 30–45, RDV-S, RDV-I, and RDV-N.

"Is using Dynamic Distant Direct Ophthalmoscope Refraction an Alternative to Cycloplegic Refraction in Children? – A Comparative Study"

"Is using Dynamic Distant Direct Ophthalmoscope Refraction an Alternative to Cycloplegic Refraction in Children? – A Comparative Study"

Comparison of an open view autorefractor with an open view aberrometer in determining peripheral refraction in children

PurposeThe aim of this study was to compare central and peripheral refraction using an open view Shin-Nippon NVision-K 5001 autorefractor and an open view COAS-HD VR aberrometer in young children. MethodsCycloplegic central and peripheral autorefraction was measured in the right eye of 123 children aged 8 to 16 years. Three measurements each were obtained with both Shin-Nippon NVision-K 5001 autorefractor and COAS-HD VR aberrometer along the horizontal visual field up to 30° (nasal and temporal) in 10° steps. The refraction from the autorefractor was compared with aberrometer refraction for pupil analysis diameters of 2.5-mm and 5.0-mm. ResultsThe Shin-Nippon was 0.30 D more hyperopic than COAS-HD VR at 2.5-mm pupil and 0.50 D more hyperopic than COAS-HD VR at 5-mm pupil for central refraction. For both pupil sizes, the 95% limits of agreement were approximately 0.50 D for central refraction, and limits were wider in the nasal visual field compared to the temporal visual field. The mean difference for both J0 and J45 were within 0.15 D and the 95% limits of agreement within 0.90 D across the horizontal visual field. ConclusionDefocus components were similar between the Shin-Nippon autorefractor and the COAS-HD VR aberrometer with a 2.5-mm pupil for most visual field angles. However, there was a significant difference in defocus component between the Shin-Nippon autorefractor and the COAS-HD VR aberrometer with a 5.0-mm pupil, wherein the autorefractor measured more hyperopia. The astigmatic components J0 and J45 were similar between instruments for both central and peripheral refraction.

Effect of methylphenidate as a dopaminergic agent on myopia: Pilot study.

Background Methylphenidate (MPH) hydrochloride is used as a first-line treatment for attention deficit hyperactivity disorder (ADHD). However, there is concern that this treatment may be associated with increased risk of refractive disorder. The aim of this study was to investigate the effect of MPH therapy on myopic shifts in refraction in children diagnosed with ADHD. Methods This study, children with ADHD and meeting inclusion criteria were examined before the initiation of MPH treatment and 3, 6 and 12months after the initiation of treatment. Twenty age-gender-matched participants who applied to the outpatient ophthalmology clinic with various complaints were included in the study as a control group. Cycloplegic refraction examination and detailed eye measurements were performed at each visit. Results Nineteen patients were included in this study and the group consisted of 11 (57.9%) females and 8 (42.1%) males. The mean age of patients was 11.3±2. (range: 8-18) years. During 12months of use of MPH, the spherical equivalent changed from -0.36±1.08 to -0.39±1.05, and this difference was not statistically significant (P=.187). Axial length ranged from 22.92±0.66. There was a change to 22.93±0.62, and this difference was not statistically significant (P=.076). In the control group, the spherical equivalent changed from -0.43±0.62 to -0.56±0.84, and this difference was statistically significant. (P=.012) There was a change in the axial length from 22.97±0.78 to 22.99±0.62, and this difference was statistically significant (P=.015). Conclusions No significant changes spherical equivalent and axial length were detected during 12-month MPH use, but the increased spherical equivalent and axial length in the control group in the similar age group may indicate that MPH may reduce myopic shifts in refraction progression through dopamine, similar to in vivo studies. What's known Myopia is spreading rapidly in technologically advanced societies. There is strong evidence that myopia develops as the axial length of the eye increases as a result of spending more time indoors and working in close distances in parallel with the increase in education level. Animal studies have shown that decreased dopamine release plays an important role in the development of myopia. What's new The effect of dopamine in slowing or stopping myopia in experimental studies has also been demonstrated in human studies. No significant change in spherical equivalent and axial length was observed in methylphenidate users compared with control patients of similar age group. A significant increase in spherical equivalent and axial length was detected in the control group. This pilot study will shed light on future studies on the safe use of dopamine in the treatment of myopic shifts.

Особенности диагностики и лечения ПВХРД у детей

Purpose. To identify the clinical course of the «risk-forms» of peripheral vitreochorioretinal dystrophy (PVCRD) depending on sex, age, type and degree of refraction in children, as well as to establish the characteristics of the diagnosis and treatment of PVCRD in childhood. Methods. A retrospective analysis of medical records of pediatric patients who underwent peripheral prophylactic laser retinal coagulation (PPLRC) regarding the «risk-forms» of PVHRD at the ophthalmology department of MAUZ Children’s Clinical Hospital No. 1 from 2017 to 2019 was performed. 241 childr (293 eyes) aged 7 to 17 years (mean age 14.1 ± 2.4 years) were operated. Results. PVCRD in children is asymptomatic and it is detected at the age of 7 to 17 years, regardless of gender, the peak of occurrence is 10–14 years. The most common type of PVCRD is «lattice» dystrophy. PVCRD is predominant in low degree myopia. Quite a lot of cases of PVCRD detected in emmetropic refraction, as well as in hyperopic refraction and combined astigmatism. Conclusions. A thorough examination of the periphery of the fundus is necessary in all children, regardless of age and refraction. The parameters of laser coagulation in children differ from those in adults. Given the characteristics of childhood, the success of the operation depends on the correct preoperative preparation, including psychological preparation, contact of the surgeon with the child during the operation. Key words: peripheral dystrophy; ophthalmoscopy; mydriasis; laser coagulation; children. vitreochorioretinal

Comparing School-Aged Refraction Measurements Using the 2WIN-S Portable Refractor in Relation to Cycloplegic Retinoscopy: A Cross-Sectional Study.

Purpose To assess the repeatability and agreement of refractive measurements using 2WIN-S photoscreening with the gold-standard cycloplegic retinoscope refraction. Design Single centre, cross-sectional study. Methods Spherical, cylindrical, axis, and spherical equivalent of 194 bilateral eyes of 97 children were assessed using a retinoscope and 2WIN-S. One week later, another operator repeated the 2WIN-S measurements. The primary outcome measures were to assess the repeatability and agreement between spherical equivalent, J0, and J45 readings of 2WIN-S. The repeatability of measurements was assessed by the within-subject standard deviation (2.77 Sw) and intraclass correlation coefficient (ICC). The agreement between devices was assessed using 95% limits of agreement. The extent of the agreement between cycloplegic retinoscopy and noncycloplegic 2WIN-S measurements was assessed using Bland–Altman analysis. Results The mean age ± SD was 10.3 ± 2.46 year (range, 4–14 years). The sphere, cylinder, and spherical equivalent measurements were found to be consistent with both apparatus (r value >0.86). ICC for SE, J0, and J45 was 0.900, 0.666, and 0.639, respectively; Sw for SE, J0, and J45 was 0.61D, 0.30D, and 0.31D, respectively; Bland–Altman analysis of retinoscopy with cycloplegia and 2WIN-S for SE was 184/194 (95%) in 95% confidence interval, and the mean value was 0.46. J0 was 184/194 (95%), and the mean value is −0.04. J45 was 181/194 (93%), and the mean value is −0.15. Conclusion The objective refractive measurement of 2WIN-S had good reliability and high agreement with the gold-standard retinoscopy refraction in children and adolescents. While consistency was observed, it is essential to take into consideration that it is a screening tool.

STUDY OF PERIPHERAL REFRACTION IN CHILDREN WITH MYOPIA WITH ORTHOKERATOLOGY LENSES OF COMBINED DESIGN

Progressive myopia is a leading problem in modern optometry and ophthalmology in general. In recent years, refractive therapy with orthokeratology lenses has gained popularity among methods to control myopia progression. The aim: To study peripheral refraction in children with myopia with the use of orthokeratology lenses (OKL) of combined design. Methods. We followed up 60 children (117 eyes) diagnosed with uncomplicated mild to moderate myopia. All children underwent a complete ophthalmological examination as well as corneal keratotopography and peripheral refraction determination. Statistical analysis of correlations between peripheral corneal refraction under the influence of OKL, peripheral defocus, and axial length growth gradient was performed. Results. An inverse correlation relationship of -0.2 (p=0.03) was obtained between corneal differential power in the return 6 mm zone and peripheral refraction in its corresponding peripheral refraction of 23° on the temporal side. A positive correlation with a correlation coefficient of 0.21 (p=0.026) was obtained between the defocus in the temporal part and the gradient of myopia progression over one year, while the same result was obtained in the nasal part with a correlation coefficient of 0.2 (p=0.036). Concluсions. Difference corneal power at the periphery may be prognostic in relation to the course of myopia in OКL users. With an aboveaverage pupil diameter, combined design orthokeratology lenses are more effective in controlling myopia due to the greater influence of the formed corneal refractive ring on peripheral refraction.

The association between myopic refraction and near work among children and adolescents based on genetic risk score

Objective: To explore the relationship between myopic refraction and near work in children and adolescents with different genetic risks. Methods: From September to December 2016, Nankai District and Hongqiao District of Tianjin were taken as the study sites. Using the method of stratified cluster random sampling, 533 children and adolescents aged 6-14 years from one primary school and one junior middle school in each of the two districts were included as the study subjects. Refraction measurements by an auto-kerato-refractor and questionnaire survey about near work were conducted. 11 single nucleotide polymorphisms in the selected myopia susceptibility genes were detected, and the genetic risk of each individual was scored. After grouping by genetic risk score, the relationship between myopia and near work was analyzed by the multivariate logistic regression, and the relationship between near work and refraction was analyzed by the multivariate linear regression. Results: The age of 553 subjects was (9.8±2.5) years, including 295 boys (53.3%). The overall detection rate of myopia was 62.0%. The spherical equivalent refraction (SER) was (-1.30±1.85) D. The results of the multivariate logistic regression showed that in the low risk group of GRS, compared with those with continuous near work time less than half an hour, those with continuous near work time no less than half an hour had a higher risk of myopia [OR (95%CI) = 2.64 (1.07, 6.52)]. In the moderate risk group of GRS, the risk of myopia increased with the increase of daily computer use [OR (95%CI) = 2.14 (1.03, 4.77)]. In the high risk group of GRS, the risk of myopia increased with the increase of the total daily reading and writing time [OR (95%CI) = 1.27 (1.01, 1.59)]. The results of the multivariate linear regression showed that in the low risk group of GRS, with increase of 1 hour in the total daily reading and writing time and mobile phone time, the SER decreased by 0.18 D (95%CI:-0.30, -0.07) and 0.95 D (95%CI:-1.51, -0.39), respectively. In the moderate risk group of GRS, with increase of 1 hour in the total daily reading and writing time and computer use time, the SER decreased by 0.25 D (95%CI:-0.31, -0.18) and 0.57 D (95%CI:-0.97, -0.18), respectively. In the high risk group of GRS, with increase of 1 hour in the daily total reading and writing time, the SER decreased by 0.33 D (95%CI:-0.43, -0.22). Conclusion: Continuous near work time no less than half an hour, daily computer use time, the total daily reading and writing time, and daily mobile phone use time were associated with myopic refraction in children and adolescents.

Agreement Between Retinoscopy, Autorefractometry and Subjective Refraction for Determining Refractive Errors in Congolese Children.

ObjectiveTo assess the agreement between retinoscopy and autorefractometry and between subjective refraction and both retinoscopy and autorefractometry in Congolese children.Patients and MethodsFifty-four children (6–17 years old) were enrolled consecutively in this cross-sectional study. Refraction was evaluated before and after cycloplegia (1% cyclopentolate) with retinoscopy and autorefractometry. Readings were compared (paired t-test) and agreement assessed with Bland–Altman plots. Subjective refraction was compared with the two methods to determine which one provides better reference estimates for subjective refraction.ResultsUnder cycloplegia, the spherical power was comparable between retinoscopy and autorefractometry (1.12 ± 1.37 D vs 1.22 ± 1.06D, P = 0.70), cylinder power was significantly more myopic on retinoscopy than autorefractometry (0.80 ± 1.10D vs −0.62 ± 0.66, P = 0.019), and SE was greater on autorefractometry than retinoscopy (0.91 ± 1.10D vs 0.72 ± 1.00D, P = 0.014). Retinoscopy and autorefractometry overestimated the power of spherical (P = 0.022 and 0.002, respectively) and cylindrical components (all P < 0.001). There was an agreement between retinoscopy and autorefractometry in measuring spherical (bias: 0.09 ± 0.16D; limit of agreement, LoA: −0.40 to 0.22D) and cylindrical power (bias: −0.18 ± 0.20D; LoA: −0.57 to 0.21D). Subjective refraction agreed with cycloplegic retinoscopy for determining SE power (bias: 0.11D; LoA: −0.51 to 0.73D).ConclusionRetinoscopy and autorefractometry can be used interchangeably in children for determining the power of spherical and cylindrical components. Cycloplegic retinoscopy is better than autorefractometry to obtain SE reference values for subjective refraction in children.

DIFFERENCE BETWEEN TARGET AND POST OPERATIVE REFRACTIVE ERROR FOLLOWING CONGENITAL CATARACT SURGERY IN PAEDIATRIC PATIENTS VISITING ARMED FORCES INSTITUTE OF OPHTHALMOLOGY

Objective: To determine the difference between target and postoperative refraction in children with congenital cataract.&#x0D; Study design: Prospective interventional study&#x0D; Place and Duration of Study: This study was conducted at Armed Forces Institute of Ophthalmology from May 2017 to May 2018.&#x0D; Methods: This study was conducted on 38 eyes suffering from congenital cataract. Age at the time of surgery, axial length, average keratometry reading, estimated refraction, and the power of IOL implanted were recorded. Spherical equivalent of post-op refraction at 3 months after surgery was noted. The difference between the estimated and actual postoperative refraction was termed as prediction error. Age, keratometry, and axial length were then assessed for its effects on prediction error.&#x0D; Results: Overall the mean prediction error was 1.43±1.98 D. The mean prediction errors in eyes with axial lengths ⩾20 mm were 0.96± 1.03 D and in eyes &lt;20 mm were 5.50± 3.49 D. The mean prediction errors in eyes in children aged ⩾4 years were 0.14± 0.61 D) and in children aged &lt; 4 years was 2.60± 2.07 D. The differences between the prediction errors for both axial length and age were statistically significant (p&lt;0.05).&#x0D; Conclusion: IOL power calculations in eyes with axial length less than 20 mm and children less than 4 years of age are prone to postoperative refractive errors. This study has reflected that adult based formulas are not reliable in pediatric age group.

Risk factors and prognosis of the development of pseudophakic myopia in children

Recent studies indicate the prevalence of myopic refraction in children with pseudophakia, which significantly reduces the functional results of treatment and may be an indication for replacing the intraocular lens (IOL). Therefore, studies conducted to achieve the target refraction in children with pseudophakia are relevant. Purpose To determine the risk factors for the prognosis of myopic refraction in children after extraction of congenital cataract and IOL implantation. Material and methods The study presents the results of refraction examination in 69 (110 eyes) children aged 1 to 12 years 36 months after extraction of congenital cataract with implantation of soft IOL. Results The obtained data of anamnesis, results of ophthalmological, echobiometric, clinical and laboratory studies were subjected to statistical processing assessing the significance of differences in outcomes depending on the impact of possible risk factors for the development of pseudophakic myopia; a regression logistic model and a ROC-curve were constructed. Conclusion According to the authors, reliable risk factors for the development of pseudophakic myopia in children can be such indicators as axial eye length at the time of IOL implantation exceeding the age norm by more than 0.2 mm; the child from the first pregnancy; the AL/CR ratio of ≥3.0; myopia on the paired eye; strabismus of more than 4 prism diopters; hereditary load; tension of eye's fibrous capsule: pressure of ≤180 mm Hg at the time of IOL implantation. The presented reliable factors, as well as a combination of less significant signs (the child being outside for less than 1 hour per day, intermarriage of the patient's parents, near-sight visual loads of more than 3 hours per day, the blood Ca level of less than 1.8 mmol/L) can be used for prognosis of the development of pseudophakic myopia and to help make adjustments in the management tactics for patients to achieve target refraction.

Особенности развития глаз и состояния рефракции у детей коренных малочисленных народов Севера, проживающих в Приамурье

Purpose. To study the anatomical and morphometric parameters of the eyes and the state of refraction in children of the indigenous and alien population living in the Khabarovsk krai of Russia. Material and methods. The study included 180 children living in the Nanai District of the Khabarovsk krai, aged from 3 months to 18 years. Two groups of children were formed, according to the criteria of belonging to the indigenous/alien population. 1st group – 84 children of the indigenous population – Nanai. 2nd group – 96 children of the alien population - peoples related to the Slavs. Both groups were matched for gender and age. In each of these groups, 5 age subgroups were formed. The comparison group is the average statistical indicators of the child population of Russia in the corresponding subgroups. Results. In comparative study, difference in the refractive index of the cornea was not found between the groups. A statistically significant delayed growth of the axial length of the eye was revealed in children of the indigenous population of the Khabarovsk krai in the age subgroups of 4–6, 7–10, 11–14 years old, in comparison with similar subgroups children of the newcoming population and with the average Russian indicators. Tendency to myopization was revealed in children of the 1st group from 7–10 years and older at retinoscopy on narrow pupil, in whom, after cycloplegia with 0,5–1% solutions of Cyclopentolate, a shift towards hyperopic refraction was revealed. Conclusion. The revealed features of the development of eyes in children of the indigenous population of the Khabarovsk krai must be taken into account, conducting them retinoscopy only in the conditions of achieving complete medical accommodation paresis, and, if necessary, to prescribe them adequate optical correction. This will allow timely prevention of the formation of complications associated with the peculiarities of the development of their refraction.