Spherical Equivalent Refraction Research Articles

Cost-Effectiveness Analysis of Myopia Progression Interventions in Children

Several interventions exist for treating myopia progression in children. While these interventions' efficacy has been studied, their cost-effectiveness remains unknown and has not been compared. To determine cost-effective options for controlling myopia progression in children. In this cost-effectiveness analysis, a Markov model was designed to compare the cost-effectiveness of interventions for controlling myopia progression over 5 years from a societal perspective in a simulated hypothetical cohort of patients aged 10 years with myopia. Myopia interventions considered included atropine eye drops, 0.05% and 0.01%, defocus incorporated multiple segment spectacles, outdoor activity, soft contact lenses (daily disposable and multifocal), rigid gas-permeable contact lenses, progressive addition lenses, bifocal spectacle lenses, orthokeratology, highly aspherical lenslets (HALs), and red light therapy; all interventions were compared with single-vision lenses. Deterministic and probabilistic sensitivity analysis determined the association of model uncertainties with the cost-effectiveness. Costs were obtained from the charges of the Hospital Authority of Hong Kong and The Chinese University of Hong Kong Eye Center. The mean costs (in US dollars) per child included the cost of hospital visits, medications, and optical lenses. The outcomes of effectiveness were the annual spherical equivalent refraction (SER) and axial length (AL) reductions. Incremental cost-effectiveness ratios (ICERs) were calculated for each strategy relative to single-vision lenses over a time horizon of 5 years. Outdoor activity, atropine (0.05%), red light therapy, HALs, and orthokeratology were cost-effective. The ICER of atropine, 0.05%, was US $220/SER reduction; red light therapy, US $846/SER reduction; and HALs, US $448/SER reduction. Outdoor activity yielded a savings of US $5/SER reduction and US $8/AL reduction. Orthokeratology resulted in an ICER of US $2376/AL reduction. These findings suggest that atropine eye drops, 0.05%, and outdoor activity are cost-effective for controlling myopia progression in children. Though more expensive, red light therapy, HALs, and orthokeratology may also be cost-effective. The use of these interventions may help to control myopia in a cost-effective way.

Ray-tracing-guided myopic LASIK: real-world clinical outcomes.

To assess effectiveness of individualized ray-trace based laser in situ keratomileusis (LASIK) for correction of myopia in everyday clinical practice. Single-site private practice. Retrospective nonrandomised unmasked chart review. Consecutive, myopic eyes (range ≤-8.25 diopters [D] sphere; astigmatism 0 to -4.25 D) treated with ray-trace based LASIK were included. Patients underwent wavefront, tomography, and biometry assessment using the InnovEyes Sightmap diagnostic device. The ray-trace based algorithm (InnovEyes algorithm) then generated an individualized 3D eye model and calculated a customized LASIK ablation profile. Postoperative visual acuity, refractive error and whole eye higher-order aberrations (HOAs) were evaluated over 3 months. The procedure was performed on 400 eyes (200 patients). Mean preoperative manifest refraction spherical equivalent was -3.39 ± 1.58 D (right eye -3.84 ± 1.63 D, left eye -3.98 ± 1.75 D). At month 3, uncorrected distance visual acuity (UDVA) was ≥20/20 in all eyes, ≥20/16 in 89% (right eye 90%, left eye 89%), ≥20/12 in 51% (54% right eye; 47% left eye), and 20/10 in 8% (right eye 8%; left eye 9%) of eyes respectively. UDVA was within 1 line of preoperative corrected distance visual acuity in 98% of eyes (right eye 98.5%; left eye 98%) and 39% of eyes (right eye 38%; left eye 39%) gained 1 line improvement. There was a statistically but not clinically significant increase in total HOAs (right eye 0.06 ± 0.133 μm; left eye 0.057 ± 0.125 μm; P < .001). The spherical aberration decreased (right eye -0.047 ± 0.095 μm, P < .001; left eye -0.051 ± 0.091 μm, P < .001). Ray-trace based LASIK was safe and effective for correction of myopia with and without astigmatism. Approximately, half the eyes achieved ≥20/12.5 UDVA and 8% achieved 20/10. There was no clinically significant increase in total whole eye HOAs.

Accuracy of the PEARL-DGS Formula for Intraocular Lens Power Calculation in Post–Myopic Laser Refractive Corneal Surgery Eyes

PurposeTo investigate the accuracy of the PEARL-DGS formula for intraocular lens (IOL) power calculation in post-myopic laser refractive corneal surgery eyes. DesignRetrospective case series MethodsA total of 139 eyes of 139 patients (mean axial length: 27.4 ± 2.1 mm), who had prior myopic laser refractive corneal surgery and subsequent cataract surgery using Tecnis ZCB00 from March 2018 to February 2023 were included. Refractive outcomes of five formulas (Barrett True K, Haigis-L, Hoffer-QST, PEARL-DGS, and Shammas-PL) were evaluated. Prediction error was defined as the difference between the measured and predicted postoperative refractive spherical equivalent using the IOL power actually implanted. Mean prediction error (MPE), median absolute prediction error (MedAE), mean absolute prediction error were calculated. ResultsWithout constant optimization, the PEARL-DGS resulted in a MPE of +0.05 ± 0.65 D, while the other formulas resulted in myopic shifts. The MedAEs of the formulas were 0.39, 0.53, 0.65, 0.85, and 1.11 D for the PEARL-DGS, Hoffer-QST, Barrett True K, Shammas-PL, and Haigis-L, respectively, in order of magnitude (P < 0.05). With constant optimization, there were no statistically significant differences in the MedAEs among the five formulas (P = 0.388). ConclusionsIn comparison to other IOL formulas, the PEARL-DGS resulted in better refractive outcomes after cataract surgery in post-myopic laser refractive corneal surgery eyes without constant optimization. We suggest that PEARL-DGS be considered as the first choice for IOL power calculation in these eyes when the clinicians do not have their optimized constants.

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.

Development and progression of myopia in emmetropic children in Turkey

Aims: To investigate the development and progression of myopia in emmetrope school-aged children in Turkey.&#x0D; Methods: This retrospective study included emmetrope children aged 6-18 who attended the ophthalmology clinic for regular eye and refractive examinations between 2010 and 2021. Individuals were examined at least twice for six months period. Myopia progression was calculated as the difference between the baseline and the last visit spherical equivalent refractive (SER) values. Individuals were further categorized to determine the age-specific myopia development and progression as 6-11, 12-16, and 17-18 age groups based on the school periods of the country. According to the change in SER values, individuals were classified into those who remain emmetrope and those who develop myopia. &#x0D; Results: A total of 738 eyes of 369 children (222 female, 147 male) with a mean age of 9.4 ± 2.98 (6-18) years were included in the study. The mean follow-up time of patients was 45.62 ± 26.36 (6-130) months. The baseline mean SER value was -0.01 ± 0.10 D (range: -0.375 and +0.375) and -0.44 ± 0.8 (range: -5.00 and +0.375) at the final visit. The overall mean progression was -0.12 ± 0.25 D/year (range: -2.21 and +0.36). 234 eyes (31.75%) developed myopia, and annual SER change was -0.38 ± 0.31 D/year (p

Turkish children myopia progression in the urban area, a retrospective evaluation

Aims: To investigate myopia trends and progression in urban school-aged myopic children in Turkey.&#x0D; Methods: This retrospective study included myopic children aged 6-18 years attending the ophthalmology clinic for regular eye and refractive examinations between 2003 and 2021. Myopia progression was calculated as the difference between the baseline and the last visit spherical equivalent refractive (SER) values. Individuals were further categorized to determine the age-specific myopia progression as 6-11, 12-16, and 17-18 age groups based on the school periods of the country. According to the SER values, individuals were classified into mild, moderate, and high myopic groups. &#x0D; Results: A total of 602 eyes of 301 children (191 female, 110 male) with a mean age of 11.64±2.81 (6-18) years were included in the study. The mean follow-up time of patients was 37.51±19.18 (6-98) months. The baseline mean SER value was -1.5±1.07 D (range: -0.50 and -5.62) and -2.55±1.50 at the final visit. The overall mean myopia progression was -0.35±0.37 D (range: +0.35 D and -3.75 D/year. There were 46 children between 6-11 years, 173 children between 12-16 years, 82 children between 17-18 years, and the annual SER changes were -0.46±0.40 D; -0.37±0.39 D and -0.26±0.29 D in the groups, respectively (p &lt; 0.001). Baseline, final, and annual myopia progression were greater in females. Although there was no statistical significance, myopia progression was faster in moderate myopes (-0.39±0.33 D/a year), followed by mild (-0.35±0.37 D/a year) and high myopes (-0.21±0.20 D/a year) (p=0.37).&#x0D; Conclusion: The progression of myopia in school-aged Turkish children from the Western Black Sea Region is comparable to the world. Our study revealed the greater myopia progression in the youngest children, moderate myopia group, and females. Myopia prevention recommendations should be carefully advised to the youngest female ones to reduce myopia progression.

Corneal metabolic biomarkers for moderate and high myopia in human

This study aimed to identify the corneal metabolic biomarkers for moderate and high myopia in human. We enrolled 221 eyes from 221 subjects with myopia to perform the femtosecond laser small incision lenticule extraction (SMILE) surgery. Among these, 71 eyes of 71 subjects were enrolled in the low myopic group, 75 eyes of 75 subjects in the moderate myopic group and 75 eyes of 75 subjects in the high myopic group. The untargeted metabolomics analysis was performed to analyze the corneal tissues extracted during the SMILE surgery using an ultra-high-performance liquid chromatography (UHPLC) coupled to a quadrupole time-of-flight (Q-TOF) mass spectrometry (MS). The one-way analysis of variance (ANOVA) was used to identify the different metabolites among the three myopic groups, the orthogonal partial least-squares discriminant analysis (OPLS-DA) model was used to reveal the different metabolites between moderate myopia and low myopia, and between high myopia and low myopia. The Venn gram was used to find the overlapped metabolites of the three datasets of the different metabolites. The stepwise multiple linear regression analysis was used to determine the metabolic molecules associated with manifest refractive spherical equivalents (MRSE). The Receiver Operating Characteristics (ROC) analysis was performed to reveal the corneal biomarkers for moderate and high myopia. The hub biomarker was further selected by the networks among different metabolites created by the Cytoscape software. A total of 1594 metabolites were identified in myopic corneas. 321 metabolites were different among the three myopic groups, 106 metabolites were different between high myopic corneas and low myopic corneas, 104 metabolites were different between moderate myopic corneas and low myopic corneas, and 30 metabolic molecules overlapped among the three datasets. The multivariate linear regression analysis revealed the myopic degree was significantly influenced by the corneal levels of azelaic acid, arginine-proline (Arg-Pro), 1-stearoyl-2-myristoyl-sn-glycero-3-phosphocholine, and hypoxanthine. The ROC curve analysis showed that azelaic acid, Arg-Pro and hypoxanthine were effective in discriminating low myopia from moderate to high myopia with the area under the curve (AUC) values as 0.982, 0.991 and 0.982 for azelaic acid, Arg-Pro and hypoxanthine respectively. The network analysis suggested that Arg-Pro had the maximum connections among these three biomarkers. Thus, this study identified azelaic acid, Arg-Pro and hypoxanthine as corneal biomarkers to discriminate low myopia from moderate to high myopia, with Arg-Pro serving as the hub biomarker for moderate and high myopia.

Choroidal thickness in relation to diopter and axial length among myopic children.

The aim of this study was to analyze the relationship between diopter (D) and choroidal thickness in myopic children by describing the values of choroidal thickness, and explore choroidal thickness as an important indicator for evaluating the progression of myopia. The study included myopic and emmetropic children aged 6-14 years (156 eyes) from the Second Hospital of Dalian Medical University. The participants were divided into four groups according to the spherical equivalent refraction (SER): low myopes, moderate myopes, high myopes, and emmetropes. Choroidal thickness was measured in nine areas using the Early Treatment Diabetic Retinopathy Study (ETDRS) grid layout, which divided the areas into concentric circles of 0 × 0 mm, 3 × 3 mm, and 5 × 5 mm from the Sub Fovea. The images were obtained manually with spectral-domain optical coherence tomography scanner. There were significant differences of choroidal thickness in the nine areas of the ETDRS grid for all myopes. The distribution of choroidal thickness in low and moderate myopes were different from that in high myopes. In the horizontal direction, choroidal thickness decreased from the temporal to nasal areas for all myopes. In the vertical direction, the choroidal thickness in the perifovea was smaller than that in the parafovea (SER ≥ -2.75D), and the choroidal thickness in the perifovea was greater than that in the parafovea (SER < -2.75D). When comparing emmetropes with myopes, the closer the choroidal thickness was to the central fovea, the more significant the differences were, while the differences were smaller to the perifovea. Among all children, choroidal thickness was positive to SER and negative to axial length (AL) in all areas. For every 1D increase in myopia, the subfoveal choroidal thickness decreased by 13 μm, and for every 1 mm increase in AL, the subfoveal choroidal thickness decreased by 23 μm. Furthermore, SER and AL showed the strongest correlation with choroidal thickness in the inferior area. Optical coherence tomography results revealed choroidal thickness was thinner in myopic children. Choroidal thickness was positive to SER and negative to AL. Therefore, we consider choroidal thickness to be an important indicator for evaluating the myopia progress.

Comparison of two different orthokeratology lenses and defocus incorporated soft contact (DISC) lens in controlling myopia progression

BackgroundTo compare axial elongation in 8–11-year-old myopes wearing orthokeratology (OK) lenses with different back optic zone diameters (BOZD), defocus incorporated soft contact (DISC) lenses, and single-vision soft contact lenses (SCLs).MethodsA total of 122 children (aged 8–11 years) with spherical equivalent refraction (SER) between − 1.00 D and − 4.00 D were enrolled in this prospective study and randomly assigned to four groups: 5.0 mm-BOZD OK, 6.2 mm-BOZD OK, DISC, and single-vision SCLs. Children in each group were further divided into subgroups stratified by the average baseline SER: low myopic eyes (SER: − 1.00 D to − 2.50 D) and moderate myopic eyes (SER: − 2.50 D and over). Axial length (AL) was measured at baseline and after one year.ResultsThe 5.0 mm-BOZD OK, 6.2 mm-BOZD OK, and DISC groups exhibited significantly slower AL elongation than the SCL group. The proportion of slow progressors (AL elongation ≤ 0.18 mm/year) in the first three groups was 42%, 23%, and 29%, respectively. Furthermore, one-year AL elongation was significantly smaller in the 5.0 mm-BOZD OK group compared with the 6.2 mm-BOZD OK group. Regardless of SER, children in the 5.0 mm-BOZD OK and DISC groups showed comparably slower AL elongation than those in the SCL group. However, fitting with 6.2 mm-BOZD OK lenses significantly retarded AL elongation in moderate myopic eyes, but not in low myopic eyes.ConclusionsOverall, 5.0 mm-BOZD OK lenses, 6.2 mm-BOZD OK lenses, and DISC lenses were effective in retarding AL elongation in 8–11-year-old myopes compared with single-vision SCLs, but for children with SER less than − 2.50 D, fitting with 5.0 mm-BOZD OK lenses and DISC lenses yielded better myopia control efficacy compared to wearing single-vision SCLs or 6.2 mm-BOZD OK lenses.

Refractive errors in infants with retinopathy of prematurity treated using laser or anti-vascular endothelial growth factor monotherapy

Background: Infants treated for retinopathy of prematurity (ROP) could develop visually significant refractive errors. In this study, we report pre-treatment refractive errors in premature infants with treatment-requiring ROP treated using laser or anti-VEGF monotherapy and compare the components of post-treatment refractive error values between the two treatment groups at different follow-up timepoints.&#x0D; Methods: In this retrospective cohort study, we analyzed 360 eyes of 181 premature infants with treatment-requiring ROP who were referred to Farabi Eye Hospital, Tehran, Iran between March 2020 and April 2021. Of the 360 eyes, 195 received laser monotherapy (laser treatment group) and 165 received an intravitreal anti-VEGF injection (anti-VEGF therapy group). All included eyes underwent pre- and post-treatment cycloplegic refraction. Cycloplegia was induced for each infant by instilling a mixed eye drop containing 1% tropicamide, 2.5% phenylephrine, and 0.5% tetracaine (in equal volumes) in each eye three times at five-minute intervals. Cycloplegic refraction was performed 30 minutes after the third instillation.&#x0D; Results: The mean (standard deviation [SD]) gestational age (GA) and birth weight (BW) of the infants were 29.0 (2.0) weeks and 1241.0 (403.0) g, respectively. The male-to-female ratio in the entire study cohort was 107 (59.1%) / 74 (40.9%), whereas the ratios in the anti-VEGF therapy group and laser treatment group were 47 (56.6%) / 36 (43.4%) and 60 (61.2%) / 38 (38.8%), respectively. The pre-treatment assessment revealed that 218 (60.6%) eyes were hyperopic, 112 (31.1%) were myopic, and 30 (8.3%) were emmetropic. In the anti-VEGF therapy group, 87 (52.7%) eyes were hyperopic, 63 (38.2%) were myopic, and 15 (9.1%) were emmetropic. In the laser treatment group, 131 (67.2%) eyes were hyperopic, 49 (25.1%) were myopic, and 15 (7.7%) were emmetropic. The mean (SD) spherical refractive error and spherical equivalent of refractive error (SEQ) at the 1-week, 1-month, and &gt; 6-month post-treatment follow-up timepoints; the mean cylindrical refractive error at the 3-month post-treatment timepoint; and the mean SEQ at the time of ROP regression were significantly different between the treatment groups (all P &lt; 0.05). The rate of anisometropia increased significantly from 3.4% at baseline to 9.2% at the 6-month post-treatment follow-up timepoint (P &lt; 0.05).&#x0D; Conclusions: In this study, the most common pre-treatment refractive status of all included eyes with treatment-requiring ROP and eyes in each treatment group was hyperopia, followed by myopia and emmetropia. At the more than 6-month post-treatment follow-up, cycloplegic refraction revealed that the laser-treated eyes were significantly more hyperopic than the anti-VEGF-treated eyes, a finding similar to the pre-treatment refraction results. Further studies of same cohort with a longer follow-up period and a control group are needed to determine the real-world effect of each treatment modality on the refractive statuses of children treated for ROP.

Differences in Axial Length and Anterior Chamber Depth among Keratoconic, Myopic and Emmetropic Eyes

Purpose: To report variation of the axial length (AL) and anterior chamber depth (ACD) among keratoconic (KC) eyes compared to myopic and emmetropic eyes in an African population sample. Study Design: Cross sectional observational. Place and Duration of Study: Al-Faisal Eye Hospital at Khartoum state of Sudanfrom January 2022 to September 2022. Methods: One-hundred and twenty-four eyes of 62 patients were divided into KC group (n =17, eyes=34), myopic group (n=28, eyes=56), and an age/gender matched emmetropic group (n=17, eyes =34). Central corneal thickness (CCT) was measured using ultrasonic pachymeter, AL, ACD and keratometry readings (K-reading) were recorded for each patient using non-contact partial coherence interferometry with an IOL Master. Results: Mean age of the sample population was 22.27± 6.05 (range; 10 – 40 years). KC patients had the highest spherical equivalent of refraction (SER) (-6.19±3.91 dioptres), highest k-reading (48.98±5.68 dioptres) and the thinnest CCT. Myopic participants had a longer AL compared to other refractive error groups (AL=24.99±2.39, p&lt;0.001). KC patients exhibited a larger ACD in comparison to emmetropes and myopes (ACD=3.6?9±0.26, p&lt;0.001). Among all participants, SER exhibited the highest correlation with AL (r=-0.71, p&lt;0.001) followed by a weaker correlation with ACD (r=-0.26, p=0.003). However, among KC patients, SER exhibited a weaker correlation with AL compared to myopes (r=-0.55, p=0.001), and a higher correlation with ACD compared to myopes (r=-0.38, p=0.03). Conclusion: ACD and corneal curvature were the most significantly detrimental parameters in KC. KC participants demonstrated a lower correlation between SER and AL and higher correlation between SER and ACD.

Retinal and Choroidal Changes Following Implantable Collamer Lens V4c Implantation in High Myopia Patients-A 1-Year Follow-Up Study.

This prospective study aimed to evaluate the impact of Visian Implantable Collamer Lens (ICL) V4c implantation on retinal and choroidal morphology in patients with high myopia. A total of 97 eyes from 52 high myopic patients who underwent ICL V4c implantation were followed up for 12 months. Preoperative and postoperative evaluations included comprehensive ophthalmic assessments and enhanced depth imaging optical coherence tomography (EDI-OCT) to analyze changes in central retinal thickness (CRT), retinal volume (CRV), choroidal thickness (ChT), total choroidal area (TCA), luminal area (LA), and choroidal vascular index (CVI). Repeated measures mixed-effects models were used for comparing pre- and postoperative measurement variables and exploring relationships among age, axial length (AL), spherical equivalent refraction (SER), and postoperative retinal and choroidal changes, with statistical significance set at p < 0.05. Follow-up assessments were conducted at various time points, with participation rates ranging from 21% to 98%. Baseline characteristics showed a median age of 26.7 years, -10.14 diopters of SER, and an AL of 27.44 mm. Throughout the 12-month follow-up, CRT and 3.0 mm CRV consistently increased compared to the baseline, with statistically significant rises observed at postoperative day 1, week 1, and month 12. Most ChT measurements, including subfoveal ChT, declined over the 12 months, except at postoperative 6 months. Horizontal and vertical TCA and LA values significantly increased throughout the follow-up, except for month 6. After surgery, both horizontal and vertical CVI parameters exhibited an increase compared to the baseline, with some changes reaching statistical significance. Correlation analysis performed by repeated measures mixed-effects models showed that no relationship was found between age, AL, and SER and changes in postoperative retinal parameters and CVI parameters. However, postoperative changes in ChT and choroidal area parameters showed a negative correlation with AL and a positive correlation with SER. Our research demonstrated that ICL V4c implantation resulted in noteworthy alterations in retinal and choroidal morphology over a 1-year follow-up period. Moreover, in patients with high myopia, individuals with longer AL and higher degrees of myopia exhibited more pronounced postoperative changes in the choroid and retina. Further studies with extended follow-up durations are necessary to comprehensively understand the long-term effects of ICL implantation on retinal and choroidal morphology and function.

Changes of retinal vessel density in low to moderate myopic eyes with orthokeratology evaluated by optical coherence tomography angiography.

To explore the effect of orthokeratology (OK) fitting on retinal vessel density in low to moderate myopia adolescents by using optical coherence tomography angiography. Children aged 10 to 14y with a cycloplegic spherical equivalent refraction of -0.50 diopter (D) to -5.00 D and astigmatism with more than -1.50 D were recruited. The enrolled adolescents were divided into OK group and spectacle group. During regular follow-up, adolescents were measured respectively at pre-wear, 1, 3, and 6mo after treatment. The follow-up included uncorrected distance visual acuity (UDVA), axial length (AL), superficial capillary plexus density (SCPD), deep capillary plexus density (DCPD), central retinal thickness (CRT), foveal avascular zone area (FAZ-A), foveal avascular zone perimeter (FAZ-P) and foveal vessel density in a 300-µm-wide region around foveal avascular zone (FD-300). The collected data were analyzed using statistical methods. By one month, SCPD significantly increased in the fovea and superior retina, and DCPD significantly increased inferiorly in OK group compared to spectacle group (P<0.05). By three months, there were significant increases in SCPD in the fovea and inferior retina, and DCPD in the parafovea, superior, and inferior retina in OK group (P<0.05), while the increase in SCPD and DCPD in the fovea were observed by six months (P<0.05). The FD-300 significantly increased at every follow-up in OK group compared to spectacle group (P<0.05). No significant differences in the CRT, FAZ-A and FAZ-P and FD-300 were observed between two groups (P>0.05). OK group showed a significant improvement in UDVA after wearing OK, compared to spectacle group (P<0.01), while the AL did not show a significant difference between two groups (P>0.05). Short-term OK worn can increase local retinal vessel density in adolescents with low-to-moderate myopia.

Effect of Extracurricular After-School Physical Activities on Academic Performance of Schoolchildren

The beneficial effects of increasing outdoor physical activity time on children's myopia onset and physical well-being are widely acknowledged. However, in countries with competitive educational systems, such as China, parents and school administrators may be relatively reluctant to increase the extracurricular physical activity time for children due to concerns that this action will compromise children's academic performance. To investigate whether additional extracurricular physical activity time after school compromises the academic performance of schoolchildren. This cluster randomized clinical trial was conducted from October 2020 to June 2021 in Yudu, Jiangxi, China. Eligible children in grades 3 and 4 from 24 elementary schools were randomized to the intervention or control group. Primary analysis was conducted in the full sample using the intention-to-treat principle. The intervention group received 2 hours of after-school physical activity time outdoors on school days. The control group was free to arrange their after-school activity. The primary outcome was the between-group mean difference in mathematics test scores at the end of 1 academic year, with a noninferiority margin of -3.3 points. Standardized mathematics tests, physical fitness assessments (in reference to the 2018 National Physical Fitness Survey Monitoring Programme in China), and cycloplegic autorefraction were performed at baseline and the end of 1 academic year. Myopia was defined as a cycloplegic spherical equivalent refraction of -0.5 diopters or less in either eye. A total of 2032 children (mean [SD] age, 9.22 [0.62] years; 1040 girls [51.2%]) from 24 schools were randomized to the intervention group (12 schools; 1012 children) or control group (12 schools; 1020 children). The mean (SD) mathematics score at the end of 1 academic year was 78.01 (17.56) points in the intervention group and 77.70 (17.29) points in the control group. The adjusted between-group mean difference was 0.65 points (95% CI, -2.85 to 4.15). The adjusted between-group mean difference in physical fitness score was 4.95 points (95% CI, 3.56-6.34; P < .001) and -1.90% (95% CI, -18.72% to 14.91%; P > .99) in myopia incidence. Results of this trial indicate that, compared with the control practice of free play after school, adding 2 hours of extracurricular physical activity outdoors after school was noninferior in academic performance and had superior efficacy in improving physical fitness. ClinicalTrials.gov Identifier: NCT04587765.

Sector-Based Regression Strategies to Reduce Refractive Error-Associated Glaucoma Diagnostic Bias When Using OCT and OCT Angiography.

This cross-sectional study aimed to investigate the sectoral variance of optical coherence tomography (OCT) and OCT angiography (OCTA) glaucoma diagnostic parameters across eyes with varying degrees of refractive error. Healthy participants, including individuals with axial ametropia, enrolled in the Hong Kong FAMILY cohort were imaged using the Avanti/AngioVue OCT/OCTA system. The OCT and OCTA parameters obtained include peripapillary nerve fiber layer thickness (NFLT), peripapillary nerve fiber layer plexus capillary density (NFLP-CD), and macular ganglion cell complex thickness (GCCT). Sectoral measurements of NFLT, NFLP-CD, and GCCT were based on sectors and hemispheres. A total of 1339 eyes from 791 participants were stratified based on spherical equivalent refraction: high myopia (<-6 D), low myopia (-6 D to -1 D), emmetropia (-1 D to 1 D), and hyperopia (>1 D). Multivariable broken stick regression models, accounting for age, sex, and signal strength, showed that all NFLT sectors except temporally, the inferior GCCT hemisphere, and half of the NFLP-CD sectors were more affected by ametropia-related covariates than the corresponding global parameters. As expected, the false-positive rates in those sectors were elevated. Finally, sector-specific axial length (AL) and spherical equivalent (SE) adjustments helped reduce the elevated false-positive rates. The effect of optical magnification is even more prominent among sectors than the global parameters. AL- and SE-based adjustments should be individualized to each sector to mitigate this magnification bias effectively. Identifying sectoral differences among diagnostic parameters and adopting these sector-based adjustments into commercial OCT systems will hopefully reduce false-positive rates related to refractive error.

Study on relationship between intraocular pressure and hyperthyroidism

Thyroid-associated ophthalmopathy (TAO) represents a persistent autoimmune inflammatory condition impacting various ocular components, including orbital fat (OF), extraocular muscles (EOMs), the eyeball, and associated eye structures. This disorder is closely associated with autoimmune thyroid pathology. A body of research has indicated an elevated susceptibility to heightened intraocular pressure (IOP) and glaucoma among individuals with thyroid-related ailments. Nonetheless, certain studies have expressed reservations about affirming these conclusions. Furthermore, there exists a diversity of viewpoints regarding the optimal approaches for managing elevated IOP in TAO patients afflicted with ocular hypertensionA prospective research investigation was undertaken within the Department of Ophthalmology at a Tertiary Care Teaching Hospital, spanning a duration of 12 months. The techniques employed for the diagnosis of open-angle glaucoma (OAG) have been comprehensively outlined. Goldmann applanation tonometry was utilized to determine intraocular pressure (IOP). Employing a Zeiss FF3 fundus camera, a series of dilated stereoscopic 300-color retinal and optic disc images were captured. The evaluation of optic disc photographs was conducted by one of two evaluators, both of whom remained masked to the study's particulars, employing a customized protocol. In order to ascertain optic disc dimensions, adjustments for camera magnification were performed, accounting for the spherical equivalent refraction of each individual eye.A total of 90 patients were examined. Of the 90 cases, male preponderance was noted. Among 90 patients, 20 (22.2%) were hyperthyroid, 61 (67.8%) were hypothyroid, and 9 (10%) patients were euthyroid. In our study shows the frequency of different symptoms among the study group. Most of the patients came with complaint itching of (27.8%). The second most common symptom was foreign body sensation (21.1%). In this study shows the different types of signs among these two groups. In hyperthyroid lid, retraction was more common (12%). In hypothyroid lid, edema was more common (18.5%). Frequency of dry eye syndrome in patients with TD was present; 29 (26.4%) patients had dry eye disease. Among 90 patients, proptosis was present in 4 patients had proptosis. Most of the patients were myopic.Our results imply the potential link between intraocular pressure (IOP) and thyroid-related disorders, particularly in individuals undergoing thyroxine treatment. Conducting further comprehensive investigations to explore and substantiate this prospective association is advisable.

Comparison of different methods of correcting astigmatism in cataract surgery

ABSTRACT Clinical relevance Astigmatism causes a decrement in visual acuity, and deterioration in visual quality. Background The aim of this study is to compare clear corneal incision (CCI) in the steepest meridian, opposed clear corneal incision (OCCI) and toric intraocular lens implantation methods for the correction of astigmatism in cataract surgery. Methods Total of 93 preoperative patients with the rule corneal astigmatism (between 1.00–3.00 D)underwent uncomplicated cataract surgery are retrospectively included in this study. Whole patients are divided into three groups of equal number of patients of 31 by considering the astigmatism correcting methods that are as follows. Group 1 consists of patients underwent CCI on the steepest meridian, group 2 consists of the patients underwent paired OCCI, and group 3 consists of those with toric intraocular lens implantation. The preoperative and postoperative 3rd month uncorrected distance visual acuity, refraction and, keratometry values, and surgically induced astigmatism values calculated by Alpins method are recorded. Results The age, preoperative and postoperative 3rd month spherical, spherical equivalent refraction and keratometry values of the groups are similar (p > 0.05). The preoperative uncorrected distance visual acuity values are similar in whole groups, postoperative uncorrected distance visual acuity values are the highest in group 1, and lowest in group 3 (p = 0.85, p = 0.02, respectively). The preoperative and postoperative 3rd month mean cylinder refraction values are -1.86 D, -1.00 D in group 1, −1.77 D, -0.70 D in group 2, and −1.95 D, -0.40 D in group 3. There is a statistically significant difference among the groups (p = 0.01). The surgically induced astigmatism values are statistically different among the groups [it was 0.46 ± 0.21 in group 1, 0.91 ± 0.44 in group 2, 0.33 ± 0.18 in group 3 (p < 0.001, respectively)]. Conclusion This study indicated that; CCI, paired OCCI, and toric intraocular lens implantation should be preferred and performed for the steepest meridian in low D, middle D, and high D astigmatism patients, respectively. CCI can easily be applied for low to medium D without needing extra skills and tools. On the other hand, toric intraocular lens implantation is a better option for a high astigmatism with proper and accurate planning before the surgery.

Visual field after anti-vascular endothelial growth factor therapy and laser treatment for retinopathy of prematurity.

To evaluate the visual field after anti-vascular endothelial growth factor (VEGF) therapy and laser treatment for retinopathy of prematurity. Retrospective cohort study. Infants with retinopathy of prematurity treated by anti-VEGF therapy or laser treatment were included in the study. Degrees of visual field in eight directions examined by Goldmann perimeter (intensity, 1000 apostilb; size, V4e = 64 mm2) were compared between the anti-VEGF therapy and laser treatment groups. The visual acuity (VA) and spherical equivalent refraction were also compared between the two groups. Nine eyes with anti-VEGF therapy and 12 eyes with laser treatment were enrolled in the analysis. The total, upper, nasal upper, nasal, nasal lower, temporal lower, and temporal upper visual fields were significantly wider in the eyes with anti-VEGF therapy than in those with laser treatment (496 vs 416, P = .002; 53 vs 45, P = .008; 56 vs 43, P = .003; 58 vs 39, P < .001; 55 vs 44, P = .01; 72 vs 65, P = .01; and 62 vs 56, P = .03, respectively). The logarithm of the minimum angle of resolution VA tended to be better in the eyes with anti-VEGF therapy than in those with laser treatment (0.01 vs 0.15, P = .06). Eyes with anti-VEGF therapy had significantly lower myopia than those with laser treatment (spherical equivalent refraction: -0.72 vs -5.7, P = .001). Anti-VEGF therapy may provide a wider visual field, better VA, and less myopia compared with laser treatment.

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.