51
|
Clark R, Kneepkens SCM, Plotnikov D, Shah RL, Huang Y, Tideman JWL, Klaver CCW, Atan D, Williams C, Guggenheim JA. Time Spent Outdoors Partly Accounts for the Effect of Education on Myopia. Invest Ophthalmol Vis Sci 2023; 64:38. [PMID: 38010695 PMCID: PMC10683767 DOI: 10.1167/iovs.64.14.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023] Open
Abstract
Purpose The purpose of this study was to investigate if education contributes to the risk of myopia because educational activities typically occur indoors or because of other factors, such as prolonged near viewing. Methods This was a two-sample Mendelian randomization study. Participants were from the UK Biobank, Avon Longitudinal Study of Parents and Children, and Generation R. Genetic variants associated with years spent in education or time spent outdoors were used as instrumental variables. The main outcome measures were: (1) spherical equivalent refractive error attained by adulthood, and (2) risk of an early age-of-onset of spectacle wear (EAOSW), defined as an age-of-onset of 15 years or below. Results Time spent outdoors was found to have a small genetic component (heritability 9.8%) that tracked from childhood to adulthood. A polygenic score for time outdoors was associated with children's time outdoors; a polygenic score for years spent in education was inversely associated with children's time outdoors. Accounting for the relationship between time spent outdoors and myopia in a multivariable Mendelian randomization analysis reduced the size of the causal effect of more years in education on myopia to -0.17 diopters (D) per additional year of formal education (95% confidence interval [CI] = -0.32 to -0.01) compared with the estimate from a univariable Mendelian randomization analysis of -0.27 D per year (95% CI = -0.41 to -0.13). Comparable results were obtained for the outcome EAOSW. Conclusions Accounting for the effects of time outdoors reduced the estimated causal effect of education on myopia by 40%. These results suggest about half of the relationship between education and myopia may be mediated by children not being outdoors during schooling.
Collapse
Affiliation(s)
- Rosie Clark
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Sander C. M. Kneepkens
- Department of Ophthalmology, Erasmus University Medical Center, CA Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, CA Rotterdam, The Netherlands
- Generation R Study Group, Erasmus University Medical Center, CA Rotterdam, The Netherlands
| | - Denis Plotnikov
- Central Research Laboratory, Kazan State Medical University, Kazan, Russia
| | - Rupal L. Shah
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, United Kingdom
| | - Yu Huang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - J. Willem L. Tideman
- Department of Ophthalmology, Erasmus University Medical Center, CA Rotterdam, The Netherlands
- Department of Ophthalmology, Martini Hospital, RM Groningen, The Netherlands
| | - Caroline C. W. Klaver
- Department of Ophthalmology, Erasmus University Medical Center, CA Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, CA Rotterdam, The Netherlands
- Generation R Study Group, Erasmus University Medical Center, CA Rotterdam, The Netherlands
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
- Department of Ophthalmology, Radboud University Medical Center, GA Nijmegen, The Netherlands
| | - Denize Atan
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS81NU, United Kingdom
| | - Cathy Williams
- Centre for Academic Child Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS81NU, United Kingdom
| | - Jeremy A. Guggenheim
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - for the UK Biobank Eye and Vision Consortium
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
- Department of Ophthalmology, Erasmus University Medical Center, CA Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, CA Rotterdam, The Netherlands
- Generation R Study Group, Erasmus University Medical Center, CA Rotterdam, The Netherlands
- Central Research Laboratory, Kazan State Medical University, Kazan, Russia
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, United Kingdom
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Ophthalmology, Martini Hospital, RM Groningen, The Netherlands
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
- Department of Ophthalmology, Radboud University Medical Center, GA Nijmegen, The Netherlands
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS81NU, United Kingdom
- Centre for Academic Child Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS81NU, United Kingdom
| |
Collapse
|
52
|
Di Pierdomenico J, González-González R, Valiente-Soriano FJ, Galindo-Romero C, García-Ayuso D. Attitudes and knowledge of myopia management by Spanish optometrists. Int Ophthalmol 2023; 43:4247-4261. [PMID: 37596425 PMCID: PMC10520101 DOI: 10.1007/s10792-023-02835-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/27/2023] [Indexed: 08/20/2023]
Abstract
PURPOSE To investigate the knowledge, training and clinical practice of Spanish optometrists about preventing and controlling myopia progression. METHODS A web-based questionnaire was distributed to Spanish optometrists through social networks, optometric professional bodies and one of the major Spanish optometrists' associations to assess practitioner perception, understanding, and self-reported clinical practice behavior related to myopia diagnosis and management. RESULTS A total of 534 optometrists with a mean age of 40.8 ± 10.3 years completed the survey. Most respondents have been practicing optometry for more than 20 years (89.8%), report having actively treated childhood myopia (82.4%), and are very concerned about the increasing frequency of pediatric myopia in their daily practice (85.3%). Almost all of the respondents (97.3%) agreed that the efficacy of treatment is related to the age at which it is prescribed, and more than half (53.6%) considered a progression higher than - 0.50 and up to - 1.00D as the minimum necessary to consider a myopia management option. Respondents who reported actively managing childhood myopia considered orthokeratology, atropine and soft-defocus contact lenses the most effective myopia control interventions. However, the most frequently prescribed form of myopia correction by Spanish optometrists was single-vision spectacles, followed by orthokeratology and soft-defocus contact lenses. CONCLUSIONS Spanish optometrists are very active in the management of myopia, especially by fitting orthokeratology lenses or dual-focus soft contact lenses for myopia control, but there is still potential for improvement in the methodology they follow for both the diagnosis and management of myopia.
Collapse
Affiliation(s)
- Johnny Di Pierdomenico
- Facultad de Óptica y Optometría, Universidad de Murcia, Murcia, Spain
- Grupo de Investigación Oftalmología Experimental, Departamento de Oftalmología, Optometría, Otorrinolaringología y Anatomía Patológica, Facultad de Medicina, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB), Campus de Ciencias de la Salud, 30120, Murcia, España
| | | | - Francisco J Valiente-Soriano
- Facultad de Óptica y Optometría, Universidad de Murcia, Murcia, Spain
- Grupo de Investigación Oftalmología Experimental, Departamento de Oftalmología, Optometría, Otorrinolaringología y Anatomía Patológica, Facultad de Medicina, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB), Campus de Ciencias de la Salud, 30120, Murcia, España
| | - Caridad Galindo-Romero
- Facultad de Óptica y Optometría, Universidad de Murcia, Murcia, Spain
- Grupo de Investigación Oftalmología Experimental, Departamento de Oftalmología, Optometría, Otorrinolaringología y Anatomía Patológica, Facultad de Medicina, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB), Campus de Ciencias de la Salud, 30120, Murcia, España
| | - Diego García-Ayuso
- Facultad de Óptica y Optometría, Universidad de Murcia, Murcia, Spain.
- Grupo de Investigación Oftalmología Experimental, Departamento de Oftalmología, Optometría, Otorrinolaringología y Anatomía Patológica, Facultad de Medicina, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB), Campus de Ciencias de la Salud, 30120, Murcia, España.
| |
Collapse
|
53
|
Liu Y, Liu Y, Zhang W, Xue ZQ, Zhang FX, Xu WG, Zhuang WJ. Screening of genes interacting with high myopia and neuropsychiatric disorders. Sci Rep 2023; 13:18347. [PMID: 37884635 PMCID: PMC10603034 DOI: 10.1038/s41598-023-45463-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
Clinical studies have demonstrated an association between high myopia (HM) and neuropsychiatric disorders; however, the underlying mechanism of the association is not clear. We used whole exome sequencing (WES) in combination with the Genetic Variants Classification Criteria and Guidelines published by the American College of Medical Genetics (ACMG) and bioinformatics analysis to clarify the interrelationship between candidate genes. Causative genes for ocular diseases (45.38%) followed by neuropsychiatric disorders (22.69%) accounted for the highest proportion of genes that exhibited high pathogenicity in HM patients were found. Four pathogenic gene mutations were identified according to ACMG guidelines: c.164_165insACAGCA and c.C1760T in POLG, c.G1291A in COL5A1, and c.G10242T in ZNF469. Three causative genes for neuropsychiatric diseases, PTPRN2, PCDH15 and CDH23, were found to fall at the HM locus. The above results suggest that these genes may interact in high myopia and neuropsychiatric diseases.
Collapse
Affiliation(s)
- Yang Liu
- People's Hospital of Ningxia Hui Autonomous Region (Ningxia Eye Hospital), Yinchuan, China
| | - Yang Liu
- People's Hospital of Ningxia Hui Autonomous Region (Ningxia Eye Hospital), Yinchuan, China
| | - Wen Zhang
- People's Hospital of Ningxia Hui Autonomous Region (Ningxia Eye Hospital), Yinchuan, China
| | - Zhong-Qi Xue
- Department of Ophthalmology, Affiliated Hospital of Qingdao Binhai University, Qingdao, China
| | - Fang-Xia Zhang
- People's Hospital of Ningxia Hui Autonomous Region (Ningxia Eye Hospital), Yinchuan, China
| | - Wei-Gang Xu
- People's Hospital of Ningxia Hui Autonomous Region (Ningxia Eye Hospital), Yinchuan, China.
| | - Wen-Juan Zhuang
- People's Hospital of Ningxia Hui Autonomous Region (Ningxia Eye Hospital), Yinchuan, China.
| |
Collapse
|
54
|
Jeong H, Lee D, Jiang X, Negishi K, Tsubota K, Kurihara T. Opsin 5 mediates violet light-induced early growth response-1 expression in the mouse retina. Sci Rep 2023; 13:17861. [PMID: 37857760 PMCID: PMC10587185 DOI: 10.1038/s41598-023-44983-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/14/2023] [Indexed: 10/21/2023] Open
Abstract
Myopia is an abnormal vision condition characterized by difficulties in seeing distant objects. Myopia has become a public health issue not only in Asian countries but also in Western countries. Previously, we found that violet light (VL, 360-400 nm wavelength) exposure effectively suppressed myopia progression in experimental chick and mice models of myopia. The inhibitory effects of VL on myopia progression are reduced in retina-specific opsin 5 (Opn5) knockout (KO) mice. Furthermore, VL exposure upregulated early growth response-1 (Egr-1) expression in the chorioretinal tissues of chicks. However, the expression of EGR-1 and role of OPN5 in mice following VL exposure remain unclear. In this study, we examined whether VL exposure-induced EGR-1 upregulation depends on Opn5 expression in the mouse retina. EGR-1 mRNA and protein expressions increased in the mouse retina and mouse retinal 661W cells following VL exposure. These increases were consistently reduced in retina specific Opn5 conditional KO mice and Opn5 KO 661W cells. Our results suggest that OPN5 mediates VL-induced EGR-1 upregulation in mice. These molecular targets could be considered for the prevention and treatment of myopia.
Collapse
Affiliation(s)
- Heonuk Jeong
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Deokho Lee
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Xiaoyan Jiang
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
- Tsubota Laboratory, Inc., 304 Toshin Shinanomachi-ekimae Bldg., 34 Shinanomachi Shinjuku-ku, Tokyo, 160-0016, Japan.
| | - Toshihide Kurihara
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| |
Collapse
|
55
|
Fang B, Zhu QJ, Yang H, Fan LC. Vault predicting after implantable collamer lens implantation using random forest network based on different features in ultrasound biomicroscopy images. Int J Ophthalmol 2023; 16:1561-1567. [PMID: 37854385 PMCID: PMC10559038 DOI: 10.18240/ijo.2023.10.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/02/2023] [Indexed: 10/20/2023] Open
Abstract
AIM To analyze ultrasound biomicroscopy (UBM) images using random forest network to find new features to make predictions about vault after implantable collamer lens (ICL) implantation. METHODS A total of 450 UBM images were collected from the Lixiang Eye Hospital to provide the patient's preoperative parameters as well as the vault of the ICL after implantation. The vault was set as the prediction target, and the input elements were mainly ciliary sulcus shape parameters, which included 6 angular parameters, 2 area parameters, and 2 parameters, distance between ciliary sulci, and anterior chamber height. A random forest regression model was applied to predict the vault, with the number of base estimators (n_estimators) of 2000, the maximum tree depth (max_depth) of 17, the number of tree features (max_features) of Auto, and the random state (random_state) of 40.0. RESULTS Among the parameters selected in this study, the distance between ciliary sulci had a greater importance proportion, reaching 52% before parameter optimization is performed, and other features had less influence, with an importance proportion of about 5%. The importance of the distance between the ciliary sulci increased to 53% after parameter optimization, and the importance of angle 3 and area 1 increased to 5% and 8% respectively, while the importance of the other parameters remained unchanged, and the distance between the ciliary sulci was considered the most important feature. Other features, although they accounted for a relatively small proportion, also had an impact on the vault prediction. After parameter optimization, the best prediction results were obtained, with a predicted mean value of 763.688 µm and an actual mean value of 776.9304 µm. The R2 was 0.4456 and the root mean square error was 201.5166. CONCLUSION A study based on UBM images using random forest network can be performed for prediction of the vault after ICL implantation and can provide some reference for ICL size selection.
Collapse
Affiliation(s)
- Bin Fang
- School of Mechanical and Electrical Engineering, Soochow University, Suzhou 215100, Jiangsu Province, China
| | - Qiu-Jian Zhu
- Lixiang Eye Hospital of Soochow University, Suzhou 215021 Jiangsu Province, China
| | - Hui Yang
- School of Mechanical and Electrical Engineering, Soochow University, Suzhou 215100, Jiangsu Province, China
| | - Li-Cheng Fan
- School of Mechanical and Electrical Engineering, Soochow University, Suzhou 215100, Jiangsu Province, China
| |
Collapse
|
56
|
Xu R, Zheng J, Liu L, Zhang W. Effects of inflammation on myopia: evidence and potential mechanisms. Front Immunol 2023; 14:1260592. [PMID: 37849748 PMCID: PMC10577208 DOI: 10.3389/fimmu.2023.1260592] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/19/2023] [Indexed: 10/19/2023] Open
Abstract
As the most common type of refractive error, myopia has become one of the leading causes of visual impairment. With the increasing prevalence of myopia, there is a growing need to better understand the factors involved in its development. Inflammation, one of the most fundamental pathophysiological processes in humans, is a rapid response triggered by harmful stimuli and conditions. Although controlled inflammatory responses are necessary, over-activated inflammation is the common soil for many diseases. The impact of inflammation on myopia has received rising attention in recent years. Elevated inflammation may contribute to myopia progression either directly or indirectly by inducing scleral remodeling, and myopia development may also increase ocular inflammation. This article provides a comprehensive review of the interplay between inflammation and myopia and the potential biological mechanisms, which may present new targets for understanding the pathology of myopia and developing myopia therapies.
Collapse
Affiliation(s)
- Ran Xu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Zheng
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China
| | - Longqian Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China
| | - Wenqiu Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
57
|
García-Bella J, Burgos-Blasco B, Fernández-Vigo JI, Güemes-Villahoz N, Benítez-Del-Castillo JM, García-Feijóo J, Gegúndez-Fernández JA. The importance of ophthalmological check-ups in Spain: Prevalence of undiagnosed ophthalmologic diseases in the Congress of Deputies. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:551-552. [PMID: 37257652 DOI: 10.1016/j.oftale.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 06/02/2023]
Affiliation(s)
- J García-Bella
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - B Burgos-Blasco
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - J I Fernández-Vigo
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - N Güemes-Villahoz
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - J M Benítez-Del-Castillo
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - J García-Feijóo
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - J A Gegúndez-Fernández
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| |
Collapse
|
58
|
Zadnik K, Schulman E, Flitcroft I, Fogt JS, Blumenfeld LC, Fong TM, Lang E, Hemmati HD, Chandler SP. Efficacy and Safety of 0.01% and 0.02% Atropine for the Treatment of Pediatric Myopia Progression Over 3 Years: A Randomized Clinical Trial. JAMA Ophthalmol 2023; 141:990-999. [PMID: 37261839 PMCID: PMC10236322 DOI: 10.1001/jamaophthalmol.2023.2097] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/30/2023] [Indexed: 06/02/2023]
Abstract
Importance The global prevalence of myopia is predicted to approach 50% by 2050, increasing the risk of visual impairment later in life. No pharmacologic therapy is approved for treating childhood myopia progression. Objective To assess the safety and efficacy of NVK002 (Vyluma), a novel, preservative-free, 0.01% and 0.02% low-dose atropine formulation for treating myopia progression. Design, Setting, and Participants This was a double-masked, placebo-controlled, parallel-group, randomized phase 3 clinical trial conducted from November 20, 2017, through August 22, 2022, of placebo vs low-dose atropine, 0.01% and 0.02% (2:2:3 ratio). Participants were recruited from 26 clinical sites in North America and 5 countries in Europe. Enrolled participants were 3 to 16 years of age with -0.50 diopter (D) to -6.00 D spherical equivalent refractive error (SER) and no worse than -1.50 D astigmatism. Interventions Once-daily placebo, low-dose atropine, 0.01%, or low-dose atropine, 0.02%, eye drops for 36 months. Main Outcomes and Measures The primary, prespecified end point was the proportion of participants' eyes responding to 0.02% atropine vs placebo therapy (<0.50 D myopia progression at 36 months [responder analysis]). Secondary efficacy end points included responder analysis for atropine, 0.01%, and mean change from baseline in SER and axial length at month 36 in a modified intention-to-treat population (mITT; participants 6-10 years of age at baseline). Safety measurements for treated participants (3-16 years of age) were reported. Results A total of 576 participants were randomly assigned to treatment groups. Of these, 573 participants (99.5%; mean [SD] age, 8.9 [2.0] years; 315 female [54.7%]) received trial treatment (3 participants who were randomized did not receive trial drug) and were included in the safety set. The 489 participants (84.9%) who were 6 to 10 years of age at randomization composed the mITT set. At month 36, compared with placebo, low-dose atropine, 0.02%, did not significantly increase the responder proportion (odds ratio [OR], 1.77; 95% CI, 0.50-6.26; P = .37) or slow mean SER progression (least squares mean [LSM] difference, 0.10 D; 95% CI, -0.02 D to 0.22 D; P = .10) but did slow mean axial elongation (LSM difference, -0.08 mm; 95% CI, -0.13 mm to -0.02 mm; P = .005); however, at month 36, compared with placebo, low-dose atropine, 0.01%, significantly increased the responder proportion (OR, 4.54; 95% CI, 1.15-17.97; P = .03), slowed mean SER progression (LSM difference, 0.24 D; 95% CI, 0.11 D-0.37 D; P < .001), and slowed axial elongation (LSM difference, -0.13 mm; 95% CI, -0.19 mm to -0.07 mm; P < .001). There were no serious ocular adverse events and few serious nonocular events; none was judged as associated with atropine. Conclusions and Relevance This randomized clinical trial found that 0.02% atropine did not significantly increase the proportion of participants' eyes responding to therapy but suggested efficacy for 0.01% atropine across all 3 main end points compared with placebo. The efficacy and safety observed suggest that low-dose atropine may provide a treatment option for childhood myopia progression. Trial Registration ClinicalTrials.gov Identifier: NCT03350620.
Collapse
Affiliation(s)
- Karla Zadnik
- The Ohio State University College of Optometry, Columbus
| | | | | | | | | | | | | | | | | |
Collapse
|
59
|
Chen Y, Liu M, Lu H, Zhang Y, Luo D, Pan H, Wan C, Szentmáry N, Shi L. Impact of Overnight Wear of Orthokeratology Lens on Thickness of Tear Film Lipid Layer in Children with Myopia. Klin Monbl Augenheilkd 2023; 240:1151-1157. [PMID: 35858655 DOI: 10.1055/a-1905-1998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND To elucidate the influence of overnight wear of orthokeratology (OOK) lenses on the thickness of the tear lipid layer (LLT). METHODS We conducted a retrospective cross-sectional study of children who visited The First Affiliated Hospital of USTC between July and September 2021. LLT and blinking dynamics were assessed. Diopters and corneal topography were also recorded. RESULTS The number of children enrolled in this program was 402 (804 eyes). One hundred and seventy-one children (342 eyes, 79 males and 92 females) aged 4 - 17 years (10.59 ± 2.54 years) who never wore OOK were included in the control group, while 231 children (462 eyes, 121 males and 110 females) aged 7 - 18 years (11.09 ± 2.24 years) who wore OOK for more than 1 week were included in the observation group. Compared to the control group with an LLT of 58.5 ± 18.19 nm, the OOK group exhibited a significant decrease in the LLT value to 54.42 ± 17.60 nm. In addition, the LLT in females was significantly thicker than that in males in both the control (male 54.78 ± 16.56 nm, female 61.70 ± 18.95 nm) and observation groups (male 51.88 ± 16.68 nm, female 57.21 ± 18.18 nm). It is worth noting that the influence of wearing OOK on the LLT value was only detected up to 18 months. Eighteen months later, there was almost no difference in LLT between the control and observation groups. We also noted that there was no change in LLT correlated to the surface regularity index/surface asymmetry index. CONCLUSION Wearing OOK can affect tear film LLT within the first 18 months after wear. More attention should be given to children wearing OOK for less than 18 months, especially males.
Collapse
Affiliation(s)
- Yuanyuan Chen
- Graduate School, Bengbu Medical College, Bengbu, China
- Department of Ophthalmology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Ming Liu
- Department of Ophthalmology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Huayi Lu
- Department of Ophthalmology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yong Zhang
- Department of Ophthalmology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Dan Luo
- Department of Ophthalmology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Hongbiao Pan
- Department of Ophthalmology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Chuan Wan
- Department of Ophthalmology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Nóra Szentmáry
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Homburg (Saar), Germany
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Lei Shi
- Graduate School, Bengbu Medical College, Bengbu, China
- Department of Ophthalmology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| |
Collapse
|
60
|
Nitzan I, Akavian I, Einan-Lifshitz A, Shemer A, Afek A, Peled A. The Definition-Dependent Nature of Myopia Prevalence: A Nationwide Study of 1.5 Million Adolescents. Ophthalmic Epidemiol 2023; 30:515-522. [PMID: 36598174 DOI: 10.1080/09286586.2022.2159984] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 11/26/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE The application of myopia definition varies considerably within the literature. The purpose of this study was to examine the relationship between different myopia and high myopia definitions and resultant prevalence estimates. METHODS A population-based cross-sectional study of 1,588,508 Israeli adolescents assessed for medical fitness before mandatory military service at the age of 17 years between 1993 through 2015. Participants underwent non-cycloplegic autorefraction. Nine definitions of myopia and seven definitions of high myopia were examined. Prevalence estimates for each definition were calculated and compared with the reference definition (right eye spherical equivalent (SE)≤-0.50D and ≤-6.00D for myopia and high myopia, respectively), to yield a rate ratio (RR) across definitions. RESULTS Applying the right eye SE≤-0.50D reference definition yielded 31.0% myopia prevalence. While some definitions resulted in similar prevalence estimates, using the right eye SE of ≤-0.75D; ≤-1.00D or least minus meridian of ≤-0.75D definitions yielded 28.8%, 26.3%, and 26.9% myopia prevalence, respectively, which corresponded to a 7.1%, 15.1% and 13.4% reduction in myopia RR, respectively. The prevalence of high myopia demonstrated considerable alternations, with a 1.7-fold increase in prevalence for the narrower threshold of SE≤-5.00D compared with SE≤-6.00D reference definition (4.2% and 2.4%, respectively). CONCLUSIONS The prevalence of myopia and especially high myopia varies between frequently applied definitions, considering diverse thresholds, eye lateralization, and spherical vs. astigmatic refractive components. This variability highlights the pressing need for standardization of myopia definition in ophthalmic research. The results of this study provide crude estimates of a "conversion rate" across data, allowing comparisons between studies that utilize different myopia definitions.
Collapse
Affiliation(s)
- Itay Nitzan
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Department of Military Medicine and "Tzameret", Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Inbal Akavian
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Adi Einan-Lifshitz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel
| | - Asaf Shemer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Central Management, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
| | - Alon Peled
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel
| |
Collapse
|
61
|
Huang Y, Chen Z, Wang B, Zhao J, Zhou X, Qu X, Wang X, Zhou X. Chinese Parents' Perspective on Myopia: A Cross-Sectional Survey Study. Ophthalmol Ther 2023; 12:2409-2425. [PMID: 37314644 PMCID: PMC10265565 DOI: 10.1007/s40123-023-00743-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/23/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION The prevalence of myopia in young generations has dramatically increased over the years, especially in China. This study aims to understand Chinese parents' perspectives on myopia for further improvement of treatment compliance and informing future health planning and policy. METHODS This was a prospective cross-sectional survey study. A self-administrated, internet-based questionnaire was distributed to 2545 parents in China. Detailed information about the demographics, the awareness of myopia, related complications, and practices of myopia prevention and control of the respondents were collected. The distribution of answers was compared among different groups of children's age, children's refractions, and parents' residential locations. Relationships between parental cognition and behavior were also analyzed. RESULTS Eligible responses were returned by 2500 parents. A total of 55.1% of the respondents considered myopia as a disease and more than 70% of respondents did not realize pathological changes related to myopia. Most parents thought myopia could be prevented (82.0%) and controlled (75.2%), and these parents were more likely to take measures than the parents who did not think so (P < 0.001). The most common myopia control modality was spectacles (87.0%), among which single-vision spectacles are the most used (63.7%). CONCLUSIONS Knowledge about health risks related to myopia was lacking in Chinese parents and their practices of myopia control mainly involved single-vision glasses. Nationwide education for parents about myopia is needed to further advance outcomes of myopia prevention and control.
Collapse
Affiliation(s)
- Yangyi Huang
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Zhi Chen
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Bingjie Wang
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Jing Zhao
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Xueyi Zhou
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Xiaomei Qu
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Xiaoying Wang
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China.
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China.
| |
Collapse
|
62
|
Guimarães S, Barros da Silva P, Oliveiros B, Silva E. Myopia control: short-term effect of 0.01% atropine vs. defocus incorporated multiple segment lenses-a retrospective study in European children. Int Ophthalmol 2023; 43:3777-3784. [PMID: 37420123 PMCID: PMC10504187 DOI: 10.1007/s10792-023-02788-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/22/2023] [Indexed: 07/09/2023]
Abstract
PURPOSE To compare 0.01% atropine with DIMS spectacle lenses in the prevention of myopia progression in European children. METHODS This was a retrospective study including data from pediatric European patients with myopia. From November 2021 to March 2022, only 0.01% atropine was prescribed because DIMS lenses were still not available in Portugal. From March to October 2022, only DIMS spectacle lenses were prescribed due to patients' parents' preference. Myopia progression endpoints were axial length (AL) and spherical equivalent (SE) differences between before and 6 months after treatment. AL and SE evolution were compared using a general linear model with repeated measures. RESULTS The study included 98 eyes from 50 patients: 47 in the atropine group and 51 in the DIMS group. There were no statistically significant differences between groups in terms of initial AL, initial SE, sex or age. The mean AL elongation at 6 months was 0.057 mm in the atropine group (SD = 0.118) and 0.002 mm (SD = 0.077) in the DIMS group. SE progression was - 0.098 (SD = 0.232) D in the atropine group and - 0.039 (SD = 0.105) D in the DIMS group. AL elongation was significantly lower in the DIMS lens group (p = 0.038, partial Eta2 = 0.045). There was no difference in SE progression between groups (p = 0.302, partial Eta2 = 0.011). CONCLUSION Comparison between 0.01% atropine eyedrops and DIMS spectacle lenses for slowing the progression of myopia favored DIMS lenses in terms of AL elongation in a short-term follow-up. There was no difference in terms of SE between groups.
Collapse
Affiliation(s)
- Sandra Guimarães
- Instituto de Investigação, Inovação e Desenvolvimento da Universidade Fernando Pessoa (FP-I3ID), Gondomar, Porto, Portugal
- Hospital-Escola da Universidade Fernando Pessoa (HE-UFP), Gondomar, Porto, Portugal
- Escola Superior de Saúde da Universidade Fernando Pessoa (ESS-UFP), Gondomar, Porto, Portugal
| | - Patrícia Barros da Silva
- CRI - OftaPed, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
| | - Bárbara Oliveiros
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine (iCBR-FMUC), University of Coimbra, Coimbra, Portugal
- Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine (LBIM, FMUC), University of Coimbra, Coimbra, Portugal
| | - Eduardo Silva
- CRI - OftaPed, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| |
Collapse
|
63
|
Goto S, Zhang Y, Vyas SA, Zhu Q, Wildsoet CF. Changes in Expression in BMP2 and Two Closely Related Genes in Guinea Pig Retinal Pigment Epithelium during Induction and Recovery from Myopia. Biomolecules 2023; 13:1373. [PMID: 37759773 PMCID: PMC10526436 DOI: 10.3390/biom13091373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/09/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE We previously reported differential gene expression of the bone morphogenetic protein 2 (Bmp2) in guinea pig retinal pigment epithelium (RPE) after 1 day of hyperopic defocus, imposed with a negative contact lens (CLs). The study reported here sought to obtain insights into the temporal profiles of gene expression changes in Bmp2, as well as those of two closely related genes, the inhibitor of DNA binding 3 (Id3) and Noggin (Nog), both during myopia induction and when the CL treatment was terminated to allow recovery from induced myopia. METHODS To induce myopia, 2-week-old pigmented guinea pigs (New Zealand strain, n = 8) wore monocular -10 diopter (D) rigid gas-permeable (RGP) CLs for one week, while the other eye served as a control. Ocular measurements were made at baseline, 3 days, and 7 days after the initiation of CL wear, with treatment then being terminated and additional measurements being made after a further 3 days, 1 week, and 2 weeks. Spherical equivalent refractive errors (SERs), axial length (AL), choroidal thickness (ChT), and scleral thickness (ScT) data were collected using retinoscopy, optical biometry (Lenstar), and spectral domain optical coherence tomography (SD-OCT), respectively. RPE samples were collected from both eyes of the guinea pigs after either 1 day or 1 week of CL wear or 1 day or 2 weeks after its termination, and RNA was subsequently isolated and subjected to quantitative real-time PCR (qRT-PCR) analyses, targeting the Bmp2, Id3, and Nog genes. RESULTS Mean interocular differences (treated-control) in AL and SER were significantly different from baseline after 3 and 7 days of CL wear, consistent with induced myopia (p < 0.001 for all cases). Termination of CL wear resulted in the normalization (i.e., recovery) of the ALs and SERs of the treated eyes within 7 days, and the earlier significant ChT thinning with CL wear (p = 0004, day 7) was replaced by rapid thickening, which remained significant on day 7 (p = 0.009) but had normalized by day 14. The ChT changes were much smaller in magnitude than the AL changes in both phases. Interocular differences in the ScT showed no significant changes. The Bmp2 and Id3 genes were both significantly downregulated with CL wear, after 1 day (p = 0.012 and 0.016) and 7 days (p = 0.002 and 0.005), while Bmp2 gene expression increased and Nog gene expression decreased after the termination of CL wear, albeit transiently, which was significant on 1 day (p = 0.004 and 0.04) but not 2 weeks later. No change in Id3 gene expression was observed over the latter period. Conclusions: The above patterns of myopia induction and recovery validate this negative RGP-CL model as an alternative to traditional spectacle lens models for guinea pigs. The defocus-driven, sign-dependent changes in the expression of the Bmp2 gene in guinea pig RPE are consistent with observations in chicks and demonstrate the important role of BMP2 in eye growth regulation.
Collapse
Affiliation(s)
- So Goto
- Herbert Wertheim School Optometry and Vision Science, University of California, Berkeley, CA 94720, USA
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita 565-0871, Japan
- Department of Ophthalmology, National Hospital Organization, Tokyo Medical Center, Meguro-ku, Tokyo 152-8902, Japan
| | - Yan Zhang
- Herbert Wertheim School Optometry and Vision Science, University of California, Berkeley, CA 94720, USA
| | - Sonal Aswin Vyas
- Herbert Wertheim School Optometry and Vision Science, University of California, Berkeley, CA 94720, USA
| | - Qiurong Zhu
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - Christine F. Wildsoet
- Herbert Wertheim School Optometry and Vision Science, University of California, Berkeley, CA 94720, USA
| |
Collapse
|
64
|
Tham YC, Yam JC, Wang YX, Wong TY. Digital strategies in the global war on myopia. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 38:100883. [PMID: 37649587 PMCID: PMC10462871 DOI: 10.1016/j.lanwpc.2023.100883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Yih-Chung Tham
- Centre of Innovation and Precision Eye Health, Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Eye Academic Clinical Program (Eye ACP), Duke NUS Medical School, Singapore
| | - Jason C. Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Ya Xing Wang
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
- School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China
| |
Collapse
|
65
|
Li R, Zhang K, Li SM, Zhang Y, Tian J, Lu Z, Li H, Wang L, Wan X, Zhang F, Li L, Jin ZB, Wang N, Liu H. Implementing a digital comprehensive myopia prevention and control strategy for children and adolescents in China: a cost-effectiveness analysis. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 38:100837. [PMID: 37520278 PMCID: PMC10372367 DOI: 10.1016/j.lanwpc.2023.100837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/30/2023] [Accepted: 06/19/2023] [Indexed: 08/01/2023]
Abstract
Background Children and adolescents' myopia is a major public problem. Although the clinical effect of various interventions has been extensively studied, there is a lack of national-level and integral assessments to simultaneously quantify the economics and effectiveness of comprehensive myopia prevention and control programs. We aimed to compare the cost-effectiveness between traditional myopia prevention and control strategy, digital comprehensive myopia prevention and control strategy and school-based myopia screening program in China. Methods A Markov model was used to compare the cost-utility and cost-effectiveness among school-based myopia screening, traditional myopia prevention and control strategy, and digital comprehensive myopia prevention and control strategy among 6 to 18-year-old rural and urban schoolchildren. Parameters were collected from published sources. The primary outcomes were quality-adjusted life-year, disability-adjusted life-year, incremental cost-utility ratio, and incremental cost-effectiveness ratio. Extensive sensitivity analyses were performed to test the robustness and sensitivity of base-case analysis. Findings Compared with school-based myopia screening strategy, after implementing digital comprehensive myopia prevention and control strategy, the prevalence of myopia among 18-year-old students in rural and urban areas was reduced by 3.79% and 3.48%, respectively. The incremental cost-utility ratio per quality-adjusted life-year gained with the digital myopia management plan ($11,301 for rural setting, and $10,707 for urban setting) was less than 3 times the per capita gross domestic product in rural settings ($30,501) and less than 1 time the per capita gross domestic product in urban settings ($13,856). In cost-effectiveness analysis, the incremental cost-effectiveness ratio produced by digital comprehensive myopia management strategy ($37,446 and $41,814 per disability-adjusted life-year averted in rural and urban settings) slightly exceeded the cost-effectiveness threshold. When assuming perfect compliance, full coverage of outdoor activities and spectacles satisfied the cost-effectiveness threshold, and full coverage of outdoor activities produced the lowest cost ($321 for rural settings and $808 for urban settings). Interpretations Health economic evidence confirmed the cost-effectiveness of promoting digital comprehensive myopia prevention and control strategies for schoolchildren at the national level. Sufficient evidence provides an economic and public health reference for further action by governments, policy-makers and other myopia-endemic countries. Funding National Natural Science Foundation of China, NSFC (82171051), Beijing Natural Science Foundation (JQ20029), Capital Health Research and Development of Special (2020-2-1081), National Natural Science Foundation of China, NSFC (82071000), National Natural Science Foundation of China, NSFC (8197030562).
Collapse
Affiliation(s)
- Ruyue Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Kaiwen Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Shi-Ming Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yue Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Jiaxin Tian
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Zhecheng Lu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Huiqi Li
- School of Medical Technology, Beijing Institute of Technology, Beijing, 102488, China
| | - Liyuan Wang
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150000, China
| | - Xiuhua Wan
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Fengju Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Li Li
- Department of Ophthalmology, National Key Discipline of Pediatrics, Ministry of Education, Beijing Children's Hospital, Capital Medical University, Beijing, 100000, China
| | - Zi-Bing Jin
- Beijing Institute of Ophthalmology, Beijing, 100730, China
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing, 100730, China
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
- School of Medical Technology, Beijing Institute of Technology, Beijing, 102488, China
- National Institute of Health Data Science at Peking University, Beijing, 100000, China
| | - Hanruo Liu
- Beijing Institute of Ophthalmology, Beijing, 100730, China
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
- School of Medical Technology, Beijing Institute of Technology, Beijing, 102488, China
- National Institute of Health Data Science at Peking University, Beijing, 100000, China
| |
Collapse
|
66
|
Ortiz-Peregrina S, Solano-Molina S, Martino F, Castro-Torres JJ, Jiménez JR. Parental awareness of the implications of myopia and strategies to control its progression: A survey-based study. Ophthalmic Physiol Opt 2023; 43:1145-1159. [PMID: 37345262 DOI: 10.1111/opo.13190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/16/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Myopia has emerged as a significant public health concern. Effective methods have now been developed to delay its onset and progression. However, this information may not be reaching parents, and they are key players in terms of implementing the necessary preventive measures. This study investigated parental awareness of myopia, its implications and the strategies available for controlling it. METHODS A self-administered online survey was distributed to parents of children 6-16 years of age. To be eligible to respond, their child had to be myopic or at risk of developing myopia due to family history. RESULTS A total of 330 parents completed the survey, of which 321 were included for analysis. Sixty-seven percent of respondents had at least one myopic son/daughter, and most were between -1.00 and -1.75 D. Among parents of myopic children, 20.9% thought that their child's myopia progressed moderately. Sixty-seven percent of parents had a significant level of concern about the progression of the myopia and felt that it was caused mainly by the use of electronic devices and genetics. A generalised linear model showed that parental concern was significantly predicted by the perception of evolution (p < 0.001) and the number of known health-related consequences (p < 0.001). Almost 40% of parents were unaware of the existence of myopia control strategies. Relatives and eye care practitioners are the main sources of information. The most well-known myopia control strategy was myopia control soft contact lenses (29.2%), although the option that most parents would opt for was spectacles with peripheral defocus lenses (47.1%). The selection of a contact-lens-based myopia control method correlated significantly with the age of the children (p < 0.001). CONCLUSIONS Society in general and parents in particular need more information about myopia, its consequences and the options available for its control. Eye care practitioners play an important role in this issue.
Collapse
Affiliation(s)
- Sonia Ortiz-Peregrina
- Department of Optics, Laboratory of Vision Sciences and Applications, University of Granada, Granada, Spain
| | - Salvador Solano-Molina
- Department of Optics, Laboratory of Vision Sciences and Applications, University of Granada, Granada, Spain
- Centro Nazaríes Especialistas, Granada, Spain
| | - Francesco Martino
- Department of Optics, Laboratory of Vision Sciences and Applications, University of Granada, Granada, Spain
| | - José J Castro-Torres
- Department of Optics, Laboratory of Vision Sciences and Applications, University of Granada, Granada, Spain
| | - José R Jiménez
- Department of Optics, Laboratory of Vision Sciences and Applications, University of Granada, Granada, Spain
| |
Collapse
|
67
|
Turnbull PRK, Goodman LK, Phillips JR. Dual-focus contact lenses for myopia control modify central retinal electrophysiology in humans. Ophthalmic Physiol Opt 2023; 43:1100-1109. [PMID: 37184059 DOI: 10.1111/opo.13163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Dual-focus contact lenses create two focal planes, one providing a clear retinal image while the other imposes myopic defocus on the retina to slow myopia progression. This study used global-flash multifocal electroretinogram (gmfERG) response amplitudes to compare central versus peripheral retinal responses under dual-focus conditions and to assess the optimal degree of myopic defocus compared with a single-vision control lens. METHODS Twenty participants each underwent three gmfERG trials, wearing a spectacle correction over dual-focus contact lenses with plano central power and peripheral secondary focal powers of either +2.00D, +4.00D or a plano single-vision lens. We compared amplitudes and latencies of the gmfERG direct and induced components (DC and IC) within participants, between the three different contact lens powers and at different retinal eccentricities (gmfERG ring). RESULTS We observed significant differences in the gmfERG responses between the single-vision and dual-focus contact lenses. Overall, DC amplitudes peaked between zero and +2.00D secondary power, while IC amplitudes were maximal between +2.00D and +4.00D. Compared with the single-vision control, the greatest increase in DC and IC amplitudes while wearing dual-focus lenses occurred within the central 10° of the retina. There was no interaction effect between gmfERG ring (eccentricity) and secondary power, and no difference in the latency of the gmfERG responses between different powers. CONCLUSION We found that dual-focus contact lenses with a +2.00D secondary power are close to that expected to induce the greatest increase in gmfERG responses relative to a single-vision lens. Dual-focus lenses produced the highest DC and IC response amplitudes relative to a single-vision lens in the central 10° of the retina. This suggests that dual-focus contact lenses slow myopia progression by modifying central rather than peripheral retinal activity.
Collapse
Affiliation(s)
- Philip R K Turnbull
- Myopia Laboratory, School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Lucy K Goodman
- Myopia Laboratory, School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - John R Phillips
- Myopia Laboratory, School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
- Department of Optometry, Asia University, Taichung, Taiwan
| |
Collapse
|
68
|
Shen T, Liang M, Chen L. Myopic progression in school-aged children with moderate intermittent exotropia. Front Pediatr 2023; 11:1192387. [PMID: 37654689 PMCID: PMC10466788 DOI: 10.3389/fped.2023.1192387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023] Open
Abstract
Objective It is still controversial whether intermittent exotropia (IXT) affects myopic progression during the critical period of visual development. This study retrospectively analyzed the long-term myopic changes and the impact of IXT surgery on myopic progression in school-aged children with moderate IXT. Methods The medical records of 65 children from 5 to 13 years old with or without IXT between 2015 and 2021 were retrospectively reviewed. Patients whose spherical equivalent refraction (SER) were less than -3.00 diopter (D) were included and divided into three groups: IXT surgery group (Group A), which comprised 22 IXT patients who received IXT surgery, IXT observation group (Group B), which comprises 19 IXT patients who only received long-term observational follow-up; and normal control group (Group C), which comprised 24 normal controls without IXT. The main outcome measurement was the rate of myopic progression, which was defined as the mean myopic shift in SER per year. Results The 3- and 5-years long-term follow-up rates of myopic progression were -0.47 ± 0.28 D per year and -0.48 ± 0.23 D per year respectively in Group B, and those were significantly slower than that in Group C (-0.73 ± 0.32 D per year and -0.76 ± 0.19 D per year respectively). However, there was no significant difference in the rate of myopic progression between Group A and B or between Group A and C. Conclusion Moderate IXT may have lower rate of myopic progression in school-aged children. Whether IXT surgery influence the rate of myopic progression still needs further study.
Collapse
Affiliation(s)
- Tao Shen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | | | | |
Collapse
|
69
|
Khan HA, Naduvilath T, Tahhan N, Sankaridurg PR. Myopia Progression in Adults: A Retrospective Analysis. Optom Vis Sci 2023; 100:537-542. [PMID: 37499166 DOI: 10.1097/opx.0000000000002045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
SIGNIFICANCE Studies on adult myopia progression are limited. This retrospective analysis of a large data set of young adult myopes characterizes myopia progression during adulthood. PURPOSE This study aimed to determine the mean annual progression of myopia and to estimate the proportion of progressors in adult myopes. METHODS Longitudinal, noncycloplegic subjective refraction data for young adult myopes (spherical equivalent refractive error, -0.5 D or more), age ranging from 18 to 30 years, were retrospectively analyzed. The mean annual progression, as well as the proportion of progressors (at least -0.50 D shift between visits and annualized progression of -0.25 D or more), was estimated. RESULTS A total of 354 myopes (230 females [64.7%]), with a mean (standard deviation) age of 22.2 (3.8) years, were considered. The mean (standard deviation) annualized progression was -0.10 (0.21), -0.08 (0.2), and -0.04 (0.21) D in the 18- to 21-year, 22- to 26-year, and 27- to 30-year age groups, respectively ( P = .003). The difference between 18- to 21- and 27- to 30-year age groups was significant ( P = .05), whereas all other pairwise comparisons were not significant. The proportion (95% confidence interval) of progressors in the 18- to 21-, >21- to 26-, and >26- to 30-year age groups was 18.3% (14.9 to 21.7%), 10.9% (7.1 to 14.7%), and 8.8% (4.4 to 13.1%), respectively. The proportion of progressors working or studying in a higher learning/academic environment was 16.2% with an odds ratio (95% confidence interval) for progression of 2.07 (1.15 to 3.74) compared with those in nonacademic environments ( P = .02), with no significant effect of sex or ethnicity. CONCLUSIONS This study is consistent with other studies on myopia in young adults, which show that myopia does not progress by substantial amounts throughout the adult years, particularly after the age of 21 years. Although future studies may be challenged by the small rates of change and the small proportion of progressors, further research is needed to understand the implications of adult myopia progression on clinical management.
Collapse
Affiliation(s)
| | | | | | - Padmaja R Sankaridurg
- School of Optometry and Vision Sciences, University of New South Wales, Sydney, Australia
| |
Collapse
|
70
|
Huang Y, Wang Y, Shen Y, Chen Z, Peng X, Zhang L, Han T, Zhou X. Defocus-induced spatial changes in choroidal thickness of chicks observed by wide-field swept-source OCT. Exp Eye Res 2023:109564. [PMID: 37419380 DOI: 10.1016/j.exer.2023.109564] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/07/2023] [Accepted: 06/29/2023] [Indexed: 07/09/2023]
Abstract
Choroid has been claimed to be of importance during ocular development. However, how the choroid responds spatially to different visual cues has not been fully understood. The aim of this study was to investigate defocus-induced spatial changes in choroidal thickness (ChT) in chicks. Eight 10-day-old chicks were fitted monocularly with -10 D or +10 D lenses (day 0), which were removed seven days later (day 7). The ChT was measured on days 0, 7, 14, and 21 using wide-field swept-source optical coherence tomography (SS-OCT) and analyzed with custom-made software. Comparisons of the ChT in the central (1 mm), paracentral (1-3 mm), and peripheral (3-6 mm) ring areas and the ChT in the superior, inferior, nasal, and temporal regions were conducted. Axial lengths and refractions were also evaluated. In the negative lens group, the global ChT of the treated eyes was significantly less than that of the fellow eyes on day 7 (interocular difference: 179.28 ± 25.94 μm, P = 0.001), but thicker on day 21 (interocular difference: 241.80 ± 57.13 μm, P = 0.024). These changes were more pronounced in the central choroid. The superior-temporal choroid changed more during induction but less during recovery. In the positive lens group, the ChT of both eyes increased on day 7 and decreased on day 21, with most changes occurring in the central region, too. The inferior-nasal choroid of the treated eyes changed more during induction but less during recovery. These results provide evidence for regionally asymmetric characteristics of the choroidal response to visual cues and insights into the underlying mechanisms of emmetropization.
Collapse
Affiliation(s)
- Yangyi Huang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Research Center of Ophthalmology and Optometry, China; Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, China
| | - Yuliang Wang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Research Center of Ophthalmology and Optometry, China; Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, China
| | - Yang Shen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Research Center of Ophthalmology and Optometry, China; Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, China
| | - Zhi Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Research Center of Ophthalmology and Optometry, China; Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, China
| | - Xiaoliao Peng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Research Center of Ophthalmology and Optometry, China; Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, China
| | - Luoli Zhang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Research Center of Ophthalmology and Optometry, China; Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, China
| | - Tian Han
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Research Center of Ophthalmology and Optometry, China; Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, China.
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Research Center of Ophthalmology and Optometry, China; Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, China.
| |
Collapse
|
71
|
Dou L, Xu Y, Chen G, Li S. Psychometric properties and comparison of four health utility approaches among myopia patients in China. Health Qual Life Outcomes 2023; 21:66. [PMID: 37403059 DOI: 10.1186/s12955-023-02150-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 06/14/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND The increased prevalence of myopia creates and earlier age of onset has created public health concerns for the long-term eye health, vision impairment and carries with it a significant economic burden. The quality of the economic evaluation is dependent on the sensitivity and validity of the approaches. Nowadays, there are many approaches to measure patients' health state utility (HSU). However, little is known regarding the performance of direct approach and indirect approach in people with myopia. This study is aimed to compare the psychometric properties of four HSU approaches among patients with myopia in mainland China, including two direct approaches (TTO and SG), the generic preference-based measures (PBM) (AQoL-7D) and the disease-specific PBM (VFQ-UI). METHODS A convenience sampling framework was used to recruit patients with myopia who attended a large ophthalmic hospital in Jinan, China. Spearman's rank correlations coefficient was used to assess concurrent validity. Known-group validity was analyzed by: (1) whether the patients wear corrective devices; (2) severity of myopia as low or moderate to high of the better eye; (3) duration of myopia as ≤ 10 years or > 10 years. Effect size (ES), relative efficiency (RE) statistic and the largest area under the receiver operating characteristic curve (AUC) were used to assess sensitivity. The intra-class correlation coefficient (ICC) and Bland-Altman plots were used to assess agreement. RESULTS A valid sample size of 477 myopia patients was analyzed (median duration: 10 years). The mean HSU scores between TTO and SG were similar (0.95) and higher than AQoL-7D (0.89) and VFQ-UI (0.83). Overall, the VFQ-UI had the best performance based on the psychometric analysis. The agreement indicated that there was no pair of approaches that could be used interchangeably. CONCLUSIONS The VFQ-UI showed better psychometric properties than other three approaches for providing health state utility in Chinese myopia patients. Given the widespread use and its generic nature of the AQoL-7D, it could be used alongside with VFQ-UI to provide complementary health state utility from a generic and disease-specific perspective for economic evaluation. More evidence on the responsiveness of four health utility approaches in myopia patients is required.
Collapse
Affiliation(s)
- Lei Dou
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
- Center for Health Preference Research, Shandong University, Jinan, China
| | - Yanjiao Xu
- Afliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Gang Chen
- Center for Health Economics, Monash Business School, Monash University, Melbourne, Australia
| | - Shunping Li
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China.
- Center for Health Preference Research, Shandong University, Jinan, China.
- Center for Health Management and Policy Research, School of Public Health, Shandong University, Wenhua Xi Rd 44, Shandong Province, 250012, Jinan, China.
| |
Collapse
|
72
|
Zhou X, Liu T, Wu A, Cheng B, Chen M, Wang K. Prevalence of myopia among senior students in Fenghua, Eastern China, before and during the COVID-19 pandemic. Front Public Health 2023; 11:1180800. [PMID: 37346105 PMCID: PMC10279843 DOI: 10.3389/fpubh.2023.1180800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/19/2023] [Indexed: 06/23/2023] Open
Abstract
Background Myopia is a common cause of vision impairment worldwide. In China, the prevalence, the affected population, and the onset age of myopia are prominent issues. Prevention and intervention of myopia are great public health concerns. Methods This school-based retrospective study retrieved visual acuity and refractive data of senior students (grade 12th) from six high schools in Fenghua City, Zhejiang Province, eastern China, from 2016 and 2022. Noncycloplegic autorefraction was performed for refractive status. Students were divided into three subgroups by their school types. The overall myopia prevalence, as well as the prevalence of low myopia, moderate myopia, and high myopia, were calculated separately for each year. Statistical analyzes were performed using SPSS 25.0 and Graphpad Prism software. Results The mean myopia prevalence in Fenghua was 84.5% (95% CI: 84.0-85.0%), and a slightly downward trend was found in myopia prevalence after 2019, but the change was not statistically significant (p = 0.078). The overall prevalence of myopia was 79.6, 85.2, and 86.1% in vocational high schools, general high schools, and key high schools, respectively, with statistically significant differences (p < 0.001). The prevalence of myopia among senior students in the vocational high school was significantly lower than that in the other two high schools. There's no significant change in the overall prevalence of myopia (84.7% vs. 84.3%, p = 0.265) before and during the COVID-19 pandemic, and it remained statistically insignificant after stratifying by gender (male p = 0.207, female p = 0.918) or school types (vocational high school p = 0.112; general high school p = 0.299; key high school p = 0.393). Conclusion The prevalence of myopia among senior students in Fenghua is relatively high, and the COVID-19 pandemic has no significant impact on it. The prevalence of myopia among vocational high school students is lower than that of general high school and key high school. Attention should be paid to the effects of educational pressure on the prevalence of myopia among students.
Collapse
Affiliation(s)
- Xuewei Zhou
- Department of Ophthalmology, The People’s Hospital of Fenghua, Ningbo, Zhejiang, China
| | - Tong Liu
- Eye Center, The 2nd Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Ophthalmology, Hangzhou, China
| | - Aimin Wu
- Department of Ophthalmology, The People’s Hospital of Fenghua, Ningbo, Zhejiang, China
| | - Bo Cheng
- Department of Ophthalmology, The People’s Hospital of Fenghua, Ningbo, Zhejiang, China
| | - Min Chen
- Eye Center, The 2nd Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Ophthalmology, Hangzhou, China
| | - Kaijun Wang
- Eye Center, The 2nd Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Ophthalmology, Hangzhou, China
| |
Collapse
|
73
|
Hyman LG, Zangwill L. The Myopia Epidemic, Glaucoma Risk, Race, and Ethnicity-Another Piece of the Puzzle. JAMA Ophthalmol 2023; 141:532-533. [PMID: 37103941 DOI: 10.1001/jamaophthalmol.2023.1380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- Leslie G Hyman
- Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Linda Zangwill
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| |
Collapse
|
74
|
Tong HJ, Huang ZM, Li YL, Chen YM, Tian B, Ding LL, Zhu LL. Machine learning to analyze the factors influencing myopia in students of different school periods. Front Public Health 2023; 11:1169128. [PMID: 37333519 PMCID: PMC10270291 DOI: 10.3389/fpubh.2023.1169128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Purpose We aim to develop myopia classification models based on machine learning algorithms for each schooling period, and further analyze the similarities and differences in the factors influencing myopia in each school period based on each model. Design Retrospective cross-sectional study. Participants We collected visual acuity, behavioral, environmental, and genetic data from 7,472 students in 21 primary and secondary schools (grades 1-12) in Jiamusi, Heilongjiang Province, using visual acuity screening and questionnaires. Methods Machine learning algorithms were used to construct myopia classification models for students at the whole schooling period, primary school, junior high school, and senior high school period, and to rank the importance of features in each model. Results The main influencing factors for students differ by school section, The optimal machine learning model for the whole schooling period was Random Forest (AUC = 0.752), with the top three influencing factors being age, myopic grade of the mother, and Whether myopia requires glasses. The optimal model for the primary school period was a Random Forest (AUC = 0.710), with the top three influences being the myopic grade of the mother, age, and extracurricular tutorials weekly. The Junior high school period was an Support Vector Machine (SVM; AUC = 0.672), and the top three influencing factors were gender, extracurricular tutorial subjects weekly, and whether can you do the "three ones" when reading and writing. The senior high school period was an XGboost (AUC = 0.722), and the top three influencing factors were the need for spectacles for myopia, average daily time spent outdoors, and the myopic grade of the mother. Conclusion Factors such as genetics and eye use behavior all play an essential role in students' myopia, but there are differences between school periods, with those in the lower levels focusing on genetics and those in the higher levels focusing on behavior, but both play an essential role in myopia.
Collapse
Affiliation(s)
- Hao-Jie Tong
- School of Public Health, Jiamusi University, Jiamusi, Heilongjiang, China
| | - Ze-Min Huang
- School of Public Health, Jiamusi University, Jiamusi, Heilongjiang, China
| | - Yu-Lan Li
- School of Public Health, Jiamusi University, Jiamusi, Heilongjiang, China
| | - Yi-Ming Chen
- School of Public Health, Jiamusi University, Jiamusi, Heilongjiang, China
| | - Ben Tian
- School of Public Health, Jiamusi University, Jiamusi, Heilongjiang, China
| | - Ling-Ling Ding
- Clinical College of Anhui Medical University, Hefei, Anhui, China
| | - Li-Ling Zhu
- School of Public Health, Jiamusi University, Jiamusi, Heilongjiang, China
| |
Collapse
|
75
|
Wolffsohn JS, Whayeb Y, Logan NS, Weng R. IMI-Global Trends in Myopia Management Attitudes and Strategies in Clinical Practice-2022 Update. Invest Ophthalmol Vis Sci 2023; 64:6. [PMID: 37126357 PMCID: PMC10155870 DOI: 10.1167/iovs.64.6.6] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 05/02/2023] Open
Abstract
Purpose Surveys in 2015 and 2019 identified a high level of eye care practitioner concern/activity about myopia, but the majority still prescribed single vision interventions to young myopes. This research aimed to provide updated information. Methods A self-administered, internet-based questionnaire was distributed in 13 languages, through professional bodies to eye care practitioners globally. The questions examined awareness of increasing myopia prevalence, perceived efficacy and adoption of available strategies, and reasons for not adopting specific strategies. Results Of the 3195 respondents, practitioners' concern about the increasing frequency of pediatric myopia in their practices differed between continents (P < 0.001), being significantly higher in Asia (9.0 ± 1.5 of 10) than other continents (range 7.7-8.2; P ≤ 0.001). Overall, combination therapy was perceived by practitioners to be the most effective method of myopia control, followed by orthokeratology and pharmaceutical approaches. The least effective perceived methods were single vision distance undercorrection, spectacles and contact lenses, as well as bifocal spectacles. Practitioners rated their activity in myopia control between (6.6 ± 2.9 in South America to 7.9 ± 1.2/2.2 in Australasia and Asia). Single-vision spectacles are still the most prescribed option for progressing young myopia (32.2%), but this has decreased since 2019, and myopia control spectacles (15.2%), myopia control contact lenses (8.7%) and combination therapy (4.0%) are growing in popularity. Conclusions More practitioners across the globe are practicing myopia control, but there are still significant differences between and within continents. Practitioners reported that embracing myopia control enhanced patient loyalty, increasing practice revenue and improving job satisfaction.
Collapse
Affiliation(s)
- James S. Wolffsohn
- College of Health & Life Sciences, Aston University, Birmingham, United Kingdom
| | - Yasmin Whayeb
- College of Health & Life Sciences, Aston University, Birmingham, United Kingdom
| | - Nicola S. Logan
- College of Health & Life Sciences, Aston University, Birmingham, United Kingdom
| | - Rebecca Weng
- Brien Holden Vision Institute, Sydney, NSW, Australia
| |
Collapse
|
76
|
Tahhan N, Wolffsohn JS, Sankaridurg P, Jonas JB, Bullimore MA, Flitcroft I, Ostrin LA, Wildsoet C, Resnikoff S. Editorial: International Myopia Institute White Paper Series 2023. Invest Ophthalmol Vis Sci 2023; 64:1. [PMID: 37126361 PMCID: PMC10153580 DOI: 10.1167/iovs.64.6.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Affiliation(s)
- Nina Tahhan
- Brien Holden Vision Institute, Sydney Australia
- School of Optometry and Vision Science, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - James S Wolffsohn
- College of Health & Life Sciences, Aston University, Birmingham, United Kingdom
| | - Padmaja Sankaridurg
- Brien Holden Vision Institute, Sydney Australia
- School of Optometry and Vision Science, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Mark A Bullimore
- University of Houston, College of Optometry, Houston, Texas, United States
| | - Ian Flitcroft
- Centre for Eye Research Ireland, School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
- Department of Ophthalmology, Children's Health Ireland at Temple Street Hospital, Dublin, Ireland
| | - Lisa A Ostrin
- University of Houston, College of Optometry, Houston, Texas, United States
| | - Christine Wildsoet
- UC Berkeley Wertheim School Optometry & Vision Science, Berkeley, California, United States
| | - Serge Resnikoff
- Brien Holden Vision Institute, Sydney Australia
- School of Optometry and Vision Science, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
77
|
Banashefski B, Rhee MK, Lema GMC. High Myopia Prevalence across Racial Groups in the United States: A Systematic Scoping Review. J Clin Med 2023; 12:jcm12083045. [PMID: 37109381 PMCID: PMC10144975 DOI: 10.3390/jcm12083045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/03/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
High myopia is a significant public health issue globally and in the United States (US), where it affects ~4% of the population or 13 million people. This is a potentially blinding condition, but complications can be prevented with early intervention in childhood. Several countries have developed robust data on high myopia, but the United States' data on high myopia remains lacking. Further, underrepresented populations are at particular risk of complications due to reduced access to optometric and ophthalmic care. We performed a systematic scoping review of population-based studies that investigated the prevalence of high myopia across racial and ethnic groups in the US to identify the impact of high myopia on underrepresented communities. Only four studies were identified that met inclusion criteria, which highlights the need to further investigate the topic in the United States. The prevalence of high myopia ranged from a low of 1.8% among Hispanic populations to a high of 11.8% among Chinese populations. Our study demonstrated a paucity of high myopia data in the United States and variable rates of high myopia depending on the time and location of each study. More complete prevalence data will help identify opportunities for community-based interventions to prevent debilitating and blinding complications of high myopia.
Collapse
Affiliation(s)
- Bryana Banashefski
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Michelle K Rhee
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Gareth M C Lema
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- John J. Peters VA Medical Center, Bronx, NY 10468, USA
| |
Collapse
|
78
|
Farassat N, Böhringer D, Küchlin S, Molnár FE, Schwietering A, Seger D, Hug MJ, Knöbel AB, Schneider-Fuchs S, Ihorst G, Wabbels B, Beisse C, Ziemssen F, Schuettauf F, Hedergott A, Ring-Mangold T, Schuart C, Wolf A, Schmickler S, Biermann J, Eberwein P, Hufendiek K, Eckstein A, Gusek-Schneider G, Schittkowski M, Lischka T, Lagrèze WA. Low-dose AtropIne for Myopia Control in Children (AIM): protocol for a randomised, controlled, double-blind, multicentre, clinical trial with two parallel arms. BMJ Open 2023; 13:e068822. [PMID: 37080623 PMCID: PMC10124292 DOI: 10.1136/bmjopen-2022-068822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION Myopia is a major cause of degenerative eye disease and increases the risk of secondary visual impairment. Mitigating its progression therefore has great potential of clinically relevant benefit as shown by using highly diluted atropine eye drops in children of Asian origin. However, limited evidence is available regarding the efficacy and safety of low-dose atropine therapy in non-Asian populations. Hence, the Low-dose AtropIne for Myopia Control in Children (AIM) study will test the efficacy and safety of 0.02% atropine vs placebo in a German population. METHODS AND ANALYSIS AIM is a national, multicentre, prospective, randomised, placebo-controlled, double-blind trial with two parallel arms. The primary objective is to assess the efficacy of atropine 0.02% eyedrops for myopia control in children of Caucasian origin. The primary outcome is the change in cycloplegic refraction after 1 year of treatment (D/year). Secondary and tertiary outcome measures comprise the change in axial length (mm/year) in children treated with 0.02% atropine compared with placebo, the myopic progression of participants treated with 0.01% compared with 0.02% atropine (D/year and mm/year), and the safety profile of both 0.02% and 0.01% atropine. Furthermore, the myopic progression 1 year after cessation of therapy with 0.02% atropine will be evaluated. Inclusion criteria are an age of 8-12 years and myopia of -1 D to -6 D with an estimated annual myopia progression of ≥0.5 D. After randomisation, patients will receive either atropine 0.02% (arm A) or placebo eye drops (arm B) in the first year of treatment. In the second year, they will continue to receive atropine 0.02% (arm A) or switch to atropine 0.01% (arm B). In the third year, they will switch to placebo (arm A) or continue with atropine 0.01% (arm B). To achieve a statistical power of 80%, the calculated sample size is 300. The trial has started in October 2021 with a planned recruitment period of 18 months. ETHICS AND DISSEMINATION AIM has been approved by the Central Ethics Committee of the University Medical Center Freiburg (21-1106), local ethics committees of each participating centre and the German Federal Institute for Drugs and Medical Devices (61-3910-4044659). It complies with the Declaration of Helsinki, local laws and ICH-GCP. Results and underlying data from this trial will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT03865160.
Collapse
Affiliation(s)
- Navid Farassat
- Eye Center, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany
| | - Daniel Böhringer
- Eye Center, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany
| | - Sebastian Küchlin
- Eye Center, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany
| | - Fanni E Molnár
- Eye Center, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany
| | - Anne Schwietering
- Eye Center, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany
| | - Dorina Seger
- Eye Center, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany
| | - Martin J Hug
- Department of Pharmacy, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany
| | - Anja-Birte Knöbel
- Clinical Trials Unit, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany
| | - Sabine Schneider-Fuchs
- Clinical Trials Unit, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany
| | - Bettina Wabbels
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Christina Beisse
- Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Focke Ziemssen
- Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany
| | - Frank Schuettauf
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Hedergott
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Theresia Ring-Mangold
- Department of Ophthalmology, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Claudia Schuart
- Department of Ophthalmology, Medical Faculty of Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Armin Wolf
- Department of Ophthalmology, Ulm University Medical Center, Ulm, Germany
| | | | - Julia Biermann
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
| | | | | | - Anja Eckstein
- Department of Ophthalmology, University Duisburg Essen, Essen, Germany
| | - Gabriele Gusek-Schneider
- Department of Ophthalmology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Schittkowski
- Department of Ophthalmology, Section for Strabismus and Neuroophthalmology, University Medicine Göttingen, Göttingen, Germany
| | - Thomas Lischka
- Department of Ophthalmology, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany
| | - Wolf A Lagrèze
- Eye Center, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany
| |
Collapse
|
79
|
Zheng Q, Hong C, Peng Y, He T, Lai Y, Tan L, Shen T. Association between axial length and HDL in children: a hospital-based cross-sectional study. BMC Ophthalmol 2023; 23:164. [PMID: 37072771 PMCID: PMC10114358 DOI: 10.1186/s12886-023-02902-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/03/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND To analyze the relationship between axial length and levels of high-density lipoprotein (HDL) cholesterol in children. METHODS A retrospective, hospital-based cross-sectional research with 69 right eyes from 69 children who underwent health examination by Zhejiang Provincial People's Hospital was carried out. The participants were split into three groups: Group A (axial length < = 23 mm), Group B (axial length 23-24 mm), and Group C (axial length > 24 mm). Demographic epidemiological information, blood biochemical parameters and ophthalmic characteristics including refractive status and ocular geometric parameters were obtained and analyzed. RESULTS 69 right eyes from 69 patients (25 males and 44 females) with a median age of 10.00 years old (IQR: 8.00-11.00 years) were included in the study. Within Group A, there were a total of 17 individuals; Group B consisted of 22 individuals; Group C included 30 individuals. The mean axial length of three groups was 22.148(0.360), 23.503(0.342) and 24.770(0.556) mm, respectively (p < 0.0001). The mean HDL levels were significantly different in three groups are 1.824(0.307), 1.485(0.253) and 1.507 (0.265) mmol/L, respectively. By applying a Pearson Coefficient, we evaluated the association between axial length and HDL and discovered that there was a statistically significant (p = 0.00025) and adverse (R = -0.43) association between axial length and HDL. CONCLUSIONS We concluded from our study that there was a significantly inverse relationship between axial length and the levels of HDL in children.
Collapse
Affiliation(s)
- Qingqing Zheng
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Chaoyang Hong
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yaling Peng
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ting He
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yuan Lai
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lingtong Tan
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ting Shen
- Eye Center, the Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
| |
Collapse
|
80
|
Huang J, Ma W, Li R, Zhao N, Zhou T. Myopia prediction for children and adolescents via time-aware deep learning. Sci Rep 2023; 13:5430. [PMID: 37012269 PMCID: PMC10070443 DOI: 10.1038/s41598-023-32367-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
This is a retrospective analysis. Quantitative prediction of the children's and adolescents' spherical equivalent based on their variable-length historical vision records. From October 2019 to March 2022, we examined uncorrected visual acuity, sphere, astigmatism, axis, corneal curvature and axial length of 75,172 eyes from 37,586 children and adolescents aged 6-20 years in Chengdu, China. 80% samples consist of the training set, the 10% form the validation set and the remaining 10% form the testing set. Time-Aware Long Short-Term Memory was used to quantitatively predict the children's and adolescents' spherical equivalent within two and a half years. The mean absolute prediction error on the testing set was 0.103 ± 0.140 (D) for spherical equivalent, ranging from 0.040 ± 0.050 (D) to 0.187 ± 0.168 (D) if we consider different lengths of historical records and different prediction durations. Time-Aware Long Short-Term Memory was applied to captured the temporal features in irregularly sampled time series, which is more in line with the characteristics of real data and thus has higher applicability, and helps to identify the progression of myopia earlier. The overall error 0.103 (D) is much smaller than the criterion for clinically acceptable prediction, say 0.75 (D).
Collapse
Affiliation(s)
- Junjia Huang
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, 611731, People's Republic of China
| | - Wei Ma
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Rong Li
- Eye See Inc., Chengdu, 610041, People's Republic of China
| | - Na Zhao
- Key Laboratory in Software Engineering of Yunnan Province, Yunnan University, Kunming, 650091, People's Republic of China
- Computational Education Lab, SeekingTao Tech. Inc., Chengdu, 610095, People's Republic of China
| | - Tao Zhou
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, 611731, People's Republic of China.
- Computational Education Lab, SeekingTao Tech. Inc., Chengdu, 610095, People's Republic of China.
| |
Collapse
|
81
|
He X, Wang J, Zhu Z, Xiang K, Zhang X, Zhang B, Chen J, Yang J, Du L, Niu C, Leng M, Huang J, Liu K, Zou H, He M, Xu X. Effect of Repeated Low-level Red Light on Myopia Prevention Among Children in China With Premyopia: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e239612. [PMID: 37099298 PMCID: PMC10134010 DOI: 10.1001/jamanetworkopen.2023.9612] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/09/2023] [Indexed: 04/27/2023] Open
Abstract
Importance Myopia is a global concern, but effective prevention measures remain limited. Premyopia is a refractive state in which children are at higher risk of myopia, meriting preventive interventions. Objective To assess the efficacy and safety of a repeated low-level red-light (RLRL) intervention in preventing incident myopia among children with premyopia. Design, Setting, and Participants This was a 12-month, parallel-group, school-based randomized clinical trial conducted in 10 primary schools in Shanghai, China. A total of 139 children with premyopia (defined as cycloplegic spherical equivalence refraction [SER] of -0.50 to 0.50 diopter [D] in the more myopic eye and having at least 1 parent with SER ≤-3.00 D) in grades 1 to 4 were enrolled between April 1, 2021, and June 30, 2021; the trial was completed August 31, 2022. Interventions Children were randomly assigned to 2 groups after grade stratification. Children in the intervention group received RLRL therapy twice per day, 5 days per week, with each session lasting 3 minutes. The intervention was conducted at school during semesters and at home during winter and summer vacations. Children in the control group continued usual activities. Main Outcomes and Measures The primary outcome was the 12-month incidence rate of myopia (defined as SER ≤-0.50 D). Secondary outcomes included the changes in SER, axial length, vision function, and optical coherence tomography scan results over 12 months. Data from the more myopic eyes were analyzed. Outcomes were analyzed by means of an intention-to-treat method and per-protocol method. The intention-to-treat analysis included participants in both groups at baseline, while the per-protocol analysis included participants in the control group and those in the intervention group who were able to continue the intervention without interruption by the COVID-19 pandemic. Results There were 139 children (mean [SD] age, 8.3 [1.1] years; 71 boys [51.1%]) in the intervention group and 139 children (mean [SD] age, 8.3 [1.1] years; 68 boys [48.9%]) in the control group. The 12-month incidence of myopia was 40.8% (49 of 120) in the intervention group and 61.3% (68 of 111) in the control group, a relative 33.4% reduction in incidence. For children in the intervention group who did not have treatment interruption secondary to the COVID-19 pandemic, the incidence was 28.1% (9 of 32), a relative 54.1% reduction in incidence. The RLRL intervention significantly reduced the myopic shifts in terms of axial length and SER compared with the control group (mean [SD] axial length, 0.30 [0.27] mm vs 0.47 [0.25] mm; difference, 0.17 mm [95% CI, 0.11-0.23 mm]; mean [SD] SER, -0.35 [0.54] D vs -0.76 [0.60] D; difference, -0.41 D [95% CI, -0.56 to -0.26 D]). No visual acuity or structural damage was noted on optical coherence tomography scans in the intervention group. Conclusions and Relevance In this randomized clinical trial, RLRL therapy was a novel and effective intervention for myopia prevention, with good user acceptability and up to 54.1% reduction in incident myopia within 12 months among children with premyopia. Trial Registration ClinicalTrials.gov Identifier: NCT04825769.
Collapse
Affiliation(s)
- Xiangui He
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Jingjing Wang
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
| | - Zhuoting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Division of Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Kaidi Xiang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Xinzi Zhang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Bo Zhang
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
| | - Jun Chen
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
| | - Jinliuxing Yang
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
| | - Linlin Du
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
| | - Chunjin Niu
- Department of Ophthalmology Prevention, Changning Center for Disease Control and Prevention, Shanghai, China
| | - Mei Leng
- Department of Teaching and Research, Changning Institute of Education, Shanghai, China
| | - Jiannan Huang
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
| | - Kun Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Haidong Zou
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Division of Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Xun Xu
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Engineering Center for Visual Science and Photomedicine, Shanghai, China
| |
Collapse
|
82
|
Ramamurthy D, Samuel Paulraj AK, Lakshmi T, Rajagopalan T, Lavanya R. Development of smart spectacles to monitor and modify myopia-related health behaviour in children. Ophthalmic Physiol Opt 2023; 43:517-524. [PMID: 36882952 DOI: 10.1111/opo.13119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/19/2023] [Accepted: 02/22/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE To develop a wearable, spectacle-mounted, sensor-based device to monitor and modify myopia risk factors in children, namely near-working distance, light levels and spectral composition. METHODS A wearable, spectacle-mounted device has been developed, which consists of inbuilt sensors, namely: (i) light sensor to detect ambient light intensity; (ii) proximity sensor to measure near-work distance; (iii) microspectrograph to measure spectral power for six visible channels, namely red, green, blue, yellow, orange and violet and (iv) a global positioning system tracker to track the location and the device. The sensors were programmed by Arduino Nano, and the circuit was fixed onto a printed circuit board fitted onto a spectacle frame for pilot testing. Laboratory testing of the prototype was performed using a mannequin. An alert will be set when exceeding the predetermined threshold to help control myopia risk factors. RESULTS The indoor and outdoor light levels measured using the prototype were less than and greater than 1000 lux, respectively. The actual target distance and the corresponding distance measured by the prototype were highly correlated (R2 = 0.99). The mean distance measured by the prototype was within 1.5 cm of the actual target distance for distances between 30 and 95 cm. The spectral energy of the indoor location was highest for the orange channel at about 100-160 counts/μW/cm2 , whereas it was highest for the blue channel in outdoor daylight (10,000-19,000 counts/μW/cm2 ). CONCLUSION A working prototype that can simultaneously measure the viewing distance, light intensity and spectral composition has been developed.
Collapse
Affiliation(s)
- Dharani Ramamurthy
- Department of Optometry, Faculty of Medical and Health Sciences, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, Kattankulathur, India
| | - Angeline Kirubha Samuel Paulraj
- Department of Biomedical Engineering, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, India
| | - Teja Lakshmi
- Department of Biomedical Engineering, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, India
| | - Tejashwini Rajagopalan
- Department of Optometry, Faculty of Medical and Health Sciences, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, Kattankulathur, India
| | - Reddy Lavanya
- Department of Optometry, Faculty of Medical and Health Sciences, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, Kattankulathur, India
| |
Collapse
|
83
|
Khanal S, Norton TT, Gawne TJ. Limited bandwidth short-wavelength light produces slowly-developing myopia in tree shrews similar to human juvenile-onset myopia. Vision Res 2023; 204:108161. [PMID: 36529048 PMCID: PMC9974583 DOI: 10.1016/j.visres.2022.108161] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
During postnatal development, an emmetropization feedback mechanism uses visual cues to modulate the axial growth of eyes so that, with maturation, images of distant objects are in focus on the retina. If the visual cues indicate that the eye has become too long, it generates STOP signals that slow eye elongation. Myopia is a failure of this process where the eye becomes too long. The existing animal models of myopia have been essential in understanding the mechanics of emmetropization but use visual cues that lead to rapidly progressing myopia and don't match the stimuli that lead to human myopia. Form deprivation removes esssentially all spatial contrast. Minus lens wear accurately guides axial elongation to restore sharp focus: technically it is not a model of myopia! In contrast, childhood myopia involves a slow drift into myopia, even with the presence of clear images. We hypothesize that, in the modern visual environment, STOP signals are present but often are not quite strong enough to prevent myopic progression. Using tree shrews, small diurnal mammals closely related to primates, we have developed an animal model that we propose better represents this situation. We used limited bandwidth light to provide limited chromatic cues for emmetropization that are not quite enough to produce fully effective STOP signaling, resulting in a slow drift into myopia as seen in children. We hypothesize that this animal model of myopia may prove useful in evaluating anti-myopia therapies where form deprivation and minus lens wear would be too powerful.
Collapse
Affiliation(s)
- Safal Khanal
- Dept. of Optometry and Vision Science, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
| | - Thomas T Norton
- Dept. of Optometry and Vision Science, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
| | - Timothy J Gawne
- Dept. of Optometry and Vision Science, University of Alabama at Birmingham (UAB), Birmingham, AL, United States.
| |
Collapse
|
84
|
Ma Y, Lin Q, Zhao Q, Jin ZB. Prevalence and Characteristics of Myopia in Adult Rhesus Macaques in Southwest China. Transl Vis Sci Technol 2023; 12:21. [PMID: 36947048 PMCID: PMC10050901 DOI: 10.1167/tvst.12.3.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Purpose To investigate the prevalence of myopia in a large cohort of adult rhesus macaques at Yunnan Province in southwest China and describe the characteristics of myopic rhesus macaque eyes. Methods A total of 219 rhesus macaques 14.07 ± 2.72 years old (range, 8-21) were randomly recruited for this study. We performed fundus photography and measurements of cycloplegic refractive error (RE) and axial length (AL) on macaques. Results A total of 429 eyes of 219 macaques were examined. The median RE was -1.25 diopters (D), and the median AL was 18.69 mm. The prevalence of myopia was 62.47%, and one-third of the myopic eyes were highly myopic. The presence of fundus tessellations was higher in myopic eyes than non-myopic eyes (42.54% vs. 6.21%). The cutoff value for the presence of tessellations was -3.52 D for RE and 19.38 mm for AL. In myopic eyes, there were significant differences between grade 1 and grade 3 fundus tessellations on RE (-5.57 ± 2.97 D vs. -8.13 ± 3.51 D) and AL (19.66 ± 0.55 mm vs. 20.60 ± 1.06 mm). Beta-peripapillary atrophy (β-PPA) was found in 48.10% of myopic eyes and 6.83% of non-myopic eyes. The presence of β-PPA is associated with the presence of fundus tessellations, AL, and RE. The presence of β-PPA was higher in grade 3 than grade 1 fundus tessellations (94.4% vs. 76%). Conclusions More than half of adult rhesus macaques in southwest China are myopic, and one-third of the myopic ones are highly myopic. Similar to humans, tessellated fundi and β-PPA are the characteristic signs of myopic rhesus macaques. Adult rhesus macaques are optimal animal models for research on the pathogenesis of myopia. Translational Relevance This study not only provides a reference for the refractive state and AL in myopic rhesus macaques but also indicates that adult rhesus macaques with spontaneous myopia are optimal animal models for research on the pathogenesis of myopia.
Collapse
Affiliation(s)
- Ya Ma
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qiang Lin
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Qi Zhao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zi-Bing Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
85
|
Shneor E, Ostrin LA, Doron R, Benoit JS, Levine J, Davidson K, Gordon-Shaag A. Baseline characteristics in the Israel refraction, environment, and devices (iREAD) study. Sci Rep 2023; 13:2855. [PMID: 36806309 PMCID: PMC9938253 DOI: 10.1038/s41598-023-29563-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/07/2023] [Indexed: 02/19/2023] Open
Abstract
The purpose of this study is to present baseline data from a longitudinal study assessing behavioral factors in three groups of boys in Israel with varying myopia prevalence. Ultra-Orthodox (N = 57), religious (N = 67), and secular (N = 44) Jewish boys (age 8.6 ± 1.4 years) underwent cycloplegic autorefraction and axial-length measurement. Time-outdoors and physical-activity were assessed objectively using an Actiwatch. Ocular history, educational factors, and near-work were assessed with a questionnaire. Group effects were tested and mixed effects logistic and linear regression were used to evaluate behaviors and their relationship to myopia. The prevalence of myopia (≤ - 0.50D) varied by group (ultra-Orthodox: 46%, religious: 25%, secular: 20%, P < 0.021). Refraction was more myopic in the ultra-Orthodox group (P = 0.001). Ultra-Orthodox boys learned to read at a younger age (P < 0.001), spent more hours in school (P < 0.001), spent less time using electronic devices (P < 0.001), and on weekdays, spent less time outdoors (P = 0.02). Increased hours in school (OR 1.70) and near-work (OR 1.22), increased the odds of myopia. Being ultra-Orthodox (P < 0.05) and increased near-work (P = 0.007) were associated with a more negative refraction. Several factors were associated with the prevalence and degree of myopia in young boys in Israel, including being ultra-Orthodox, learning to read at a younger age, and spending more hours in school.
Collapse
Affiliation(s)
- Einat Shneor
- Department of Optometry, Hadassah Academic College, Haniviim St. 37, 9101001, Jerusalem, Israel.
| | - Lisa A. Ostrin
- grid.266436.30000 0004 1569 9707College of Optometry, University of Houston, Houston, TX 77004 USA
| | - Ravid Doron
- grid.443085.e0000 0004 0366 7759Department of Optometry, Hadassah Academic College, Haniviim St. 37, 9101001 Jerusalem, Israel
| | - Julia S. Benoit
- grid.266436.30000 0004 1569 9707Texas Institute for Measurement, Evaluation, and Statistics, Houston, TX 77004 USA
| | - Jonathan Levine
- grid.443085.e0000 0004 0366 7759Department of Optometry, Hadassah Academic College, Haniviim St. 37, 9101001 Jerusalem, Israel
| | - Kevin Davidson
- grid.266436.30000 0004 1569 9707Texas Institute for Measurement, Evaluation, and Statistics, Houston, TX 77004 USA
| | - Ariela Gordon-Shaag
- grid.443085.e0000 0004 0366 7759Department of Optometry, Hadassah Academic College, Haniviim St. 37, 9101001 Jerusalem, Israel
| |
Collapse
|
86
|
Nti AN, Owusu-Afriyie B, Osuagwu UL, Kyei S, Ovenseri-Ogbomo G, Ogbuehi KC, Ouzzani M, Agho KE, Mashige KP, Ekure E, Ekpenyong BN, Ocansey S, Ndep AO, Obinwanne CJ, Berntsen DA, Wolffsohn JS, Naidoo KS. Trends in myopia management attitudes and strategies in clinical practice: Survey of eye care practitioners in Africa. Cont Lens Anterior Eye 2023; 46:101597. [PMID: 35428590 DOI: 10.1016/j.clae.2022.101597] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE There remains a lack of information on the perception and adoption of myopia control strategies among African eye care practitioners (ECPs). This study provides an African perspective to similar previous studies conducted in other parts of the world. METHODS A self-administered survey in English and French was distributed to ECPs across Africa. The items on the questionnaire assessed their level of concern about the increasing prevalence of paediatric myopia, perceived efficacy, opinions on, and adoption of various myopia management modalities. RESULTS Responses were obtained from 330 ECPs working in 23 African countries. Respondents were highly concerned about the increasing prevalence of paediatric myopia in their clinic (median 8/10) and perceived approved myopia control soft contact lenses as the most effective at slowing myopia progression (mean perceived reduction in myopia progression ± SD; 53.9 ± 27.1%), followed by single vision spectacles (53.1 ± 30.9%), and orthokeratology (52.8 ± 28.0%). Multifocal soft contact lenses (40.4 ± 25.8%) and pharmaceutical agents such as topical atropine drops (39.5 ± 27.1%) were perceived as least effective in slowing myopia progression. Although ECPs reported being aware of various myopia control strategies, they still mainly prescribed single vision spectacles to a large proportion (64.3 ± 29.9%) of young progressing myopes. Nearly one-third (27%) of ECPs who prescribed single vision lenses stated they were concerned about the cost implications to patients. Other reported concerns included safety of, and inadequate information about myopia control options. CONCLUSIONS African ECPs continue to prescribe single vision lenses for progressing myopes despite being aware of the various myopia control options. Practitioners' perceptions of the efficacy of several modalities to slow myopia progression do not align with the current best evidence. Clear practice guidelines and continuing education on myopia control are warranted to inform and guide the management of myopic patients in Africa.
Collapse
Affiliation(s)
- Augustine N Nti
- The Ocular Surface Institute, University of Houston College of Optometry, Houston, TX, United States of America
| | - Bismark Owusu-Afriyie
- Clinical Optometry Programme, School of Optometry and Vision Sciences, Cardiff University, United Kingdom
| | - Uchechukwu Levi Osuagwu
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; African Vision Research Institute, Discipline of Optometry, University of KwaZulu-Natal, Westville Campus, Durban 3629, South Africa
| | - Samuel Kyei
- Department of Optometry and Vision Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Godwin Ovenseri-Ogbomo
- Department of Optometry, Centre for Health Sciences, University of the Highlands and Islands, Inverness IV2 3JH, UK
| | - Kelechi C Ogbuehi
- Department of Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - Mhamed Ouzzani
- Optometry Research Group, LPCMME, Université Oran 1, B.P 1524, El M'Naouer 31000 Oran, Algeria; IRLCM: Innovation-Recherche en Lentille cornéenne de l'Université de Montréal, 3744 Rue Jean-Brillant Bureau 110, Montréal, QC H3T 1P1, Canada
| | - Kingsley E Agho
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; School of Health Science, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Khathutshelo Percy Mashige
- African Vision Research Institute, Discipline of Optometry, University of KwaZulu-Natal, Westville Campus, Durban 3629, South Africa
| | | | - Bernadine N Ekpenyong
- Epidemiology & Medical Statistics Unit, Department of Public Health, University of Calabar, Calabar, Nigeria
| | - Stephen Ocansey
- Department of Optometry and Vision Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Antor O Ndep
- Health Education & Health Promotion Unit, Department of Public Health, University of Calabar, Calabar, Nigeria
| | - Chukwuemeka Junior Obinwanne
- Cornea, Contact Lens, and Myopia Control Unit, De Lens Ophthalmics Family Eye and Vision Care Center, Suite G14, Febson Mall, Plot 2425, Hebert Macaulay Way, Wuse Zone 4, Abuja, Nigeria
| | - David A Berntsen
- The Ocular Surface Institute, University of Houston College of Optometry, Houston, TX, United States of America
| | - James S Wolffsohn
- Optometry and Vision Science Research Group, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Kovin S Naidoo
- African Vision Research Institute, Discipline of Optometry, University of KwaZulu-Natal, Westville Campus, Durban 3629, South Africa; School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.
| |
Collapse
|
87
|
Foo LL, Lim GYS, Lanca C, Wong CW, Hoang QV, Zhang XJ, Yam JC, Schmetterer L, Chia A, Wong TY, Ting DSW, Saw SM, Ang M. Deep learning system to predict the 5-year risk of high myopia using fundus imaging in children. NPJ Digit Med 2023; 6:10. [PMID: 36702878 PMCID: PMC9879938 DOI: 10.1038/s41746-023-00752-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023] Open
Abstract
Our study aims to identify children at risk of developing high myopia for timely assessment and intervention, preventing myopia progression and complications in adulthood through the development of a deep learning system (DLS). Using a school-based cohort in Singapore comprising of 998 children (aged 6-12 years old), we train and perform primary validation of the DLS using 7456 baseline fundus images of 1878 eyes; with external validation using an independent test dataset of 821 baseline fundus images of 189 eyes together with clinical data (age, gender, race, parental myopia, and baseline spherical equivalent (SE)). We derive three distinct algorithms - image, clinical and mix (image + clinical) models to predict high myopia development (SE ≤ -6.00 diopter) during teenage years (5 years later, age 11-17). Model performance is evaluated using area under the receiver operating curve (AUC). Our image models (Primary dataset AUC 0.93-0.95; Test dataset 0.91-0.93), clinical models (Primary dataset AUC 0.90-0.97; Test dataset 0.93-0.94) and mixed (image + clinical) models (Primary dataset AUC 0.97; Test dataset 0.97-0.98) achieve clinically acceptable performance. The addition of 1 year SE progression variable has minimal impact on the DLS performance (clinical model AUC 0.98 versus 0.97 in primary dataset, 0.97 versus 0.94 in test dataset; mixed model AUC 0.99 versus 0.97 in primary dataset, 0.95 versus 0.98 in test dataset). Thus, our DLS allows prediction of the development of high myopia by teenage years amongst school-going children. This has potential utility as a clinical-decision support tool to identify "at-risk" children for early intervention.
Collapse
Affiliation(s)
- Li Lian Foo
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Gilbert Yong San Lim
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Carla Lanca
- grid.418858.80000 0000 9084 0599Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL), Instituto Politécnico de Lisboa, Lisboa, Portugal ,grid.10772.330000000121511713Comprehensive Health Research Center (CHRC), Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Chee Wai Wong
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore ,grid.415572.00000 0004 0620 9577Asia Pacific Eye Centre, Gleneagles Hospital, Singapore, Singapore
| | - Quan V. Hoang
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ,grid.21729.3f0000000419368729Dept. of Ophthalmology, Columbia University, Columbia, SC USA
| | - Xiu Juan Zhang
- grid.10784.3a0000 0004 1937 0482Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Jason C. Yam
- grid.10784.3a0000 0004 1937 0482Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China ,grid.490089.c0000 0004 1803 8779Hong Kong Eye Hospital, Hong Kong, China ,grid.415197.f0000 0004 1764 7206Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China ,grid.10784.3a0000 0004 1937 0482Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China ,Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong, China
| | - Leopold Schmetterer
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Audrey Chia
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Tien Yin Wong
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Daniel S. W. Ting
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Seang-Mei Saw
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Marcus Ang
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| |
Collapse
|
88
|
Zhang X, Zhou Y, Wang Y, Du W, Yang J. Trend of myopia through different interventions from 2010 to 2050: Findings from Eastern Chinese student surveillance study. Front Med (Lausanne) 2023; 9:1069649. [PMID: 36743682 PMCID: PMC9889364 DOI: 10.3389/fmed.2022.1069649] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/02/2022] [Indexed: 01/20/2023] Open
Abstract
Purpose First, to investigate the utilization rate and effect of proven myopic interventions. Second, to predict the prevalence of myopia and high myopia, as well as Years Lived with Disability (YLD) caused by an uncorrected refractive error in children and teens in Eastern China from 2010 to 2050 under different interventions. Methods (1) The surveillance of common diseases among children and adolescents in Jiangsu Province from 2010 to 2021 provides the database for myopia screening and intervention utilization surveys. (2) The National Bureau of Statistics and the Global Burden of Disease Study 2016 (GBD2016) are the foundation for the estimated myopes and YLD. (3) A systematic review provides the strong or weak impact of intervention in the prediction model. (4) The trend of screening myopia from 2010 to 2050 under various treatments is predicted using a GM (1,1) model. Results By the year 2050, myopia is expected to affect 8,568,305 (7-12 years old) and 15,766,863 (13-18 years old) children and adolescents, respectively (95% CI: 8,398,977-8,737,633). The utilization prevalence of myopia-proven interventions for myopic children included outdoor activities, orthokeratology lenses, atropine treatment, contact lenses, frame glasses, and eye exercises, with respective rates of 31.9-33.1, 2.1-2.3, 6.0-7.5, 2.2-2.7, 60.4-62.2, and 64.7-72.5%. All interventions have substantial effects on myopia after parental myopia and behavior pattern adjustment, including physical activity, near work, dietary pattern, and sleep. Under strong intervention, the estimated reduced myopia prevalence by the year 2050 is 1,259,086 (95% CI: 1,089,758-1,428,414) for children aged 7-12, and 584,785 (95% CI: 562,748-606,823) for children aged 13-18, respectively. Conclusion Among myopic Chinese children and adolescents, the use rates and effects of proven myopia interventions vary. Under the present intervention strategy, the prevalence of myopia and high myopia will increase from 2010 to 2050. The overall number of myopic people can be greatly decreased by implementing timely, steady, comprehensive interventions.
Collapse
Affiliation(s)
- Xiyan Zhang
- Department of Child and Adolescent Health Promotion, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China,School of Public Health, Nanjing Medical University, Nanjing, China,*Correspondence: Xiyan Zhang,
| | - Yonlin Zhou
- Department of Child and Adolescent Health Promotion, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yan Wang
- Department of Child and Adolescent Health Promotion, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Wei Du
- School of Public Health, Southeast University, Nanjing, China
| | - Jie Yang
- Department of Child and Adolescent Health Promotion, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China,School of Public Health, Nanjing Medical University, Nanjing, China,Jie Yang,
| |
Collapse
|
89
|
Diress M, Getnet M, Akalu Y, Dagnew B, Belsti Y, Gela YY, Chilot D, Belay DG, Bitew DA, Terefe B, Getahun AB. Myopia and its associated factors among pregnant women at health institutions in Gondar District, Northwest Ethiopia: A multi-center cross-sectional study. Front Glob Womens Health 2023; 3:1078557. [PMID: 36727043 PMCID: PMC9884705 DOI: 10.3389/fgwh.2022.1078557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Background Myopia is the most common form of uncorrected refractive error with a growing burden worldwide. It is the principal complaint of most women during pregnancy. Although myopia has led to several consequences across the standard life of pregnant women, there is no previous study in Ethiopia regarding this topic. Thus, this study determined the prevalence of myopia and identifies its associated factors among pregnant women attending antenatal care units at governmental health institutions in Gondar City District, Northwest Ethiopia. Methods An institution-based cross-sectional study design was conducted from 08 February to 08 April 2021. From the selected health centres, study participants were recruited by systematic random sampling technique. A pre-tested, structured-interviewer-administered questionnaire consisting of socio-demographic variables, obstetric and clinical-related variables was used to collect the required data. Non-cycloplegic refraction was performed using trial lenses, trial frames, and retinoscopy in a semi-dark examination room. EpiData 3 and STATA 14 were used for data entry and statistical analysis respectively. Both bivariable and multivariable binary logistic regression analyses were executed to identify associated factors of myopia. Variables with a p-value ≤0.05 in the multivariable logistic regression analysis were declared as statistically significant with myopia. Model fitness was checked by Hosmer and Lemeshow goodness of test (at p > 0.05). Results A total of four-hundred and twenty-three pregnant women participated with a 100% response rate in this study. The overall prevalence of myopia among pregnant women was 26.48% (95% CI: 22.48-30.91). Eighty-Eight (20.81%) and Eighty-Four (19.85%) of the study participants had myopia in their right and left eyes respectively. The prevalence of myopia was significantly associated with age (AOR = 1.17; 95% CI: 1.09-1.28), the third trimester of gestation (AOR = 2.05, 95% CI: 1.08-3.90), multi & grand multipara (AOR = 3.15; 95% CI: 1.59-6.25), and history of contraceptive use (AOR = 3.30; 95% CI: 1. 50-7.28). Conclusion The finding of our study shows that there is a higher prevalence of myopia among pregnant women in our study area. Further prospective analytical studies regarding visual systems among pregnant women, particularly as a result of pregnancy, are strongly recommended.
Collapse
Affiliation(s)
- Mengistie Diress
- Department of Human Physiology, University of Gondar, Gondar, Ethiopia,Correspondence: Mengistie Diress
| | - Mihret Getnet
- Department of Human Physiology, University of Gondar, Gondar, Ethiopia
| | - Yonas Akalu
- Department of Human Physiology, University of Gondar, Gondar, Ethiopia
| | - Baye Dagnew
- Department of Human Physiology, University of Gondar, Gondar, Ethiopia
| | - Yitayeh Belsti
- Department of Human Physiology, University of Gondar, Gondar, Ethiopia,Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | | | - Dagmawi Chilot
- Department of Human Physiology, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia,Department of Human Anatomy, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Desalegn Anmut Bitew
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Bewuketu Terefe
- Department of Community Health Nursing, School of Nursing, University of Gondar, Gondar, Ethiopia
| | - Amare Belete Getahun
- Department of Anesthesia, School of Medicine, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
90
|
Lanca C, Repka MX, Grzybowski A. Topical Review: Studies on Management of Myopia Progression from 2019 to 2021. Optom Vis Sci 2023; 100:23-30. [PMID: 36705712 DOI: 10.1097/opx.0000000000001947] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
SIGNIFICANCE Myopia is a common eye condition that increases the risk of sight-threatening complications. Each additional diopter increases the chance of complications. The purpose of this review was to make an overview of myopia control treatment options for children with myopia progression.In this nonsystematic review, we searched PubMed and Cochrane databases for English-language studies published from 2019 to September 2021. Emphasis was given to selection of randomized controlled trials. Nineteen randomized controlled trials and two retrospective studies were included. Topical atropine and orthokeratology remain the most used treatments, whereas lenses with novel designs are emerging treatments. Overall myopia progression in the treatment groups for low-dose atropine and orthokeratology was lower than in the control groups, and their efficacy was reported in several randomized controlled trials and confirmed by various systematic reviews and meta-analysis. The findings of myopia progression and axial elongation for the MiSight, defocus incorporated multiple segment spectacle lens, highly aspherical lenslets, and diffusion optics technology spectacle lens were comparable. Public health interventions to optimize environmental influences may also be important strategies to control myopia. Optimal choice of management of myopia depends on treatment availability, acceptability to child and parents, and specific patient features such as age, baseline myopia, and lifestyle. Eye care providers need to understand the advantages and disadvantages of each therapy to best counsel parents of children with myopia.
Collapse
Affiliation(s)
| | - Michael X Repka
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | |
Collapse
|
91
|
de Lestrange-Anginieur E. Meridional Attentional Asymmetries in Astigmatic Eyes. Eye Brain 2023; 15:63-76. [PMID: 37200891 PMCID: PMC10188198 DOI: 10.2147/eb.s407481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/06/2023] [Indexed: 05/20/2023] Open
Abstract
Purpose To investigate the impact of attention orientation in young myopic adults with astigmatism. Methods The effect of attention on foveal meridional performance and anisotropy was measured in corrected myopes with various levels of astigmatism (with-the-rule astigmatism ≤ -0.75D, Axis: 180 ± 20) using orientation-based attention. Attention was manipulated by instructing subjects to attend to either the horizontal or the vertical line of a central pre-stimulus (a pulsed cross) along separate blocks of trials. For each attention condition, meridional acuity and reaction times were measured via an annulus Gabor target situated remotely from the cross and presented at random horizontally and vertically in a two-alternative forced-choice employing two interleaved staircase procedures (one-up/one-down). Attention modulations were estimated by the difference in performance between horizontal and vertical attention. Results Foveal meridional performance and anisotropy were strongly affected by the orientation of attention, which appeared critical for the enhancement of reaction times and resolution. Under congruent orienting of attention, foveal meridional anisotropy was correlated with the amount of defocus for both reaction time and resolution, demonstrating greater vertical performance than horizontal performance as myopia increased. Compatible with an attentional compensation of blur through optimal orienting of attention, vertical attention enhanced reaction times compared to horizontal attention and was accompanied by an increase in overall acuity when myopia increased. Increased astigmatism was associated with smaller attention effects and asymmetry, suggesting potential deficits in the compensation of blur in astigmatic eyes. Conclusion Collectively, attention to orientation plays a significant role in horizontal-vertical foveal meridional anisotropy and can modulate the asymmetry of foveal perception imposed by the optics of the eye in episodes of uncorrected vision. Further work is necessary to understand how attention and refractive errors interact during visual development. These results may have practical implications for methods to enhance vision with attention training in myopic astigmats.
Collapse
Affiliation(s)
- Elie de Lestrange-Anginieur
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong
- Laboratory of Experimental Optometry, Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
- Centre for Eye and Vision Research (CEVR), Kowloon, Hong Kong
- Correspondence: Elie de Lestrange-Anginieur, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, Tel +8522766 4186, Fax +852 2764 6051, Email
| |
Collapse
|
92
|
Martínez-Pérez C, Villa-Collar C, Santodomingo-Rubido J, Wolffsohn JS. Strategies and attitudes on the management of myopia in clinical practice in Spain. JOURNAL OF OPTOMETRY 2023; 16:64-73. [PMID: 35365431 PMCID: PMC9811371 DOI: 10.1016/j.optom.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/14/2022] [Accepted: 03/06/2022] [Indexed: 06/02/2023]
Abstract
OBJECTIVE In 2019, an international survey was conducted to evaluate strategies and attitudes in the management of myopia in clinical practice worldwide. This study reports on the results found in Spain and how these results compare with those from other regions of the world. METHODS A self-administrated, internet-based questionnaire was distributed to eye care professionals around the world through professional associations. The questions examined were based on the available strategies and their use. RESULTS A total of 173 Spanish optometrists, of the 1,336 practitioners from the five different continents who participated in the study, responded to the online survey. Spain, Asia and South America were found among the regions with the highest concern regarding the increased incidence of myopia (p ≤ 0.001). However, in these regions, the prescription of single-vision spectacles and single-vision contact lenses continues to be the main methods of visual correction prescribed to young myopic patients (p ≤ 0.001). Spanish practitioners, like those from other regions, considered orthokeratology to be the most effective treatment to control myopia progression (p ≤ 0.001). The major reasons why Spanish practitioners were not prescribing myopia control strategies were increased cost, inadequate information and unpredictable outcomes (p < 0.05). CONCLUSIONS The uptake of myopia control methods by Spanish practitioners is relatively low, despite the increase in the prevalence of paediatric myopia as well as increased concern and perceived clinical activity in the area in recent years.
Collapse
Affiliation(s)
- Clara Martínez-Pérez
- Optics & Optometry Department, Faculty of Health Sciences, Universidad Europea, Madrid, Spain
| | - César Villa-Collar
- Optics & Optometry Department, Faculty of Health Sciences, Universidad Europea, Madrid, Spain
| | | | - James S Wolffsohn
- College of Health & Life Sciences, Aston University, Birmingham, United Kingdom
| |
Collapse
|
93
|
Alves Carneiro VL, González-Méijome JM. Prevalence of refractive error in Portugal estimated from ophthalmic lens manufacturing data: Ten-years analysis. PLoS One 2023; 18:e0284703. [PMID: 37083583 PMCID: PMC10121041 DOI: 10.1371/journal.pone.0284703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/05/2023] [Indexed: 04/22/2023] Open
Abstract
PURPOSE To investigate the prevalence, distribution and trends of refractive error from ophthalmic lens manufacturing data over a ten-year period. METHODS Fully anonymized data from ophthalmic lenses, for the years between 2010 and 2020, provided by the leading ophthalmic lens manufacturer operating in Portugal were analysed (no human participants were involved in the research). Prescriptions delivered were divided in single vision prescriptions and progressive/multifocal prescriptions and categorized into 14 spherical equivalent ranges. Given the lack of absolute values, indirect estimates and a qualitative analysis of the current situation and trends on refractive error epidemiology was carried out. RESULTS Dataset from manufacturer comprises percentage values of ophthalmic lenses dispensed in Portugal. The distribution of ophthalmic prescriptions for single vision prescriptions presents most of the observations in the range [-1.49, -0.50] diopters, in every year from 2010 to 2020. For the progressive prescription's lenses, most of the observations is in an interval of two ranges, [0.50, 1.49] and [1.50, 2.99] diopters. From 2010 to 2020 the proportion of single vision ophthalmic lens prescriptions for myopia increased from 38.13% to 46.21%; the proportion for high myopia increased from 2.76% to 4.45%; and the proportion for hyperopia decreased from 40.85% to 31.36%. CONCLUSIONS Ophthalmic lens manufacturing data can be a valuable source for long-term analysis of refractive error prescription and trends over time. It was possible to observe a trend of increasing prevalence of myopia and high myopia from 40.89% in 2010 to 50.66% in 2020. That increase trend has important implications for public health and in the planning of services.
Collapse
Affiliation(s)
- Vera L Alves Carneiro
- Clinical and Experimental Optometry Research Lab (CEORLab), Center of Physics (Optometry), School of Sciences, University of Minho, Braga, Portugal
| | - José Manuel González-Méijome
- Clinical and Experimental Optometry Research Lab (CEORLab), Center of Physics (Optometry), School of Sciences, University of Minho, Braga, Portugal
| |
Collapse
|
94
|
Zhou Z, Li S, Yang Q, Yang X, Liu Y, Hao K, Xu S, Zhao N, Zheng P. Association of n-3 polyunsaturated fatty acid intakes with juvenile myopia: A cross-sectional study based on the NHANES database. Front Pediatr 2023; 11:1122773. [PMID: 37138572 PMCID: PMC10150007 DOI: 10.3389/fped.2023.1122773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
Aim Inflammation is involved in the development of myopia. n-3 polyunsaturated fatty acids (n-3 PUFAs) have vasodilating and anti-inflammatory effects, which may be involved in controlling myopia. It is of great significance to explore the relationship between n-3 PUFA intakes and juvenile myopia in order to control and alleviate myopia among teenagers through dietary intervention. Methods Sociodemographic data, information of nutrient intakes, cotinine, PUFAs, and eye refractive status of 1,128 juveniles were extracted from the National Health and Nutrition Examination Survey (NHANES) database in this cross-sectional study. PUFAs contained total polyunsaturated fatty acid (TPFAs), alpha-linolenic acid, octadecatetraenoic acid, eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA). Covariates were screened by comparison among groups of normal vision, low myopia, and high myopia. The association between n-3 PUFA intakes and the risk of juvenile myopia was evaluated using univariate and multivariate logistic regression analyses with odds ratios (ORs) and 95% confidence intervals (CIs). Results Among the juveniles, 788 (70.68%) had normal vision, 299 (25.80%) had low myopia, and 41 (3.52%) had high myopia. There were significant differences in average EPA and DHA intakes among the three groups, and mean DPA and DHA intakes in the normal vision group were lower than those in the low myopia group (P < 0.05). After adjustment for age, gender, TPFAs, and cotinine, a high dietary intake of EPA (≥11 mg/1,000 kcal) in juveniles seemed to be associated with the risk of high myopia (OR = 0.39, 95% CI: 0.18-0.85), while no significant associations were identified between n-3 PUFA intakes and the risk of low myopia. Conclusion A high dietary intake of EPA may be associated with a decreased risk of high myopia among juveniles. A further prospective study is needed to validate this observation.
Collapse
|
95
|
Agyekum S, Chan PP, Zhang Y, Huo Z, Yip BHK, Ip P, Tham CC, Chen LJ, Zhang XJ, Pang CP, Yam JC. Cost-effectiveness analysis of myopia management: A systematic review. Front Public Health 2023; 11:1093836. [PMID: 36923029 PMCID: PMC10008871 DOI: 10.3389/fpubh.2023.1093836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/10/2023] [Indexed: 03/03/2023] Open
Abstract
The rising prevalence of myopia is a major global public health concern. Economic evaluation of myopia interventions is critical for maximizing the benefits of treatment and the healthcare system. This systematic review aimed to evaluate the cost-effectiveness of interventions for treating myopia. Five databases were searched - Embase, Emcare, PubMed, Web of Science, and ProQuest - from inception to July 2022 and a total of 2,099 articles were identified. After careful assessments, 6 studies met the eligibility criteria. The primary outcomes of this systematic review were costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). The secondary outcomes included utility values and net monetary benefits (NMB). One study determined the cost-effectiveness of photorefractive screening plus treatment with 0.01% atropine, 2 studies examined cost-effectiveness of corneal refractive surgery, and 3 studies evaluated cost-effectiveness of commonly used therapies for pathologic myopia. Corneal refractive surgeries included laser in situ keratomileusis (LASIK), femtosecond laser-assisted in situ keratomileusis (FS-LASIK), photorefractive keratectomy (PRK), and small-incision lenticule extraction (SMILE). Interventions for pathologic myopia included ranibizumab, conbercept, and photodynamic therapy (PDT). At an incremental cost of NZ$ 18 (95% CI 15, 20) (US$ 11) per person, photorefractive screening plus 0.01% atropine resulted in an ICER of NZ$ 1,590/QALY (US$ 1,001/QALY) (95% CI NZ$ 1,390, 1,791) for an incremental QALY of 0.0129 (95% CI 0.0127, 0.0131). The cost of refractive surgery in Europe ranged from €3,075 to €3,123 ([US$4,046 to $4,109 - adjusted to 2021 inflation). QALYs associated with these procedures were 23 (FS-LASIK) and 24 (SMILE and PRK) with utility values of 0.8 and ICERs ranging from approximately €14 (US$17)/QALY to €19 (US$23)/QALY. The ICER of LASIK was US$683/diopter gained (inflation-adjusted). The ICER of ranibizumab and PDT were £8,778 (US$12,032)/QALY and US$322,460/QALY respectively, with conbercept yielding a saving of 541,974 RMB (US$80,163)/QALY, respectively. The use of 0.01% atropine and corneal refractive surgery were cost-effective for treating myopia. Treating pathologic myopia with ranibizumab and conbercept were more cost-effective than PDT. Prevention of myopia progression is more cost-effective than treating pathologic myopia.
Collapse
Affiliation(s)
- Sylvia Agyekum
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Poemen P Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China.,Department of Ophthalmology and Visual Sciences, Lam Kin Chung, Jet King-Shing Ho Glaucoma Treatment and Research Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Zhaohua Huo
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Benjamin H K Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China.,Department of Ophthalmology, Hong Kong Children Hospital, Kowloon, Hong Kong SAR, China.,Joint Shantou International Eye Centre of Shantou University and Chinese University of Hong Kong, Shantou, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China.,Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China.,Joint Shantou International Eye Centre of Shantou University and Chinese University of Hong Kong, Shantou, China
| | - Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China.,Department of Ophthalmology, Hong Kong Children Hospital, Kowloon, Hong Kong SAR, China.,Joint Shantou International Eye Centre of Shantou University and Chinese University of Hong Kong, Shantou, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Department of Ophthalmology and Visual Sciences, Lam Kin Chung, Jet King-Shing Ho Glaucoma Treatment and Research Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Joint Shantou International Eye Centre of Shantou University and Chinese University of Hong Kong, Shantou, China.,Hong Kong Hub of Pediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China.,Department of Ophthalmology and Visual Sciences, Lam Kin Chung, Jet King-Shing Ho Glaucoma Treatment and Research Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China.,Department of Ophthalmology, Hong Kong Children Hospital, Kowloon, Hong Kong SAR, China.,Joint Shantou International Eye Centre of Shantou University and Chinese University of Hong Kong, Shantou, China.,Hong Kong Hub of Pediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| |
Collapse
|
96
|
Yue P, Wang Z, Wu D, Zhang H, Zhang P. The effect of small incision lenticule extraction on contrast sensitivity. Front Neurosci 2023; 17:1132681. [PMID: 37123358 PMCID: PMC10130440 DOI: 10.3389/fnins.2023.1132681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/22/2023] [Indexed: 05/02/2023] Open
Abstract
The improvements due to small incision lenticule extraction (SMILE) in vision, e.g., in spherical equivalent (SE) and visual acuity (VA), has been widely recognized. However, the contrast sensitivity (CS) change after SMILE was not certain. Here, we investigated the effect of SMILE on CS before, 1 day after and 7 days after surgery and then clarified the corresponding mechanism by using a perceptual template model (PTM). In addition, the relationship among SE, VA, and CS was discussed. The quick contrast sensitivity function (qCSF) was applied to measure CS with high precision and accuracy. We found that (1) CS was significantly improved 1 day after SMILE and was also increased 7 days after the surgery, (2) CS improvements were dependent on spatial frequency and external noise, (3) the increase in CS was due to the decreased internal additive noise and an enhanced perceptual template, and (4) Greater SE improvements predicted better VA improvements 1 day after SMILE, and a positive correlation between SE improvements and AULCSF improvements 7 days after SMILE was observed. These findings help us better understand the effect of SMILE and provide effective indicators for future visual research.
Collapse
Affiliation(s)
- Pinqing Yue
- Department of Psychology, Hebei Normal University, Shijiazhuang, China
| | - Zeng Wang
- Department of Psychology, Hebei Medical University, Shijiazhuang, China
| | - Di Wu
- Department of Medical Psychology, Air Force Medical University, Xi’an, China
| | - Hua Zhang
- Department of Ophthalmology, Shijiazhuang People’s Hospital, Shijiazhuang, China
- Hua Zhang,
| | - Pan Zhang
- Department of Psychology, Hebei Normal University, Shijiazhuang, China
- *Correspondence: Pan Zhang,
| |
Collapse
|
97
|
Lanca C, Szeps A, Iribarren R, Cortinez F, Danza R, Marceillac J, Dankert S, Bruno M, Saracco G, Pfortner T, Impagliazzo R, de Tomas M, Bertozzi D, Andreola M, Comba M, Mattio A, Iribarren R. Role of tutorial classes and full day schooling on self-reported age of myopia onset: findings in a sample of Argentinian adults. J AAPOS 2022; 26:314.e1-314.e6. [PMID: 36265752 DOI: 10.1016/j.jaapos.2022.08.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/05/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the effect of tutorial classes and schooling schedule in childhood on age of myopia onset. METHODS Refractive data for subjects ≥18 years of age were collected from 8 dispensing opticians or refractive ophthalmologists' offices in Argentina. Age of myopia onset, spherical equivalent (SE), and risk factors were determined using questionnaires. Multiple linear regression models were applied to assess possible factors associated with age of myopia onset or final adult SE. RESULTS A total of 274 adults (61.3% females) with myopia between -0.50 and -6.00 D were included. Mean age was 36.9 ± 14.5 years. The mean adult SE was -2.95 ± 1.45 D, and the mean age of myopia onset was 14.2 ± 5.4 years. Subjects that attended after-school tutorial classes (β = -2.23; P = 0.005) or a full day schedule in primary school (β = -1.07; P = 0.035) or that spent more time on near work (β = -0.70; P = 0.010) in childhood, had younger age of myopia onset. CONCLUSIONS In our study cohort, adults that had attended tutorial classes and/or full-day schooling during childhood had younger age of myopia onset.
Collapse
Affiliation(s)
- Carla Lanca
- Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL), Instituto Politécnico de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center (CHRC), Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Abel Szeps
- Liniers Ophthalmological Center, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
98
|
You Y, Fu J, Xu M, Song Y, Zhou H, Wei S. Prevalence of refractive error among Chinese preschool children: The Changsha children eye study. Front Public Health 2022; 10:1019816. [PMID: 36483253 PMCID: PMC9722943 DOI: 10.3389/fpubh.2022.1019816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/31/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose We aimed to investigate the refractive status and prevalence of refractive error, as well as its characteristics in Chinese preschool children aged 1-6 years old. Methods A population-based cross-sectional study-Changsha Children Eye Study (CCES) was conducted. The prevalence of refractive errors among children aged 1-6 years old from 18 community health service centers was surveyed. A handheld child vision screener, Suowei, was used for examination. Results A total of 43,105 preschool children were included. The mean spherical equivalent (SE) was 0.42 ± 1.05 D for the right eyes. The mean astigmatism (diopter of cylinder, DC) was -0.83 ± 1.02 D for the right eyes. The magnitude of refractive error was lower in older children, indicating the ongoing of the emmetropization during the 1-6-year-old children. The prevalence of myopia (SE ≤ -1.00 D), hyperopia (SE ≥ +2.00 D) and astigmatism (DC ≥1.50 D) was 2.94, 13.8 and 17.6%, respectively. The prevalence of myopia decreased with the increase of age between the six age groups (P < 0.001). The prevalence of hyperopia was lower in 5-6 years old, whereas, the prevalence of myopia was slightly higher at this period of time. With-the-rule (WTR) astigmatism (+ cylinder axis 90° ± 15°) was the most prevalent type of astigmatism than against-the-rule (ATR) astigmatism (+ cylinder axis 180° ± 15°) and oblique (OBL) astigmatism (X 2 = 209.5, P < 0.001). The binary logistic regression model showed that older age and suffering astigmatism were independently associated with the development of myopia. In addition, there was no significant gender difference in the prevalence of myopia, emmetropia, and hyperopia. Conclusions Our population-based cross-sectional study investigated the prevalence of myopia, hyperopia, and astigmatism in preschool children aged 1-6 years old. The distribution of the refractive error was disperse in the younger group and gradually turned more centralized in older group. Similar to hyperopia, with age increased, the prevalence of myopia was lower in preschool children younger than 5 years old and then slightly increased at 5-6 years, which may indicate an early sign of myopia in school-age children. Therefore, we emphasize that more attention should be given to the children at this age.
Collapse
Affiliation(s)
- Yuxia You
- Beijing Aier Intech Eye Hospital, Beijing, China,Aier Eye Hospital Group, Changsha, Hunan, China,Department of Ophthalmology, The Chinese People's Liberation Army Medical School, The Chinese People's Liberation Army General Hospital, Beijing, China
| | - Junxia Fu
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming Xu
- Aier Eye Hospital Group, Changsha, Hunan, China
| | - Yali Song
- Aier Eye Hospital Group, Changsha, Hunan, China
| | - Huanfen Zhou
- Department of Ophthalmology, The Chinese People's Liberation Army Medical School, The Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shihui Wei
- Department of Ophthalmology, The Chinese People's Liberation Army Medical School, The Chinese People's Liberation Army General Hospital, Beijing, China,*Correspondence: Shihui Wei
| |
Collapse
|
99
|
Yu S, Du L, Ji N, Li B, Pang X, li X, Ma N, Huang C, Fu A. Combination of orthokeratology lens with 0.01% atropine in slowing axial elongation in children with myopia: a randomized double-blinded clinical trial. BMC Ophthalmol 2022; 22:438. [PMID: 36380280 PMCID: PMC9665032 DOI: 10.1186/s12886-022-02635-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To evaluate the additive effects of orthokeratology (OK) lenses and 0.01% atropine on slowing axial elongation in myopic children. METHODS A prospective, randomized, double-blinded, placebo-controlled trial was conducted over a 12-month period. Sixty children aged 8 to 12 years with spherical equivalent refraction from - 1.00 to -4.00 D who had been wearing OK lenses successfully for 2 months (as baseline) were randomly assigned in a 1:1 ratio to combination group (combination of OK lens and 0.01% atropine eye drops) and control group (combination of OK lens and placebo). The primary outcome was change in axial length, along with secondary outcomes including change in pupil diameter (PD) and accommodative amplitude (AMP) at 12 months (measured at 4-month intervals). RESULTS After 12 months, the overall axial elongation was 0.10 ± 0.14 mm and 0.20 ± 0.15 mm (p = 0.01) in the combination and control groups, respectively. The change in axial length in the two groups showed significant differences only in the first four months (median [Q1, Q3] (95% CI), -0.01 mm [-0.07, 0.05] (-0.06, 0.04) vs. 0.04 mm [0.00, 0.10] (0.02, 0.09); p = 0.04), but no difference thereafter. Multivariate linear regression analysis showed that the axial elongation was significantly slower in the combination group than in the control group (standard β = -0.10, p = 0.02). PD significantly increased by 0.45 mm [0.20, 0.68] at the 4th month visit (p < 0.001) and then remained stable in the combination group. The PD in the control group and AMP in the two groups remained stable from baseline to 12 months (all p > 0.05). CONCLUSION The combination therapy was more effective than the OK lens alone in slowing axial elongation after 12 months of treatment, and mainly in the first 4 months. TRIAL REGISTRATION The First Affiliated Hospital of Zhengzhou University, ChiCTR2000033904. Registered 16/06/2020, http://www.chictr.org.cn/login.aspx?referurl=%2flistbycreater.aspx.
Collapse
Affiliation(s)
- Shiao Yu
- grid.412633.10000 0004 1799 0733The First Affiliated Hospital of Zhengzhou University, 450000 Zhengzhou, China
| | - Liping Du
- grid.412633.10000 0004 1799 0733The First Affiliated Hospital of Zhengzhou University, 450000 Zhengzhou, China
| | - Na Ji
- grid.488140.10000 0004 6411 8542The Affiliated Eye Hospital of Suzhou Vocational Health College, 215000 Suzhou, China
| | - Binbin Li
- grid.412633.10000 0004 1799 0733The First Affiliated Hospital of Zhengzhou University, 450000 Zhengzhou, China
| | - Xuena Pang
- grid.412633.10000 0004 1799 0733The First Affiliated Hospital of Zhengzhou University, 450000 Zhengzhou, China
| | - Xiuhong li
- grid.412633.10000 0004 1799 0733The First Affiliated Hospital of Zhengzhou University, 450000 Zhengzhou, China
| | - Nana Ma
- grid.412633.10000 0004 1799 0733The First Affiliated Hospital of Zhengzhou University, 450000 Zhengzhou, China
| | - Congcong Huang
- grid.412633.10000 0004 1799 0733The First Affiliated Hospital of Zhengzhou University, 450000 Zhengzhou, China
| | - Aicun Fu
- grid.412633.10000 0004 1799 0733The First Affiliated Hospital of Zhengzhou University, 450000 Zhengzhou, China
| |
Collapse
|
100
|
Ocular biometrics and uncorrected visual acuity for detecting myopia in Chinese school students. Sci Rep 2022; 12:18644. [PMID: 36333404 PMCID: PMC9636232 DOI: 10.1038/s41598-022-23409-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
The study is to evaluate the performance of ocular biometric measures and uncorrected visual acuity (UCVA) for detecting myopia among Chinese students. Among 5- to 18-year-old Chinese students from two cities of China, trained eye-care professionals performed assessment of ocular biometrics (axial length (AL), corneal curvature radius (CR), anterior chamber depth) under noncycloplegic conditions using NIDEK Optical Biometer AL-Scan, distance visual acuity using retro-illuminated logMAR chart with tumbling-E optotypes, and cycloplegic refractive error using NIDEK autorefractor with administration of 0.5% tropicamide. Spherical equivalent (SER) in diopters (D) was calculated as sphere plus half cylinder, and myopia was defined as SER ≤ - 0.5 D. Performances of ocular biometrics and UCVA (individually and in combination) for detecting myopia were evaluated using sensitivity and specificity, predictive values, and area under ROC curve (AUC) in both development dataset and validation dataset. Among 3436 students (mean age 9.7 years, 51% female), the mean (SD) cycloplegic SER was - 0.20 (2.18) D, and 1269 (36.9%) had myopia. Cycloplegic SER was significantly correlated with AL (Pearson Correlation coefficient r = - 0.82), AL/CR ratio (r = - 0.90), and UCVA (r = 0.79), but was not correlated with CR (r = 0.02, p = 0.15). The AL/CR ratio detected myopia with AUC 0.963 (95% CI 0.957-0.969) and combination with UCVA improved the AUC to 0.976 (95% CI 0.971-0.981). Using age-specific AL/CR cutoff (> 3.00 for age < 10 years, > 3.06 for 10-14 years, > 3.08 for ≥ 15 years) as myopia positive, the sensitivity and specificity were 87.0% (95% CI 84.4-89.6%) and 87.8% (86.0-89.6%), respectively, in the development dataset and 86.4% (95% CI 83.7-89.1%) and 89.4% (95% CI 87.3-91.4%), respectively, in the validation dataset. Combining AL/CR and UCVA (worse than 20/32 for age < 10 years, and 20/25 for ≥ 10 years) provided 91.9% (95% CI 90.4-93.4%) sensitivity and 87.0% (95% CI 85.6-88.4%) specificity, positive value of 80.6% (95% CI 78.5-82.6%) and negative value of 94.8% (95% CI 93.8-95.8%). These results suggest that AL/CR ratio is highly correlated with cycloplegic refractive error and detects myopia with high sensitivity and specificity, AL/CR ratio alone or in combination with UCVA can be used as a tool for myopia screening or for estimating myopia prevalence in large epidemiological studies with limited resources for cycloplegic refraction.
Collapse
|