Association of Age at Myopia Onset With Risk of High Myopia in Adulthood in a 12-Year Follow-up of a Chinese Cohort

Efficacy of weekly dose of 1% atropine for myopia control in Chinese children

PURPOSE

To assess the effect of weekly 1% atropine use on children's myopia progression and whether the effect is sustainable.

METHODS

Medical records of myopic children aged 3-15 years receiving weekly 1% atropine for more than 1 year were retrospectively reviewed. Axial length (AL) and spherical equivalent refraction (SER) at every visit were collected. The changes in AL or SER over time were analysed using generalised estimating equation. The related factors of myopic progression were performed by multiple linear regression. The performance of short-term AL change to predict atropine-poor responders (AL change >0.2 mm/year) was assessed using receiver operating characteristic analysis.

RESULTS

A total of 694 participants with a mean age of 8.83 years were included. The participants with follow-up time reached 1, 2, 3 and 4 years were 256 (36.9%), 250 (36.0%), 143 (20.6%) and 45 (6.5%) separately. The cumulative change in AL was 0.05 mm, 0.24 mm, 0.47 mm, 0.56 mm separately for 1-year, 2-year, 3-year and 4- year treatment. Approximate 0.20 mm elongation per year was observed since the second-year of the treatment. Older age and lower initial myopic refraction were independently associated with less myopic progression. A decrease in AL of more than 0.04 mm during the initial 2 months could serve as an indicator for identifying fast progressors (AL change >0.2 mm/year) over a 2-year period, with sensitivity and specificity rates of 0.78 and 0.73, respectively.

CONCLUSION

Weekly 1% atropine may be a potentially effective treatment with longer lasting effects for children with myopia control especially in those with older age and lower myopia.

A novel Lenslet-ARray-Integrated spectacle lenses for myopia control: a one-year randomized, double-masked, controlled trial

PURPOSE

To investigate the myopia control efficacy of novel Lenslet-ARray-Integrated (LARI) spectacle lenses with positive (PLARI) and negative (NLARI) power lenslets worn for one year in myopic children.

DESIGN

Randomized, double-masked, controlled clinical trial.

PARTICIPANTS

A total of 240 children, aged 6 to 12 years, with spherical equivalent refraction (SER) between -4.00 and -1.00 diopter (D), astigmatism of 1.50 D or less, and anisometropia of 1.00 D or less.

METHODS

Participants were assigned randomly in a 1:1:1 ratio to PLARI, NLARI, and a control (single-vision (SV)) groups. Cycloplegic autorefraction and axial length were measured at baseline and 6-month intervals after lens wear.

MAIN OUTCOME MEASURES

Changes in SER, axial elongation (AE), and differences between groups.

RESULTS

After 1-year, SER changes and AE in the PLARI and NLARI groups were significantly less than those in the SV group (SER: -0.30 ± 0.48 D, -0.21 ± 0.35 D, -0.66 ± 0.40 D; AE: 0.19 ± 0.20 mm, 0.17 ± 0.14 mm, 0.34 ± 0.18 mm, respectively) (all P < 0.001). There were no significant differences in SER changes and AE between PLARI and NLARI groups (P = 0.54 and P = 1.00, respectively). Younger age was associated with more rapid SER increase and larger AE in the SV (r = 0.40, P < 0.001 and r = -0.59, P < 0.001, respectively) and PLARI (r= 0.46, P < 0.001 and r = -0.52, P < 0.001, respectively) groups, but not in the NLARI group (r = -0.002, P = 0.98 and r = -0.08, P = 0.48, respectively).

CONCLUSIONS

Compared with the SV group, both PLARI and NARI groups showed significantly slower myopia progression in terms of SER and axial elongation. Faster myopia progression, in terms of both SER and AE, was associated with younger age in the SV and PLARI groups, but not in the NLARI group.

Myths in Myopia Epidemiology and Treatment

This Viewpoint discusses common myths about myopia and educational strategies for bringing clinical practice better in line with evidence.

Development and validation of predictive models for myopia onset and progression using extensive 15-year refractive data in children and adolescents

BACKGROUND

Global myopia prevalence poses a substantial public health burden with vision-threatening complications, necessitating effective prevention and control strategies. Precise prediction of spherical equivalent (SE), myopia, and high myopia onset is vital for proactive clinical interventions.

METHODS

We reviewed electronic medical records of pediatric and adolescent patients who underwent cycloplegic refraction measurements at the Eye & Ear, Nose, and Throat Hospital of Fudan University between January 2005 and December 2019. Patients aged 3-18 years who met the inclusion criteria were enrolled in this study. To predict the SE and onset of myopia and high myopia in a specific year, two distinct models, random forest (RF) and the gradient boosted tree algorithm (XGBoost), were trained and validated based on variables such as age at baseline, and SE at various intervals. Outputs included SE, the onset of myopia, and high myopia up to 15 years post-initial examination. Age-stratified analyses and feature importance assessments were conducted to augment the clinical significance of the models.

RESULTS

The study enrolled 88,250 individuals with 408,255 refraction records. The XGBoost-based SE prediction model consistently demonstrated robust and better performance than RF over 15 years, maintaining an R2 exceeding 0.729, and a Mean Absolute Error ranging from 0.078 to 1.802 in the test set. Myopia onset prediction exhibited strong area under the curve (AUC) values between 0.845 and 0.953 over 15 years, and high myopia onset prediction showed robust AUC values (0.807-0.997 over 13 years, with the 14th year at 0.765), emphasizing the models' effectiveness across age groups and temporal dimensions on the test set. Additionally, our classification models exhibited excellent calibration, as evidenced by consistently low brier score values, all falling below 0.25. Moreover, our findings underscore the importance of commencing regular examinations at an early age to predict high myopia.

CONCLUSIONS

The XGBoost predictive models exhibited high accuracy in predicting SE, onset of myopia, and high myopia among children and adolescents aged 3-18 years. Our findings emphasize the importance of early and regular examinations at a young age for predicting high myopia, thereby providing valuable insights for clinical practice.

Method comparison and overview of refractive measurements in children: implications for myopia management

OBJECTIVE

This study investigated the agreement between objective wavefront-based refraction and subjective refraction in myopic children. It also assessed the impact of cyclopentolate and refraction levels on the agreement.

METHODS

A total of 84 eyes of myopic children aged 6-13 years were included in the analysis. Non-cycloplegic and cycloplegic objective wavefront-based refraction were determined and cycloplegic subjective refraction was performed for each participant. The data were converted into spherical equivalent, J0 and J45, and Bland-Altman plots were used to analyse the agreement between methods.

RESULTS

Linear functions were used to determine the dependency between the central myopic refractive error and the difference between the method of refraction (=bias). The influence of central myopia was not clinically relevant when analysing the agreement between wavefront results with and without cyclopentolate (comparison 1). The bias for wavefront-based minus subjective spherical equivalent refraction (comparison 2) was ≤-0.50 D (95% limits of agreement -0.010 D to -1.00 D) for myopia of -4.55 D and higher when cycloplegia was used (p<0.05). When no cyclopentolate was used for the wavefront-based refraction (comparison 3), the bias of -0.50 D (95% limits of agreement -0.020 D to -0.97 D) was already reached at a myopic error of -2.97 D. Both astigmatic components showed no clinically relevant bias.

CONCLUSION

The spherical equivalent, measured without cycloplegic agents, led to more myopic measurements when wavefront-based refraction was used. The observed bias increased with the amount of myopic refractive error for comparisons 2 and 3, which needs to be considered when interpreting wavefront-refraction data.

TRIAL REGISTRATION NUMBER

NCT05288335.

The prevalence of myopia remains stable under tighter COVID-19 social restriction in preschoolers receiving a school-based eyecare program

PURPOSE

This study investigated the impact of different levels of COVID-19 social restrictions (social distancing in 2020, large-scale home confinement in 2021) on myopia prevalence and behaviours in a preschool population with school-based eyecare programme.

METHODS

Repeated cross-sectional surveys were conducted between August and December in 2019, 2020 and 2021. Children aged 5-6 years received ocular examinations, and questionnaires were answered by caregivers before the day of the examination. The main outcome measures were the changes in after-school time spent on homework, screen-based devices and outdoors. Secondary outcome was the change in myopia prevalence (spherical equivalent [SE] ≤ -0.5 D in either eye after cycloplegia).

RESULTS

A total of 9997 preschoolers were included in the analysis. Under tighter restrictions, more preschoolers spent ≥1 h/day on screen-based devices (42.8% in 2019, 45.2% in 2020, 48.9% in 2021, p < 0.001), and fewer preschoolers spent ≥30 min/day on after-school outdoor activities (49.5% in 2019, 46.0% in 2020, 41.0% in 2021, p < 0.001) on weekdays. A similar trend was found on weekends. While more preschoolers spent ≥2 h/day on screen-based devices (35.3% in 2019, 38.5% in 2020, 43.0% in 2021, p < 0.001), fewer preschoolers spent ≥2 h/day on outdoor activities (41.7% in 2019, 41.7% in 2020, 34.0% in 2021, p < 0.001). The mean SE and myopia prevalence were stable (9.1% in 2019, 10.3% in 2020, 9.4% in 2021, p = 0.707).

CONCLUSION

Our study showed dose-dependent effect of social restrictions on near-work and outdoor behaviours at home. The prevalence of myopia did not increase significantly with short-term cessation of school-based eyecare programmes.

Eye exercises for myopia prevention and control: a comprehensive systematic review and meta-analysis of controlled trials

OBJECTIVES

To evaluate the efficacy of eye exercises in preventing and controlling myopia.

METHODS

We searched studies on eye exercises from nine Chinese and English databases from their inception to December 15, 2022. Using random-effect models and sensitivity/subgroup analyses, we estimated the effects of eye exercises compared to control on changes in three measures: visual acuity, refractive error (both quantified using standardized mean differences, SMDs), and protective/mitigating effects (assessed through risk ratios, RRs).

RESULTS

Eleven studies were included in the meta-analysis, with 921 participants. Nine studies had some concerns of bias in at least two domains, and two studies had a high risk of bias in two domains. Seven studies used visual acuity to measure myopia; visual acuity declined after eye-exercise interventions (SMD = -0.67, 95% CI -1.28 to -0.07, Z = 2.17, P = 0.03) and the effect was not better than control (SMD = -0.50, 95% CI -1.16 to 0.16, Z = 1.49, P = 0.14). Two studies used refractive error to measure myopia; the effect of eye-exercise interventions did not differ from control (SMD = -1.74, 95% CI -6.27 to 2.79, Z = 0.75, P = 0.45). Seven studies reported on protective/mitigating effects; eye exercises exhibited a greater protective/mitigating effect than control (RR = 0.40, 95% CI 0.23-0.71, Z = 3.13, P < 0.01).

CONCLUSIONS

Overall, the results suggest that eye exercises have limited to no efficacy in preventing or controlling myopia progression. Until robust evidence supports their efficacy, available evidence suggests retiring the eye-exercise policy.

Low concentration atropine and myopia: a narrative review of the evidence for United Kingdom based practitioners

The prevalence of myopia is increasing across the world. Controlling myopia progression would be beneficial to reduce adverse outcomes such as retinal detachment and myopic maculopathy which are associated with increased axial length. Pharmacological control of myopia progression with atropine has been investigated since the 19th century and the benefits of slowing myopia progression are considered against the side-effects of near blur and photophobia. More recently, randomised trials have focused on determining the optimum concentration of atropine leading to low-concentration atropine being used to manage myopia progression by practitioners across the world. Currently, in the United Kingdom, there is no licensed pharmacological intervention for myopia management. The aim of this review is to interpret the available data to inform clinical practice. We conducted a narrative review of the literature and identified peer-reviewed randomised controlled trials using the search terms 'myopia' and 'atropine', limited to the English language. We identified two key studies, which were the Atropine in the Treatment Of Myopia (ATOM) and Low-concentration Atropine for Myopia Progression (LAMP). Further studies were identified using the above search terms and the references from the identified literature. Atropine 0.01% has a modest effect on controlling axial length progression. Atropine 0.05% appears to be superior to atropine 0.01% in managing myopia progression. There is a dose-dependent rebound effect when treatment is stopped. Atropine is a well-tolerated, safe, and effective intervention. Treatment would be needed for several years and into adolescence, until axial length progression is stable.

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

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

Nutritional intake, environmental factors, and their impact on myopia prevalence in Korean children aged 5-12 years

BACKGROUND

Myopia is a complex condition influenced by numerous factors, including genetic predisposition, environmental factors, and lifestyle choices. Although evidence indicates that certain dietary factors may influence the development of myopia, this relationship is still not completely understood and is a topic of ongoing research.

METHODS

This study analyzed the relationship between dietary habits, environmental factors, and the prevalence of myopia in a sample of 24,345 children aged 5-12 years from the seventh Korea National Health and Nutrition Examination Survey (KNHANES VII). The average daily intake of dietary nutrients associated with the refractive error status of the participants was analyzed using analysis of variance (GLM) and the Scheffe method for post-hoc comparison. Multiple logistic regression analysis was conducted between the participant's refractive error status and daily dietary nutrient intake, while taking into consideration the age, sex, BMI, parental myopia, and near-work hours.

RESULTS

The risk of myopia increased with age, especially notable between ages 11 and 12, and was higher in children with both parents having myopia. Dietary factors played a crucial role; children with myopia had significantly lower intake of fat, omega-3 fatty acids, and retinol but higher intake of other nutrients compared to emmetropic and hyperopic counterparts. High consumption of carbohydrates, protein, phosphorus, iron, potassium, and sodium was associated with increased myopia risk. High sodium intake was particularly associated with a 2.05-fold increased myopia risk.

CONCLUSIONS

This study highlights the significant role of diet and lifestyle choices in the development of myopia in children. Our findings suggest the importance of considering these specific factors in the management and prevention strategies for myopia, underscoring the need for targeted interventions in children's health and vision care.

Myopia progression after cessation of atropine in children: a systematic review and meta-analysis

Purpose: To comprehensively assess rebound effects by comparing myopia progression during atropine treatment and after discontinuation. Methods: A systematic search of PubMed, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov was conducted up to 20 September 2023, using the keywords "myopia," "rebound," and "discontinue." Language restrictions were not applied, and reference lists were scrutinized for relevant studies. Our study selection criteria focused on randomized control trials and interventional studies involving children with myopia, specifically those treated with atropine or combination therapies for a minimum of 6 months, followed by a cessation period of at least 1 month. The analysis centered on reporting annual rates of myopia progression, considering changes in spherical equivalent (SE) or axial length (AL). Data extraction was performed by three independent reviewers, and heterogeneity was assessed using I2 statistics. A random-effects model was applied, and effect sizes were determined through weighted mean differences with 95% confidence intervals Our primary outcome was the evaluation of rebound effects on spherical equivalent or axial length. Subgroup analyses were conducted based on cessation and treatment durations, dosage levels, age, and baseline SE to provide a nuanced understanding of the data. Results: The analysis included 13 studies involving 2060 children. Rebound effects on SE were significantly higher at 6 months (WMD, 0.926 D/y; 95%CI, 0.288-1.563 D/y; p = .004) compared to 12 months (WMD, 0.268 D/y; 95%CI, 0.077-0.460 D/y; p = .006) after discontinuation of atropine. AL showed similar trends, with higher rebound effects at 6 months (WMD, 0.328 mm/y; 95%CI, 0.165-0.492 mm/y; p < .001) compared to 12 months (WMD, 0.121 mm/y; 95%CI, 0.02-0.217 mm/y; p = .014). Sensitivity analyses confirmed consistent results. Shorter treatment durations, younger age, and higher baseline SE levels were associated with more pronounced rebound effects. Transitioning or stepwise cessation still caused rebound effects but combining optical therapy with atropine seemed to prevent the rebound effects. Conclusion: Our meta-analysis highlights the temporal and dose-dependent rebound effects after discontinuing atropine. Individuals with shorter treatment durations, younger age, and higher baseline SE tend to experience more significant rebound effects. Further research on the rebound effect is warranted. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=463093], identifier [registration number].

Association between dietary nutrient intake and prevalence of myopia in Korean adolescents: evidence from the 7th Korea National Health and Nutrition Examination Survey

Background

The rise in myopia prevalence, particularly among adolescents in East Asia, is a cause for concern. While a combination of environmental and genetic factors is understood to contribute to this trend, the role of dietary nutrients is not yet fully clarified.

Objective

To assess the potential association between the intake of specific nutrients and the prevalence of myopia in a large, population-based sample of Korean adolescents.

Methods

Data from 18,077 adolescents (average age: 15.05 ± 1.67 years; 51.7% male, 48.3% female) who participated in the 7th Korea National Health and Nutrition Examination Survey (KNHANES VII, 2016) were analyzed. Refractive error was measured using an auto-refractor-keratometer (KR-8800) without cycloplegia. Dietary intake of 14 nutrients was assessed through a 24-h personalized dietary recall method.

Results

The study revealed a myopia prevalence of 87.6% among the adolescents. Multivariable models adjusted for age, gender, BMI, and other confounding factors indicated that higher intakes of carbohydrates, proteins, cholesterol, sodium, and vitamin B2 were associated with an increased risk of myopia. Conversely, higher intake of vitamin C was found to be associated with a decreased risk.

Conclusion

The findings suggested a potential association between dietary nutrient intake and myopia prevalence in Korean adolescents. While the study did not establish a causal link, the differences in nutrient intake between the myopic and non-myopic groups could indicate that diet plays a role in the development or progression of myopia. Further research is warranted to corroborate these findings and explore the underlying mechanisms.

Trajectories of spherical equivalent refraction from grades 1 to 4 in Chinese children

BACKGROUND

The development trajectories of children's SER remain unknown. This study aimed to characterize spherical equivalent refraction (SER) trajectories during grades 1-4 in Chinese children.

METHODS

This prospective cohort study included 1226 first-grade non-myopic children from 12 public primary schools, randomly selected in two districts in Guangzhou, China. From November 2018 to March 2022, four-wave ocular examinations and questionnaire surveys have been completed. The group-based trajectory modeling was used to explore SER trajectories in grades 1-4.

RESULTS

All five trajectories showed an upward trend and rose faster after grade 2. Children in the sharp-developing (n = 44), high-developing (n = 136), and rapid-developing (n = 237) myopia groups developed myopia before grades 2, 3, and 4, respectively. Their SER development speed remained at a relatively high level after myopia, almost consistent with that before myopia. Children in the moderate-developing (n = 418) and low-developing (n = 391) non-myopia groups did not develop myopia before grade 4. Some characteristics in grade 1 were independently associated with SER trajectories, including sex, axial length, number of parents with myopia, residence, academic achievement, and the duration of outdoor activity. Based on the baseline characteristics, we established the model predicting the probability of children belonging to each group.

CONCLUSIONS

Myopia interventions are best started in grade 1 or preschool age. If interventions are not taken in time, the latest intervention window might be in grades 1, 2, and 3 for children with a high probability of belonging to the sharp-developing, high-developing, and rapid-developing myopia groups, respectively. The above probabilities might be predicted using the model we established. Moreover, the interventions for myopic children shouldn't be ignored.

Five-year follow-up of a posterior chamber phakic intraocular lens with a central hole for correction of myopia

PURPOSE

To evaluate intermediate and long-term visual outcomes and safety of a phakic intraocular posterior chamber lens with a central hole (ICL V4c) for myopic eyes.

METHODS

Retrospective, consecutive case study of patients that uneventfully received a ICL V4c for myopia correction, with a 5-year postoperative follow-up. Department of Ophthalmology, Goethe University Frankfurt, Germany.

RESULTS

From 241 eyes that underwent ICL implantation, we included 45 eyes with a mean age at surgery of 33 years ± 6 (18-48 years), with a 5 years follow-up. CDVA improved from 0.05logMAR ± 0.15 CDVA preoperatively to  - 0.00 ± 0,07 at 5 years and did not change significantly from 3 to 5 years' time (p = 0.266). The mean spherical equivalent (SE) improved from -10.13D ± 3.39 to  - 0.45D ± 0.69. The change in endothelial cell count showed a mean decrease of 1.9% per year throughout the follow-up. Safety and efficacy index were 1.16 and 0.78, respectively. Cataract formation was seen in 2 of 241 eyes (0.8%), but in none of the 45 eyes that finished the 5-year follow-up.

CONCLUSIONS

Our data show a good intermediate and long-term stability, efficiency, and safety of ICL V4c phakic lenses in myopic eyes comparable to other known literature.

Significant myopic shift over time: Sixteen-year trends in overall refraction and age of myopia onset among Chinese children, with a focus on ages 4-6 years

Background

Myopia or near-sightedness is a major cause of blindness in China and typically develops between the ages of 6-12 years. We aimed to investigate the change in refractive error and the age of myopia onset in Chinese children from 2005 to 2021.

Methods

We first conducted a series of cross-sectional studies to determine the refractive states and the age of myopia onset over time, after which we analysed longitudinal data to investigate the dose-response relationship between hyperopic reserve and future risk of myopia. The analysis was based on the refraction data of children aged 4-18 years who visited the Fudan University Eye and Ear, Nose, and Throat (FUEENT) Hospital, a large tertiary hospital in Shanghai, China, for eye examinations between 2005 and 2021. We examined the prevalence of hyperopia (spherical equivalent refractive error (SERE) >0.75D), pre-myopia (-0.50D < SERE ≤ 0.75D), and myopia (SERE ≤-0.50D), the average SERE for each age group at the initial visit, the average age of myopia onset, and the safety threshold of hyperopic reserve against myopia onset.

Results

We included 870 372 eligible patients aged 4-18 years who attended examination between 2005 and 2021, 567 893 (65.2%) of whom were myopic at their initial visit to FUEENT. The mean SERE decreased in most (n/N = 14/15) of the age groups over the 16 calendar years, with a mean SERE for the whole cohort decreasing from -1.01D (standard deviation (SD) = 3.46D) in 2005 to -1.30D (SD = 3.11D) in 2021. The prevalence of pre-myopia increased over the 16 years (P < 0.001), while those of myopia and hyperopia remained largely stable (both P > 0.05). We observed a significant decrease in the prevalence of hyperopia (2005: 65.4% vs 2021: 51.1%; P < 0.001) and a significant increase in the prevalence of pre-myopia (2005: 19.0% vs 2021: 26.5%; P < 0.001) and myopia (2005: 15.6% vs 2021: 22.4%; P < 0.001) in children aged 4-6 years. We found an earlier myopia onset over time, with the mean age of onset decreasing from 10.6 years in 2005 to 7.6 years in 2021 (P < 0.001). Children with a hyperopic reserve of less than 1.50D were at increased risk of developing myopia during a median follow-up of 1.3 years.

Conclusions

We found an overall myopic shift in SERE in Chinese children aged 4-18 years over the past 16 years, particularly in those aged 4-6 years. The mean age of myopia onset decreased by three years over the same period. The "safety threshold" of hyperopic reserve we identified may help target the high-risk population for early prevention.

Incidence and its risk factors of high myopia in Chinese rural adults: A population-based six-year cohort study

BACKGROUND

To investigate the incidence rate of high myopia and its risk factors in adults.

METHODS

This was a population-based cohort study, 4582 adults aged ≥ 30 years from rural area of China were included. The follow-up duration was six years. Objective refraction (sphere, cylinder, and axis) was measured using an autorefractor. Multivariable Logistic regression was used to explore risk factors of high myopia, odds ratio (OR) with 95% confidence interval (CI) were reported.

RESULTS

During the six-year follow-up, 25 participants developed high myopia. The incidence rate was 0.55% (95%CI: 0.44% to 0.66%), and were 0.54% (11/2035) in males and 0.55% (14/2547) in females. The age-gender standardized annual incidence rate was 0.11%. The median changes in spherical equivalent (SE) of all participants was 0.25D (IQR: -0.125 to 0.625). For the baseline myopic adults and non-myopic adults, the median changes in SE were 0.125D (IQR: -0.375 to 0.5), and 0.25D (IQR: -0.125 to 0.625). The difference was significant (p < 0.001). Of the two subgroups, 1.52% (21/1383) and 0.13% (4/3199) developed high myopia during six years. The risk of developing high myopia in baseline myopic adults was 11.7 times higher than that of the baseline non-myopic adults (p < 0.001). Age (OR = 1.061, 95%CI: 1.022 to 1.103, p = 0.002), and baseline myopia (OR = 1.007, 95%CI: 1.001 to 1.012, p < 0.001) were risk factors for high myopia.

CONCLUSION

The age-gender standardized annual incidence rate of high myopia in Chinese rural adults is 0.11%. More than 30% of adults still have myopia progression. Myopia control is of great significance for high myopia prevention.

Control of myopia using diffusion optics spectacle lenses: 12-month results of a randomised controlled, efficacy and safety study (CYPRESS)

BACKGROUND

Mutations in the L/M cone opsin gene array cause abnormally high perceived retinal contrast and the development of myopia. Environmental factors may also lead to high visual contrast and cause myopia. Diffusion optics technology (DOT) lenses are designed to reduce contrast signalling in the retina and slow myopia progression.

METHODS

The Control of Myopia Using Peripheral Diffusion Lenses Efficacy and Safety Study (CYPRESS, NCT03623074) is a 36-month, multicentre, randomised, controlled, double-masked trial evaluating two investigational spectacle lenses versus control lenses in myopic children aged 6-10, with a planned interim analysis at 12 months. The primary endpoints are change from baseline in axial length (AL) and spherical equivalent refraction (SER).

RESULTS

256 children (58% female; mean age at screening, 8.1 years) were dispensed spectacles. Across all groups, baseline averages were AL 24.02 mm (SD±0.77 mm), SER -2.01 D (SD±0.9 D) using manifest refraction, and SER -1.94 D (SD±1.0 D) using cycloplegic autorefraction. At 12 months, mean difference in SER progression for test 1 versus control was -0.40 D (p<0.0001), representing a 74% reduction and -0.32 D for Test 2 (p<0.0001), representing a 59% reduction. The difference in AL progression for test 1 versus control was 0.15 mm (p<0.0001) and test 2 versus control was 0.10 mm (p=0.0018).

CONCLUSION

12-month results from this ongoing trial demonstrate the safety and effectiveness of DOT spectacles for reducing myopic progression.

Demographic factors associated with myopia knowledge, attitude and preventive practices among adults in Ghana: a population-based cross-sectional survey

PURPOSE

Knowledge, positive attitude and good preventive practices are keys to successful myopia control, but information on these is lacking in Africa. This study determined the KAP on myopia in Ghana.

METHODS

This was a population-based cross-sectional survey conducted among adults (aged 18 years and older) living across 16 regions of Ghana between May and October 2021. Data on socio-demographic factors (sex, age, gender, level of education, working status, type of employment, monthly income, and region of residence), respondents' awareness, and knowledge, attitude and preventive practices (KAP) about myopia were collected. Composite and mean scores were calculated from eleven knowledge (total score = 61), eight attitude (48), and nine preventive practice items (33). Differences in mean scores were assessed using one-way analysis of variance (ANOVA) and standardized coefficients (β) with 95% confidence intervals (CI), using multiple linear regression to determine the associations between the dependent (KAP) and demographic variables.

RESULTS

Of the 1,919 participants, mean age was 37.4 ± 13.4 years, 42.3% were aged 18-30 years, 52.6% were men, 55.8% had completed tertiary education, and 49.2% had either heard about myopia, or accurately defined myopia as short sightedness. The mean KAP scores were 22.9 ± 23.7, 33.9 ± 5.4, and 22.3 ± 2.8, respectively and varied significantly with many of the demographic variables particularly with age group, region, marital status, and type of employment. Multiple linear regression analyses revealed significant associations between region of residence and knowledge (β =-0.54, 95%CI:-0.87, -0.23, p < 0.001), attitude (β =-0.24, 95%CI:-0.35,-0.14, p < 0.001) and preventive practices (β = 0.07, 95%CI: 0.01, 0.12, p = 0.015). Preventive practices were also associated with type of employment (self-employed vs employee: β = 0.25, 95%CI: 0.15, 4.91, p < 0.05). Knowledge scores were significantly higher in those who lived in the Greater Accra (39.5 ± 18.5) and Eastern regions (39.1 ± 17.5) and lower among those who lived in the Upper West region (6.4 ± 15.6). Government employees and those with tertiary education had significantly higher mean knowledge scores compared with non-government employees (β = 4.56, 95%CI 1.22, 7.89, p = 0.007), and those with primary/no education (β = 18.35, 95%CI: 14.42, 22.27, p < 0.001).

CONCLUSION

Ghanaian participants had adequate knowledge of myopia but showed poor attitude and low preventive practices, which varied significantly between regions and were modified by socio-demographic factors. Further research into how education can be used to stimulate Ghanaians' engagement in preventive practices is needed.

Advances in myopia prevention strategies for school-aged children: a comprehensive review

Myopia has significantly risen in East and Southeast Asia, and the pathological outcomes of this condition, such as myopic maculopathy and optic neuropathy linked to high myopia, have emerged as leading causes of irreversible vision loss. Addressing this issue requires strategies to reduce myopia prevalence and prevent progression to high myopia. Encouraging outdoor activities for schoolchildren and reducing near-work and screen time can effectively prevent myopia development, offering a safe intervention that promotes healthier habits. Several clinical approaches can be employed to decelerate myopia progression, such as administering low-dose atropine eye drops (0.05%), utilizing orthokeratology lenses, implementing soft contact lenses equipped with myopia control features, and incorporating spectacle lenses with aspherical lenslets. When choosing an appropriate strategy, factors such as age, ethnicity, and the rate of myopia progression should be considered. However, some treatments may encounter obstacles such as adverse side effects, high costs, complex procedures, or limited effectiveness. Presently, low-dose atropine (0.05%), soft contact lenses with myopia control features, and orthokeratology lenses appear as promising options for managing myopia. The measures mentioned above are not necessarily mutually exclusive, and researchers are increasingly exploring their combined effects. By advocating for a personalized approach based on individual risk factors and the unique needs of each child, this review aims to contribute to the development of targeted and effective myopia prevention strategies, thereby minimizing the impact of myopia and its related complications among school-aged children in affected regions.

Pattern of choroidal thickness in early-onset high myopia

Purpose

To explore the etiology and choroidal thickness (ChT) pattern in children with early-onset high myopia (eoHM).

Methods

Sixty children with eoHM and 20 healthy controls were enrolled in this study between January 2019 and December 2021. All children underwent comprehensive ophthalmologic examinations including swept-source optical coherence tomography. ChT was measured in the subfoveal region and at 1000 μm and 2,500 μm nasal, temporal, superior, and inferior to the fovea.

Results

Overall, 120 eyes of 60 children with eoHM were examined (mean spherical equivalent, -8.88 ± 3.05 D; mean axial length, 26.07 ± 1.59 mm). Simple high myopia (SHM), familial exudative vitreoretinopathy (FEVR), and Stickler syndrome (STL) were the most frequent etiologies of eoHM and were included in further ChT analysis. Adjusted the effect of SE, multivariate regression analysis showed that children with SHM had thinnest ChT at N2500 and I2500 among the subgroups (p = 0.039, p = 0.013). FEVR group showed thinner ChT at T2500 (p = 0.023), while STL patients exhibited thin ChT at all locations.

Conclusion

This study revealed that SHM, STL and FEVR was the most frequent etiology, and showed a distinctive pattern of ChT. Asymmetric nasal ChT thinning is a distinctive biomarker for SHM, asymmetric temporal ChT thinning might serve as a biomarker for FEVR, and symmetric diffuse thinning is more common in STL. These ChT patterns may provide a convenient, fast, and noninvasive strategy to differentiate the potential etiology of eoHM.

A Survey of Myopia Correction Pattern of Children and Parent's Attitudes in China

SIGNIFICANCE

This survey provides information about Chinese children's myopia correction status and parents' attitudes toward myopia correction.

PURPOSE

Under the background of a guideline of appropriate techniques for the prevention and control of children's myopia, this study aimed to investigate the current myopia correction pattern of children and parents' attitudes.

METHODS

Two self-administered questionnaires were distributed to 684 children with myopia corrections and 450 parents (384 mothers and 66 fathers) to explore children's myopia correction patterns and parental attitudes. The questionnaire investigated the pattern of children's myopia correction, prescribing of children's myopia correction, the incidence of high myopia, parental attitudes toward various myopia corrections methods, and preferred initial age for contact lens usage.

RESULTS

Single-vision spectacles (n = 600; 88.2 ± 7.4%) are widely used in China because of their comfort and affordability. More than 80% of children use single-vision spectacles prescribed by ophthalmologists and opticians. Children who used single-vision spectacles at an earlier age had more incidence of high myopia (18.4 ± 4.2%) than those who used single-vision spectacles at a later age (0.7 ± 0.9%). Effective myopia control was the primary reason parents preferred to choose different optical corrections, followed by safety, convenience, clarity, affordability, comfort, and other reasons. The survey indicated that 52.4% of parents whose children used orthokeratology lenses would have preferred safe and convenient options if available. In addition, 50% of the parents preferred delaying their children's use of orthokeratology lenses and other contact lenses to an older age.

CONCLUSIONS

Single-vision spectacles are still a popular option to correct myopia in children. There was a demonstrated increase in myopia in children who used single spectacles at an earlier age. Parents' attitudes were important factors for selecting myopia corrections in children.

Does multidimensional daily information predict the onset of myopia? A 1-year prospective cohort study

PURPOSE

This study aimed to develop an interpretable machine learning model to predict the onset of myopia based on individual daily information.

METHOD

This study was a prospective cohort study. At baseline, non-myopia children aged 6-13 years old were recruited, and individual data were collected through interviewing students and parents. One year after baseline, the incidence of myopia was evaluated based on visual acuity test and cycloplegic refraction measurement. Five algorithms, Random Forest, Support Vector Machines, Gradient Boosting Decision Tree, CatBoost and Logistic Regression were utilized to develop different models and their performance was validated by area under curve (AUC). Shapley Additive exPlanations was applied to interpret the model output on the individual and global level.

RESULT

Of 2221 children, 260 (11.7%) developed myopia in 1 year. In univariable analysis, 26 features were associated with the myopia incidence. Catboost algorithm had the highest AUC of 0.951 in the model validation. The top 3 features for predicting myopia were parental myopia, grade and frequency of eye fatigue. A compact model using only 10 features was validated with an AUC of 0.891.

CONCLUSION

The daily information contributed reliable predictors for childhood's myopia onset. The interpretable Catboost model presented the best prediction performance. Oversampling technology greatly improved model performance. This model could be a tool in myopia preventing and intervention that can help identify children who are at risk of myopia, and provide personalized prevention strategies based on contributions of risk factors to the individual prediction result.

IMI-Onset and Progression of Myopia in Young Adults

Myopia typically starts and progresses during childhood, but onset and progression can occur during adulthood. The goals of this review are to summarize published data on myopia onset and progression in young adults, aged 18 to 40 years, to characterize myopia in this age group, to assess what is currently known, and to highlight the gaps in the current understanding. Specifically, the peer-reviewed literature was reviewed to: characterize the timeline and age of stabilization of juvenile-onset myopia; estimate the frequency of adult-onset myopia; evaluate the rate of myopia progression in adults, regardless of age of onset, both during the college years and later; describe the rate of axial elongation in myopic adults; identify risk factors for adult onset and progression; report myopia progression and axial elongation in adults who have undergone refractive surgery; and discuss myopia management and research study design. Adult-onset myopia is common, representing a third or more of all myopia in western populations, but less in East Asia, where onset during childhood is high. Clinically meaningful myopia progression continues in early adulthood and may average 1.00 diopters (D) between 20 and 30 years. Higher levels of myopia are associated with greater absolute risk of myopia-related ocular disease and visual impairment, and thus myopia in this age group requires ongoing management. Modalities established for myopia control in children would be options for adults, but it is difficult to predict their efficacy. The feasibility of studies of myopia control in adults is limited by the long duration required.

Myopia prediction for children and adolescents via time-aware deep learning

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).

The Causal Effect of Education on Myopia: Evidence That More Exposure to Schooling, Rather Than Increased Age, Causes the Onset of Myopia

Purpose

To distinguish the effects of age and grade on the development of myopia.

Methods

Grade 1 (n = 1465, mean age 6.71 ± 0.29 years; 53.5% male) and Grade 2 students (n = 1381, mean age 7.76 ± 0.30 years; 52.5% male) were examined in 2018, with a follow-up examination in 2019. Cycloplegic spherical equivalent (SE) in diopter (D) was measured. Regression discontinuity (RD) analysis was used to assess the causal effects on refraction at each visit.

Results

The sample in a grade was divided into three 4-month age blocks according to their birth month, the youngest, middle, and the oldest. At the 2018 visit, within each grade, there were no significant differences in SE among age blocks (all P > 0.05), despite an age range of 12 months. However, comparing the youngest block in Grade 2 to the oldest block in Grade 1, an average age difference of four months, a significant difference in SE was found (0.82 ± 0.69 D vs. 1.05 ± 0.55 D, t-test P < 0.01). Formal RD analysis found a significant casual effect of grade increase on myopic refraction shift (β = -0.32 D; 95% CI, -0.73 to -0.01; P = 0.042). Consistent results were found using the 2019 data.

Conclusions

Increased grade, rather than increasing age, is the major cause of myopic shifts in refraction. A causal link implies that interventions aimed at reducing the myopigenic exposures experienced during a school year have the potential to markedly reduce the myopic shifts in refraction associated with a grade of schooling.

Effect of Repeated Low-level Red Light on Myopia Prevention Among Children in China With Premyopia: A Randomized Clinical Trial

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.

Prevention of myopia shift and myopia onset using 0.01% atropine in premyopic children - a prospective, randomized, double-masked, and crossover trial

This study aims to evaluate the efficacy of 0.01% atropine eye drops in preventing myopia shift and myopia onset in premyopic children. A prospective, randomized, double-masked, placebo-controlled, and crossover trial was conducted over 13 months. Sixty premyopic children aged 6-12 years with cycloplegic spherical equivalent refraction (SER) >  - 0.75 D and ≤  + 0.50 D in both eyes were assigned in a 1:1 ratio to receive one drop of 0.01% atropine or placebo once nightly for 6 months (period 1), followed by a 1-month recovery period. Then, the 0.01% atropine group was crossed over to the placebo group, and the latter was crossed over to the 0.01% atropine group for another 6 months (period 2). The primary outcomes were changes in SER and axial length (AL), and the secondary outcomes were the proportion of myopia onset (SER ≤  - 0.75D) and fast myopic shift (change in SER ≤  - 0.25D) in the two periods. Generalized estimating equation (GEE) model performed a statistically significant treatment effect of 0.01% atropine compared with placebo (p_SER = 0.02, p_AL < 0.001), with a mean SER and AL difference of 0.20D (- 0.15 ± 0.26D vs. - 0.34 ± 0.34D) and 0.11 mm (0.17 ± 0.11 mm vs. 0.28 ± 0.14 mm) in period 1, and 0.17D (- 0.18 ± 0.24D vs. - 0.34 ± 0.31D) and 0.10 mm (0.15 ± 0.15 mm vs. 0.24 ± 0.11 mm) in period 2. The GEE model showed that the proportion of myopia onset (p = 0.004) and fast myopic shift (p = 0.009) was significantly lower in the 0.01% atropine group than that in the placebo group. The period effect was not statistically significant (all p > 0.05). A total of 0.01% atropine significantly prevented myopic shift, axial elongation, and myopia onset in premyopic schoolchildren in central Mainland China.

CONCLUSION

Within the limits of only two consecutive 6-month observation period, 0.01% atropine eye drops effectively prevented myopic shift, axial elongation, and myopia onset in premyopic children.

TRIAL REGISTRATION

This trial was registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR2000034760). Registered 18 July 2020.

WHAT IS KNOWN

• Minimal studies on interventions for pre-myopia, despite the International Myopia Institute stating that preventing myopia is an "even more valuable target" for science and practice than reducing progression after onset.

WHAT IS NEW

• A total of 0.01% atropine eye drops may safely and effectively reduce the proportion of myopia onset and fast myopic shift in premyopic schoolchildren.

Myopia control and prevention: From lifestyle to low-concentration atropine. The 2022 Josh Wallman Memorial Lecture

The purpose of this study was to explore the findings from the Hong Kong Children Eye Study and the Low Concentration Atropine for Myopia Progression (LAMP-1) Study. The incidence of myopia among schoolchildren in Hong Kong more than doubled during the COVID-19 pandemic, with outdoor time decreased significantly and screen time increased. The change in lifestyle during the COVID-19 pandemic aggravated myopia development. Low-concentration atropine (0.05%, 0.025% and 0.01%) is effective in reducing myopia progression with a concentration-related response. This concentration-dependent response was maintained throughout a 3-year follow-up period, and all low concentrations were well tolerated. An age-dependent effect was observed in each treatment group with 0.05%, 0.025% and 0.01% atropine. Younger age was associated with a poor treatment response to low-concentration atropine. Additionally, low-concentration atropine induced choroidal thickening along a concentration-dependent response throughout the treatment period. During the third year, continued atropine treatment achieved a better effect across all concentrations compared with the washout regimen. Stopping treatment at an older age and receiving lower concentration were associated with a smaller rebound effect. However, differences in the rebound effect were clinically small across all the three concentrations studied.

Prevalence Patterns and Onset Prediction of High Myopia for Children and Adolescents in Southern China via Real-World Screening Data: Retrospective School-Based Study

BACKGROUND

Patients with high myopia have an increased lifetime risk of complications. The prevalence patterns of high myopia in children and adolescents in southern China are unclear. Early identification of high-risk individuals is critical for reducing the occurrence and development of high myopia and avoiding the resulting complications.

OBJECTIVE

This study aimed to determine the prevalence of high myopia in children and adolescents in southern China via real-world screening data and to predict its onset by studying the risk factors for high myopia based on machine learning.

METHODS

This retrospective school-based study was conducted in 13 cities with different gross domestic products in southern China. Through data acquisition and filtering, we analyzed the prevalence of high myopia and its association with age, school stage, gross domestic product, and risk factors. A random forest algorithm was used to predict high myopia among schoolchildren and then assessed in an independent hold-out group.

RESULTS

There were 1,285,609 participants (mean age 11.80, SD 3.07, range 6-20 years), of whom 658,516 (51.2%) were male. The overall prevalence of high myopia was 4.48% (2019), 4.88% (2020), and 3.17% (2021), with an increasing trend from the age of 11 to 17 years. The rates of high myopia increased from elementary schools to high schools but decreased at all school stages from 2019 to 2021. The coastal and southern cities had a higher proportion of high myopia, with an overall prevalence between 2.60% and 5.83%. Age, uncorrected distance visual acuity, and spherical equivalents were predictive factors for high myopia onset in schoolchildren. The random forest algorithm achieved a high accuracy of 0.948. The area under the receiver operator characteristic curve (AUC) was 0.975. Both indicated sufficient model efficacy. The performance of the model was validated in an external test with high accuracy (0.971) and a high AUC (0.957).

CONCLUSIONS

High myopia had a high incidence in Guangdong Province. Its onset in children and adolescents was well predicted with the random forest algorithm. Efficient use of real-world data can contribute to the prevention and early diagnosis of high myopia.

Deep learning system to predict the 5-year risk of high myopia using fundus imaging in children

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.

Effect of atropine 0.01% on myopia control in children aged 6-13 years during the 2022 lockdown in Shanghai

Purpose

To compare the myopic progression in children treated with 0. 01% atropine and those who discontinued atropine during the 2022-home quarantine in Shanghai.

Methods

In this retrospective study, children aged 6-13 years with follow-up visits before (between January 2022 and February 2022) and after the lockdown (between July 2022 and August 2022) were included. Cycloplegic refraction and axial length (AL) were measured at both visits. The atropine group had continuous medication during the lockdown while the control group discontinued. The 0.01% atropine eyedrops were administered daily before bedtime. The types of spectacle lens were recorded: single vision (SV) spectacles or defocus incorporated multiple segments lenses (DIMS).

Results

In total, 41 children (81 eyes) in the atropine group and 32 children (64 eyes) in the control group were enrolled. No significant difference was found in the demographic characteristics, spherical diopter, spherical equivalent (SE), AL, and follow-up time between the two groups before the lockdown in 2022 (all p > 0.1). After the home confinement, a greater myopia progression was observed in the control group (-0.46 ± 0.42 D) compared to atropine group (-0.26 ± 0.37 D; p = 0.0023). Axial elongation was also longer in the control group than that in children sustained with atropine (0.21 ± 0.17 vs. 0.13 ± 0.15 mm, p = 0.0035). Moreover, there was no significant change of spherical diopter and SE during lockdown in the atropine + DIMS combined subgroup (0.03 ± 0.033 D for spherical diopter, p = 0.7261 and 0.08 ± 0.27 D for SE, p = 0.2042, respectively). However, significant myopic shift was observed in the atropine + SV subgroup during the quarantine time (-0.31 ± 0.39 D for SE and 0.15 ± 0.16 mm for AL, both p < 0.001).

Conclusion

Children treated with 0.01% atropine had slower myopia progression during the lockdown period in Shanghai compared with children discontinued. Moreover, the effect of atropine on myopic prevention can be strengthened with DIMS lenses.

Topical Review: Studies on Management of Myopia Progression from 2019 to 2021

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.

Myopia: An ounce of prevention is worth a pound of cure

PURPOSE

Myopia severity has a profound impact on visual impairment in later life. A patient's final level of myopia may be lowered by myopia control, but also by delaying onset. Here, we evaluate the influence of the age of onset on the final recorded level of myopia.

METHODS

Data were extracted from: (1) Three prospective cohort studies of myopia progression in East Asia and the United States where the final recorded level of myopia is presented as a function of the established age of onset. (2) Four retrospective studies of myopia progression in Finland, India, the Netherlands and China and two cross-sectional studies in Argentina and the UK where the age of onset was based on self-report of age at first spectacle prescription. (3) A cohort study of Finnish subjects originally recruited for a clinical trial and followed into adulthood. Subjects were divided into five groups according to age at recruitment that was used as a surrogate for the age of onset.

RESULTS

Final recorded level of myopia was plotted as a function of age of onset for all studies. Among the three East Asian studies, the slopes are between 0.68 and 0.97 D/year, meaning that each later year of onset is associated with between 0.68 and 0.97 less myopia at the final recorded refraction. For six of the seven non-East Asian studies, the slopes are substantially flatter, with slopes between 0.23 and 0.50 D/year. By contrast, the slope for the Finnish study was 0.87 D/year. Increasing age of final recorded refraction tended to be associated with higher levels of myopia.

CONCLUSION

Among East Asians, delaying the onset of myopia by 1 year has the potential to lower the final myopia level by 0.75 D or more-equivalent to 2-3 years of myopia control with existing modalities. The benefit is lower, but meaningful, among non-East Asians.

Myopia and axial length in school-aged children before, during, and after the COVID-19 lockdown-A population-based study

Background

Myopic shift had been observed during the COVID-19 lockdown in young school children. It remains unknown whether myopic shift is accompanied with increase in axial length. We aimed to evaluate the impact of the COVID-19 lockdown on myopia and axial length of school children in China by comparing them before, during and after the lockdown.

Methods

In this population-based cross-sectional study, school-based myopia screenings were conducted in the Fall of 2019, 2020, and 2021 (representing before, during and after COVID-19 lockdown respectively) in Chengdu, China. Myopia screenings were performed on 83,132 students aged 6 to 12 years. Non-cycloplegic refractive error was examined using NIDEK auto-refractor (ARK-510A; NIDEK Corp., Tokyo, Japan) and axial length was measured using AL-Scan (NIDEK Corp., Tokyo, Japan). Spherical equivalent (SER, calculated as sphere+ 0.5^*cylinder), prevalence of myopia (SER ≤ -0.50 D), and axial length were compared across 3 years stratified by age.

Results

Myopia prevalence rate was 45.0% (95% CI: 44.6-45.5%) in 2019, 48.7% (95% CI: 48.3-49.1%) in 2020, and 47.5% (95% CI: 47.1-47.9%) in 2021 (p < 0.001). The mean non-cycloplegic SER (SD) was -0.70 (1.39) D, -0.78 (1.44) D, and -0.78 (1.47) D respectively (p < 0.001). The mean (SD) axial length was 23.41 (1.01) mm, 23.45 (1.03) mm, and 23.46 (1.03) mm across 3 years respectively (p < 0.001). From the multivariable models, the risk ratio (RR) of myopia was 1.07 (95% CI: 1.06-1.08) times, the SER was 0.05 D (95% CI: 0.04 D to 0.06 D) more myopic and the mean axial length increased by 0.01 mm (95% CI: 0.01 mm to 0.02 mm) in 2020 compared to 2019. In 2021, the risk ratio (RR) of myopia was 1.05 (95% CI: 1.04-1.06), the mean SER was 0.06 D (95% CI: 0.05 D to 0.07 D) more myopic, and the mean axial length increased by 0.03 mm (95% CI: 0.02 mm to 0.04 mm) compared to 2019.

Conclusions

The COVID-19 lockdown had significant impact on myopia development and axial length, and these impacts remained 1 year after the lockdown. Further longitudinal studies following-up with these students are needed to help understand the long-term effects of COVID-19 lockdown on myopia.

Role of tutorial classes and full day schooling on self-reported age of myopia onset: findings in a sample of Argentinian adults

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.

Factors Associated With Follow-Up Visits in Parents With Myopic Children Wearing Orthokeratology Lens

BACKGROUND

Orthokeratology (Ortho-k) is an effective method for slowing the progression of myopia and correcting refractive error in school children. Although parents of children aged < 10 years play a major role in Ortho-k lens care, they have a generally low level of compliance in performing regular follow-up visits.

PURPOSE

This study was developed to analyze the associations between follow-up visits by parents of Ortho-k lens wearers aged < 10 years and, respectively, the Ortho-k-related knowledge of these parents and information resources promoting Ortho-k use.

METHODS

A cross-sectional study design was used. Parents of children who wear Ortho-k lenses were recruited through a private Facebook group with 3,500 members in 2020 that was created in 2018 for information sharing and exchange among parents of these children. The following data were collected: demographics of the parents and their children, four-item Ortho-k-related knowledge, information resources that prompted the decision to use Ortho-k, and the regularity of follow-up visits. These data were presented in terms of means, standard deviations, and percentages. Logistic regression was performed to compute the odds ratios ( OR s) and 95% confidence intervals (CIs).

RESULTS

The study showed that 83.11% had regular follow-up visits. The correct response rate on Ortho-k-related knowledge was > 80%. However, 15.51% of the participants did not recognize axial length as an indicator for monitoring myopia progress, and 10.76% did not know that at least 6 hours of nighttime sleep is required for myopia control with Ortho-k. The most common information resource leading to Ortho-k use was self-acquisition from Internet sources. The spherical equivalent refraction of < -2.0 D was 2.58 times higher in participants with regular follow-up visits than in their peers with irregular follow-up visits ( OR = 2.58, 95% CI [0.22, 5.63]). In addition, acknowledgment of "There is no need to change the Ortho-k lenses regularly as long as there is no discomfort" was 7.19 times higher in participants with regular follow-up visits than in their peers with irregular follow-up visits ( OR = 7.19, 95% CI [1.26, 13.93]). However, participants with regular follow-up visits did not receive Internet ophthalmology advertisements prompting their decision to use Ortho-k 2.62 times higher than their peers with irregular follow-up visits ( OR = 2.62, 95% CI [0.04, 4.29]).

CONCLUSIONS

The results support that both information sources and knowledge of Ortho-k use influence the frequency of follow-up visits among parents of Ortho-k lens wearers aged < 10 years. Related support from health professionals in terms of providing appropriate information and guidance is recommended to promote higher rates of regular follow-up visit attendance.

Early Detection of Refractive Errors by Photorefraction at School Age

Early detection and treatment of refractive defects during school age are essential to avoid irreversible future vision loss and potential school problems. Previously, vision screening of preschool children used methods based on subjective visual acuity; however, technologies such as photorefraction have promoted the detection of refractive errors quickly and easily. In this study, 1347 children from 10 schools in Madrid aged 4 to 12 years participated in a program of early detection of visual problems, which consisted of visual screening composed of anamnesis and photorefraction with a PlusOptix A12R. The prevalence of refractive errors was analyzed in terms of spherical equivalent, cylinder and its orientation, and potential cases of development of high myopia or amblyopia. Hyperopia predominates in the early years, but the number of myopic subjects is higher than that of hyperopic subjects from the age of ten onwards. At all ages, the predominant orientation of astigmatism was with-the-rule. On average, 80% of the myopic subjects were uncorrected. Potential high myopia increased with age, from 4 to 21% of the measured population. Potential amblyopia cases decreased across age groups, from 19 to 13.7%. There is a need to raise awareness of the importance of vision screening at school age to address vision problems.

Effect of treatment zone decentration on axial length growth after orthokeratology

Objective

To study the effect of treatment zone (TZ) decentration on axial length growth (ALG) in adolescents after wearing the orthokeratology lenses (OK lenses).

Materials and methods

This retrospective clinical study selected 251 adolescents who were fitted OK lenses at the Clinical College of Ophthalmology, Tianjin Medical University (Tianjin, China) from January 2018–December 2018 and wore them continuously for >12 months. The age of the subjects was 8–15 years, spherical equivalent (SE): −1.00 to −5.00 diopter (D), and astigmatism ≤ 1.50 D. The corneal topography were recorded at baseline and 1-, 6-, and 12-month visits, and the axial length (AL) were recorded at baseline and 6-, 12-month visits. The data of the right eye were collected for statistical analysis.

Results

The subjects were divided into three groups according to the decentration distance of the TZ after wearing lenses for 1 month: 56 cases in the mild (<0.5 mm), 110 in the moderate (0.5–1.0 mm), and 85 in the severe decentration group (>1.0 mm). A significant difference was detected in the ALG between the three groups after wearing lenses for 6 and 12 months (F = 10.223, P < 0.001; F = 13.380, P < 0.001, respectively). Among these, the 6- and 12-month ALG of the mild decentration group was significantly higher than that of the other two groups. Multivariable linear regression analysis showed that age, baseline SE, and 1-month decentration distance associated with the 12-month ALG (P < 0.001, P < 0.001, and P = 0.001, respectively).

Conclusion

The decentration of the TZ of the OK lens affected the growth of the AL in adolescents, i.e., the greater the decentration, the slower the ALG.

Efficacy and Safety of Consecutive Use of 1% and 0.01% Atropine for Myopia Control in Chinese Children: The Atropine for Children and Adolescent Myopia Progression Study

INTRODUCTION

The purpose of this study was to investigate the efficacy and safety of consecutive use of 1% and 0.01% atropine compared with 0.01% atropine alone over 1 year.

METHODS

A total of 207 participants aged 6-12 years with myopia of - 0.50 to - 6.00 D in both eyes were enrolled in this randomized, controlled, non-masked trial and randomly assigned (1:1) to groups A and B. Group A received 1% atropine weekly and were tapered to 0.01% atropine daily at the 6-month visit, and group B received 0.01% atropine daily for 1 year.

RESULTS

Of the 207 participants, 109 were female (52.7%) and the mean (± standard deviation) age was 8.92 ± 1.61 years. Ninety-one participants (87.5%) in group A and 80 participants (77.7%) in group B completed the 1-year treatment. Group A exhibited less refraction progression (- 0.53 ± 0.49 D vs. - 0.74 ± 0.52 D; P = 0.01) and axial elongation (0.26 ± 0.17 mm vs. 0.36 ± 0.21 mm; P < 0.001) over 1 year compared with group B. The changes in refraction (- 0.82 ± 0.45 D vs. - 0.46 ± 0.35 D; P < 0.001) and axial length (0.29 ± 0.12 mm vs. 0.17 ± 0.11 mm; P < 0.001) during the second 6 months in group A were greater than those in group B, with 72.5% of participants presenting refraction rebound. No serious adverse events were reported.

CONCLUSIONS

The 1-year results preliminarily suggest that consecutive use of 1% and 0.01% atropine confers an overall better effect in slowing myopia progression than 0.01% atropine alone, despite myopia rebound after the concentration switch. Both regimens were well tolerated. The long-term efficacy and rebound after the concentration switch and regimen optimization warrant future studies to determine.

TRIAL REGISTRATION NUMBER

Clinical Trials.gov PRS (Registration No. NCT03949101).

Progression of Vision in Chinese School-Aged Children Before and After COVID-19

Objectives: To investigate the changes of vision, including the prevalence of myopia, hyperopia, poor vision, and the spherical equivalent refraction (SER), in school-aged children before and after the pandemic of Coronavirus Disease 2019 (COVID-19).

Methods: A school-based vision screening study was performed on children in 133 primary schools in Wuhan. This study was conducted in 4 consecutive years (2018–2021).

Results: A total of 468,094 children (936,188 eyes) were recruited, 255,863 (54.7%) were boys. The SER decreased in 2020 compared to other years after the age of 10. A positive myopia shift was found in younger children aged 6 (0.1 D), 7 (0.05D), and 8 (0.03 D) in 2020 compared to 2019. The progression of vision has improved slightly in 2021. Among the students included in the study, 33.7% were myopia.

Conclusion: The vision of older children decreased significantly during the COVID-19. After the pandemic, there is still a high risk for them. In the future, the focus on vision prevention and control should move forward to preschool children.

Classification-Based Approaches to Myopia Control in a Taiwanese Cohort

Purpose

Myopia is a disorder of growing prevalence in school-aged children worldwide, especially in Asia. Although low-dose atropine is recognized as an effective treatment to slow myopia progression, different studies have reported varying efficacies of treatment, and the optimal concentration of low-dose atropine remains an open question.

Methods

A two-stage approach was conducted in this study. First, an observational study was conducted to plot the axial length growth curve for Taiwanese children. Second, an interventional 2-year study was performed in which different concentrations of low-dose atropine were applied based upon the risk-level status from the first stage.

Results

A total of 4,091 subjects, consisting of 2,105 boys (51.5%) and 1,986 girls (48.5%), were enrolled in the first stage to plot the axial growth curve for Taiwanese children aged between 3 and 16 years. The percentage of children with myopia increased from 2.3% in 4-year-olds to 88.0% in 16-year-olds. At the second stage, a total of 886 subjects [307 (34.65%) at low risk, 358 (40.41%) at moderate risk and 221 (24.94%) at high risk] were enrolled to receive low-dose atropine based upon the risk level (0.02, 0.03, and 0.05%, respectively). With this approach, the mean annual myopia progression was −0.33, −0.57, and −0.82 D in the low-risk, moderate-risk and high-risk groups, respectively. Applying annual myopic progression < -1.0 D as a criterion for responder, the responder rates were 95.77, 83.52, and 70.59% in the low-risk, moderate-risk, and high-risk groups, respectively.

Conclusions

We proposed a classification-based approach involving different concentrations of low-dose atropine based upon an individual's risk-level status. With this approach, myopic progression can be effectively controlled in patients without exposure to atropine side effects due to exposure to a higher dose than actually needed.

The Limited Value of Prior Change in Predicting Future Progression of Juvenile-onset Myopia

SIGNIFICANCE

Identifying children at highest risk for rapid myopia progression and/or rapid axial elongation could help prioritize who should receive clinical treatment or be enrolled in randomized clinical trials. Our models suggest that these goals are difficult to accomplish.

PURPOSE

This study aimed to develop models predicting future refractive error and axial length using children's baseline data and history of myopia progression and axial elongation.

METHODS

Models predicting refractive error and axial length were created using randomly assigned training and test data sets from 916 myopic participants in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study. Subjects were 7 to 14 years of age at study entry with three consecutive annual visits that included cycloplegic A-scan ultrasound and autorefraction. The effect of adding prior change in axial length and refractive error was evaluated for each model.

RESULTS

Age, ethnicity, and greater myopia were significant predictors of future refractive error and axial length, whereas prior progression or elongation, near work, time outdoors, and parental myopia were not. The 95% limits for the difference between actual and predicted change were ±0.22 D and ±0.14 mm without prior change data compared with ±0.26 D and ±0.16 mm with prior change data. Sensitivity and specificity for identifying fast progressors were between 60.8 and 63.2%, respectively, when the cut points were close to the sample average. Positive predictive value and sample yield were even lower when the cut points were more extreme.

CONCLUSIONS

Young, more myopic Asian American children in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study were the most likely to progress rapidly. Clinical trials should expect average progression rates that reflect sample demographics and may have difficulty recruiting generalizable samples that progress faster than that average. Knowing progression or elongation history does not seem to help the clinical decision regarding initiating myopia control.

Premyopia at Preschool Age: Population-based Evidence of Prevalence and Risk Factors from A Serial Survey in Taiwan

PURPOSE

Premyopia at a young age carries a great risk of developing early-onset myopia, especially in regions with the epidemic of myopia, such as the developed areas in East Asia. This study aims to report the prevalence of premyopia and its risk factors in a Taiwan preschool population and lifestyle changes among premyopic preschoolers before and during the coronavirus disease 2019 (COVID-19) pandemic.

DESIGN

Repeated countywide population-based, cross-sectional study in Yilan County, northeastern Taiwan.

PARTICIPANTS

From 2014 through 2020, a total of 23,930 kindergarteners aged 5-6 years were identified in the Yilan Myopia Prevention and Vision Improvement Program (YMVIP). Of those, 21,761 (11,335 [52.1%] boys; mean age, 5.15 ± 0.37 years) were included for final analysis.

METHODS

Annual kindergarten-based eye examinations and myopia prevention strategies have been conducted since the commencement of the YMVIP in 2014. Refractive error was determined by cycloplegic autorefraction. The data of potential risk factors for myopia were gathered by caregiver-administered questionnaires.

MAIN OUTCOME MEASURES

The prevalence of premyopia (spherical equivalent [SE] > -0.5 diopter [D] and ≤ +0.75 D in the eye with less SE value) RESULTS: The prevalence of myopia (SE ≤ -0.5 D), premyopia, and hyperopia (SE > +0.75) was 10.7% (95% confidence interval [CI], 10.3%-11.1%), 52.0% (95% CI, 51.3%-52.7%), and 37.3% (95% CI, 36.7%-37.9%), respectively. Multinomial logistic regression analysis showed that premyopia prevalence was significantly associated with male gender (odds ratio [OR], 1.25; 95% CI, 1.18-1.32), caregiver myopia (OR, 1.46; 95% CI, 1.37-1.56), screen time ≥ 1 hour per weekdays (OR, 1.10; 95% CI, 1.04-1.17), 2-year exposure to myopia prevention strategy (OR, 0.59; 95% CI, 0.54-0.65), and college or higher education level of caregiver (OR, 0.91; 95% CI, 0.85-0.96). Even without large-scale school closure in Taiwan, there was a slight upward trend of increased time spent on screen-based devices during the COVID-19 pandemic.

CONCLUSIONS

Our findings showed that premyopia was the most common refractive error in a Taiwan preschool population. Premyopia was also associated with both parental and environmental myopiogenic factors. Longitudinal studies are warranted to examine the lifestyle change and myopic shift of premyopic preschoolers in the post-pandemic era.

Update on Myopia Control: The US Perspective

ABSTRACT

Myopia is a global epidemic on the rise, garnering increased attention, particularly in therapeutics and prevention, and the field of myopia control. This study reviews the current management options including contact lenses, spectacles, atropine, and environmental and behavioral modifications. Particular attention is given to the US perspective.

Prevalence and risk factors for myopia and high myopia: A cross-sectional study among Han and Uyghur students in Xinjiang, China

PURPOSE

This study aimed to investigate the prevalence and risk factors for myopia and high myopia among Han and Uyghur students in Xinjiang, China.

METHODS

This cross-sectional study with a multistage, stratified cluster sampling method was completed in Xinjiang, China. Visual acuity and noncycloplegic refraction were measured. The crude and sex- and age-adjusted prevalence of myopia and high myopia in Han and Uyghur students were compared. Multivariate logistic regression analyses were applied to identify risk factors associated with myopia and high myopia.

RESULTS

In total, 84,033 participants were included in the final analysis, comprising 64,110 Han and 19,923 Uyghur participants. The overall age- and sex-adjusted prevalence of myopia and high myopia were 47.70% (95% CI: 47.67-47.74) and 2.55% (95% CI: 2.54-2.56), respectively. Compared to the Uyghur population, the Han population had a higher prevalence of myopia (63.59% vs. 21.34%, p < 0.0001) and high myopia (4.68% vs. 0.6%, p < 0.0001). Han ethnicity, age, female sex, higher education level and living in urban areas were found to be positively associated with myopia and high myopia. Living in northern Xinjiang was found to be positively associated with myopia but negatively associated with high myopia.

CONCLUSIONS

Our study investigated the prevalence of myopia and high myopia among Han and Uyghur students aged 4-23 years in Xinjiang, China. The Han population had a higher prevalence of myopia and high myopia than the Uyghur population. However, the prevalence of myopia among the Uyghur population showed a more remarkable increasing trend than that among the Han population in Xinjiang.

Rates of Myopia Development in Young Chinese Schoolchildren During the Outbreak of COVID-19

Importance

During the outbreak of COVID-19, outdoor activities were limited and digital learning increased. Concerns have arisen regarding the impact of these environmental changes on the development of myopia.

Objective

To investigate changes in the development of myopia in young Chinese schoolchildren during the outbreak of COVID-19.

Design, Setting, and Participants

In this observational study, 2 groups of students from 12 primary schools in Guangzhou, China, were prospectively enrolled and monitored from grade 2 to grade 3. Comparisons between the exposure and nonexposure groups were made to evaluate any association between environmental changes during the COVID-19 outbreak period and development of myopia. The exposure group received complete eye examinations in November and December 2019 and November and December 2020. The nonexposure group received examinations in November and December 2018 and November and December 2019.

Main Outcomes and Measures

Changes in cycloplegic spherical equivalent refraction (SER), axial length (AL) elongation, and myopia incidence from grade 2 to grade 3.

Results

Among the 2679 eligible students in grade 2 (mean [SD] age, 7.76 [0.32] years; 1422 [53.1%] male), 2114 (1060 in the nonexposure group and 1054 in the exposure group) were reexamined in grade 3. Compared with the period from November and December 2018 to November and December 2019, the shift of SER, AL elongation, and myopia incidence from grade 2 to grade 3 from November and December 2019 to November and December 2020 was 0.36 D greater (95% CI, 0.32-0.41; P < .001), 0.08 mm faster (95% CI, 0.06-0.10; P < .001), and 7.9% higher (95% CI, 5.1%-10.6%; P < .001), respectively. In grade 3 students, the prevalence of myopia increased from 13.3% (141 of 1060 students) in November and December 2019 to 20.8% (219 of 1054 students) in November and December 2020 (difference [95% CI], 7.5% [4.3-10.7]; P < .001); the proportion of children without myopia and with SER greater than -0.50 D and less than or equal to +0.50 D increased from 31.1% (286 of 919 students) to 49.0% (409 of 835 students) (difference [95% CI], 17.9% [13.3-22.4]; P < .001).

Conclusions and Relevance

In this study, development of myopia increased during the COVID-19 outbreak period in young schoolchildren in China. Consequently, myopia prevalence and the proportion of children without myopia who were at risk of developing myopia increased. Future studies are needed to investigate long-term changes in myopia development after the COVID-19 pandemic.

Who needs myopia control?

Myopia has become a major visual disorder among school-aged children in East Asia due to its rising prevalence over the past few decades and will continue to be a leading health issue with an annual incidence as high as 20%-30%. Although various interventions have been proposed for myopia control, consensus in treatment strategies has yet to be fully developed. Atropine and orthokeratology stand out for their effectiveness in myopia progression control, but children with rapid progression of myopia require treatment with higher concentrations of atropine that are associated with increased rates of side effects, or with orthokeratology that carries risk of significant complication. Therefore, improved risk assessment for myopia onset and progression in children is critical in clinical decision-making. Besides traditional prediction models based on genetic effects and environmental exposures within populations, individualized prediction using machine learning and data based on age-specific refraction is promising. Although emerging treatments for myopia are promising and some have been incorporated into clinical practice, identifying populations who require and benefit from intervention remains the most important initial step for clinical practice.

Stepwise low concentration atropine for myopic control: a 10-year cohort study

The aim of this study was to analyze changes in refraction and evaluate the variables in school children who received atropine as myopic control for 10 years. Low-concentration atropine (0.05%) was prescribed initially, and the dose was increased in a stepwise manner if rapid myopic progression (≥ 0.5D per half year) was noted during the regular follow-up visit. 23 children with a mean age of 6.96 ± 1.07 years were included. The initial spherical equivalent was − 1.25 ± 0.84 D. The overall mean myopic progression was − 0.30 ± 0.27 D/year. Younger initial age, female, higher initial spherical equivalent and the need of higher concentration of atropine were found to be risk factors for myopic progression in multivariate mixed-effect analysis (p = 0.013, 0.017, 0.024 and 0.014). Children who kept using a lower concentration of atropine (≤ 0.1%) tended to have slower myopic progression throughout the 10-year course than those who shifted to higher concentrations (> 0.1%) (p ≤ 0.001). Stepwise low concentration of atropine might be effective for long-term myopic control in school students. Those who had poor response to lower concentration of atropine may have the risk of faster progression, even with high concentration of atropine. Additional or alternative treatment might be considered.

Prevalence Trend of Myopia after Promoting Eye Care in Preschoolers: A Serial Survey in Taiwan before and during the Coronavirus Disease 2019 Pandemic

PURPOSE

To report the prevalence of preschool myopia after implementing a policy intervention promoting outdoor activities and the secular trend of myopia before and during the coronavirus disease 2019 (COVID-19) pandemic in a Taiwan preschool population.

DESIGN

Repeated countywide population-based, cross-sectional surveys based on the Yilan Myopia Prevention and Vision Improvement Program (YMVIP).

PARTICIPANTS

Among 23 930 kindergarteners 5 to 6 years of age from 7 school-year cohorts in Yilan County from 2014 through 2020, a total of 21 761 children (90.9%) were included for analysis.

METHODS

Since launching the YMVIP in August 2014, myopia prevention strategies, such as increasing outdoor activities (2 hours/weekday), have been promoted in all kindergartens, and countywide school-based eye examinations, including cycloplegic autorefraction, and caregiver-administered questionnaires have been carried out annually for all participants.

MAIN OUTCOME MEASURES

The prevalence of myopia (spherical equivalent, ≤ -0.5 D in either eye) in each of the 7 school-year cohorts of preschoolers 5 to 6 years of age.

RESULTS

The prevalence of myopia continuously decreased for 2 years after implementing the YMVIP: 2014 cohort, 15.5% (95% confidence interval [CI], 14.2%-16.8%); 2015 cohort, 13.5% (95% CI, 12.3%-14.7%); and 2016 cohort, 8.4% (95% CI, 7.4%-9.4%). Subsequent cohorts were exposed maximally to these school-based myopia prevention strategies, and the prevalence of myopia remained relatively stable, between 8.5% and 10.3%, even during the COVID-19 pandemic. Multivariate logistic regression analysis showed a dose-dependent association between the duration of exposure to preventive strategies and the prevalence of myopia (up to 1-year YMVIP exposure, odds ratio, 0.86 [95% CI, 0.74-0.99]; up to 2-year YMVIP exposure, odds ratio, 0.56 [95% CI, 0.50-0.63]) after controlling other myopigenic factors.

CONCLUSIONS

This population-based evidence showed high prevalence of preschool myopia and an L-shaped decline after introducing strategies to promote outdoor activities in kindergartens. With undisrupted school-based preventive strategies, the prevalence of myopia can be kept stable, even during the COVID-19 pandemic.