Prevalence and Causes of Low Vision and Blindness in a Japanese Adult Population

Evaluating the Volume of Eyes With Pathologic Myopia Using 3D MRI

Purpose

To determine the volume of eyes and its relationship to the shape and the presence of posterior staphylomas in patients with high myopia (HM).

Methods

We studied 370 eyes of 199 patients with HM (refractive error >8.00 diopters [D] or an axial length ≥26.5 mm) and 44 eyes of 35 control patients without HM (refractive error from -7.50 to +2.50 D). Magnetic resonance imaging (MRI) of the ocular orbit was used to measure the volume of the eye using three-dimensional (3D) MRI. Reconstructed 3D images of eye were classified according to symmetry and steepness of the posterior curvature.

Results

The mean volume was 12.42 ± 2.40 mL of the 370 HM eyes and 9.67 ± 1.41 mL of the 44 non-HM eyes. Thus, the volume of the HM eyes was 1.3 times larger than the mean volume of the non-HM eyes. The mean volume of the eye was significantly smaller in the cylindrically shaped and larger in barrel-shaped eyes than the eyes with other shapes. The mean eye volume in the HM eyes with a posterior staphyloma was not significantly different from that of HM eyes without a posterior staphyloma.

Conclusions

The volume of HM eyes is larger than non-HM eyes and is associated with steepness of posterior curvature but not with the presence of a posterior staphyloma, suggesting that local outward protrusion of the posterior eye wall is not directly caused by global expansion of eyes and should be monitored specifically in HM eyes.

Topical review: Potential mechanisms of atropine for myopia control

SIGNIFICANCE

Atropine is effective at slowing myopia progression in children, but the mechanism of action by which it controls myopia remains unclear. This article is an evidenced-based review of potential receptor-based mechanisms by which atropine may act to slow the progression of myopia.The rising number of individuals with myopia worldwide and the association between myopia and vision-threatening ocular pathologies have made myopia control treatments one of the fastest growing areas of ophthalmic research. High-concentration atropine (1%) is the most effective treatment for slowing myopia progression to date; low concentrations of atropine (≤0.05%) appear partially effective and are currently being used to slow myopia progression in children. While significant progress has been made in the past few decades in understanding fundamental mechanisms by which atropine may control myopia, the precise characterization of how atropine works for myopia control remains incomplete. It is plausible that atropine slows myopia via its affinity to muscarinic receptors and influence on accommodation, but animal studies suggest that this is likely not the case. Other studies have shown that, in addition to muscarinic receptors, atropine can also bind, or affect the action of, dopamine, alpha-2-adrenergic, gamma-aminobutyric acid, and cytokine receptors in slowing myopia progression. This review summarizes atropine's effects on different receptor pathways of ocular tissues and discusses how these effects may or may not contribute to slowing myopia progression. Given the relatively broad array of receptor-based mechanisms implicated in atropine control of myopia, a single mode of action of atropine is unlikely; rather atropine may be exerting its myopia control effects directly or indirectly via several mechanisms at multiple levels of ocular tissues, all of which likely trigger the response in the same direction to inhibit eye growth and myopia progression.

Topical Dopamine Application on Form-Deprivation Myopia in Rabbits

Background/Objectives: This study aimed to investigate the efficacy of topical dopamine administration in inhibiting form deprivation (FD) myopia in a rabbit model. Methods: A total of 16 neonatal New Zealand white rabbits were randomly assigned to two groups: a control group and a dopamine treatment group. FD myopia was induced in both groups by applying a light diffuser to one eye. The dopamine group received daily topical instillations of 4% dopamine in the eye with FD myopia, while the control group received normal saline instillations over a four-week period. Axial length measurements were taken to assess the degree of myopia, and histological analysis was performed to evaluate retinal safety and structural integrity. Results: The results indicated that dopamine treatment significantly inhibited axial elongation of the FD eyes compared to the control group, with measurements of 15.07 ± 0.34 mm for the dopamine group versus 15.63 ± 0.33 mm for the control group (p = 0.015). Histological analysis showed no evidence of structural alterations or apoptosis in the retina, confirming the safety of topical dopamine. Conclusions: Topical dopamine appears to be a promising therapeutic approach for controlling the progression of myopia in a rabbit model, demonstrating significant efficacy in reducing axial elongation without inducing ocular toxicity. These findings highlight the potential of dopamine in managing myopia and warrant further investigation in clinical settings.

Application of 3D MRI and SS-OCT/OCTA in Assessment of Posterior Scleral Contraction for Myopic Traction Maculopathy

Purpose

To evaluate the clinical efficacy and safety of posterior scleral contraction (PSC) in the treatment of myopic traction maculopathy (MTM) by three-dimensional magnetic resonance imaging (3D MRI), swept-source optical coherence tomography (SS-OCT) and swept-source optical coherence tomography angiography (SS-OCTA).

Methods

In this prospective study, 30 eyes of 25 patients with MTM were treated with PSC. The ocular parameters of the patients were measured before surgery and at 1 month, 6 months, and 1 year after 3D MRI and SS-OCT/OCTA.

Results

The differences in preoperative and postoperative parameters, including axial length (AL), spherical equivalent (SE), best-corrected visual acuity (BCVA), retinoschisis area, total posterior staphyloma height (PSH), and vitreous volume were statistically significant (P < 0.001). The choroidal thickness (CT) in each sector, choroidal perfusion area (CPA) in subfoveal and temporal sectors, and choroidal vascularity index (CVI) in inferior and temporal sectors increased significantly after PSC surgery (P < 0.05). Additionally, 3D MRI showed that the surgical strips remained strong and stable during the follow-up period, without complications such as strip displacement, fracture, and loosening.

Conclusions

The application of 3D MRI and SS-OCT/OCTA in assessment of the treatment of MTM with PSC was comprehensive with multiple ocular parameters and could further guide the clinical diagnosis and treatment of MTM.

Translational Relevance

We combined SS-OCT/OCTA and 3D MRI to provide the basis of a theory for guiding the clinical diagnosis and treatment of MTM.

UPLC-MS/MS-based serum metabolomics analysis for comprehensive pathological myopia profiling

Pathological myopia (PM) is associated with ocular morbidities that cause blindness. PM often occurs in eyes with high myopia (HM) while they are distinctly different. Identifying the differences in metabolites and metabolic pathways between patients with PM and HM may provide information about the pathogenesis of PM, which is currently unknown. This study aimed to reveal the comprehensive metabolic alterations associated with PM. Thirty patients with PM, 27 with simple HM and 27 with low myopia (LM) were enrolled in this study. Ultra-performance liquid chromatography/tandem mass spectrometry (UPLC-MS/MS) was performed, and a Venn diagram was generated to explore the overlapping differential metabolites and enriched pathways between each set of two groups. The area under the receiver operating characteristic curve (AUC) was computed to assess the discrimination capacity of each metabolite marker. A total of 134, 125 and 81 differential metabolites were identified in each comparison. Thirty-two differential metabolites were overlapped between the PM vs HM comparison and the PM vs LM comparison. Of these 32 metabolites, 16 were common to all three comparisons; among these metabolites, high levels of 4-hydroxy-l-glutamic acid and low levels of succinic semialdehyde and 2,3-dinor-8-iso prostaglandin F2α appeared to be risk factors for PM. The remaining 16 metabolites were shared only between the PM versus HM and PM versus LM comparisons, most of which are lipid molecules. Pathway analysis revealed that alanine, aspartate and glutamate metabolism was the key metabolic pathway altered in PM patients. Overall, significant differences in the metabolites and metabolic pathways were observed in patients with PM. The metabolic differences identified in this study included differential factors between PM and HM patients, addressing current gaps in PM research. These findings provide a novel perspective of the molecular mechanism of PM.

Low Vision Practice and Service Provision Among Optometrists in Ghana: A Nationwide Survey

PURPOSE

To characterize practice patterns of low vision services among Optometrists in Ghana.

METHODS

The nationwide cross-sectional survey identified entities through the Ghana Optometrists Association (GOA) registry and utilized a semi-structured questionnaire to consolidate survey information that comprises practitioners' demographics, available services, diagnostic equipment, barriers to service provision and utilization, and interventions.

RESULTS

300 Optometrists were identified, with 213 surveyed (71% response rate). About fifty percent (52.6%) were in private practice, and more than two-thirds (77%) did not provide low vision services. Most (≥70%) reported lack of assistive devices, and basic eye care examination kits as the main barriers to low vision service provision. Similarly, practitioners reported unawareness of the presence of low vision centres (76.1%), and high cost of low vision aids (75.1%) as the prime perceived barriers for patients to utilize low vision services. Continuous professional development and public education (89-90%) were suggested as interventions to improve the uptake of low vision services. After statistical adjustment, private facility type (Adjusted odds ratio [AOR] = 0.35, p = 0.010) and lack of basic eye examination kits (AOR = 0.32, p = 0.002) were significantly associated with reduced odds of low vision service provision. Conversely, ≥15 years of work experience (AOR = 6.37, p = 0.011) was significantly associated with increased odds of low vision service provision.

CONCLUSIONS

Overall, the results indicate inadequate low vision coverage and service delivery. Government policies must be directed towards equipping practitioners with equipment and subsidize patient cost of treatment to optimize low vision care.

Effect of 0.01% atropine eye drops combined with different optical treatments to control low myopia in Chinese children

PURPOSE

To investigate the efficacy and safety of 0.01% atropine (AT) in combination with different optical treatments for controlling myopia in Chinese children.

METHODS

This retrospective study analyzed 341 Chinese children aged 6-11 years with myopia between -0.50 D and -3.0 D between January 2022 and May 2023. The fast-progressing, myopic children received three optical treatments combined with 0.01 % atropine: 75 children with single-vision spectacles and atropine (SV + AT), 162 children with defocus-incorporated multi-segment spectacles and atropine (DIMS + AT), or 104 children with orthokeratology and atropine (OK + AT). The changes in spherical equivalent refraction (SER), axial length (AL), intraocular pressure (IOP), and amplitude of accommodation (AMP) were observed at 6-month and 1-year intervals.

RESULTS

After controlling for baseline variables, at 6 months, the increase in adjusted AL was significantly greater in the SV + AT group than in the DIMS + AT group (difference = 0.13 mm, 95 % CI: 0.07-0.20, P < 0.05) and in the OK + AT group (difference = 0.09 mm, 95 % CI: 0.09-0.17, P < 0.05). A more significant progression in adjusted SER was also observed in the SV + AT group than in the DIMS group (difference = -0.20D, 95 % CI: -0.29 to -0.11, P < 0.05). At 12 months, the greatest increase in adjusted AL was observed in the SV + AT group, with a statistically significant difference of 0.24 mm (95 % CI: 0.19-0.29, P < 0.05) compared with the DIMS group and a difference of 0.19 mm (95 % CI: 0.13-0.25, P < 0.05) compared with the OK + ST group. Similarly, a more significant progression in adjusted SER was observed in the SV + AT group than in the DIMS group (difference = -0.36 D, 95 % CI: -0.48 to -0.24, P < 0.05).

CONCLUSIONS

This study suggested that 0.01% atropine combined with DIMS or orthokeratology may be viable for controlling low myopia in fast-progressing, myopic children.

Quantitative analysis of retinal vascular parameters changes in school-age children with refractive error using artificial intelligence

Aim

To quantitatively analyze the relationship between spherical equivalent refraction (SER) and retinal vascular changes in school-age children with refractive error by applying fundus photography combined with artificial intelligence (AI) technology and explore the structural changes in retinal vasculature in these children.

Methods

We conducted a retrospective case-control study, collecting data on 113 cases involving 226 eyes of schoolchildren aged 6-12 years who attended outpatient clinics in our hospital between October 2021 and May 2022. Based on the refractive spherical equivalent refraction, we categorized the participants into four groups: 66 eyes in the low myopia group, 60 eyes in the intermediate myopia group, 50 eyes in the high myopia group, and 50 eyes in the control group. All participants underwent a series of examinations, including naked-eye and best-corrected visual acuity, cycloplegic spherical equivalent refraction, intraocular pressure measurement, ocular axial measurement (AL), and color fundus photography. Using fundus photography, we quantitatively analyzed changes in the retinal vascular arteriovenous ratio (AVR), average curvature, and vascular density with AI technology. Data were analyzed using the χ2 test and one-way analysis of variance.

Results

The AVR in the low myopia group, moderate myopia group, high myopia group, and control group were 0.80 ± 0.05, 0.80 ± 0.04, 0.76 ± 0.04, and 0.79 ± 0.04, respectively, and the vessel densities were 0.1024 ± 0.0076, 0.1024 ± 0.0074, 0.0880 ± 0.0126, and 0.1037 ± 0.0143, respectively The difference between the AVR and vascular density in the high myopia group was statistically significant compared to the other three groups (p < 0.05). Linear correlation analysis showed a strong negative correlation between the spherical equivalent refraction and the ocular axis (r = -0.874, p < 0001), a moderate positive correlation between the spherical equivalent refraction and the vascular density (r = 0.527, p < 0001), and a moderate negative correlation between the ocular axis and the vascular density (r = -0.452, p < 0001).

Conclusion

Schoolchildren with high myopia showed a decreased AVR and decreased vascular density in the retinal vasculature. The AVR and vascular density may be early predictors of myopia progression.

Dietary caloric restriction protects experimental autoimmune uveitis by regulating Teff/Treg balance

Uveitis, an autoimmune disease, often leads to blindness. CD4+ T cells, including regulatory T cells (Tregs) and effector T cells (Th1 and Th17), play a critical role in its pathogenesis. Caloric restriction (CR) has been shown to alleviate autoimmune diseases. However, careful characterization of the impact of CR on experimental autoimmune uveitis (EAU) is poorly understood. This study used single-cell RNA sequencing to analyze cervical draining lymph nodes in mice under ad libitum (AL) and CR diets, with or without EAU. CR increased Tregs, altered immune cell metabolism, reduced EAU symptoms, and downregulated inflammatory and glycolysis genes. Flow cytometry confirmed CR's inhibitory effect on Th1 and Th17 proliferation and its promotion of Treg proliferation. CR also balanced CD4+ T cells by inhibiting the PI3K/AKT/c-Myc pathway and reducing GM-CSF in Th17 cells. These findings suggest CR as a potential therapeutic strategy for autoimmune diseases.

Comparison of visual acuity outcome and choroidal thickness variation of intravitreal ranibizumab injection for myopic choroidal neovascularization with or without dome-shaped macula

BACKGROUND

To investigate the visual acuity outcome and choroid thickness (CT) change after intravitreal ranibizumab in highly myopic eyes with or without dome-shaped macula (DSM) in Chinese patients.

METHODS

This retrospective, observative study included 80 treatment-naive eyes (80 patients), which received ranibizumab according to the 1+PRN protocol. The best corrective visual acuity (BCVA) and CT change were compared between eyes with or without DSM.

RESULTS

There was no significant difference between eyes with or without DSM in BCVA and central macular thickness (CMT). The recurrent rate was not different between the two groups during the first year of treatment. The CT was significantly thinner in eyes with DSM than in eyes without DSM before treatment (median 40.00um versus 71.00um), at 1 month after treatment (median 31.00um versus 65.50um), and in the last follow up (median, 32.00um versus 65.00um) (p = 0.0101). Axial length (AL) was longer in eyes with DSM than those without DSM (median, 29.17 mm versus 28.10 mm) before treatment, and in the last follow up (median, 29.44 mm versus 28.20 mm) (p = 0.0055). The CT was significantly correlated with AL (p < 0.0001).

CONCLUSIONS

No difference was found in visual outcome between eyes with or without DSM. The visual acuity significantly improved at 1 month after ranibizumab injection and it was recovery sooner in extrafoveal choroidal neovascularization (CNV) group than in subfoveal CNV group. The CT was thinner in eyes with DSM, which was significantly correlated with AL.

Choroidal Thickness and Visual Acuity in High Myopia Without Myopic Maculopathy: Insights From a Chinese Population Study

Purpose

To evaluate the association of choroidal thickness (ChT) with best-corrected visual acuity (BCVA) in patients with high myopia (HM) and without myopic maculopathy.

Methods

This study was a retrospective, cross-sectional study of participants aged 7 to 70 years with bilateral HM but without myopic maculopathy. Swept-source optical coherence tomography was used to measure ChT at the fovea. A BCVA of logMAR 0.1 was regarded as the benchmark for normal. The association between ChT and BCVA was evaluated by linear regression models with confounders fully adjusted. Subgroup analyses were performed across sex and age groups.

Results

A total of 412 eligible participants were enrolled in this study. The mean age, spherical equivalence, and subfoveal (SF) ChT of the included participants were 21.17 ± 9.55 years, -9.77 ± 2.40 diopters, and 171.56 ± 61.33 µm, respectively. The SF ChT was thinner in participants with abnormal BCVA (normal. 176.74 ± 60.24 µm; abnormal, 139.30 ± 58.63 µm). A thinner ChT in all subregions of the posterior pole of the Early Treatment Diabetic Retinopathy Study grid was associated significantly with a worse BCVA after adjusting for age, sex, and axial length (SF ChT: coefficient, × 10-4, -2.64; 95% confidence interval, -4.73 to -0.55; P < 0.05 in all subregions). The strongest correlation was observed in the outer inferior region, where a per 21 µm thinning of ChT led to a 0.01 worsening of BCVA. This correlation presented a stronger magnitude in male aged more than 40 years.

Conclusions

In patients with HM without myopic maculopathy, a thinner ChT was associated independently with a worse BCVA.

Translational Relevance

The findings of this study suggest that thinning ChT should be considered a vital risk factor for irreparable visual acuity impairment.

Can we really distinguish 'responders' from 'non-responders' to myopia control interventions?

PURPOSE

It is common to hear talk of 'responders' and 'non-responders' with respect to myopia control interventions. We consider the reality of distinguishing these sub-groups using data from the first year of the Low-concentration Atropine for Myopia Progression (LAMP) study.

METHODS

The first year of the LAMP study was a robustly designed, placebo-controlled trial of three different low concentrations of atropine using a large sample size (N > 100 randomised to each group). The authors subsequently published mean axial elongation and myopia progression rates by age group. We used these data to calculate efficacy in terms of both absolute reduction in myopic progression and absolute reduction in axial elongation for each of the different atropine concentrations at each age group. We then compared these efficacy data to the overall progression for each of the two progression metrics.

RESULTS

Plotting efficacy as a function of overall myopia progression and axial elongation for each of the different atropine concentrations demonstrates the invariant nature of efficacy, in terms of clinically meaningful reduction in progression, despite a substantial range of underlying overall progression. That is, faster progressors-the so-called non-responders-achieved similar reduction in axial elongation and myopia progression as the slower progressors-the so-called responders-within the various atropine treatment groups.

CONCLUSION

The use of the terms, responders and non-responders, during myopia progression interventions is not supported by evidence. Those designated as such may simply be slower or faster progressors, who, on average achieve the same benefit from treatment.

Systemic Oxidative Stress Level as a Pathological and Prognostic Factor in Myopic Choroidal Neovascularization

Purpose

To investigate the association of systemic oxidative stress level with myopic choroidal neovascularization (mCNV) and its clinical outcomes.

Design

Retrospective case-control study.

Participants

This retrospective study included 52 eyes of 52 healthy participants (mean age: 62.5 years), 30 eyes of 30 patients (mean age: 59.6 years) with high myopia (HM) but without mCNV, and 23 eyes of 23 patients (mean age: 61.8 years) with HM and mCNV who received intravitreal anti-VEGF antibody injections (IVIs) using a pro re nata regimen during the 6-month follow-up after the first IVI.

Methods

Clinical findings, including oxidative stress parameters, such as diacron reactive oxygen metabolites (dROMs), biological antioxidant potential (BAP), and the BAP/dROM ratio (B/d ratio), were analyzed.

Main Outcome Measures

Clinical features and oxidative stress parameters.

Results

Both BAP and the B/d ratio were significantly lower in the HM/mCNV group than in the HM/no mCNV group (P = 0.002 and P = 0.012, respectively) and than in the control group (P = 0.001 and P = 0.026, respectively). In a multiple logistic regression analysis, axial length (odds ratio 1.878, P = 0.042) and the B/d ratio (odds ratio 0.470, P = 0.026) were significantly associated with mCNV. Dividing the patients into high and low B/d ratio groups (with a cutoff of 5.2) showed that subfoveal choroidal thickness (SFCT) was lower (P = 0.002) and the number of IVI treatments was higher (P = 0.029) in the low B/d ratio group than in the high B/d ratio group. In multiple regression analyses, only the B/d ratio was significantly associated with SFCT (β = 0.684, P = 0.006).

Conclusions

The oxidative stress level in eyes with HM differed according to mCNV, SFCT, and the number of IVI treatments. Measuring oxidative stress parameters might be useful in eyes with HM both for assessing the risk of developing mCNV and determining disease activity.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Risk of visual impairment according to the comorbidity of systemic and ocular diseases

PURPOSE

To investigate the risk of visual impairment (VI) based on the presence or absence of four diseases: hypertension (HTN), diabetes mellitus (DM), glaucoma, and diabetic retinopathy (DR).

METHODS

This retrospective population-based study included 1,000,000 randomly selected participants from the National Health Checkup Program database between 2015 and 2016. VI was defined as a presenting visual acuity ≤ 0.5 in the better eye. The participants were divided into 12 groups according to the presence or absence of disease. Adjusting for age and sex, the risk of VI in each disease group was analyzed and compared with the others.

RESULTS

Among the 1,000,000 participants, 88,931 (8.89%) had VI. The odds ratios (ORs) of age, male sex, HTN, DM, glaucoma, and DR for VI were 1.06 (95% CI, 1.05-1.06), 0.52 (95% CI, 0.52-0.53), 1.11 (95% CI, 1.09-1.13), 1.07 (95% CI, 1.05-1.09), 0.92 (95% CI, 0.90-0.74), and 1.29 (95% CI, 1.25-1.34), respectively (all P < 0.001). The group with HTN, DM, glaucoma, and DR had the highest OR of 1.98 (P < 0.001) compared to the healthy group. HTN, DM, and DR were positively correlated with VI in all groups. Glaucoma was positively correlated in the group with DM and DR and in the group with HTN, DM, and DR (ORs 1.18, 1.11, all P < 0.05); however, it demonstrated a negative correlation in the other groups (ORs 0.85-0.93, all P < 0.05).

CONCLUSION

HTN, DM, and DR, either alone or in combination, increase the risk of VI. Glaucoma also increases the risk when combined with DR; however, it has a negative correlation with VI in the absence of DR. Periodic ophthalmologic examinations for glaucoma, which primarily affects the peripheral visual field and not central visual acuity, might help prevent VI caused by other diseases.

Choroidal thinning in myopia is associated with axial elongation and severity of myopic maculopathy

High myopia can lead to pathologic myopia and visual impairment, whereas its causes are unclear. We retrospectively researched high myopia cases from patient records to investigate the association between axial elongation and myopic maculopathy. Sixty-four eyes were examined in patients who visited the department between July 2017 and June 2018, had an axial length of 26 mm or more, underwent fundus photography, and had their axial length measured twice or more. The average axial length was 28.29 ± 1.69 mm (mean ± standard deviation). The average age was 58.3 ± 14.4 years old. Myopic maculopathy was categorized as mild (grades 0 and 1) and severe (grades 2, 3, and 4). The severe group had longer axial lengths than the mild group (P < 0.05). Moreover, the severe group exhibited thinner choroidal thickness than the mild group (P < 0.05). When subjects were grouped by axial elongation over median value within a year, the elongation group showed thinner central choroidal thickness than the non-elongation group (142.1 ± 91.9 vs. 82.9 ± 69.8, P < 0.05). In conclusion, in patients with high myopia, the severity of maculopathy correlated with choroidal thickness and axial length. Thinner choroidal thickness was associated with axial elongation based on the baseline axial length.

Comparative analysis of macular characteristics in mCNV and contralateral eyes

Purpose

To illustrate the characteristics of perforating scleral vessels in macular regions between mCNV eyes and contralateral eyes in unilateral mCNV patients.

Methods

This was a retrospective study that included patients with unilateral naive mCNV. The study aimed to identify and analyze the distribution of perforating scleral vessels (PSVs) in the macular region of mCNV eyes and contralateral eyes. The central macular choroidal thicknesses (mChT) were measured using optical coherence tomography angiography (OCTA). The grades of myopic atrophic maculopathy (MAM) and macular myopic diffuse chorioretinal atrophy (DCA) were evaluated within groups. The number of PSVs and mChT were compared between contralateral and mCNV eyes based on the grade of DCA. The ROC curves were utilized to explore the diagnostic indexes for mCNV.

Results

A total of 102 eyes from 51 patients with unilateral mCNV were included. There was no significance in the severity of MAM or the grade of DCA between mCNV eyes and contralateral eyes (p = 0.074, p = 0.054, respectively). The mean number of PSVs in mCNV eyes was fewer than the contralateral eyes [1.00 (1.00-2.00) vs. 2.00 (0.75-3.00), p = 0.030]. The mChT in mCNV eyes was thinner than the contralateral eyes [36.00 (25.00-53.75) μm vs. 46.00 (31.00-75.25) μm, p = 0.001]. The mean grade of DCA in mCNV eyes was higher than that in contralateral eyes [3.00 (3.00-3.00) vs. 3.00 (2.00-3.00), p = 0.004]. When DCA involved the macular region, there were more PSVs in contralateral eyes than in mCNV eyes [1.50 (1.00-2.00) vs. 2.00 (1.00-3.00), p = 0.042]. Similarly, when DCA involved the foveal region, there were more PSVs in contralateral eyes than in mCNV eyes [1.50 (1.00-2.00) vs. 3.00 (2.00-4.00), p = 0.004]. The grade of DCA and mChT were valuable factors for predicting mCNV eyes (AUC = 0.6566, p = 0.021; AUC = 0.6304, p = 0.029; respectively). When the extent of DCA exceeded the foveal region, the count of PSVs was a good diagnostic factor for predicting mCNV (AUC = 0.7430, p = 0.003).

Conclusion

The mean amount of PSVs was significantly lower in the mCNV eyes compared to the contralateral eyes. When the extent of DCA exceeded the foveal region, the count of PSVs was a good diagnostic factor for predicting mCNV. Myopic eyes with a higher grade of DCA and a thinner mChT were more likely to develop mCNV.

Morphological characteristics of the foveal avascular zone in pathological myopia and its relationship with macular structure and microcirculation

PURPOSE

To explore the characteristics of macular structure, microcirculation, and foveal avascular zone (FAZ) morphology in pathological myopia and to research the associations between these factors and pathological myopia.

METHODS

This is a cross-sectional study. The study included 103 eyes with non-high myopia and 206 eyes with high myopia (139 with simple high myopia and 67 with pathological myopia). Macular structural and microcirculation parameters were determined using optical coherence tomography angiography (OCTA). The FAZ morphological parameters were measured manually using Image J software. Correlations between pathological myopia and various factors were analyzed.

RESULTS

Patients with pathological myopia had a thinner retinal thickness (RT) and choroidal thickness (CT) and a lower retinal superficial vascular density (SVD), retinal deep vascular complex density (DVD), choriocapillaris perfusion area (CCPA), and choroidal vascularity index (CVI) (all P < 0.05). Patients with pathological myopia had a larger FAZ area, perimeter, major axis, minor axis, acircularity index (AI), and lower circularity index (CI) (all P < 0.01). The axial length (AL), the major axis of the superficial FAZ, CI, and AI were significantly correlated with myopia severity (all P < 0.05).

CONCLUSIONS

Patients with pathological myopia exhibited worse macular microcirculation and thinner macular retina and choroid. The FAZ in pathological myopia was larger and more irregular. The AL, CI, and AI were significantly associated with myopia severity. Thus, CI and AI might serve as new indicators for monitoring the progression of myopia. Further investigations should be performed.

TRIAL REGISTRATION

Clinical Trials.gov Identifier: ChiCTR2100046590.

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

Purpose

The purpose of this study was to assess the choroidal thickness and the Bruch's membrane opening size and their relationship to visual acuity in eyes with myopic macular degeneration (MMD).

Methods

This was a population-based, cross-sectional study. Patients over the age of 30 years with high myopia (spherical equivalent ≤-5 diopters [D]) were recruited. The eyes were grouped according to the International Meta-Analysis for Pathologic Myopia (META-PM) classification based on fundus photographs and diffuse atrophy was subdivided into peripapillary diffuse choroidal atrophy (PDCA) or macular diffuse choroidal atrophy (MDCA). Swept-source optical coherence tomography imaging was performed and then the subfoveal choroidal thickness (SFCT) and Bruch's membrane opening diameter (BMOD) were measured.

Results

Of the 470 study participants recruited, 373 patients (691 eyes), with a mean age of 42.8 ± 7.2 years, were eligible for the study and included in the analysis. There was no significant difference in SFCT between MDCA and patchy atrophy (M3) groups (P = 1.000), and the BMOD enlarged significantly from no myopic macular lesions to M3 (the P values of multiple comparison tests were all <0.005). Simple linear regression analysis showed that BMOD correlated positively with age (P < 0.001) and axial length (P < 0.001). Multiple linear regression analysis showed that best corrected visual acuity (BCVA) was significantly correlated with age (P = 0.041), axial length (P = 0.001), and BMOD (P = 0.017), but not with SFCT (P = 0.231).

Conclusions

The significant variation of BMOD among MMD groups and the correlation between BMOD and BCVA in MMD eyes suggest that BMOD may be an imaging biomarker for monitoring MMD.

Prevalence and Incidence of Registered Severe Visual Impairment and Blindness Due to Uveitis in Germany

PURPOSE

To assess prevalence and incidence of severe visual impairment (VI) and blindness due to uveitis in Northrhine, Germany.

METHODS

 A random sample of 5088 out of 20 390 cases of the blindness registry in Northrhine was evaluated. The number of cases of severe VI and blindness were projected up to the year 2030.

RESULTS

The prevalence of registered severe VI and blindness due to uveitis was 1123.9 (95% CI: 1059.5 to 1191.2) per 100 000 in our study cohort and 550.31 (95% CI: 365.98-794.38) per 100 000 in Northrhine, respectively. The incidence of registered severe VI and blindness due to uveitis was 311.8 per 100 000 PYs (95% CI: 149.6-572.7) in our study cohort and 11.1 per 100 000 (95% CI: 5.6-19.8) in Northrhine, respectively.

CONCLUSIONS

We report prevalence and incidence of severe VI and blindness due to uveitis in a large German cohort.

Factors associated with pathologic myopia onset and progression: A systematic review and meta-analysis

PURPOSE

To synthesise evidence across studies on factors associated with pathologic myopia (PM) onset and progression based on the META-analysis for Pathologic Myopia (META-PM) classification framework.

METHODS

Findings from six longitudinal studies (5-18 years) were narratively synthesised and meta-analysed, using odds ratio (OR) as the common measure of association. All studies adjusted for baseline myopia, age and sex at a minimum. The quality of evidence was rated using the Grades of Recommendation, Assessment, Development and Evaluation framework.

RESULTS

Five out of six studies were conducted in Asia. There was inconclusive evidence of an independent effect (or lack thereof) of ethnicity and sex on PM onset/progression. The odds of PM onset increased with greater axial length (pooled OR: 2.03; 95% CI: 1.71-2.40; p < 0.001), older age (pooled OR: 1.07; 1.05-1.09; p < 0.001) and more negative spherical equivalent refraction, SER (OR: 0.77; 0.68-0.87; p < 0.001), all of which were supported by an acceptable level of evidence. Fundus tessellation was found to independently increase the odds of PM onset in a population-based study (OR: 3.02; 2.58-3.53; p < 0.001), although this was only supported by weak evidence. There was acceptable evidence that greater axial length (pooled OR: 1.23; 1.09-1.39; p < 0.001), more negative SER (pooled OR: 0.87; 0.83-0.92; p < 0.001) and higher education level (pooled OR: 3.17; 1.36-7.35; p < 0.01) increased the odds of PM progression. Other baseline factors found to be associated with PM progression but currently supported by weak evidence included age (pooled OR: 1.01), severity of myopic maculopathy (OR: 3.61), intraocular pressure (OR: 1.62) and hypertension (OR: 0.21).

CONCLUSIONS

Most PM risk/prognostic factors are not supported by an adequate evidence base at present (an indication that PM remains understudied). Current factors for which an acceptable level of evidence exists (limited in number) are unmodifiable in adults and lack personalised information. More longitudinal studies focusing on uncovering modifiable factors and imaging biomarkers are warranted.

Violet light transmission through eyeglasses and its effects on myopic children: A systematic review and meta-analysis

PURPOSE

Myopia is a refractive error that impairs visual function and leads to visual blurring. This study aims to investigate the effect of violet light (VL) on controlling myopia, specifically in terms of axial length (AL), spherical equivalent refraction (SER), and visual acuity (VA).

METHODS

A systematic review was conducted to compare VL and single-vision spectacles (SVSs) for treating childhood myopia. The search terms used were "Myopia" and "Violet Light." Extensive searches were carried out in the PubMed, Embase, and Cochrane databases. The mean differences were evaluated. The effects of the therapy were examined. Publication bias was assessed with a funnel plot and further investigated through sensitivity analysis. Meta-analysis was performed using Bayesian statistics with Jeffery's Amazing Statistical Package.

RESULTS

The meta-analysis included 126 myopic children: 64 in the VL group and 62 in the SVS group. The pooled effect size for AL shortening was evaluated as 0.659 ± 0.184, with a 95% credible interval of 0.299-1.023. The pooled effect size for SER decrease was estimated as 0.669 ± 0.188, with a 95% credible interval of 0.303-1.036. Likewise, for VA in Log-MAR, after intervention (VL and SVS), the values were 0.082 ± 0.171 with a credible interval of 0.262-0.423. Publication bias was assessed with a funnel plot, which revealed no bias. Impact sizes for the fixed effect model were determined due to the similarity in study population, geography, type of intervention, and study design.

CONCLUSION

VL transmission glasses play a significant role in controlling myopia among children, resulting in axial shortening, reduction of SER, and improvement in VA. However, further investigation is required to examine the long-term rebound effect.

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

BACKGROUND

To compare the ocular features of highly myopic eyes with posterior staphyloma of wide macular type according to its morphological complexity.

METHODS

In this cross-sectional study, wide macular posterior staphyloma (WMPS) was classified into the primary (Curtin type I) and the compound (Curtin types VI to X) forms based on the configuration within the staphyloma. The grades of myopic maculopathy and the thicknesses of choroid and sclera were compared between the primary and compound forms of WMPS.

RESULTS

A total of 154 eyes (103 patients) with primary WMPS and 65 eyes (49 patients) with compound WMPS were included. Eyes with compound WMPS had worse visual acuity (P = 0.001) and greater axial length (P < 0.001) than those with primary WMPS. Compared to primary WMPS, compound WMPS had a higher grade of myopic macular degeneration (P < 0.001) and a higher frequency of lamellar or full-thickness macular hole associated with myopic traction (21.5% vs. 10.4%; P = 0.028) and active or scarred myopic choroidal neovascularization (33.8% vs. 20.1%; P = 0.030). On swept-source optical coherence tomography, eyes with compound WMPS had significantly thinner choroid and sclera.

CONCLUSIONS

The compound form of WMPS had more severe myopic macular changes and worse visual prognosis compared to the primary form of WMPS, and these were associated with more structural deformation in the posterior eyeball. Compound WMPS should be considered as an advanced form of staphyloma.

Forecasting Myopic Maculopathy Risk Over a Decade: Development and Validation of an Interpretable Machine Learning Algorithm

Purpose

The purpose of this study was to develop and validate prediction model for myopic macular degeneration (MMD) progression in patients with high myopia.

Methods

The Zhongshan High Myopia Cohort for model development included 660 patients aged 7 to 70 years with a bilateral sphere of ≤-6.00 diopters (D). Two hundred twelve participants with an axial length (AL) ≥25.5 mm from the Chinese Ocular Imaging Project were used for external validation. Thirty-four clinical variables, including demographics, lifestyle, myopia history, and swept source optical coherence tomography data, were analyzed. Sequential forward selection was used for predictor selection, and binary classification models were created using five machine learning algorithms to forecast the risk of MMD progression over 10 years.

Results

Over a median follow-up of 10.9 years, 133 patients (20.2%) showed MMD progression in the development cohort. Among them, 69 (51.9%) developed newly-onset MMD, 11 (8.3%) developed patchy atrophy from diffuse atrophy, 54 (40.6%) showed an enlargement of lesions, and 9 (6.8%) developed plus signs. Top six predictors for MMD progression included thinner subfoveal choroidal thickness, longer AL, worse best-corrected visual acuity, older age, female gender, and shallower anterior chamber depth. The eXtreme Gradient Boosting algorithm yielded the best discriminative performance (area under the receiver operating characteristic curve [AUROC] = 0.87 ± 0.02) with good calibration in the training cohort. In a less myopic external validation group (median -5.38 D), 48 patients (22.6%) developed MMD progression over 4 years, with the model's AUROC validated at 0.80 ± 0.008.

Conclusions

Machine learning model effectively predicts MMD progression a decade ahead using clinical and imaging indicators. This tool shows promise for identifying "at-risk" high myopes for timely intervention and vision protection.

Cataract Surgery and Chronic Kidney Disease: A Hospital-based Prospective Cohort Study

Objective Cataract and chronic kidney disease (CKD) occur with increasing frequency with age and share common risk factors including smoking, diabetes, and hypertension. We evaluated the risk of incident cataract surgery in patients with non-dialysis-dependent CKD and dialysis-dependent CKD compared to non-CKD patients, while taking into account the competing risk of death. Methods The participants included 1,839 patients from Sado General Hospital enrolled in the Project in Sado for Total Health (PROST) between June 2008 and December 2016 (54% men; mean age, 69 years). Among these patients, 50%, 44%, and 6% had non-CKD, non-dialysis-dependent CKD, and dialysis-dependent CKD, respectively. Results During a median follow-up of 5.6 years (interquartile range, 4.7-7.1), 193 participants underwent cataract surgery [18.7 (95% confidence interval (CI), 16.2-21.5)/1,000 person-years] and 425 participants died without undergoing cataract surgery [41.0 (95% CI, 37.4-45.2)/1,000 person-years]. The cumulative incidence of cataract surgery was the highest in the dialysis-dependent CKD group, followed by the non-dialysis-dependent CKD and non-CKD groups (log-rank p=0.002). After adjusting for potential confounding factors, the dialysis-dependent CKD group [hazard ratio (HR) 2.48; 95% CI 1.43-4.31], but not the non-dialysis-dependent CKD group (HR, 1.01; 95% CI 0.74-1.38), had a higher risk of cataract surgery than the non-CKD group. However, this association was no longer significant according to a competing risk analysis (sub-hazard ratio, 1.67; 95% CI 0.93-3.03). Conclusion Dialysis-dependent CKD patients were found to have an increased risk of cataract surgery; however, the association was attenuated and no longer significant when death was considered a competing risk.

Myopia and Nutrient Associations with Age-Related Eye Diseases in Korean Adults: A Cross-Sectional KNHANES Study

This study assessed the prevalence of myopia, cataracts, glaucoma, and macular degeneration among Koreans over 40, utilizing data from the 7th Korea National Health and Nutrition Examination Survey (KNHANES VII, 2018). We analyzed 204,973 adults (44% men, 56% women; mean age 58.70 ± 10.75 years), exploring the association between myopia and these eye diseases through multivariate logistic regression, adjusting for confounders and calculating adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results showed a myopia prevalence of 44.6%, cataracts at 19.4%, macular degeneration at 16.2%, and glaucoma at 2.3%, with significant differences across ages and genders. A potential link was found between myopia and an increased risk of cataracts and macular degeneration, but not with glaucoma. Additionally, a higher dietary intake of carbohydrates, polyunsaturated and n-6 fatty acids, vitamins, and minerals correlated with lower risks of these diseases, underscoring the importance of the diet in managing and preventing age-related eye conditions. These findings highlight the need for dietary considerations in public health strategies and confirm myopia as a significant risk factor for specific eye diseases in the aging Korean population.

PREVALENCE AND CLINICAL FEATURES OF RADIAL FUNDUS AUTOFLUORESCENCE IN HIGH MYOPIC WOMEN

PURPOSE

To determine the prevalence and characteristics of radial fundus autofluorescence (FAF) in highly myopic women.

METHODS

This was a retrospective, observational case study to determine the prevalence of radial FAF in the ultra-widefield FAF images in women. The clinical characteristics of these patients were evaluated.

RESULTS

Fifteen of 1,935 (0.78%) highly myopic women were found to have radial FAF. Their mean age was 36.6 ± 25.6 years, and their mean best-corrected visual acuity was 0.3 ± 0.42 logMAR units. The mean axial length (AL) was 28.8 ± 2.8 mm. Among the 15 cases, eight did not have pigmentary changes and seven had pigmentary changes in the ultra-widefield FAF images. The women with the pigmentary changes were significantly older ( P = 0.021), had poorer BCVA ( P = 0.001), and had longer ALs ( P = 0.002). The visual fields and electroretinograms were worse in the eyes with pigmentary changes.

CONCLUSION

The prevalence of radial FAF was 0.78% in women with high myopia. These patients might have mutations in the RPGR or RP2 genes and can develop high myopia and retinitis pigmentosa. Ultra-widefield FAF images should be examined in all highly myopic patients for early detection of radial FAF, and myopia prevention and genetic counseling for possible genetic therapy are recommended.

The Effects of Repeated Low-Level Red-Light Therapy on the Structure and Vasculature of the Choroid and Retina in Children with Premyopia

INTRODUCTION

The purpose of this study was to explore the effects of repeated low-level red-light (RLRL) therapy on the structure and vasculature of the choroid and retina in Chinese children with premyopia.

METHODS

This study was a single-center randomized clinical trial. A total of 94 children with premyopia (- 0.50 D < spherical equivalent [SE] ≤  + 0.75 D) were randomly assigned to either the RLRL therapy or control group. Follow-up visits were planned at 1, 3, 6, 9, and 12 months. Optical coherence biometry was used to measure axial length (AL) and anterior segment parameters. Choroidal thickness (CT), retinal thickness (RT), superficial retinal vascular density (SRVD), deep retinal vascular density (DRVD), choriocapillaris perfusion area (CCPA), and choroidal vessel volume (CVV) were measured by optical coherence tomography angiography, centered on the foveal, parafoveal (ParaF), and perifoveal (PeriF) regions.

RESULTS

The thickening of the choroid was observed across the entire macular region at different time points in the RLRL therapy group. Relative to the baseline measurement, foveal CT significantly increased at the 1-month follow-up with RLRL therapy, with a mean (± standard deviation [SD]) adjusted change of 16.96 ± 19.87 μm. The greatest magnitude of foveal CT changes was observed at the 3-month visit (an increase of 19.58 ± 20.59 μm), with a slight reduction in the extent of foveal CT increase at the 6-month visit (an increase of 15.85 ± 23.77 μm). The second greatest CT increase was observed at the 9-month visit (an increase of 19.57 ± 35.51 μm), after which the extent of CT increase gradually decreased until the end of the study at the 12-month visit (an increase of 11.99 ± 32.66 μm). We also observed a significant increase in CT in the ParaF and PeriF areas in the RLRL group over 12 months. In contrast, CT across the entire macular region in the control group significantly decreased throughout the follow-up visits (all P < 0.05). Regarding the vascular parameters of the choroid, significant increases in CVV were observed primarily in the ParaF and PeriF regions of the choroid in the RLRL group. In comparison, the control group exhibited decreases in CVV throughout the entire area. Furthermore, notable elevations in CCPA were detected in the PeriF area of the choroid in the RLRL group during the 1-month (an increase of 0.40 mm2), 3-month (an increase of 0.25 mm2), and 12-month visits (an increase of 0.42 mm2) (all P < 0.05). In addition, no notable differences were observed between the groups regarding foveal RT and retinal vascular parameters throughout the 12 months (P > 0.05). Notably, RLRL therapy achieved a notable reduction in SE shift by 73.8%, a substantial decrease in AL change by 67.9%, and a significant reduction in myopia incidence by 45.1% within 1 year.

CONCLUSION

Our study demonstrated a significant increase in CT and flow in the RLRL-treated eyes throughout the 12-months of the study. Combined with its reduction in spherical equivalent progression and axial elongation, RLRL could be used as an effective therapy for preventing progression in premyopes.

TRIAL REGISTRATION

ChiCTR2200062028.

LONGITUDINAL CHANGES OF POSTERIOR VORTEX VEINS IN HIGHLY MYOPIC EYES DETERMINED BY RETROSPECTIVE ANALYSES OF INDOCYANINE GREEN ANGIOGRAMS

PURPOSE

To assess the longitudinal changes of the posterior vortex veins (VVs) in highly myopic (HM) eyes.

METHODS

The medical records of 1,730 consecutive HM eyes that had undergone indocyanine green angiography were studied. Eyes that had posterior VVs and had undergone at least two indocyanine green angiography examinations with a minimum interval of 3 years were selected from this group.

RESULTS

Ninety-one eyes of 78 patients met the inclusion criteria. A total of 124 posterior VVs were identified. Over an average interval of 7.8 ± 5.0 years, 41 (33.1%) of the 124 posterior VVs had marked changes consisting mainly of an attenuation of vessels in 36 posterior VVs (87.8%) and alterations in the drainage course in 16 posterior VVs (39.0%). Fifteen posterior VVs had both types of changes. Most of the attenuations of the vessels occurred for smaller branches, but a complete loss of the entire trunk was seen in three eyes. Additionally, four eyes had posterior VV changes in association with changes of peripheral VVs.

CONCLUSION

Posterior VV in highly myopic eyes can undergo changes with increasing time. The associated factors included the development and progression of myopic maculopathy lesions. In some cases, the blood drainage shifted from posterior VV to peripheral VV by forming anastomotic channels.

Four-Year Progression of Myopic Maculopathy in Children and Adolescents With High Myopia

Importance

Individuals with high myopia younger than 18 years are at relatively high risk of progressively worsening myopic maculopathy. Additional studies are needed to investigate the progression of myopic maculopathy in this age group, as well as the risk factors associated with progression.

Objective

To investigate the 4-year progression of myopic maculopathy in children and adolescents with high myopia, and to explore potential risk factors.

Design, Setting, and Participants

This hospital-based observational study with 4-year follow-up included a total of 548 high myopic eyes (spherical power -6.00 or less diopters) of 274 participants aged 7 to 17 years. Participants underwent comprehensive ophthalmic examination at baseline and 4-year follow-up. Myopic maculopathy was accessed by the International Photographic Classification and Grading System. The data analysis was performed from August 1 to 15, 2023.

Main Outcomes and Measures

The progression of myopic maculopathy progression over 4 years and associated risk factors.

Results

The 4-year progression of myopic maculopathy was found in 67 of 548 eyes (12.2%) of 274 participants (138 girls [50.4%] at baseline and 4-year follow-up) with 88 lesion changes, including new signs of the tessellated fundus in 16 eyes (18.2%), diffuse atrophy in 12 eyes (13.6%), patchy atrophy in 2 eyes (2.3%), lacquer cracks in 9 eyes (10.2%), and enlargement of diffuse atrophy in 49 eyes (55.7%). By multivariable analysis, worse best-corrected visual acuity (odds ratio [OR], 6.68; 95% CI, 1.15-38.99; P = .04), longer axial length (AL) (OR, 1.73; 95% CI, 1.34-2.24; P < .001), faster AL elongation (OR, 302.83; 95% CI, 28.61-3205.64; P < .001), and more severe myopic maculopathy (diffuse atrophy; OR, 4.52; 95% CI, 1.98-10.30; P < .001 and patchy atrophy; OR, 3.82; 95% CI, 1.66-8.80; P = .002) were associated with myopic maculopathy progression.

Conclusions and Relevance

In this observational study, the progression of myopic maculopathy was observed in approximately 12% of pediatric high myopes for 4 years. The major type of progression was the enlargement of diffuse atrophy. Risk factors for myopic maculopathy progression were worse best-corrected visual acuity, longer AL, faster AL elongation, and more severe myopic maculopathy. These findings support consideration of follow-up in these individuals and trying to identify those at higher risk for progression.

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

PURPOSE

To investigate the current prevalence and causes of moderate and severe visual impairment (MSVI) and blindness in elderly people in suburban Shanghai, China.

METHODS

A cross-sectional study based on the population was conducted, which involved 5846 individuals (11,692 eyes) aged 65 years or older. Thorough eye examinations were performed to assess the prevalence and leading factors of MSVI (BCVA <20/63 to ≥20/400) and blindness (BCVA <20/400).

RESULTS

The standardized prevalence of bilateral MSVI and blindness was 3.3% and 0.6%, correspondingly. The standardized prevalence of monocular MSVI and blindness was 7.4% and 2.0%, correspondingly. Cataract (47.9% and 20.7%, correspondingly) and myopic macular degeneration (MMD, 25.7% and 31.1%, correspondingly) were the principal causes of bilateral MSVI and blindness. As for monocular MSVI, the primary causes were cataract (39.4%), age-related macular degeneration (AMD, 16.6%), and MMD (16.6%). The primary causes of monocular blindness were other posterior segment eye diseases (30.1%) and MMD (14.2%). In adults aged 65-74 years, MMD was the foremost factor causing bilateral vision impairment. Conversely, cataract was identified as the primary cause of bilateral and monocular vision impairment among adults aged ≥ 75 years. AMD accounts for a significant proportion of individuals across all age groups.

CONCLUSIONS

The significant prevalence of MSVI and blindness among Chinese adults represents a critical public health issue. In addition to cataract, the vision impairment caused by MMD and AMD become an important issue in the elderly Chinese people.

Insights into artificial intelligence in myopia management: from a data perspective

Given the high incidence and prevalence of myopia, the current healthcare system is struggling to handle the task of myopia management, which is worsened by home quarantine during the ongoing COVID-19 pandemic. The utilization of artificial intelligence (AI) in ophthalmology is thriving, yet not enough in myopia. AI can serve as a solution for the myopia pandemic, with application potential in early identification, risk stratification, progression prediction, and timely intervention. The datasets used for developing AI models are the foundation and determine the upper limit of performance. Data generated from clinical practice in managing myopia can be categorized into clinical data and imaging data, and different AI methods can be used for analysis. In this review, we comprehensively review the current application status of AI in myopia with an emphasis on data modalities used for developing AI models. We propose that establishing large public datasets with high quality, enhancing the model's capability of handling multimodal input, and exploring novel data modalities could be of great significance for the further application of AI for myopia.

MACULAR CHORIORETINAL ATROPHY AND VISUAL OUTCOMES IN RANIBIZUMAB- OR AFLIBERCEPT-TREATED MYOPIC CHOROIDAL NEOVASCULARIZATION

PURPOSE

To investigate the predictors of macular chorioretinal atrophy, consisting of patchy atrophy (PA) at the macula and choroidal neovascularization (CNV)-related macular atrophy (CNV-MA), during treatment with ranibizumab or aflibercept for myopic CNV (mCNV) and its impact on visual outcomes.

METHODS

This retrospective study included 82 eyes with treatment-naïve mCNV who were treated with pro re nata injections of ranibizumab or aflibercept.

RESULTS

Nine eyes (11.0%) presented with macular PA at baseline (PA group), and 73 eyes (89.0%) did not (non-PA group). VA improved during the first year in the non-PA group; a similar trend was noted in the PA group until 3 months after initial treatment. This improvement was maintained until 24 months ( P < 0.001) in the non-PA group, but not in the PA group. In the PA group, macular chorioretinal atrophy progressed faster ( P < 0.0001), and CNV-MA was more frequent during the 2 years of treatments ( P = 0.04). Even non-PA group eyes sometimes developed CNV-MA (42% at Month 24) if they had a larger CNV and thinner subfoveal choroidal thickness at baseline, resulting in poorer visual prognosis ( P < 0.01).

CONCLUSION

Macular PA at baseline was a risk factor for CNV-MA development and was associated with poor visual outcomes.

[Risk factors associated with myopic maculopathy in acquired myopia]

PURPOSE

This study aimed to identify factors associated with the development of myopic maculopathy (MM) in patients with acquired myopia.

MATERIAL AND METHODS

The study included a total of 135 patients (41 men, 94 women; 135 eyes) over 30 years old with acquired myopia and axial length (AL) of 26 mm. Forty-six patients had MM, while 89 (66%) had no macular changes. Optical coherence tomography angiography (OCT-A) and B-scan ultrasound of the eyes were performed to detect staphylomas of the posterior pole sclera. OCT was used to assess corneal stromal thickness and choroidal thickness. Corneal biomechanics were measured using the Corvis ST device, and ocular vessel hemodynamics were evaluated using color Doppler imaging. Binary logistic regression was employed, with a multivariable logistic model built for each of these potential risk factors, adjusted for sex, age, AL, and spherical equivalent (SE).

RESULTS

Age, AL, SE, and extra-macular myopic changes were significantly associated with the presence of MM. Of the seven qualitative risk factors studied, the presence of extra-macular changes, staphyloma, and wide macular staphyloma localization were statistically significant. Among the quantitative factors, significant associations were found with the width and depth of staphyloma, the area of the ultrasound cross-section of staphyloma (W×D), choroidal thickness in all examined zones, all corneal stromal thickness parameters, corneal deformation amplitude (DA), curvature radius highest concavity (radius HC), and corneal peak distance (PD).

CONCLUSION

The statistically significant risk factors associated with MM were age, AL, SE, the presence and size of staphylomas, choroidal and corneal stromal thickness, as well as several parameters characterizing corneal biomechanical properties. The strongest associations with MM were found for corneal PD, staphyloma depth, and choroidal thickness in the nasal perifovea.

Epidemiology of eye diseases: outcomes from a free provincial eye clinic in Papua New Guinea

Aim

To ascertain the prevalence and pattern of eye problems in Madang Province, Papua New Guinea.

Materials and methods

A six-month retrospective study was performed at Madang Provincial Hospital Eye Clinic. Convenience sampling was used in this study and all patient records from January to June 2020 were included. Data was extracted using Microsoft Excel and the data included gender, age, occupation, district where the patient lived, presenting visual acuity, and diagnosis. It was then analyzed using International Business Machines Corporation's Statistical Package for the Social Sciences version 26. A p-value of ≤0.05 was considered statistically significant.

Results

A total of 1,715 patients received services at the eye clinic between January and June 2020, and 1,664 were included in this study. The mean age of the patients was 39.3 ± 20.3 years. There were slightly more males (50.4%) than females. The overall leading ocular morbidities were corneal ulcers and keratitis (20.7%), refractive errors (17.4%), and cataracts (16.8%). More than half of the patients (56.2%) were either visually impaired or blind. Nearly half of the patients (41.8%) traveled long distances to seek services at the eye clinic. There was a significant association between demographic characteristics, diagnosis, and level of visual impairment.

Conclusion

There is a high prevalence of potential causes of visual impairment and blindness in Madang Province and these conditions affect all age groups and genders. It is essential to increase accessibility to eye care services in the country.

Association Between Choroidal Thickness and Myopic Maculopathy in a Japanese Population: The Hisayama Study

Purpose

To examine the association between choroidal thickness and myopic maculopathy in a general Japanese population.

Design

Population-based cross-sectional study.

Participants

A total of 2841 residents of a Japanese community aged ≥ 40 years, who consented to participate and had available data of choroidal thickness and fundus photographs, were enrolled in this study.

Methods

The choroidal thickness was measured by swept-source OCT. Participants were divided into quartiles of choroidal thickness. Myopic maculopathy was defined according to the classification system of the Meta-analysis of Pathologic Myopia Study Group. Main outcome measures were odds ratios (ORs) of choroidal thickness for prevalent myopic maculopathy. The ORs and 95% confidence intervals (CIs) were estimated using a logistic regression model.

Main Outcome Measures

Prevalent myopic maculopathy.

Results

Eighty-one participants had myopic maculopathy (45 diffuse chorioretinal atrophy, 31 patchy chorioretinal atrophy, and 5 macular atrophy). Individuals in the lowest quartile of choroidal thickness had a significantly greater OR for the presence of myopic maculopathy than those in the highest quartile of choroidal thickness (OR: 4.78 [95% CI: 1.78-16.72]) after adjusting for confounders, including axial length. The sensitivity analysis among the 1176 myopic individuals with axial length of ≥ 24.0 mm also showed that thinner choroidal thickness was significantly associated with prevalent myopic maculopathy.

Conclusions

The present study demonstrated the significant inverse association between choroidal thickness and the likelihood of myopic maculopathy, suggesting that the measurement of choroidal thickness in addition to axial length would be useful for assessing the risk of myopic maculopathy and elucidating its pathogenesis.

Financial Disclosures

Proprietary or commercial disclosure may be found after the references.

Visual impairment and blindness caused by retinal diseases: A nationwide register-based study

Background

Retinal disorders cause substantial visual burden globally. Accurate estimates of the vision loss due to retinal diseases are pivotal to inform optimal eye health care planning and allocation of medical resources. The purpose of this study is to describe the proportion of visual impairment and blindness caused by major retinal diseases in China.

Methods

A nationwide register-based study of vitreoretinal disease covering all 31 provinces (51 treating centres) of mainland China. A total of 28 320 adults diagnosed with retinal diseases were included. Participants underwent standardised ocular examinations, which included best-corrected visual acuity (BCVA), dilated-fundus assessments, and optical coherence tomography. Visual impairment and blindness are defined using BCVA according to the World Health Organization (WHO) (visual impairment: <20/63-≥20/400; blindness: <20/400) and the United States (visual impairment: <20/40-≥20/200; blindness: <20/200) definitions. The risk factors of vision loss were explored by logistic regression analyses.

Results

Based on the WHO definitions, the proportions for unilateral visual impairment and blindness were 46% and 18%, respectively, whereas those for bilateral visual impairment and blindness were 31% and 3.3%, respectively. Diabetic retinopathy (DR) accounts for the largest proportion of patients with visual impairment (unilateral visual impairment: 32%, bilateral visual impairment: 60%) and blindness (unilateral blindness: 35%; bilateral blindness: 64%). Other retinal diseases that contributed significantly to vision loss included age-related macular degeneration, myopic maculopathy, retinal vein occlusion, and rhegmatogenous retinal detachment and other macular diseases. Women (bilateral vision loss: P = 0.011), aged patients (unilateral vision loss: 45-64 years: P < 0.001, ≥65 years: P < 0.001; bilateral vision loss: 45-64 years: P = 0.003, ≥65 years: P < 0.001 (reference: 18-44 years)) and those from Midwest China (unilateral and bilateral vision loss: both P < 0.001) were more likely to suffer from vision loss.

Conclusions

Retinal disorders cause substantial visual burden among patients with retinal diseases in China. DR, the predominant retinal disease, is accountable for the most prevalent visual disabilities. Better control of diabetes and scaled-up screenings are warranted to prevent DR. Specific attention should be paid to women, aged patients, and less developed regions.

Visual impairment as a risk factor of cognitive function impairment A six-year cohort study

PURPOSE

To explore whether baseline visual impairment (VI) increases the risk of cognitive function impairment (CFI).

METHODS

We conducted a population-based cohort study, with a six-year follow-up period. The exposure factor of interest in this study was VI. The Mini-Mental State Examination (MMSE) was used to assess participants' cognitive function. The Logistic regression model was used to investigate whether baseline VI had an effect on CFI. Confounding factors were adjusted in the regression model. The odds ratio (OR) and 95% confidence interval (CI) were used to quantify the effect of VI on CFI.

RESULTS

A total of 3297 participants were included in the present study. The mean age of included participants was 58.5 ± 7.2 years. Male accounted for 1480 (44.9%) of all participants. At baseline, 127 (3.9%) of the participants had VI. The MMSE score of participants who had VI at baseline decreased by 1.7 ± 3.3 points on average during the six-year follow-up, and that of participants who had no VI at baseline decreased by 1.1 ± 3.3 points on average. The difference was significant (t = 2.03, p = 0.040). Results of the multivariable Logistic regression model showed that VI was a risk factor for CFI, with an OR of 1.052 (95%CI: 1.014 to 1.092, p = 0.017).

CONCLUSIONS

Averagely, participants with VI experienced a decline in cognitive function 0.1 points faster per year than participants without VI, as measured by MMSE score. VI is an independent risk factor for CFI.

Pathogenesis of myopic choroidal neovascularization: A systematic review and meta-analysis

Myopic choroidal neovascularization (CNV) is a vision-threatening complication of high myopia. Here, we systematically review cohort, case-control, and cross-sectional studies in PubMed, Embase, and Web of Science, and summarize the associated factors of myopic CNV using meta-analysis where applicable. Among 1,333 records assessed, 50 were found eligible, all having a low-to-moderate risk of bias. Highly myopic eyes with CNV had a higher risk of lacquer cracks (odds ratio = 2.88) and patchy chorioretinal atrophy (odds ratio = 3.43) than those without. The mean posterior staphyloma height (µm) was greater in myopic CNV eyes than in highly myopic eyes without CNV (mean difference = 82.03). The thinning of choroidal thickness (µm) between myopic eyes with and without CNV differed significantly (mean difference = -47.76). The level of vascular endothelial growth factor (pg/ml) in the aqueous humor of myopic CNV eyes was significantly higher than in highly myopic eyes without CNV (mean difference = 24.98), the same as interleukin-8 (IL-8) (pg/ml, mean difference = 7.73). Single-nucleotide polymorphisms in the vascular endothelial growth factor, complement factor I, and collagen type VIII alpha 1 genes were associated with myopic CNV. We found that myopic CNV eyes have a higher ratio of lacquer cracks and patchy chorioretinal atrophy, thinner choroid, greater posterior staphyloma height, and a higher level of vascular endothelial growth factor and IL-8 in aqueous. Structural predisposing lesions, hemodynamic, genetic, and systemic factors are also associated with myopic CNV.

Tear inflammatory cytokines as potential biomarkers for myopic macular degeneration

Previous studies have reported that inflammatory cytokine levels increase in the intraocular fluids (aqueous humor and vitreous) of highly myopic eyes, However, there has been currently no study revealing the levels of inflammatory cytokines in tear. Therefore, this study aimed to determine tear cytokine levels of highly myopic eyes, and their relationships with myopic macular degeneration (MMD). This case-control study screened inflammatory cytokines of tear samples from 132 highly myopic and 105 emmetropic eyes using a multiplex cytokine antibody array, and cytokines showing significant intergroup differences were further validated using ProQuantum immunoassays in tear samples from another 60 highly myopic and 60 emmetropic eyes. Ultra-widefield fundus photographs of eyes were classified according to the meta-analyses of the Pathologic Myopia Classification. Associations between tear cytokine levels and MMD category were investigated. As a result, tear levels of interleukin (IL)-6, IL-13 and monocyte chemoattractant protein (MCP)-1 were screened significantly higher in highly myopic eyes than in emmetropic controls (IL-6: 11.70 ± 16.81 versus 8.22 ± 10.76 pg/mL; MCP-1: 63.60 ± 54.40 versus 33.87 ± 43.82 pg/mL; both P < 0.05). Validation assays further demonstrated the elevated concentrations of IL-6 and MCP-1 (IL-6: 13.97 ± 8.41 versus 8.06 ± 7.94 pg/mL, P < 0.001; MCP-1: 32.69 ± 8.41 versus 18.07 ± 8.41 pg/mL, P = 0.003). Tear levels of IL-6 and MCP-1 differed significantly among MMD categories (both P < 0.05). The area under receiver operating characteristic curve were 0.783 and 0.682 respectively (both P < 0.05), when using tear IL-6 and MCP-1 levels to predict the presence of MMD (category ≥2). The ordered logistic regression model also indicated that longer axial length, and higher IL-6 and MCP-1 tear levels were independent predictors of higher MMD category. In our study, highly myopic eyes presented significantly higher levels of tear IL-6 and MCP-1, which may also serve as potential biomarkers for MMD.

Association between Global Myopia Prevalence and International Levels of Education

SIGNIFICANCE

The Global Myopia Prevalence and International Levels of Education study models national trends in educational performance with myopia prevalence in children; it examines the association of near work with myopia in the form of an ecologic analysis and also discusses how this may relate to educational frameworks.

PURPOSE

This study aimed to investigate the relationship between myopia prevalence and national educational performance.

METHODS

The prevalence of myopia in the 15- to 19-year age group in 35 regions was obtained from a meta-analysis by Holden et al. (Ophthalmology 2016;123:1036-1042) and matched with educational performance quantified by the Organisation for Economic Cooperation and Development Programme for International Student Assessment (PISA) testing from 2000 to 2018. A generalized estimating equation was used to describe the relationship between PISA scores and myopia prevalence. Clustering effects of country and chronological year were accounted for in the analysis. Linear and nonlinear terms of PISA scores using lines of best fit were further explored.

RESULTS

There is a significant positive relationship between Organisation for Economic Cooperation and Development PISA educational performance and myopia prevalence in teenagers with higher PISA scores correlating with higher myopia prevalence, even after accounting for chronological year (generalized estimating equation model: P = .001, .008, and .005 for math, science, and reading, respectively). Scatterplots with cubic and logistic fits indicated that PISA math showed the strongest relationship with myopia prevalence ( r2 = 0.64), followed by science ( r2 = 0.41) and reading ( r2 = 0.31).

CONCLUSIONS

These results strongly suggest that educational achievement at a national level is associated with higher myopia prevalence. Programme for International Student Assessment scores are a significant driver of many countries' education policies, and countries that have a balance between high PISA scores and lower myopia prevalence may be good models of educational policies to address the myopia public health issue.

Microvasculature and microstructure alteration in dry-type high myopia

BACKGROUND

To investigate the alterations in the retinal vasculature and microstructure in dry-type high myopia.

METHODS

One hundred and eighty-nine dry-type high myopia eyes were classified into three groups. Group 1 consisted of 86 eyes with no myopic retinal degenerative lesion (C0). Group 2 consisted of 71 eyes with tessellated fundus (C1). Group 3 consisted of 32 eyes with diffuse chorioretinal atrophy (C2). Retinal vascular density and retinal thickness were measured with optical coherence tomography angiography. The scanning area was a 3 × 3 mm2 ring with the fovea of the macular. All data were analyzed with the SPSS 23.0 by one-way ANOVA test among comparison groups. Pearson's correlation analysis was used to determine the relations among measurements. Univariate linear regression showed a correlation between the vascular densities and retinal thicknesses.

RESULTS

The microvessel density significantly decreased and significant thinning of the superior and temporal macular thickness in the C2 group. The vascular densities of macular decreased significantly with the increase of axial length (AL) and refractive diopter in the C2 group. The retinal thicknesses of the macular fovea increased significantly with the increase of vascular densities in the C0 group and C1 group.

CONCLUSIONS

The impairment of retinal microstructure is more likely related to reduced oxygen and nutrients due to microvessel density decreases.

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.

Prevalence and causes of visual impairment and blindness in Lao People's Democratic Republic: the Vientiane Eye Study

AIMS

To determine the prevalence and causes of visual impairment and blindness in Vientiane Province, the Lao People's Democratic Republic (Lao PDR).

METHODS

We conducted a population-based, cross-sectional study of 1264 participants aged 40 years and older from urban and rural areas of Vientiane Province. The ophthalmic examination included presenting and pinhole Snellen visual acuity (VA) with an illiterate E chart, slit-lamp examination of the anterior segment and dilated stereoscopic fundus examination. Visual impairment and blindness were defined by both presenting and pinhole VA based on the better eye according to WHO criteria: VA worse than 6/12 to 6/18 for mild impairment, VA worse than 6/18 to 6/60 for moderate impairment, VA worse than 6/60 to 3/60 for severe impairment and VA worse than 3/60 for blindness.

RESULTS

Comprehensive ophthalmic examinations were performed on 1264 participants (77.8% participation rate). Population-weighted prevalence of presenting bilateral blindness was 1.4% (95% CI 0.8 to 2.0) and bilateral visual impairment was 22.4% (95% CI 14.7 to 30.1). After pinhole correction, the corresponding prevalence of blindness was 1.3% (95% CI 0.8 to 2.0) and that of visual impairment was 12.6% (95% CI 8.2 to 16.9). Cataract was the leading cause of presenting bilateral blindness (52.9%), whereas uncorrected refractive error was the predominant cause of presenting visual impairment (40.3%).

CONCLUSIONS

Visual impairment and blindness remain major public health problems in Lao PDR. There is an ongoing need to fund ophthalmic care resources and community education programmes to improve access to healthcare in this region.

Trends in the Prevalence of Blindness and Correlation With Health Status in Korean Adults: A 10-Year Nationwide Population-Based Study

BACKGROUND

Contemporary data on vision impairment form an important basis for public health policies. However, most data on the clinical epidemiology of blindness are limited by small sample sizes and focused not on systemic conditions but ophthalmic diseases only. In this study, we examined the ten-year trends of blindness prevalence and its correlation with systemic health status in Korean adults.

METHODS

This study investigated 10,000,000 participants randomly extracted from the entire Korean population (aged ≥ 20 years) who underwent a National Health Insurance Service health checkup between 2009 and 2018. Participants with blindness, defined as visual acuity in the better-seeing eye of ≤ 20/200, were identified. The prevalence of blindness was assessed, and the systemic health status was compared between participants with blindness and without blindness.

RESULTS

The mean prevalence of blindness was 0.473% (47,115 blindness cases) and tended to decrease over ten years (0.586% in 2009 and 0.348% in 2018; P < 0.001). The following factors were significantly associated with blindness: female sex, underweight (body mass index < 18.5), high serum creatinine (> 1.5 mg/dL), and bilateral hearing loss. In addition, except for those aged 30-39 and 40-49 years, high fasting glucose (≥ 126 mg/dL) and low hemoglobin (male: < 12 g/dL, female: < 10 g/dL) were significantly correlated with prevalent blindness.

CONCLUSION

Our ten-year Korean nationwide population-based study suggested a gradual decrease in the prevalence of blindness and its association with specific systemic health status. These conditions might be the cause or consequence of blindness and can be used as a reference for the prevention and/or rehabilitation of blindness to establish public health policies.

High-frequency ultrasound point-of-care device to quantify myopia-induced microstructural changes in the anterior sclera

PURPOSE

To develop a point-of-care (POC) device using high-frequency ultrasound (US) for evaluating microstructural changes in the anterior sclera associated with myopia.

METHODS

The proposed POC device must satisfy four primary requirements for effective clinical use: the measurement component is handheld; the software must be simple and provide real-time feedback; patient safety and health data security requirements set forth by relevant governing bodies must be satisfied and the measurement data must have sufficient signal-to-noise ratio (SNR) and repeatability. Radiofrequency (RF) echo data acquired by the POC device will be processed using our quantitative US methods to characterise tissue microstructure and biomechanical properties.

RESULTS

All stated requirements have been met in the developed POC device. The high-frequency transducer is housed in a custom, 3D-printed, pen-like holder that allows for easy measurements of the anterior sclera. Custom software provides a simple interface for data acquisition, real-time data display and secure data storage. Exposimetry measurements of the US pressure field indicate device compliance with United States Food and Drug Administration limits for ophthalmic US. In vivo measurements on a volunteer suggest the RF data SNR and acquisition consistency are suitable for quantitative analysis.

CONCLUSIONS

A fully functioning POC device using high-frequency US has been created for evaluating the microstructure of the anterior sclera. Planned studies using the POC device to scan the eyes of myopia patients will help clarify how the anterior sclera microstructure may be affected by myopia. If effective, this portable, inexpensive and user-friendly system could be an important part of routine eye examinations.

Quality of Life and Economic Impacts of Retinitis Pigmentosa on Japanese Patients: A Non-interventional Cross-sectional Study

INTRODUCTION

Retinitis pigmentosa (RP) is an inherited progressive disease, characterized by a loss of photoreceptors, and is the second leading cause of visual impairment in Japan. RP is currently incurable and can result in complete blindness, with affected patients typically experiencing a gradual loss of light sensitivity, visual field, and visual acuity. Identification of any unmet medical needs of patients with this condition requires an understanding of the impacts of RP; in this study, we surveyed Japanese patients with RP to investigate the quality of life and economic impacts of visual impairment.

METHODS

This non-interventional, cross-sectional study surveyed Japanese patients with RP. Economic impact was measured using an original questionnaire that assessed out-of-pocket cost (e.g., vision aids and medical services), salary gap with the general public, and the cost of depression and anxiety. Worker productivity was assessed using the Work Productivity and Activity Impairment Questionnaire (WPAI). Quality of life was evaluated using the Health Utilities Index Mark 3 (HUI3), the National Eye Institute Visual Function Questionnaire-25 (VFQ-25), and the 5-level EQ-5D version (EQ-5D-5L). The primary outcome was direct and indirect costs of visual impairment or blindness during the lifetime of patients with RP.

RESULTS

Among 122 surveyed patients with RP, the estimated annual cost per patient was 218,520 yen (2176 USD), and the estimated lifetime cost per patient was 18,523,909 yen (184,501 USD). Additional robustness testing increased the estimated annual cost and lifetime cost per patient to 783,176 yen (7801 USD) and 66,389,827 yen (661,253 USD), respectively. In working patients, work productivity loss was 26.2% per person and impairment of daily activities was 31.6% per person. The mean VFQ-25, HUI3, and EQ-5D-5L scores were 42.0, 0.393, and 0.833, respectively.

CONCLUSION

RP imposed a heavy economic burden and negative quality of life impacts in Japanese patients.

Extreme myopia is more susceptible to SOX2 gene than high myopia

PURPOSE

To explore the association between two single-nucleotide polymorphisms (SNPs) in the SOX2 gene and high and extreme myopia in the Han Chinese population.

MATERIALS AND METHODS

A genetic association study using a case-control method was performed with 139 high myopia, 318 extreme myopia, and 918 healthy participants from the Chinese Han population. Two SNPs (rs4459940 and rs4575941) near SOX2 gene were selected for genotyping. We compared the allelic frequencies and haplotypes of the SNPs to assess their association with high and extreme myopia. This study was adjusted for sex and age of participants in the groups.

RESULT

The mean ages of the extreme myopia and control subjects were 47.44 ± 15.59 and 44.15 ± 14.08 years, respectively. The rs4575941 SNP of the SOX2 gene and the GG and AG genotypes showed no significant association with the risk of high myopia as opposed to the AA genotype (GG, OR = 0.94, 95% CI = 0.55-1.60, P = 0.820, Pc = NS; AG, OR = 0.91, 95% CI = 0.54-1.52, P = 0.708, Pc = NS). However, the frequency of the risk G allele of rs4575941 was significantly higher in the extreme myopia group than in the control group (OR = 1.31, 95% CI = 1.08-1.59; P = 0.007; Pc = 0.014). Furthermore, there were significant differences in the GG genotype frequency between the extreme myopia and control groups (OR = 1.77, 95% CI = 1.45-2.74, P = 0.009, Pc = 0.036). The A-G haplotype frequency was higher in the extreme group (OR = 1.27, 95% CI = 1.05-1.55, P = 0.014), while there were no significant differences found in high myopia group (OR = 1.18, 95% CI = 0.77-1.31, P = 0.979).

CONCLUSION

The SOX2 rs4575941 polymorphism, in Chinese Han population, contributes to the susceptibility of extreme myopia. SOX2 may thus be implicated in extreme myopia rather than in high myopia.

Progress of iPS cell-based transplantation therapy for retinal diseases

The discovery of induced Pluripotent Stem) (iPS) cells has instigated innovation in various fields, including ophthalmology. Cell therapy has shown tremendous progress in translational research on retinal diseases, including the first-in-human transplantation of autologous iPS cell-derived retinal pigment epithelium (RPE) cells for patients with age-related macular degeneration (AMD). Cell therapy for retinitis pigmentosa (RP) has also been developed. Retinal organoid and photoreceptor cell transplantation has been shown to incorporate into the degenerated host retina, forming synapses with host neurons and resulting in functional recovery. Based on preclinical data, first-in-human transplantation of iPS cell-derived retinal sheets has been conducted. In this review, we summarize the current progress in iPS cell-based retinal cell transplantation research for retinal diseases, addressing some remaining challenges and future prospects.

MyopiaDETR: End-to-end pathological myopia detection based on transformer using 2D fundus images

Background

Automated diagnosis of various retinal diseases based on fundus images can serve as an important clinical decision aid for curing vision loss. However, developing such an automated diagnostic solution is challenged by the characteristics of lesion area in 2D fundus images, such as morphology irregularity, imaging angle, and insufficient data.

Methods

To overcome those challenges, we propose a novel deep learning model named MyopiaDETR to detect the lesion area of normal myopia (NM), high myopia (HM) and pathological myopia (PM) using 2D fundus images provided by the iChallenge-PM dataset. To solve the challenge of morphology irregularity, we present a novel attentional FPN architecture and generate multi-scale feature maps to a traditional Detection Transformer (DETR) for detecting irregular lesion more accurate. Then, we choose the DETR structure to view the lesion from the perspective of set prediction and capture better global information. Several data augmentation methods are used on the iChallenge-PM dataset to solve the challenge of insufficient data.

Results

The experimental results demonstrate that our model achieves excellent localization and classification performance on the iChallenge-PM dataset, reaching AP₅₀ of 86.32%.

Conclusion

Our model is effective to detect lesion areas in 2D fundus images. The model not only achieves a significant improvement in capturing small objects, but also a significant improvement in convergence speed during training.

Interventions recommended for myopia prevention and control among children and adolescents in China: a systematic review

In 2018, a consortium of government bodies in China led by the Ministry of Education released the Comprehensive Plan to Prevent Nearsightedness among Children and Teenagers (CPPNCT), aiming to reduce the incidence of myopia and control myopic progression in China. Recommendations span from home-based to school-based interventions, including time outdoors, physical activity, light exposure, near-work activity, screen time, Chinese eye exercises, diet and sleep. To date, the levels of evidence for this suite of interventions have not been thoroughly investigated. This review has summarised the evidence of the interventions recommended by the CPPNCT in myopia prevention and control. Thus, the following statements are supposed by the evidence: (1) Increasing time outdoors and reducing near-work time are effective in lowering incident myopia in school-aged children. (2) All interventions have a limited effect on myopia progression. Ongoing research may lead to a better understanding of the underlying mechanisms of myopia development, the interaction of different interventions and recommendations, confounding variables and their true effect on myopia prevention, and the identification of those most likely to respond to specific interventions. This field may also benefit from longer-term studies of the various interventions or strategies covered within this review article, to better understand the persistence of treatment effects over time and explore more novel approaches to myopia control.