Prevalence and risk factors for myopic retinopathy in a Japanese population: the Hisayama Study. Ophthalmology. 2012;119:1760-1765. [PMID: 22578442 DOI: 10.1016/j.ophtha.2012.02.034]

Differential impact of 0.01% and 0.05% atropine eye drops on visual performance in young adults

PURPOSE

The onset and progression of myopia can occur during adulthood, suggesting that myopia should be managed in young adults. Low-concentration atropine eye drops have shown promising efficacy in myopia control. This study aimed to evaluate the impact of 0.01% and 0.05% atropine eye drops on the visual performance of university students.

METHODS

Twenty-six myopic students aged 18-30 years received 0.01% and 0.05% atropine in random order. Atropine eye drops were administered once a night in both eyes for 14 days, with a minimum 14-day washout period between concentrations. Visual assessments, including the modulation transfer function (MTF) cut-off, Strehl ratio (SR), objective scattering index, contrast sensitivity (CS) and glare disability, were conducted 1, 2, 7 and 14 days after atropine administration and corresponding time points after cessation. A questionnaire was used to evaluate ocular and general symptoms.

RESULTS

After 1 day of treatment with 0.05% atropine, the MTF cut-off (β = -8.75, p < 0.001) and SR (β = -0.05, p < 0.001) decreased significantly to their lowest levels. The area under the log CS function also decreased significantly (all p < 0.05) during administration of the 0.05% eye drops, especially in the mesopic with glare condition, and reached its lowest point 1 day after administration (β = -0.20, p < 0.001). However, all parameters returned to baseline levels 2 weeks after 0.05% atropine was stopped (all p > 0.05). Additionally, 40.91% of the young adults reported experiencing excessive daytime sleepiness and nocturnal glare during 0.05% atropine use. Treatment with 0.01% atropine had minimal effects on both visual performance and subjective symptoms.

CONCLUSIONS

Administration of 0.05% atropine had a significant but temporary effect on the visual performance of young adult myopic patients, whereas 0.01% atropine had a minimal effect.

Axial length as a predictor of myopic macular degeneration: a meta-analysis and clinical study

PURPOSE

This study aims to investigate the relationship between axial length (AL) and the severity of myopic macular degeneration (MMD).

METHODS

We conducted a comprehensive search of PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) databases from their inception until October 1, 2023, to identify population-based or hospital-based studies reporting AL across different grades of MMD. Only studies employing the International Photographic Classification and Grading System for Myopic Maculopathy (META-PM) were included. A meta-analysis was performed to assess the association between AL and MMD severity. To further validate our findings, we analyzed data from 395 eyes of 206 participants at Beijing Tongren Hospital, Capital Medical University.

RESULTS

The meta-analysis included 20 high-quality studies from seven countries, with 33822 patients studied. Information, including the study name, year of publication, country, sample size, basic demographic characteristics of the participants, AL of different grades of MMD, best corrected visual acuity (BCVA), and spherical equivalent (SE), was extracted. The meta-analysis revealed a significant overall increase in AL as MMD progressed from category C0 to C4 (P < 0.0001). AL exhibited a consistent increasing trend from categories C0 to C3; however, this trend appeared to level off between categories C3 and C4, with no further increase observed. This trend was confirmed by the distribution of our new dataset. A higher prevalence of MMD was significantly associated with longer AL (per 1 mm increase: OR, 1.90; 95% CI, 1.75-2.07; P < 0.001), older age (per 1-year increase: OR, 1.04; 95% CI, 1.02-1.05; P < 0.001), and female gender (OR, 1.89; 95% CI, 1.24-2.89; P < 0.01). Compared with C0, each 1 mm increase in AL was associated with an increasing likelihood of MMD progression, with ORs of 2.8 for C1, 3.6 for C2, 5.2 for C3, and 5.7 for C4. The increase in OR was more pronounced in later stages (C2-C3 and C3-C4) than in earlier transitions (C0-C1 and C1-C2). Similarly, the ORs for age increased significantly from C3 to C4, and the ORs for female gender increased progressively from C2 to C4.

CONCLUSIONS

The meta-analysis and new clinical study indicate a clear trend of increasing AL with advancing MMD severity from C0 to C4. However, the relationship between AL and MMD progression from C3 to C4 warrants further investigation. Additionally, older age and female gender are identified as risk factors for MMD progression.

Absolute Risks and Decision Tools for Communicating the Risks of Visual Impairment From Myopia-Related Diseases

Purpose

The risks of developing myopia complications are frequently reported in relative terms, which can be misleading. This study provides absolute risk estimates of visual impairment (VI) from myopia-related diseases.

Methods

A critical integrative review provided data on frequency of myopic macular degeneration (MMD), primary open-angle glaucoma (POAG), rhegmatogenous retinal detachment (RRD), and associated VI in predominantly White and East Asian populations. The absolute risks of persons over 40 years of age with no myopia, low myopia (-2.00 D), or high myopia (-6.00 D) developing VI from each myopia-related disease were calculated by multiplying the proportion of each refractive group with the disease by the rate of VI. The sum of the risks of VI from MMD, POAG, and RRD provided an estimate of VI risk from any of these three myopia-related diseases in adults over 40 years old.

Results

VI from MMD, POAG, or RRD combined is expected in 0.4 in 100, 1.4 in 100, and 6.8 in 100 of White persons with no myopia, low myopia, or high myopia, respectively. The same risks in an East Asian population are 0.5 in 100, 2.4 in 100 and 10.3 in 100 in persons with no myopia, low myopia, or high myopia, respectively.

Conclusions

Absolute risks are provided to enable balanced discussions of the future risk that a child may have in developing VI from myopia-related diseases when considering myopia management. These estimates should be put into context using decision tools and balanced statements providing information on the likelihood of both developing VI and not developing VI.

Association between inferior posterior staphyloma on choroidal vessels running patterns in healthy eyes

BACKGROUND

Effects of macular shape changes on the retina have been studied in pathologic myopia. However, whether there are individual differences in macular shape in non-pathologic myopia and the influence of macular shape on retinochoroidal disease in these eyes is not well known. A recently developed ultra-wide-field optical coherence tomography (UWF-OCT) has a wider imaging range and can be used to evaluate inferior posterior staphyloma (IPS). We aimed to investigate the effect of IPS on Haller vessel running patterns (HVRPs) in healthy eyes using UWF-OCT.

METHODS

This single-center retrospective study included healthy subjects. UWF-OCT images of normal subjects were stretched vertically to enhance the macula's shape and classified into IPS (n = 16) and non-IPS (n = 113) groups with or without propensity score matching (PSM) for age, sex, and ocular axis length. The HVRPs were subjectively classified into symmetry, superior dominant, and inferior dominant. Differences in the proportions of the patterns between the two groups were compared using Fisher's exact test.

RESULTS

In the non-IPS group, 65 (57.5%) individuals had a symmetric pattern of Haller's vessels, 32 (28.3%) had an upper-dominant pattern, and 16 (14.1%) had a lower-dominant pattern. In the IPS group, 14 eyes (87.5%) presented an upper dominant pattern, and 2 (12.5%) presented a symmetric pattern. There was a significant difference in vascular running patterns between the two groups (P < 0.001). After the PSM, a similar trend was confirmed.

CONCLUSIONS

The eyes with IPS are likely to have superior dominant HVRPs compared to the non-IPS group in healthy eyes. Macular shape may play a role in HVRPs, which are involved in the pathogenesis of retinochoroidal diseases.

Association between axial length and uveitis

PURPOSE

Multiple studies have examined the association between myopia and various ocular diseases, but there is no clinical report of the relationship between myopia and uveitis. This study aimed to elucidate the relationship between myopia and uveitis by comparing axial lengths (AL) of uveitis patients with control individuals.

METHODS

This study included 1052 eyes (663 patients; 288 males, 375 females; median age 56.0 years) with uveitis referred to Tokyo Medical University Hospital. Controls were 738 eyes with cataract but no other ocular diseases. AL was measured by IOLMaster or conventional A-mode ultrasound system. Uveitis eyes were grouped into various types of non-infectious uveitis, infectious uveitis, and unidentified uveitis. Median AL of each uveitis group was compared with control group using Mann-Whitney U-test, and also compared with adjustment for age and sex using multiple regression analysis. Binary logistic analysis was performed to examine whether AL plays a role in the risk of developing uveitis.

RESULTS

Of 1052 eyes, 808 eyes (76.8%) were diagnosed with non-infectious uveitis [sarcoidosis (176 eyes, 16.7%), Vogt-Koyanagi-Harada disease (122 eyes, 11.6%), Behçet's disease (130 eyes, 12.4%), and others (380 eyes, 36.1%)], 146 eyes (13.9%) with infectious uveitis, and 98 eyes (9.3%) with unidentified uveitis. Median AL in all uveitis eyes was significantly shorter than in control eyes (23.73 vs 24.31 mm, p < 0.001 unadjusted), and AL remained significantly shorter in uveitis than in control after age- and sex-adjustment (p < 0.001). Median AL was significantly shorter in non-infectious uveitis (23.72 mm) and in infectious uveitis (23.99 mm) compared to controls (p < 0.001 and < 0.05, respectively), and was significantly shorter in non-infectious uveitis than in infectious uveitis (p < 0.05). Each millimeter decrease in AL was associated with 1.266-fold increase in unadjusted risk [odds ratio (OR), 1.266; 95% confidence interval (CI), 1.196-1.341; p < 0.001) and 1.446-fold in age- and sex-adjusted risk (OR, 1.446; 95% CI, 1.349-1.549; p < 0.001) of developing uveitis.

CONCLUSION

Median AL of uveitis eyes with infectious or non-infectious etiologies was significantly shorter than that in control eyes, suggesting an increased risk of developing uveitis in eyes with shorter AL. This feature should be considered when exploring new pathogenetic mechanisms of uveitis.

KEY MESSAGES

What is known Shorter axial length may be associated with the pathogenesis of central serous chorioretinopathy and increased risk of early age-related macular degeneration. What is new Here we assessed the relationship between myopia and uveitis by comparing axial lengths of uveitis patients. Median axial length in all uveitis eyes was significantly shorter than in control eyes, and axial length remained significantly shorter in uveitis than in control after age- and sex-adjustment. Each millimeter decrease in axial length was associated with 1.266-fold increase in unadjusted risk and 1.446-fold in age- and sex-adjusted risk of developing uveitis.

Implications of myopia in diagnosis and screening of open angle glaucoma

PURPOSE OF REVIEW

Rapid increase in the prevalence of myopia has been documented worldwide. Myopia, especially high myopia, is not only an important risk factor for having open angle glaucoma (OAG), but also has a strong linking with the progression of OAG. Since myopic axial length (AXL) elongation is associated with nonglaucomatous optic nerve head (ONH) and visual field abnormalities, myopia poses a challenge in differential diagnosis of OAG. This review provides an overview of literature studying relationships between myopic AXL-elongation and diagnosis and prognosis of OAG, and functional and structural changes in the eye.

RECENT FINDINGS

Studies using optical coherence tomography (OCT), OCT-angiography, those using standard automated perimetry (SAP), other perimetric or electrophysiological methods showed dose-dependent effects of myopic AXL elongation on the structural changes in the ONH and parapapillary tissues, and functional abnormalities of an eye. Large cohort studies showed approximately one quarter of eyes with nonpathologic high myopia were complicated with various patterns of visual field defects including glaucoma-like ones.

SUMMARY

Findings of cross-sectional and longitudinal studies obtained using various fundus imaging devices must be integrated to perimetric results to improve differential diagnosis of OAG in myopic eyes, in which artificial intelligence technology may be useful.

Characteristics of myopic maculopathy in Chinese children and adolescents with high myopia

AIMS

To investigate the characteristics of myopic maculopathy among highly myopic Chinese children and adolescents and explore its associated risk factors.

METHODS

Children and adolescents aged 7-17 years with spherical equivalent (SE) ≤ -6.00 dioptres (D) were recruited. Myopic maculopathy was categorised based on the International Meta-Analysis of Pathological Myopia Classification. The extent of diffuse choroidal atrophy (DCA) was classified using Early Treatment Diabetic Retinopathy Study grid (ETDRS). The area of DCA was categorised into three classes relative to optic disk area (DA): A1 (≤1 DA), A2 (1 to ≤5 DA) and A3 (5 to ≤10 DA). Logistic regression was used to identify risk factors associated with myopic maculopathy.

RESULTS

Of the 425 participants aged 13.66±2.67 years, the proportions of tessellated fundus and DCA were 11.76% and 12.24%, and no more severe fundus lesions or 'plus' lesions. The proportion of DCA was 27.03% in children under 11, significantly higher than the 9.12% observed in those aged 11 and older (p<0.001). The percentages of DCA involving the outer, middle and central circles of the ETDRS grid were 42.31%, 55.77% and 1.92%. Myopic maculopathy was significantly associated with younger age (p<0.001), longer axial length (AL; p<0.001) and larger β-zone peripapillary atrophy (β-PPA; p=0.012).

CONCLUSION

In highly myopic children and adolescents, myopic maculopathy predominantly manifested as DCA (12.24%), with no cases of worse myopic maculopathy or 'plus' lesions. Younger age, longer AL and larger β-PPA were risk factors for myopic maculopathy.

Preoperative Retinal Detachment Variables Causing Macular Detachment

Purpose

The factors that contribute to the progression of macular involvement in RRD have not been extensively investigated. The purpose of this study is to evaluate the association between the preoperative characteristics and macular status of the eyes with rhegmatogenous retinal detachment (RRD).

Methods

This is a retrospective cohort study. All patients with RRDs who underwent initial pars plana vitrectomy or scleral buckling were included. Patients with RRD and macular hole retinal detachment, traumatic RD, proliferative diabetic retinopathy, proliferative vitreoretinopathy grade C or higher, diabetic retinopathy, or retinal vein occlusion were excluded. High myopia was defined as an axial length > of 26.5 mm.

Results

A total of 1026 eyes of 1026 patients (mean, 55.4±15.5 years) were included. There was a significant difference in the male (68.4%) to female (31.6%) ratio (the chi-squared test: P < 0.001). A total of 351 patients (34.2%) had high myopia. The 50-59 years age group had the highest number of eyes with high myopia. The proportion of highly myopic eyes in the 40-49 years group was the highest. Multiple logistic regression analysis indicated that prior cataract extraction and shorter axial length (≤24.5 mm) were significantly associated with macula-off RRD (P = 0.018, P = 0.043, respectively). Superior and temporal retinal breaks significantly increased and superior nasal retinal breaks significantly decreased the odds ratio of macular detachment (P = 0.018, P < 0.001, and P < 0.001, respectively).

Conclusion

Previous cataract extraction, shorter axial length, and superior and temporal retinal breaks are important risk factors for macular detachment.

EYE SHAPE DEFORMITY PREDICTS MYOPIC MACULOPATHY PROGRESSION AMONG HIGHLY MYOPIC INDIVIDUALS: A 4-Year Longitudinal Study

PURPOSE

To determine the impact of eye shape using three-dimensional magnetic resonance imaging on myopic maculopathy (MM) progression.

METHODS

At baseline, 67 participants with high myopia were selected. Eye shape was classified into spheroidal, ellipsoidal, temporally distorted, nasally distorted, conical, and barrel-shape identified from three-dimensional magnetic resonance imaging. Spheroidal and ellipsoidal shapes were defined as nondeformity; others were defined as eye deformity. Myopic maculopathy progression was determined through color fundus photography.

RESULTS

Within a 4-year follow-up, 17.1% (7/41) of patients with nondeformed eye shape had MM progression, whereas 69.2% (18/26) of patients with eye shape deformity had MM progression. In multivariable analysis, eye shape deformity (odds ratio, 4.35; 95% confidence interval, 1.10-17.29; P = 0.036) and axial length of ≥28 mm (odds ratio, 12.75; 95% confidence interval, 2.27-71.48; P = 0.004) significantly correlated with MM progression. The predictive discrimination of eye shape alone for MM progression did not differ from axial length (area under the curve: 0.765 vs. 0.750, P = 0.486). By incorporating age, sex, axial length, and eye shape, the prediction model achieved an area under the curve of 0.862 for discriminating MM progression.

CONCLUSION

Eye shape deformity assessed by three-dimensional magnetic resonance imaging is a novel predictor for MM progression in high myopia.

Discriminant prediction equation using an optical biometer for identifying postmyopic laser vision correction eyes

PURPOSE

To create an equation for identifying postmyopic laser vision correction (M-LVC) eyes by using corneal shape parameters in a swept-source optical coherence tomography (SS-OCT) biometer and verify its accuracy.

SETTING

Nagoya Eye Clinic, Nagoya, Japan.

DESIGN

Retrospective evaluation of a screening approach.

METHODS

Control participants were selected retrospectively from patients who visited the clinic for cataract surgery or refractive surgery. M-LVC patients were selected retrospectively from patients who visited the clinic for cataract surgery or M-LVC postoperative checkups. The control and post-M-LVC patients with keratometric values between 39 diopters (D) and 43 D were included in the final analysis. Patients were randomly assigned to equation-creation and validation groups in a 2:1 ratio. To discriminate post-M-LVC patients from control participants, multiple logistic regression analysis was performed with the corneal shape parameters from the optical biometer as independent variables.

RESULTS

The M-LVC and control groups consisted of 90 eyes from 90 patients and 97 eyes from 97 patients, respectively. The average keratometry (Ave-K) values did not differ significantly between the control and M-LVC groups ( P = .187). The multiple logistic analysis identified the asymmetry component (regression coefficient, 5.357; odds ratio, 212.158) and corneal eccentricity index (regression coefficient, -5.088; odds ratio, 0.006) as explanatory variables. The area under the receiver operating characteristic curve in the predictive equation-creation group was 0.946. The sensitivity and specificity in the validation group were 93.3% and 87.5%, respectively.

CONCLUSIONS

The M-LVC discriminant prediction equation with the topography-equipped SS-OCT biometer was effective in detecting post-M-LVC eyes with high accuracy.

A Competition for the Diagnosis of Myopic Maculopathy by Artificial Intelligence Algorithms

Importance

Myopic maculopathy (MM) is a major cause of vision impairment globally. Artificial intelligence (AI) and deep learning (DL) algorithms for detecting MM from fundus images could potentially improve diagnosis and assist screening in a variety of health care settings.

Objectives

To evaluate DL algorithms for MM classification and segmentation and compare their performance with that of ophthalmologists.

Design, Setting, and Participants

The Myopic Maculopathy Analysis Challenge (MMAC) was an international competition to develop automated solutions for 3 tasks: (1) MM classification, (2) segmentation of MM plus lesions, and (3) spherical equivalent (SE) prediction. Participants were provided 3 subdatasets containing 2306, 294, and 2003 fundus images, respectively, with which to build algorithms. A group of 5 ophthalmologists evaluated the same test sets for tasks 1 and 2 to ascertain performance. Results from model ensembles, which combined outcomes from multiple algorithms submitted by MMAC participants, were compared with each individual submitted algorithm. This study was conducted from March 1, 2023, to March 30, 2024, and data were analyzed from January 15, 2024, to March 30, 2024.

Exposure

DL algorithms submitted as part of the MMAC competition or ophthalmologist interpretation.

Main Outcomes and Measures

MM classification was evaluated by quadratic-weighted κ (QWK), F1 score, sensitivity, and specificity. MM plus lesions segmentation was evaluated by dice similarity coefficient (DSC), and SE prediction was evaluated by R2 and mean absolute error (MAE).

Results

The 3 tasks were completed by 7, 4, and 4 teams, respectively. MM classification algorithms achieved a QWK range of 0.866 to 0.901, an F1 score range of 0.675 to 0.781, a sensitivity range of 0.667 to 0.778, and a specificity range of 0.931 to 0.945. MM plus lesions segmentation algorithms achieved a DSC range of 0.664 to 0.687 for lacquer cracks (LC), 0.579 to 0.673 for choroidal neovascularization, and 0.768 to 0.841 for Fuchs spot (FS). SE prediction algorithms achieved an R2 range of 0.791 to 0.874 and an MAE range of 0.708 to 0.943. Model ensemble results achieved the best performance compared to each submitted algorithms, and the model ensemble outperformed ophthalmologists at MM classification in sensitivity (0.801; 95% CI, 0.764-0.840 vs 0.727; 95% CI, 0.684-0.768; P = .006) and specificity (0.946; 95% CI, 0.939-0.954 vs 0.933; 95% CI, 0.925-0.941; P = .009), LC segmentation (DSC, 0.698; 95% CI, 0.649-0.745 vs DSC, 0.570; 95% CI, 0.515-0.625; P < .001), and FS segmentation (DSC, 0.863; 95% CI, 0.831-0.888 vs DSC, 0.790; 95% CI, 0.742-0.830; P < .001).

Conclusions and Relevance

In this diagnostic study, 15 AI models for MM classification and segmentation on a public dataset made available for the MMAC competition were validated and evaluated, with some models achieving better diagnostic performance than ophthalmologists.

Regional Summed Corneal Refractive Power Changes in Myopic Orthokeratology and Their Relationships With Axial Elongation

PURPOSE

To determine the relationship between regional summed corneal refractive power changes (CRPCs) in myopic orthokeratology and axial elongation.

DESIGN

This retrospective study included 70 eyes of 70 patients aged 8 years to 13 years who underwent orthokeratology lens (OK lens) treatment, and all patients underwent regular follow-ups at 1 week, 1 month, 6 months, and 12 months at Zhongshan Ophthalmic Center between January 2019 and May 2021.

METHODS

Axial length (AL) was measured at baseline and 12 months by an IOLmaster 5.0. Refractive error power was measured using cycloplegia. Regional summed CRPCs were calculated by MATLAB software using difference tangential power maps at the sixth month acquired by corneal topography measurements (Medmont E300 Corneal Topographer; Medmont Pty, Victoria, Australia) and defined as changes in corneal refractive power at the sixth month from baseline. The regional summed CRPCs were then subdivided into 4-mm diameter circles, 4- to 5-mm diameter chords, and 5- to 6-mm diameter chords according to the distance from the central of the pupil and into negative, positive, and total according to the values. Pearson correlation, multiple linear regression analysis, and stepwise multiple linear regression analysis were performed to analyze the relationships among these parameters.

RESULTS

Axial elongation had a negative relationship with positive regional summed corneal refractive power in the central 4-mm diameter circle and age (r=-0.282, P =0.018; r=-0.473, P <0.001, respectively) and a positive relationship with negative regional summed corneal refractive power in the 5- to 6-mm diameter chord (r=0.361, P =0.002). Stepwise multiple linear regression analysis identified age (standardized β =-0.434, P <0.001) and negative regional summed corneal refractive power in the 5- to 6-mm diameter chord (standardized β =0.305, P =0.004) as factors influencing AL elongation.

CONCLUSION

Negative regional summed corneal refractive power in a 5- to 6-mm diameter chord after OK lens treatment may be an important index for evaluating the control effects of axial elongation.

Interdependence of Nutrition, Physical Activity, and Myopia

Background: Myopia (also known as nearsightedness), a prevalent refractive error, occurs when parallel rays of light converge in front of the retina, resulting in blurry distance vision. Recently, there has been a marked rise in myopia among the global population. The absence of effective methods of controlling the progression of this visual defect prompts the search for new preventive and therapeutic options. The impact of diet and lifestyle on the progression of myopia is still not fully understood. Therefore, our aim was to examine how these factors might affect the advancement of myopia, based on the existing literature. Methods: This manuscript was prepared through an extensive literature review conducted from June 2022 to September 2024. We searched for pertinent research articles using reputable databases, including PubMed, Scopus, and Web of Science. We included all types of publications, with a special focus on the newest ones. Results: Despite far-reaching examination, the relationship between these factors and myopia control remains inconclusive with varying degrees of evidence supporting their roles. Conclusions: However, promoting a healthy lifestyle, particularly increasing physical activity and outdoor time, is essential. Additionally, emerging research suggests that maintaining a balanced diet is important due to the potential impact of certain nutrients on myopia development. Ophthalmologists should also guide parents on the alternative correction methods beyond single vision glasses, especially for rapidly progressing cases. With the rising prevalence of myopia in children, further research is necessary.

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.

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.

Global prevalence of myopic macular degeneration in general population and patients with high myopia: A systematic review and meta-analysis

The prevalence of myopic macular degeneration (MMD) in the general population and patients with high myopia worldwide has not been fully investigated. Therefore, we screened all population-based studies that reported the prevalence of MMD, and pooled prevalence of MMD using a random-effect model. Subgroup analyses were performed to explore the differences in MMD prevalence in the general population and patients with high myopia according to ethnicity, region of residence (urban/rural), and grading system. Finally, 16 studies were included in this meta-analysis. Results obtained from 2,963 patients from seven countries on four continents indicated that the pooled prevalence of MMD in patients with high myopia was 49.0% (95% CI: 31.5%-66.7%). Results obtained from 71,052 participants from 10 countries on four continents suggested that the pooled prevalence of MMD in the general population was 1.7% (95% CI: 1.1%-2.6%). In the general population, living in urban areas and East Asians were associated with a high prevalence of MMD. Among patients with high myopia, only East Asians were at a higher risk of developing MMD. In conclusion, MMD was particularly prevalent in patients with high myopia. Compared with Europeans, East Asians (Chinese and Japanese) have a higher propensity of developing MMD, both in the general population and in patients with high myopia. It remains unclear whether the higher prevalence of MMD in patients with high myopia in East Asia is caused by differences in given age or given degree of myopia.Systematic review registration number: 202270014 (INPLASY.COM).

Differential Impact of 0.01% and 0.05% Atropine Eyedrops on Ocular Surface in Young Adults

Purpose

To evaluate the effect of low-concentration (0.01% and 0.05%) atropine eyedrops on ocular surface characteristics in young adults.

Methods

Twenty-six myopic students aged 18 to 30 years were randomly assigned to receive either 0.01% or 0.05% atropine once nightly for 14 days, followed by cessation, with a ≥14-day interval between each administration. Assessments were conducted one, two, seven, and 14 days after using atropine with corresponding timepoints after atropine cessation. Tear meniscus height and first and average noninvasive keratograph tear film breakup time (NIKBUT-first, NIKBUT-average) were measured using Keratograph 5M, whereas the objective scatter index (OSI) was measured by OQAS II devices; the ocular surface disease index (OSDI) score was also obtained.

Results

The mean OSI peaked after two days of administration of 0.05% atropine (β = 0.51, P = 0.001), accompanied by significant decreases in NIKBUT-first (β = -7.73, P < 0.001) and NIKBUT-average (β = -8.10, P < 0.001); the OSDI peaked after 14 days (β = 15.41, P < 0.001). The above parameters returned to baseline one week after atropine discontinuation (all P > 0.05). NIKBUT-first and NIKBUT-average reached their lowest points after 14 days of 0.01% atropine administration (NIKBUT-first: β = -4.46, P = 0.005; NIKBUT-average: β = -4.42, P = 0.001), but those significant changes were diminished once atropine treatment stopped.

Conclusions

Young adult myopes experienced a significant but temporary impact on the ocular surface with 0.05% atropine administration, whereas 0.01% atropine had a minimal effect.

Translational Relevance

The investigation of the ocular surface effects of different concentrations of atropine may inform evidence-based clinical decisions regarding myopia control in young adults.

Myopic choroidal neovascularization with neovascular signal around perforating scleral vessel prone to recur after anti-VEGF therapy

BACKGROUND

To compare the recurrence of myopic choroidal neovascularization (mCNV) based on the neovascular signal of mCNV around the perforating scleral vessel (PSV).

METHODS

A consecutive series of naïve patients with mCNV accepted anti-VEGF therapy with a minimum 12-month follow-up period. The neovascular signal relationship between PSV and mCNV were classified into the presence of neovascular signal of CNV around PSV or not. The recurrence of mCNV, best-corrected visual acuity (BCVA), hyperreflective foci height, CNV area and CNV flow area were analyzed between two groups.

RESULTS

Neovascular signal of CNV around PSV was detected in 20 eyes (39.2%). The one-year recurrence rate in the group with neovascular signal of CNV around PSV was significantly higher than that in the group without neovascular signal of CNV around PSV (P = 0.045). The recurrence time in the group with neovascular signal around PSV was shorter than that in the group without neovascular signal around PSV (P = 0.030). Cox proportional hazard model showed that the presence of neovascular signal of CNV around PSV [hazard ratio (HR): 2.904] and subfoveal choroidal thickness ≤ 50 μm (HR: 0.368) were risk factors for recurrence of mCNV. In the group with neovascular signal around PSV, the BCVA was worse (P = 0.024) and the CNV flow area was more unstable (P = 0.027) after therapy.

CONCLUSIONS

PSV was commonly detected in patients with mCNV. The presence of neovascular signal of CNV around PSV was prone to recur with a shorter time in mCNV patients.

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.

Influence of posterior staphyloma in myopic maculopathy and visual prognosis

BACKGROUND/OBJECTIVES

Posterior staphyloma is a hallmark of high myopia and its presence associates to greater degrees of myopic maculopathy. Nonetheless, its development, repercussion on visual function and relationship with maculopathy components, is still unclear. The objective was to analyze the impact of posterior staphyloma on the incidence and severity of myopic maculopathy and its repercussion on visual prognosis.

SUBJECTS/METHODS

Cross-sectional study conducted on 473 consecutive eyes of 259 highly myopic patients examined at Puerta de Hierro-Majadahonda University Hospital (Madrid, Spain). All patients underwent complete ophthalmologic examination including best corrected visual acuity (BCVA), axial length (AL), myopic maculopathy classification according to ATN system (atrophic/traction/neovascularization), determined the presence of posterior staphyloma, pathologic myopia (PM) and severe PM. Multimodal imaging were performed including fundus photography, optical coherence tomography (OCT), OCT-angiography, fundus autofluorescence and/ or fluorescein angiography.

RESULTS

Out of the total, 70.65% were female patients (n = 173/259), mean BCVA was 0.41 ± 0.54 logMAR units and mean AL was 29.3 ± 2.6 mm (26-37.6). Posterior staphyloma was present in 69.4% of eyes. Eyes with posterior staphyloma compared to non-staphyloma were older (p < 0.05), had greater AL (p < 0.01), worse BCVA (p < 0.01) and higher stage in ATN components (p < 0.01). Moreover, compound subgroup showed worse BCVA (p < 0.01) and greater stage in each of the ATN components (p < 0.01). Staphylomas with macular involvement presented worse BCVA (p < 0.01), higher AL (p < 0.01), and greater ATN (p < 0.05). The risk of posterior staphyloma presence in eyes with PM and severe PM eyes was 89.8% and 96.7%, respectively. Posterior staphyloma was the best predictor for BCVA in myopic patients (p < 0.01).

CONCLUSIONS

Posterior staphyloma's presence determines high risk of myopic maculopathy and therefore worse visual prognosis, especially those with macular involvement. Posterior staphyloma represented the best predictor for BCVA in highly myopic patients.

Prevalence and Cause of Loss of Visual Acuity and Visual Field in Highly Myopic Eyes: The Beijing Eye Study

PURPOSE

To explore the prevalence and causes of loss of visual acuity and visual field in highly myopic eyes.

DESIGN

Population-based study.

PARTICIPANTS

4439 subjects of the Beijing Eye Study underwent ophthalmological and systemic examinations including frequency doubling technology perimetry.

METHODS

High myopia was defined by a refractive error of ≤-6 diopters (D) or axial length >26.0 mm.

MAIN OUTCOME MEASURES

Prevalence of vision impairment causes.

RESULTS

212 highly myopic eyes from 154 participants were included with a mean age of 56.2 ± 9.6 years, a mean refractive error of -9.87 ± 3.70 D and a mean axial length of 27.2 ± 1.3 mm. We observed moderate/severe vision impairment (MSVI) in 40 eyes (18.9%; 95% confidence interval [CI], 13.6-24.2) and blindness in 10 eyes (4.7%; 95% CI, 1.8-7.6). Primary causes for MSVI and blindness were myopic macular degeneration (MMD) (29/50; 58%), age-related macular degeneration (1/50; 2%), and branch macular retinal vein occlusion (1/50; 2%). Secondary causes were MMD (4/50; 8%) and optic nerve atrophy (14/50, 28%), further differentiated into non-glaucomatous optic atrophy (NGOA) (9/50; 18%) and glaucomatous optic atrophy (GOA) (5/50; 10%). Prevalence of MMD as vision impairment cause increased significantly from 1/61 (1.6%) in the refractive error group of -6.00 to ≥-7.00 D, to 16/25 (64%) in the group of <-15.0 D. Higher MMD prevalence correlated with higher myopic refractive error (P < 0.001) and increased likelihood of concomitant optic neuropathy (P < 0.001). Similarly, prevalence of optic neuropathy as vision impairment cause increased from 0/61 (0%) in the refractive error group of -6.00 D to ≥-7.00 D, to 9/25 (36%) in the group of <-15.0 D. Higher optic neuropathy prevalence correlated with more myopic refraction (P < 0.001) and older age (P = 0.02).

CONCLUSIONS

In this population-based recruited cohort of highly myopic patients, optic neuropathy accounted for vision impairment in 9.0% eyes, which was lower than the prevalence of MMD as vision impairment cause (18.9%). Notably, optic neuropathy became a significant contributor to vision impairment in more advanced high myopia, reaching 36% in the group with refractive error of <-15.0 D.

FINANCIAL DISCLOSURE(S)

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

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.

Long-Term Axial Length Shortening in Myopic Orthokeratology: Incident Probability, Time Course, and Influencing Factors

Purpose

Long-term axial length (AL) shortening in myopia is uncommon but noteworthy. Current understanding on the condition is limited due to difficulties in case collection. The study reported percentage, probability, and time course of long-term AL shortening in myopic orthokeratology based on a large database.

Methods

This study reviewed 142,091 medical records from 29,825 subjects in a single-hospital orthokeratology database that were collected over 10 years. Long-term AL shortening was defined as a change in AL of -0.1 mm or less at any follow-up beyond 1 year. Incident probability was calculated based on multivariate logistic regression. Time course was estimated using mixed-effect regression model.

Results

A total of 10,093 subjects (mean initial age, 11.70 ± 2.52 years; 58.8% female) with 80,778 visits were included. The number of subjects experienced long-term AL shortening was 1,662 (16.47%; 95% confidence interval, 15.75%-17.21%). Initial age showed significant impact on the incident occurrence (OR, 1.37; 95% confidence interval, 1.34-1.40; P < 0.001). The estimated probability of AL shortening was approximately 2% for subjects with initial age of 6 years and 50% for those aged 18. Among the 1662 AL shortening cases, the median magnitude of the maximum AL reduction was 0.19 mm. The shortening process mostly occurred within the initial 2 years. Subject characteristics had limited associations with the shortening rate.

Conclusions

Long-term AL shortening is possible in subjects receiving myopic orthokeratology. Although age notably affect the incident probability, the time course seems to not vary significantly.

Prevalence and Associations of Nonglaucomatous Optic Nerve Atrophy in High Myopia: The Ural Eye and Medical Study

PURPOSE

To assess the prevalence of nonglaucomatous optic nerve atrophy (NGOA) in highly myopic individuals.

DESIGN

Population-based study.

PARTICIPANTS

The Ural Eye and Medical Study included 5899 (80.5%) of 7328 eligible individuals (80.5%).

METHODS

Nonglaucomatous optic nerve atrophy, graded into 5 arbitrary stages, was characterized by decreased visibility of the retinal nerve fiber layer (RNFL) on photographs, neuroretinal rim pallor, abnormally thin retinal arteriole diameter, and abnormally thin peripapillary RNFL as measured by OCT.

MAIN OUTCOME MEASURES

Nonglaucomatous optic nerve atrophy prevalence and degree.

RESULTS

Of 5709 participants (96.9%) with axial length measurements, 130 individuals (2.3%) were highly myopic, of whom 116 individuals (89.2%; age, 57.8 ± 11.1 years; axial length, 27.0 ± 1.2 mm) had available fundus photographs and OCT images and were included into the study. Nonglaucomatous optic nerve atrophy prevalence was 34/116 individuals (29.3%; 95% confidence interval [CI], 21.0-38.0), and mean NGOA degree in eyes with NGOA was 1.7 ± 1.0 arbitrary units. Higher NGOA degree correlated (multivariable analysis; regression coefficient, r2 = 0.59) with longer axial length (β, 0.22; P = 0.007), wider temporal parapapillary γ zone width (β, 0.50; P < 0.001), higher prevalence of diabetes (β, 0.20; P = 0.005), and higher systolic blood pressure (β, 0.15; P = 0.03). Higher NGOA prevalence was associated with longer axial length (odds ratio [OR], 7.45; 95% CI, 2.15-25.7), wider temporal parapapillary γ zone (OR, 6.98; 95% CI, 2.61-18.7), and higher systolic blood pressure (OR, 1.05; 95% CI, 1.01-1.10).

CONCLUSIONS

In this ethnically mixed population from Russia with an age of 40 years or more, high axial myopia showed a relatively high prevalence of NGOA, increasing with longer axial length and wider temporal parapapillary γ zone. For each 1 mm of axial elongation and γ zone widening, the odds for NGOA increased 7.45-fold and 6.98-fold, respectively. The axial elongation-associated and γ zone-related increase in the distance between the retinal ganglion cells and the optic disc may lead to a lengthening and stretching of the retinal ganglion cell axons and may be of importance pathogenetically. In highly myopic eyes, NGOA may be a reason for visual field and central visual acuity loss, unexplainable by myopic macular pathologic features.

FINANCIAL DISCLOSURE(S)

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

The underestimated role of myopia in uncorrectable visual impairment in the United States

We estimate the US prevalence of uncorrectable visual impairment in 2050 accounting for the changing distribution of both age and myopia. Age projections of the US population (from an estimated total of 379 million in 2050), were taken from the US census website. The distribution of myopia, by severity, was calculated from literature-derived prevalence estimates of 58.4% (≤ - 0.50 D, 2050 projection) and 33.1% (≤ - 1.00 D, 1999-2004 estimate) to provide predicted and conservative estimates, respectively. Uncorrectable visual impairment as a function of age and refractive error was modelled by multiple linear regression. Finally, the likely number of individuals in the US with visual impairment in 2050 was calculated. For a projected myopia prevalence of 58.4%, 222 million are projected to be myopic and 48 million will have high myopia (- 5 D or worse). The projected total number with uncorrectable visual impairment is 11.4 million of which 4.9 million cases (43%) of visual impairment will be directly attributed to increased risk of eye disease associated with myopia. For a projected myopia prevalence of 33.1%, 8.9 million are projected to have uncorrectable visual impairment of which 2.4 million cases (27%) will be directly attributed to myopia. It is predicted that between 27 and 43% of uncorrectable visual impairment in the US population in 2050 will be directly attributable to myopia. Failure to account for the increasing prevalence of myopia among the aging population leads to a substantial underestimate of the prevalence of visual impairment.

Predictors of myopic macular degeneration in a 12-year longitudinal study of Singapore adults with myopia

PURPOSE

To investigate the predictive factors for myopic macular degeneration (MMD) and progression in adults with myopia.

METHODS

We examined 828 Malay and Indian adults (1579 myopic eyes) with myopia (spherical equivalent (SE) ≤-0.5 dioptres) at baseline who participated in both baseline and 12-year follow-up visits of the Singapore Malay Eye Study and the Singapore Indian Eye Study. Eye examinations, including subjective refraction and axial length (AL) measurements, were performed. MMD was graded from fundus photographs following the Meta-Analysis for Pathologic Myopia classification. The predictive factors for MMD development and progression were assessed in adults without and with MMD at baseline, respectively as risk ratios (RR) using multivariable modified Poisson regression models. The receiver operating characteristic curve was used to visualise the performance of the predictive models for the development of MMD, with performance quantified by the area under the curve (AUC).

RESULTS

The 12-year cumulative MMD incidence was 10.3% (95% CI 8.9% to 12.0%) among 1504 myopic eyes without MMD at baseline. Tessellated fundus was a major predictor of MMD (RR=2.50, p<0.001), among other factors including age, worse SE and longer AL (all p<0.001). The AUC for prediction of MMD development was found to be 0.78 (95% CI 0.76 to 0.80) for tessellated fundus and increased significantly to an AUC of 0.86 (95% CI 0.84 to 0.88) with the combination of tessellated fundus with age, race, gender and SE (p<0.001). Older age (p=0.02), worse SE (p<0.001) and longer AL (p<0.001) were found to be predictors of MMD progression.

CONCLUSIONS

In adults with myopia without MMD, tessellated fundus, age, SE and AL had good predictive value for incident MMD. In adults with MMD, 1 in 10 eyes experienced progression over the same period. Older age, more severe myopia and longer AL were independent risk factors for progression.

Longitudinal Changes in Axial Length and Spherical Equivalent in Children and Adolescents With High Myopia

Purpose

To investigate longitudinal changes in axial length (AL) and spherical equivalent (SE) in children and adolescents with high myopia and to explore associated risk factors.

Methods

This was a longitudinal, observational cohort study of highly myopic participants (aged 7-17 years) to evaluate the mean rates of change in AL and SE. Mixed effects regression models were used to explore the risk factors.

Results

The sample consisted of 293 participants (mean age at the baseline, 13.63 ± 2.66 years; mean AL, 27.03 ± 1.30 mm diopters; mean SE, -8.99 ± 2.30 diopters) who were followed for 7.09 ± 1.64 years. Pathological myopia (PM) was present in 11.95% of the participants at the baseline. Over the follow-up period, the mean AL and SE progression rates were 0.13 mm/y (95% CI, 0.12-0.14) and -0.36 diopters/y (95% CI, -0.39 to -0.34). The multivariate analysis showed that the AL elongation and myopic SE progression decreased significantly after age 11 (β = -0.080, P < 0.001; β = 0.146, P < 0.001), increased with a greater baseline SE (β = -0.006, P = 0.014; β = 0.017, P = 0.005), and accelerated in children and adolescents who had PM at the baseline (β = 0.043, P = 0.011; β = -0.097, P = 0.025).

Conclusions

A significant association was found between acceleration of AL elongation and myopic SE progression among the children and adolescents with age, especially those younger than 11 years, and the presence of PM.

Posterior scleral birefringence measured by triple-input polarization-sensitive imaging as a biomarker of myopia progression

In myopic eyes, pathological remodelling of collagen in the posterior sclera has mostly been observed ex vivo. Here we report the development of triple-input polarization-sensitive optical coherence tomography (OCT) for measuring posterior scleral birefringence. In guinea pigs and humans, the technique offers superior imaging sensitivities and accuracies than dual-input polarization-sensitive OCT. In 8-week-long studies with young guinea pigs, scleral birefringence was positively correlated with spherical equivalent refractive errors and predicted the onset of myopia. In a cross-sectional study involving adult individuals, scleral birefringence was associated with myopia status and negatively correlated with refractive errors. Triple-input polarization-sensitive OCT may help establish posterior scleral birefringence as a non-invasive biomarker for assessing the progression of myopia.

Atropine Ophthalmic Solution to Reduce Myopia Progression in Pediatric Subjects: The Randomized, Double-Blind Multicenter Phase II APPLE Study

PURPOSE

The purpose of this study was to assess the dose-response effects of low-dose atropine on myopia progression and safety in pediatric subjects with mild-to-moderate myopia.

METHODS

This phase II, randomized, double-masked, placebo-controlled study compared the efficacy and safety of atropine 0.0025%, 0.005%, and 0.01% with placebo in 99 children, aged 6-11 years, with mild-to-moderate myopia. Subjects received 1 drop in each eye at bedtime. The primary efficacy endpoint was change in spherical equivalent (SE), while secondary endpoints included changes in axial length (AL) and near logMAR (logarithm of the minimum angle of resolution) visual acuity and adverse effects.

RESULTS

The mean±SD changes in SE from baseline to 12 months in the placebo and atropine 0.0025%, 0.005%, and 0.01% groups were -0.55±0.471, -0.55±0.337, -0.33±0.473, and -0.39±0.519 D, respectively. The least squares mean differences (atropine-placebo) in the atropine 0.0025%, 0.005%, and 0.01% groups were 0.11 D ( P =0.246), 0.23 D ( P =0.009), and 0.25 D ( P =0.006), respectively. Compared with placebo, the mean change in AL was significantly greater for atropine 0.005% (-0.09 mm, P =0.012) and 0.01% (-0.10 mm, P =0.003). There were no significant changes in near visual acuity in any of the treatment groups. The most common ocular adverse events were pruritus and blurred vision, each occurring in 4 (5.5%) atropine-treated children. Changes in mean pupil size and amplitude of accommodation were minimal.

CONCLUSIONS

Atropine doses of 0.005% and 0.01% effectively reduced myopia progression in children but no effect was noted with 0.0025%. All doses of atropine were safe and well tolerated.

Epidemiology of rhegmatogenous retinal detachment in commercially insured myopes in the United States

Myopia is a known risk factor for rhegmatogenous retinal detachment (RRD). Given global trends of increasing myopia, we aimed to determine the absolute risk (incidence rate) of RRD in non-myopes, myopes and high myopes in the United States over ten years. We performed a retrospective cohort study of 85,476,781 commercially insured patients enrolled in the Merative™ Marketscan® Research Database. The incidence rate of RRD in phakic patients in the United States was 39-fold higher in high myopes than non-myopes (868.83 per 100,000 person-years versus 22.44 per 100,000 person-years) and three-fold higher in myopes than non-myopes (67.51 per 100,000 person-years versus 22.44 per 100,000 person-years). The incidence rate was significantly higher in males in each category (P < 0.01). Combined, the incidence rate of RRD in phakic patients in the United States from 2007 to 2016 was 25.27 RRDs per 100,000 person-years, a rate higher than those in prior published studies in North America, South America, Europe, Asia, and Australia. The absolute risk of myopia and high myopia increased from 2007 to 2016. The risk of RRD in phakic high myopes rose with increasing age. Notably, the magnitude of increased risk of RRD in myopes varied substantially according to the minimum follow-up period in our models and should be accounted for when interpreting data analyses.

Prevalence and associated health and lifestyle factors of myopic maculopathy in northern China: the Kailuan eye study

BACKGROUND

To evaluate the prevalence and associated health and lifestyle factors of myopic maculopathy (MM) in a northern Chinese industrial city.

METHODS

The cross-sectional Kailuan Eye Study included subjects who participated in the longitudinal Kailuan Study in 2016. Ophthalmologic and general examinations were performed on all the participants. MM was graded based on fundus photographs using the International Photographic Classification and Grading System. The prevalence of MM was evaluated. Univariate and multiple logistic regression were adopted to evaluated risk factors of MM.

RESULTS

The study included 8330 participants with gradable fundus photographs for MM and ocular biometry data. The prevalence of MM was 1.11% (93/8330; 95% confidence interval [CI] 0.89-1.33%). Diffuse chorioretinal atrophy, patchy chorioretinal atrophy, macular atrophy, and plus lesions were observed in 72 (0.9%), 15 (0.2%), 6 (0.007%), and 32 eyes (0.4%), respectively. MM was more common in eyes with longer axial length (OR 4.517; 95%CI 3.273 to 6.235) and in participants with hypertension (OR 3.460; 95%CI 1.152 to 10.391), and older age (OR 1.084; 95%CI 1.036 to 1.134).

CONCLUSIONS

The MM was present in 1.11% of the northern Chinese individuals 21 years or older and the associate factors include longer axial length, older age, and hypertension.

Myopia control in Mendelian forms of myopia

PURPOSE

To study the effectiveness of high-dose atropine for reducing eye growth in Mendelian myopia in children and mice.

METHODS

We studied the effect of high-dose atropine in children with progressive myopia with and without a monogenetic cause. Children were matched for age and axial length (AL) in their first year of treatment. We considered annual AL progression rate as the outcome and compared rates with percentile charts of an untreated general population. We treated C57BL/6J mice featuring the myopic phenotype of Donnai-Barrow syndrome by selective inactivation of Lrp2 knock out (KO) and control mice (CTRL) daily with 1% atropine in the left eye and saline in the right eye, from postnatal days 30-56. Ocular biometry was measured using spectral-domain optical coherence tomography. Retinal dopamine (DA) and 3,4-dihydroxyphenylacetic acid (DOPAC) were measured using high-performance liquid chromatography.

RESULTS

Children with a Mendelian form of myopia had average baseline spherical equivalent (SE) -7.6 ± 2.5D and AL 25.8 ± 0.3 mm; children with non-Mendelian myopia had average SE -7.3 ± 2.9 D and AL 25.6 ± 0.9 mm. During atropine treatment, the annual AL progression rate was 0.37 ± 0.08 and 0.39 ± 0.05 mm in the Mendelian myopes and non-Mendelian myopes, respectively. Compared with progression rates of untreated general population (0.47 mm/year), atropine reduced AL progression with 27% in Mendelian myopes and 23% in non-Mendelian myopes. Atropine significantly reduced AL growth in both KO and CTRL mice (male, KO: -40 ± 15; CTRL: -42 ± 10; female, KO: -53 ± 15; CTRL: -62 ± 3 μm). The DA and DOPAC levels 2 and 24 h after atropine treatment were slightly, albeit non-significantly, elevated.

CONCLUSIONS

High-dose atropine had the same effect on AL in high myopic children with and without a known monogenetic cause. In mice featuring a severe form of Mendelian myopia, atropine reduced AL progression. This suggests that atropine can reduce myopia progression even in the presence of a strong monogenic driver.

The impact of COVID-19 home confinement on axial length in myopic children undergoing orthokeratology

CLINICAL RELEVANCE

Understanding the impact of home confinement on axial length in myopic children undergoing orthokeratology (OK) treatment facilitates the management of myopia control during coronavirus disease 2019 (COVID-19) lockdown.

BACKGROUND

The outbreak of COVID-19 and the corresponding home confinement measures have brought a considerable challenge to myopia control. The study aimed to investigate the influence of home quarantine on axial length in myopic children with OK treatment.

METHODS

Axial length measurements during and before COVID-19 home confinement were retrospectively collected from the myopic children treated with OK, and the children were prospectively followed up after finishing the quarantine. The monthly axial length growth before, during and after confinement was calculated and compared in the full dataset and subgroups stratified by age. Influencing factors for monthly axial length growth during confinement were analysed.

RESULTS

Ninety-two myopic children with OK treatment were enrolled in this study. In the full dataset, covariates adjusted (gender, time interval, baseline axial length and age) monthly axial length growth during confinement was not significantly different from that before (P = 0.213) or after the home confinement (P = 1.000). Multiple linear regression showed that the monthly axial length growth during confinement was negatively correlated with age (P = 0.002). Subgroup analysis based on age demonstrated that the adjusted monthly axial length growth was not significantly different among three periods (P > 0.05) for younger children. For children older than 12-year-old, the adjusted monthly axial length growth during home confinement was significantly slower than before the confinement (P = 0.011), but not the monthly axial length growth after the confinement (P = 1.000).

CONCLUSIONS

COVID-19 home confinement does not increase the myopic axial length elongation in children with OK treatment.

Global trends and frontiers of research on pathologic myopia since the millennium: A bibliometric analysis

Background and purpose

Pathologic myopia (PM) is an international public health issue. This study aimed to analyze PM research trends by reporting on publication trends since 2000 and identifying influential journals, countries, authors, and keywords involved in PM.

Methods

A bibliometric analysis was performed to evaluate global production and development trends in PM since 2000 and the keywords associated with PM.

Results

A total of 1,435 publications were retrieved. PM has become a fascinating topic (with relative research interest ranging from 0.0018% in 2000 to 0.0044% in 2021) and a global public health issue. The top three countries with the highest number of publications were China, the USA, and Japan. The journals, authors, and institutions that published the most relevant literature came from these three countries. China exhibited the most rapid increase in the number of publications (from 0 in 2000 to 69 in 2021). Retina published the most papers on PM. Kyoko Ohno-Matsui and Tokyo Medical and Dental University contributed the most publications among authors and institutions, respectively. Based on keyword analysis, previous research emphasized myopic choroidal neovascularization and treatment, while recent hotspots include PM changes based on multimodal imaging, treatment, and pathogenesis. Keyword analysis also revealed that deep learning was the latest hotspot and has been used for the detection of PM.

Conclusion

Our results can help researchers understand the current status and future trends of PM. China, the USA, and Japan have the greatest influence, based on the number of publications, top journals, authors, and institutions. Current research on PM highlights the pathogenesis and application of novel technologies, including multimodal imaging and artificial intelligence.

Morphological characteristics of the optic nerve head and impacts on longitudinal change in macular choroidal thickness during myopia progression

PURPOSE

The aim of this study was to investigate the association between morphological characteristics of Bruch's membrane opening distance (BMOD), border length (BL), border tissue angle (BTA), peripapillary atrophy (PPA) as well as axial length (AL) and incident decreased macular choroidal thickness (mChT) in young healthy myopic eyes.

METHODS

A total of 323 participants aged 17-30 years were included in the current 2-year longitudinal study. Each participant underwent detailed ocular examinations at baseline and follow-up. Data of AL, refraction error, PPA area, BMOD, BL, BTA and mChT were measured individually. Incident decreased mChT was defined as follow-up mChT of participants decreased into the lowest quartile of baseline mChT.

RESULTS

Subjects with longer AL, longer BMOD were more likely to have incident decreased mChT (odds ratio [OR], 1.56; 2.09, respectively, per 1 Z-score increment), whereas larger BTA was less likely to develop decreased mChT (odds ratio [OR], 0.51, per 1 Z-score increment). The area under the receiver operating curve (AUROC) of basic risk model for incident decreased mChT was 0.6284. After adding BMOD, BTA and AL separately to the basic risk model, the AUROC of the combination could reach 0.6967, 0.6944 and 0.7383, respectively. After combining BMOD, BTA and AL to the basic model, the AUROC of the combination showed the highest AUROC of 0.7608.

CONCLUSIONS

Bruch's membrane opening distance and AL are significant risk factors for incident decreased mChT, whereas BTA played protective role in the deterioration of mChT. In addition, a combination of BMOD, BTA and AL could serve as earlier predictors of the attenuation of mChT in myopia progression.

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.

Spectacle lenses with slightly aspherical lenslets for myopia control: clinical trial design and baseline data

Objectives

Myopia is a major public health problem and it is essential to find safe and effective means to control its progression. The study design and baseline data are presented for a one-year prospective, double-masked, crossover, randomized clinical trial evaluating the efficacy of single vision spectacle lenses with concentric rings of slightly aspherical contiguous lenslets technology (SAL) on myopia control.

Methods

One hundred 8- to 13-year old Chinese children with a refractive error of -0.75 D to -4.75 D were assigned to two groups. In Group 1, SAL and single vision lenses were each worn for 6 months, and Group 2 wore the lenses in the reversed order. Primary outcomes are axial length and spherical equivalent of cycloplegic refractive error. Secondary outcomes included corneal thickness, anterior chamber depth, lens thickness, visual acuity, and lens adaptation.

Results

No significant differences in baseline parameters (cycloplegic spherical equivalent, axial length, age) were found between groups (0.49 < p < 0.94). All children adapted well to the test lenses and there was no significant difference in visual acuity between the SAL and single vision lenses (p = 0.27).

Conclusions

The children in the two well balanced groups had comparable visual acuity and adapted well to the test lenses. These results imply that visual acuity can be well improved by SAL lenses. Clear visual acuity provides the assurance for good compliance in this longitudinal study.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-022-02562-0.

A review of study designs and data analyses in metabolomics studies in myopia

Metabolomics analyzes the entire range of small molecule metabolites in biological systems to reveal the response signals that are transmitted from "genetics and environment", which could help us understand complex phenotypes of diseases. Metabolomics has been successfully applied to the study of eye diseases including age-related macular degeneration, glaucoma, and diabetic retinopathy. In this review, we summarize the findings of myopic metabolomics and discuss them from a design and analysis perspective. Finally, we provide new ideas for the future development of myopia metabolomics research based on the broader ocular metabolomics study.

Sex Disparity in Myopia Explained by Puberty Among Chinese Adolescents From 1995 to 2014: A Nationwide Cross-Sectional Study

Importance

Girls in East Asia have a higher myopia prevalence than boys. Less research has been done on whether girls' earlier puberty could explain this sex difference.

Objective

The purpose of this study was to evaluate the association between myopia and puberty and the role of puberty in explaining the sex disparity in adolescent myopia prevalence.

Design, Setting, and Participants

In this nationwide cross-sectional study, data came from five consecutive national surveys from 1995 to 2014 in China. We included 338,896 boys aged 11–18 and 439,481 girls aged 9–18.

Main Outcomes and Measures

Myopia was defined according to unaided distance visual acuity and subjective refraction; puberty status was defined dichotomously as menarche or spermarche status. The association between myopia and puberty was evaluated by robust Poisson GEE regression. Mediation analyses were used to quantify how much of the sex disparity in myopia could be explained by puberty.

Results

Post-menarche girls and post-spermarche boys showed 29–41% and 8–19% higher risk of myopia than pre-menarche girls and pre-spermarche boys, respectively. The association remained significant in girls [prevalence ratio (PR) = 1.07, 95%CI:1.04–1.10] but disappeared in boys (p > 0.05) after adjusting for potential confounders. Girls had a 12–23% higher risk of myopia than boys. A total of 16.7% of the sex disparity in myopia could be explained by girls' earlier puberty, whereas 11.1% could be explained by behavioral factors.

Conclusion and Relevance

Puberty status is independently associated with myopia in girls but not in boys. A significant proportion of the sex disparity in adolescent myopia could be explained by girls' earlier puberty, suggesting the need to consider sex-differentiated strategies for myopia prevention and treatment.

Two-Year Choroidal Thickness Attenuation and Its Associations in Healthy Chinese Adults

Purpose

Identifying clinical associations causing attenuation in choroidal thickness (CT) among healthy Chinese adults.

Methods

A 2-year longitudinal study was conducted in volunteers aged over 30 years from China. All participants had no history of eye disease or surgery. All subjects underwent swept-source optical coherence tomography to measure the CT in the macular region at baseline and at 2-year follow-up. The regression models were based on the generalized estimating equation.

Results

A total of 603 eyes of 336 healthy participants were included in the final analysis (mean [SD] age, 58.88 [8.82] years; 74.70% female). Mean (SD) choroidal thickness (MCT) was reduced significantly from 206.62 (72.42) to 194.02 (72.08) µm (difference, −12.60 µm; 95% confidence interval [CI], −13.62 to −11.57). Among the Early Treatment of Diabetic Retinopathy Study (ETDRS) grid, CT at the subfoveal sector showed the greatest 2-year reduction (difference, −14.55 µm; 95% CI, −15.87 to −13.22). The largest 2-year change was observed in the 50 to 59 years group (difference, −14.51 µm; 95% CI, −16.71 to −12.32). Multivariate regression showed female gender (β = −2.85; 95% CI, −5.65 to −0.56) and baseline MCT (β = −0.040; 95% CI, −0.056 to −0.024) were significantly and independently associated with greater 2-year CT decrease.

Conclusions

These results indicated that CT among Chinese healthy adults decreased during the 2-year follow-up, and the greater choroidal thinning rate was significantly associated with female gender and larger baseline MCT.

Translational Relevance

Longitudinal CT data of healthy adults provide a reference range when evaluating pathologic variations, especially for the age-related retinal-choroidal disorders.

Distribution and association of visual impairment with myopic maculopathy across age groups among highly myopic eyes - based on the new classification system (ATN)

Purpose

To investigate the percentages and risk factors for visual impairment (VI) across age groups in a highly myopic cohort with a wide range of age (18–93 years).

Methods

A total of 2099 eyes (1220 participants) were enrolled. All participants underwent detailed ocular examinations. Myopic maculopathy (MM) was assessed as myopic atrophy maculopathy (MAM), myopic traction maculopathy (MTM) or myopic neovascular maculopathy (MNM) based on the ATN system.

Results

Most participants younger than 50 years had normal vision, while the cumulative risk of VI and blindness gradually increased after 50–59 years. The percentage of each type of MM increased nonlinearly with ageing (all p < 0.001), with an accelerated period of increase after 45 years for MAM, and after 50 years for MTM and MNM. Axial length (AL) ≥30 mm was the only associated factor for mild VI or worse in participants aged 18–39 years (p < 0.001). Older age, AL ≥30 mm and the presence of MAM were predictors for mild VI or worse in the group aged 40–49 years (all p < 0.05). In participants aged ≥50 years, older age, female sex, longer AL and increased severity of MM were risk factors for VI and blindness (all p < 0.05).

Conclusion

The percentages of MM and related VI increased nonlinearly with older age, with a turning point at 45 years for MAM, preceding that of MTM, MNM and VI by 5 years, warranting future longitudinal studies to confirm. Different age groups presented different risk factors for VI. Timely screening should be in place for middle‐aged high myopes.

Corneal Biometric Features and Their Association With Axial Length in High Myopia

PURPOSE

To characterize the morphologic features of corneal parameters and their correlation with axial length (AL) elongation in patients with high axial myopia.

DESIGN

Cross-sectional comparative study.

METHODS

A total of 299 eyes with high myopia (299 patients) and 266 eyes of age- and sex-matched control subjects (266 patients) were examined by anterior segment swept-source optical coherence tomography (SS-OCT) and an IOL Master. Central corneal thickness (CCT), thinnest corneal thickness (TCT), corneal volume (CV), and anterior corneal curvature (CC), posterior CC, and total CC were obtained, and their correlation with AL was investigated using multiple linear regression model.

RESULTS

The CCT, TCT, CV, and anterior, posterior, and total CC of patients with high myopia were smaller than those of the control subjects. The CCT, TCT, and CV had a continuous downward trend with AL. However, CC decreased rapidly with AL when AL was <26 mm and the slope decreased when AL was 26 to 28 mm. This linear association was absent when AL was >28 mm. Multiple linear regression showed that the CCT (β = -1.98, P = .007), TCT (β = -1.63, P = .019), and CV (β = -0.13, P = .001) were associated with AL. Anterior, posterior, and total CCs were negatively associated with AL when AL was <26 mm (all P < .001) and when AL was between 26 and 28 mm (all P < .05).

CONCLUSIONS

CC decreases may serve as a refractive compensation on myopia when AL is <28 mm. However, this effect does not exist when AL is >28 mm. Consideration should be given to the special distribution of cornea curvature for IOL calculations in subjects with high myopia.

Progression and associated factors of lacquer cracks/patchy atrophies in high myopia: the Beijing Eye Study 2001-2011

PURPOSE

To assess the development and progression of lacquer cracks/patchy atrophies (LCs/PAs) in high myopia.

METHODS

The case control study included highly myopic eyes (refractive error ≤  - 6.0 diopters), examined in the population-based Beijing Eye Study 2001/2011. Using fundus photographs taken in 2001 and 2011 and optical coherence tomographic images obtained in 2011, we assessed the incidence and enlargement of pre-existing LC/PAs.

RESULTS

The study included 89 highly myopic eyes (age: 65.0 ± 9.4 years). Newly developed or enlarged LC/PAs were detected in 17 (19.1%; 95% confidence interval (CI): 11.0, 27.0) eyes, with a new LC development without previous LCs, enlargement of a pre-existing LC, LC enlargement to a PA, development of a new PA without any previous LCs, and enlargement of a pre-existing PA detected in 3, 3, 5, 3, and 3 eyes, respectively. In 14 (82.4%; 95%CI: 62.3, 100) of the 17 eyes with LC/PA development or enlargement, the LC/PAs elongated perpendicularly to, and widened in, the direction of gamma zone enlargement. Higher prevalence of LC/PA enlargement was associated (multivariable analysis) with higher myopic maculopathy stage in 2001 (odds ratio (OR): 7.83; 95%CI: 2.65, 23.2; P < 0.001) and higher frequency of parapapillary delta zone enlargement (OR: 32.0; 95%CI: 3.07, 334; P < 0.001). Prevalence of LC/PA enlargement was lower than the prevalence of changes in other myopic maculopathy features (disc-fovea distance elongation: 71%; choroidal vessel shift: 55%; reduction in ophthalmoscopical disc size: 34%; ophthalmoscopic disc size enlargement: 25%). All eyes with LC/PA enlargement showed a pre-existing and enlarging gamma zone.

CONCLUSIONS

Development and enlargement of LC/PAs were associated with enlargement of parapapillary delta zone and often occurred in association with the direction of gamma zone enlargement.

Clinical profile and distribution of peripheral retinal changes in myopic population in a hospital-based study in North India

Purpose

To evaluate the prevalence of different types of peripheral retinal changes in a myopic population in North India and correlate them with axial length.

Methods

This cross-sectional, hospital-based survey included 600 eyes of 300 myopic individuals, aged between 10 and 40 years, attending the outdoor ophthalmology clinic of a tertiary eye care hospital in North India were examined from July 2019 to July 2020. They were divided into mild, moderate, high, and severe myopia according to the spherical equivalent of refraction. Axial length was recorded. Peripheral retinal changes were examined by scleral indentation binocular indirect ophthalmoscopy. Standardized findings considered with their fundus location were lattice degeneration, white without pressure and white with pressure, snail-track degenerations, peripheral chorioretinal atrophy, retinal holes, tears, and detachment. The study was approved by the institutional ethics committee, and all participants provided informed consent.

Results

Peripheral retinal degenerations were found in almost half (53%) of all myopes included in the study. The most common peripheral retinal degeneration found was lattice degeneration, followed by white without pressure, white with pressure, and chorioretinal atrophy. Most of the peripheral retinal degenerations were seen in the temporal quadrant of the fundus, either superotemporal or inferotemporal. There was a significant positive association between the prevalence of peripheral retinal degeneration with age, increased axial length, and severity of myopia.

Conclusion

The results of our study indicate the necessity for careful peripheral fundus examinations of all myopes, irrespective of age and degree of myopia, for early diagnosis and better management of visual-threatening complications like retinal detachment.

A systematic review of clinical practice guidelines for myopic macular degeneration

Background

Myopic macular degeneration (MMD) is a primary cause of blindness and visual impairment in many parts of the world. A review of clinical practice guidelines (CPGs) for intervention selection are required with the increasing demand for MMD management in clinical practice as well as in national health services. Therefore, we aim to systematically review CPGs for MMD and assist the recommendations development of the Package of Eye Care Interventions (PECI) program of the World Health Organization.

Methods

A systematic review of CPGs published on MMD between 2010 and April 2020 was conducted. Guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Cochrane systematic reviews were also included when the evidence from included CPGs were inadequate or contradict.

Results

After applying exclusion criteria and conducting the quality appraisal, two CPGs were finally included. The average of the AGREE II ratings for the identified Guidelines were 56 and 63 respectively (7 for each item). To provide further information on interventions for MMD, one Cochrane review on MMD was additionally identified and included in the study. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) drugs were recommended for patients with myopic choroidal neovascularization (mCNV) as first-line therapy to improve vision and reduce central macular thickness, and ranibizumab showed significant effectiveness compared to photodynamic therapy (PDT). PDT was recommended to be performed in those resistant to the treatment by one CPG but lacked of adequate description and support. Data extracted from the Cochrane systematic reviews indicated that anti-VEGF therapy for mCNV had significant effectiveness in improving visual acuity and reducing CMT compared to PDT with moderate to low certainty of evidence. Ranibizumab and bevacizumab were considered as equally effective with moderate certainty.

Conclusions

The outcomes of this review suggest that high quality clinical practice guidelines for MMD management are limited. Intravitreal injection of anti-VEGF agents was recommended as an effective intervention to treat myopic CNV as the first-line treatment, while there was inadequate guidance for the application of PDT in myopic CNV management. The use of other interventions for MMD were not recommended at this time and additional evidence is called for.

Pathologic myopia: advances in imaging and the potential role of artificial intelligence

Pathologic myopia is a severe form of myopia that can lead to permanent visual impairment. The recent global increase in the prevalence of myopia has been projected to lead to a higher incidence of pathologic myopia in the future. Thus, imaging myopic eyes to detect early pathological changes, or predict myopia progression to allow for early intervention, has become a key priority. Recent advances in optical coherence tomography (OCT) have contributed to the new grading system for myopic maculopathy and myopic traction maculopathy, which may improve phenotyping and thus, clinical management. Widefield fundus and OCT imaging has improved the detection of posterior staphyloma. Non-invasive OCT angiography has enabled depth-resolved imaging for myopic choroidal neovascularisation. Artificial intelligence (AI) has shown great performance in detecting pathologic myopia and the identification of myopia-associated complications. These advances in imaging with adjunctive AI analysis may lead to improvements in monitoring disease progression or guiding treatments. In this review, we provide an update on the classification of pathologic myopia, how imaging has improved clinical evaluation and management of myopia-associated complications, and the recent development of AI algorithms to aid the detection and classification of pathologic myopia.

Genome-wide Association Study of Axial Length in Population-based Cohorts in Japan

Purpose

To elucidate the differences in ocular biometric parameters by generation and gender and to identify axial length (AL)-associated genetic variants in Japanese individuals, we analyzed Tohoku Medical Megabank Organization (ToMMo) Eye Study data.

Design

We designed the ToMMo Eye Study, examined AL variations, and conducted genome-wide association studies (GWASs).

Participants

In total, 33 483 participants aged > 18 years who were recruited into the community-based cohort (CommCohort) and the birth and three-generation cohort (BirThree Cohort) of the ToMMo Eye Study were examined.

Methods

Each participant was screened with an interview, ophthalmic examinations, and a microarray analysis. The GWASs were performed in 22 379 participants in the CommCohort (discovery stage) and 11 104 participants in the BirThree Cohort (replication stage). We evaluated the associations of single nucleotide polymorphisms (SNPs) with AL using a genome-wide significance threshold (5 × 10^-8) in each stage of the study and in the subsequent meta-analysis.

Main Outcome Measures

We identified the association of SNPs with AL and distributions of AL in right and left eyes and individuals of different sexes and ages.

Results

In the discovery stage, the mean AL of the right eye (23.99 mm) was significantly greater than that of the left eye (23.95 mm). This difference was reproducible across sexes and ages. The GWASs revealed 703 and 215 AL-associated SNPs with genome-wide significance in the discovery and validation stages, respectively, and many of the SNPs in the discovery stage were replicated in the validation stage. Validated SNPs and their associated loci were meta-analyzed for statistical significance (P < 5 × 10^-8). This study identified 1478 SNPs spread over 31 loci. Of the 31 loci, 5 are known AL loci, 15 are known refractive-error loci, 4 are known corneal-curvature loci, and 7 loci are newly identified loci that are not known to be associated with AL. Of note, some of them shared functional relationships with previously identified loci.

Conclusions

Our large-scale GWASs exploiting ToMMo Eye Study data identified 31 loci linked to variations in AL, 7 of which are newly reported in this article. The results revealed genetic heterogeneity and similarity in SNPs related to ethnic variations in AL.

Association of Myopia With Risk of Incident Metabolic Syndrome: Findings From the UK Biobank Study Cohort of 91,591 Participants

Purpose

To investigate the association between myopia and risk of metabolic syndrome (MetS) in a prospective cohort from the UK Biobank Study.

Methods

Volunteers (aged 40 years and above) free of baseline MetS and cataract included from the UK Biobank Study, a prospective follow-up cohort. Myopia was defined using uncycloplegic autorefraction, self-report-myopia, and medical records for refractive error at baseline. MetS as well as components of MetS were diagnosed based on health records, blood biochemistry, and questionnaires. Questionnaires determined the status of smoking, drinking, physical activity and dietary supplements, as well as ethnicity and education.

Results

A total of 91,591 participants were available in the analysis, with a mean age of 55.37 ± 8.07 years at baseline and a median follow-up years of 11.16 years. The proportion of myopia was 49.7%, and a total of 937 (1.0%) participants were identified as having incident MetS (0.09/100 person years). Subjects with myopia were more likely to have MetS compared with non-myopic subjects (0.82 vs. 0.21%, Log-rank test P < 0.001). Mopes had greater risk of incident MetS (Hazard ratio [HR] = 4.19, 95% confidence interval [CI] 3.57-4.93, P < 0.001) adjusting for baseline age, gender, education and ethnicity. After further controlling for lifestyle factors (smoking, drinking, physical activity, and fish oil supplement) or baseline metabolic disorders, the risk of incident MetS were 3.88- and 4.06-fold greater in myopic subjects than those without myopia, respectively (P < 0.001 for both models). The severity of myopia was not significantly correlated to incident MetS in multivariate-adjusted models.

Conclusions

An increased risk of incident MetS among the elderly is associated with myopia, but not the degree of myopia. These findings highlighted the need of prevention of MetS among older adults with myopia.

Prevalence of Myopic Macular Features in Dutch Individuals of European Ancestry With High Myopia

Question

What is the prevalence of myopic macular degeneration in Dutch individuals of European ancestry with high myopia?

Findings

In this cross-sectional study of 626 individuals with European ancestry with high myopia, the prevalence of myopic macular degeneration was 25.9% and increased with older age, lower spherical equivalent of refractive error, and higher axial length.

Meaning

Myopic retinal features were frequent in this highly myopic study population, but not different than patients of Asian ancestry with similar risk profiles.

Importance

High myopia incidence and prevalence is increasing worldwide, and the visual burden caused by myopia is expected to rise accordingly. Studies investigating the occurrence of myopic complications in individuals of European ancestry with high myopia are scarce, hampering insights into the frequency of myopic retinal complications in European individuals and their visual burden.

Objective

To assess the frequency of myopic macular features in individuals of European ancestry with high myopia.

Design, Setting, and Participants

This cross-sectional analysis of the Dutch Myopia Study (MYST) and individuals with high myopia from the Rotterdam Study (RS) included 626 patients with high myopia (spherical equivalent of refractive error [SER] ≤−6 diopters [D] or axial length [AL] ≥26 mm) who underwent an extensive ophthalmic examination including multimodal retinal imaging. In addition to this combination of a population-based cohort study and mix-based high myopia study, a systematic literature review was also performed to compare findings with studies of individuals of Asian ancestry.

Exposures

High myopia, age, and AL.

Main Outcomes and Measures

Frequency of myopic macular and optic disc features: tessellated fundus, myopic macular degeneration (MMD), staphyloma, peripapillary intrachoroidal cavitation, peripapillary atrophy (PPA), and “plus” lesions (choroidal neovascularization, Fuchs spot, and lacquer cracks).

Results

The mean (SD) SER of the combined study population (MYST and RS) was −9.9 (3.2) D; the mean (SD) age was 51.4 (15.1) years, and 387 (61.8%) were women. The prevalence of MMD was 25.9% and increased with older age (P for trend <.001), lower SER (odds ratio [OR], 0.70; 95% CI, 0.65-0.76; P < .001), and higher AL (OR, 2.53; 95% CI, 2.13-3.06; P < .001). Choroidal neovascularization or Fuchs spot was present in 2.7% (n = 17), both lesions in 0.3% (n = 2), and lacquer cracks in 1.4% (n = 9). Staphyloma, PPA, and MMD were highly prevalent in visual impaired and blind eyes (frequency was 73.9% [20 of 27], 90.5% [19 of 21], and 63.0% [17 of 27] of unilateral blind eyes for MMD, staphyloma, and PPA, respectively). Seven previous studies in Asian populations reported a variable MMD frequency ranging from 8.3% to 64%, but frequencies were similar for comparable risk profiles based on age and SER.

Conclusions and Relevance

In this cross-sectional study of a highly myopic Dutch population of European ancestry, myopic retinal features were frequent; were associated with age, SER, and AL; and occurred in all visually severely impaired eyes. The absence of treatment options for most of these retinal complications emphasizes the need for effective strategies to prevent high myopia.