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Li T, Deng C, Li J, Chen Y, Chen X, Zhang N, Li Z, Wang E, Qin W, Yang M, Li X, Li L, Wang H, Guo Y, Lu W, Qian X, Yan J. Mediation effect of sleep time on the association between outdoor activity and myopia in Chinese children and adolescents: a cross-sectional study. J Public Health (Oxf) 2024:fdae104. [PMID: 38887029 DOI: 10.1093/pubmed/fdae104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/22/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND This study aimed to assess the association between outdoor activity and myopia among children and adolescents and investigate whether sleep time could mediate this relationship. METHODS This cross-sectional study was performed on students aged 4-16 years in China, from August 2021 to January 2022. Outdoor activity was assessed by the Assessment Questionnaire of Exposure to Sunlight Activities for Students (AQESAS). Binary logistic regression combined with the mediation analysis was used to analyze the association of AQESAS with myopia and the mediating effect of sleep time on this relationship. RESULTS The prevalence of myopia was 53.51% (N = 1609). Multivariate logistic regression analysis showed that more sleep time (OR = 0.794, 95%CI: 0.707-0.893) and a higher score of AQESAS (OR = 0.989, 95%CI: 0.981-0.996) were significantly associated with a decreased risk of myopia. Mediation analysis revealed that sleep time plays a mediating role in the association between outdoor activity and myopia (ACME = -0.0006, P < 0.001), and the mediation proportion was 19.7%. CONCLUSION Outdoor activity affects myopia directly and indirectly through sleep time. The result suggested that children may be able to reduce the risk of myopia by promoting sleep through increased awareness of outdoor activity and exposure to sunlight.
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Affiliation(s)
- Tongtong Li
- School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
| | - Chaoming Deng
- Health Science Research Department, BYHEALTH Institute of Nutrition & Health, No. 3 Kehui 3rd Street, No. 99 Kexue Avenue Central, Huangpu District, Guangzhou 510663, China
| | - Jing Li
- School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, No. 251. Fukang Road, Tianjin 300384, China
| | - Ying Chen
- School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
| | - Xukun Chen
- School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
| | - Naijian Zhang
- School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
| | - Zhongxia Li
- Health Science Research Department, BYHEALTH Institute of Nutrition & Health, No. 3 Kehui 3rd Street, No. 99 Kexue Avenue Central, Huangpu District, Guangzhou 510663, China
| | - Enming Wang
- Department of Ophthalmology, The People Hospital of Feicheng, No. 108 Xincheng Road, Feicheng 271600, China
| | - Wei Qin
- Medical Laboratory, The People Hospital of Feicheng, No. 108 Xincheng Road, Feicheng 271600, China
| | - Mengtong Yang
- Health Science Research Department, BYHEALTH Institute of Nutrition & Health, No. 3 Kehui 3rd Street, No. 99 Kexue Avenue Central, Huangpu District, Guangzhou 510663, China
| | - Xiangyun Li
- Outpatient Department, The People Hospital of Feicheng, No. 108 Xincheng Road, Feicheng 271600, China
| | - Li Li
- Medical Laboratory, The People Hospital of Feicheng, No. 108 Xincheng Road, Feicheng 271600, China
| | - Haiyan Wang
- ENT Department, The People Hospital of Feicheng, No. 108 Xincheng Road, Feicheng 271600, China
| | - Yanjun Guo
- School of Optometry, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
| | - Wenli Lu
- School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
| | - Xuehan Qian
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, No. 251. Fukang Road, Tianjin 300384, China
| | - Jing Yan
- School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
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Kido A, Miyake M, Watanabe N. Interventions to increase time spent outdoors for preventing incidence and progression of myopia in children. Cochrane Database Syst Rev 2024; 6:CD013549. [PMID: 38864362 PMCID: PMC11167692 DOI: 10.1002/14651858.cd013549.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
BACKGROUND Myopia or nearsightedness is a type of refractive error. It causes people to see near objects clearly but distant objects as blurred. Good vision can be obtained if the refractive error is corrected properly but, where this is not possible, impaired vision will remain. The remaining myopia imposes a considerable personal and societal burden. In addition, the progression of myopia is more likely to be accompanied by other ocular diseases such as cataract, glaucoma and retinal detachment. Myopia has emerged as a significant global public health problem in recent years. The World Health Organization (WHO) reported uncorrected or undercorrected myopia to be a major cause of visual impairment worldwide. From both an individual and social perspective, it is important to prevent the onset of myopia and slow down its progression. Observational studies have shown that children who spend more time outdoors have a lower incidence of myopia. Several other non-Cochrane systematic reviews have focused on the association between increasing children's outdoor activity time and the prevention of myopia. However, none of these systematic reviews were limited to randomised controlled trials (RCTs), as they included all types of study designs, including observational studies and non-RCTs, in addition to RCTs. OBJECTIVES To assess the effects of interventions to increase outdoor time on the incidence and progression of myopia in children. SEARCH METHODS We searched CENTRAL, MEDLINE Ovid, Embase Ovid, ISRCTN registry, ClinicalTrials.gov, and the WHO ICTRP with no language restrictions. The databases were last searched on 24 June 2022. SELECTION CRITERIA We included RCTs and cluster-RCTs in which interventions were performed to increase the outdoor time for children with the aim of preventing the incidence and progression of myopia. DATA COLLECTION AND ANALYSIS We employed the standard methods recommended by Cochrane and assessed the certainty of the evidence using GRADE. We considered the following outcome measures: mean change in refractive error from baseline, incidence of myopia, mean change in the axial length from baseline, mean change in unaided distance visual acuity from baseline, quality of life and adverse event. MAIN RESULTS We included five RCTs in this review, four of which were cluster-RCTs. The total number of participants was 10,733. The included participants were primary school children, most of whom were in first or second grade (aged six to nine years). Four cluster-RCTs involved school-based interventions to encourage children to spend more time outdoors. The interventions included classroom time outdoors, routine for spending recess outdoors, motivational tools for spending time outdoors, and encouragement through electronic information tools. The intervention groups had less change in refractive errors in the direction of myopia; however, 95% confidence intervals (CIs) included no benefit or both benefit and harm at years one and three, and differences at year two included both clinically important and unimportant benefits (at 1 year: mean difference (MD) 0.08 dioptres (D), 95% CI -0.01 to 0.17; 4 studies, 1656 participants; low-certainty evidence; at 2 years: MD 0.13 D, 95% CI 0.06 to 0.19; 4 studies, 2454 participants; moderate-certainty evidence; at 3 years: MD 0.17 D, 95% CI -0.17 to 0.51; 1 study, 729 participants; low-certainty evidence). Our protocol defined a difference of 0.1 D in the change in refractive error as clinically important. At one year, the difference was less than 0.1 D, but at two and three years it was more than 0.1 D. The incidence of myopia was lower in the intervention groups compared to the control groups, but 95% CIs included no change or clinically unimportant benefits (at 1 year: 7.1% with intervention versus 9.5% with control; risk ratio (RR), 0.82, 95% CI 0.56 to 1.19; 3 studies, 1265 participants; low-certainty evidence; at 2 years: 22.5% with intervention versus 26.7% with control; RR 0.84, 95% CI 0.72 to 0.98; 3 studies, 2104 participants; moderate-certainty evidence; at 3 years: 30.5% with intervention versus 39.8% with control; RR 0.77, 95% CI 0.59 to 1.01; 1 study, 394 participants; moderate-certainty evidence). Our protocol defined a difference of 3% in the incidence of myopia as clinically important. At one year, the difference was 2.4%, but there were clinically important differences between the two groups at two (4.2%) and three years (9.3%). The intervention groups had smaller changes in axial lengths in the direction of myopia than the control groups; however, 95% CIs included no benefit or both benefit and harm at years one and three (at 1 year: MD -0.04 mm, 95% CI -0.09 to 0; 3 studies, 1666 participants; low-certainty evidence; at 2 years: MD -0.04 mm, 95% CI -0.07 to -0.01; 3 studies, 2479 participants; moderate-certainty evidence; at 3 years: MD -0.03 mm, 95% CI -0.13 to 0.07; 1 study, 763 participants; moderate-certainty evidence). No included studies reported changes in unaided distance visual acuity and quality of life. No adverse events were reported. AUTHORS' CONCLUSIONS The intervention methods varied from adopting outdoor activities as part of school lessons to providing information and motivation for encouraging outdoor activities. The results of this review suggest that long-term interventions to increase the time spent outdoors may potentially reduce the development of myopia in children. However, although the interventions may also suppress the progression of myopia, the low certainty of evidence makes it difficult to draw conclusions. Further research needs to be accumulated and reviewed.
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Affiliation(s)
- Ai Kido
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Norio Watanabe
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
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Tang T, Lu Y, Li X, Zhao H, Wang K, Li Y, Zhao M. Comparison of the long-term effects of atropine in combination with Orthokeratology and defocus incorporated multiple segment lenses for myopia control in Chinese children and adolescents. Eye (Lond) 2024; 38:1660-1667. [PMID: 38418604 PMCID: PMC11156845 DOI: 10.1038/s41433-024-02987-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/13/2024] [Accepted: 02/05/2024] [Indexed: 03/01/2024] Open
Abstract
PURPOSE The aim of this study was to evaluate the efficacy of Orthokeratology (Ortho-K), defocus incorporated multiple segment (DIMS) lens, combined Ortho-K/atropine, and combined DIMS/atropine for myopia control in children. METHODS A retrospective study included 167 myopic children aged 6-14 years with a spherical equivalent refraction (SER) of -0.75 to -4.00 diopter treated with Ortho-K (OK, n = 41), combined Ortho-K/atropine (OKA, n = 43), DIMS (n = 41), or combined DIMS/atropine (DIMSA, n = 42). Axial length (AL) was measured at baseline and at 3, 6, 9 and 12 months. Axial elongation over time and between groups were analysed. RESULTS After 12 months, the AL change was 0.20 ± 0.12 mm, 0.12 ± 0.14 mm, 0.22 ± 0.14 mm, and 0.15 ± 0.15 mm in the OK, OKA, DIMS, and DIMSA, respectively. There was no significant difference in AL change between OK and DIMS. OKA and DIMSA significantly slowed axial elongation compared to OK and DIMS monotherapy. After stratification by age, in the subgroup aged 6-10 years, there was significant difference in AL change between OKA and DIMS (p = 0.013), and no difference between other groups, while in the subgroup aged 10-14 years, the difference between OKA and DIMS became insignificant (p = 0.237), and the difference between OK and OKA, OK and DIMSA, DIMS and DIMSA became significant. CONCLUSIONS Ortho-K and DIMS lenses show similar reductions in myopia progression among children with low initial myopia. Atropine can significantly improve the efficacy of myopia control of both Ortho-K and DIMS lenses, and this add-on effect is better in older children.
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Affiliation(s)
- Tao Tang
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Yuchang Lu
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Xuewei Li
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Heng Zhao
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Kai Wang
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China.
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China.
- College of Optometry, Peking University Health Science Center, Beijing, China.
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China.
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.
| | - Yan Li
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Mingwei Zhao
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
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Eppenberger LS, Grzybowski A, Schmetterer L, Ang M. Myopia Control: Are We Ready for an Evidence Based Approach? Ophthalmol Ther 2024; 13:1453-1477. [PMID: 38710983 PMCID: PMC11109072 DOI: 10.1007/s40123-024-00951-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/11/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Myopia and its vision-threatening complications present a significant public health problem. This review aims to provide an updated overview of the multitude of known and emerging interventions to control myopia, including their potential effect, safety, and costs. METHODS A systematic literature search of three databases was conducted. Interventions were grouped into four categories: environmental/behavioral (outdoor time, near work), pharmacological (e.g., atropine), optical interventions (spectacles and contact lenses), and novel approaches such as red-light (RLRL) therapies. Review articles and original articles on randomized controlled trials (RCT) were selected. RESULTS From the initial 3224 retrieved records, 18 reviews and 41 original articles reporting results from RCTs were included. While there is more evidence supporting the efficacy of low-dose atropine and certain myopia-controlling contact lenses in slowing myopia progression, the evidence about the efficacy of the newer interventions, such as spectacle lenses (e.g., defocus incorporated multiple segments and highly aspheric lenslets) is more limited. Behavioral interventions, i.e., increased outdoor time, seem effective for preventing the onset of myopia if implemented successfully in schools and homes. While environmental interventions and spectacles are regarded as generally safe, pharmacological interventions, contact lenses, and RLRL may be associated with adverse effects. All interventions, except for behavioral change, are tied to moderate to high expenditures. CONCLUSION Our review suggests that myopia control interventions are recommended and prescribed on the basis of accessibility and clinical practice patterns, which vary widely around the world. Clinical trials indicate short- to medium-term efficacy in reducing myopia progression for various interventions, but none have demonstrated long-term effectiveness in preventing high myopia and potential complications in adulthood. There is an unmet need for a unified consensus for strategies that balance risk and effectiveness for these methods for personalized myopia management.
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Affiliation(s)
- Leila Sara Eppenberger
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Andrzej Grzybowski
- University of Warmia and Mazury, Olsztyn, Poland
- Institute for Research in Ophthalmology, Poznan, Poland
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemical and Biological Engineering, Nanyang Technological University, Singapore, Singapore
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
- Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore, Singapore.
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Dhakal R, Lawrenson JG, Huntjens B, Shah R, Verkicharla PK. Light exposure profiles differ between myopes and non-myopes outside school hours. BMJ Open Ophthalmol 2024; 9:e001469. [PMID: 38816010 PMCID: PMC11138295 DOI: 10.1136/bmjophth-2023-001469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 04/27/2024] [Indexed: 06/01/2024] Open
Abstract
PURPOSE Considering the putative role of light in myopia, and variations in socioeconomic, lifestyle, educational and environmental factors across ethnicities, we objectively investigated light exposure patterns in Indian school children. METHODS The light exposure profile of 143 school children (9-15 years, 50 myopes) recorded using a validated wearable light tracker for six continuous days was analysed. Additional data for non-school days were available for 87 children (26 myopes). The illuminance exposure levels, time spent outdoors and epoch (number of times participant is exposed to a predefined range of lux level per day) were compared between myopes and non-myopes across different light conditions: ≥1000, ≥3000, ≥5000 and ≥10 000 lux. For school days, light exposure profiles during (1) before school, school and after school hours; and (2) class, break and transition (when a student travels to and from school) time were analysed. RESULTS The overall median (IQR) daily illuminance exposure level, time spent outdoors and epochs at outdoors (≥1000 lux) were 807 (507-1079) lux/day, 46 (30-64) min/day and 9 (6-12) times/day, respectively. The daily illuminance exposure on non-school days was significantly higher in non-myopes than myopes (6369 (4508-9112) vs 5623 (2616-6929) lux/day, p=0.04). During transition time (school days), non-myopes had significantly higher illuminance exposure (910 (388-1479) vs 550 (263-1098) lux/day, p=0.04), spent more time outdoors (25 (10-43) vs 14 (4-29) min/day, p=0.01) and had higher outdoor epochs (6 (4-11) vs 5 (2-8) times/day, p=0.01) than myopes. CONCLUSIONS A small but significant difference in illuminance exposure, time spent outdoors and epoch was noted between myopes and non-myopes during transition time, which may have implications in myopia control.
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Affiliation(s)
- Rohit Dhakal
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre & Brien Holden Institute of Optometry and Vision Sceinces, LV Prasad Eye Institute, Hyderabad, India
- Centre for Applied Vision Research, City University of London, London, UK
| | - John G Lawrenson
- Centre for Applied Vision Research, City University of London, London, UK
| | - Byki Huntjens
- Centre for Applied Vision Research, City University of London, London, UK
| | - Rakhee Shah
- Centre for Applied Vision Research, City University of London, London, UK
| | - Pavan Kumar Verkicharla
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre & Brien Holden Institute of Optometry and Vision Sceinces, LV Prasad Eye Institute, Hyderabad, India
- Infor Myopia Centre, L V Prasad Eye Institute, Hyderabad, India
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Lyu P, Hu J, Wang Y, Wang J, He X, Shi H. Impact of ophthalmic clinical service use in mitigating myopia onset and progression in preschool children: a retrospective cohort study. BMC Ophthalmol 2024; 24:221. [PMID: 38802768 PMCID: PMC11129446 DOI: 10.1186/s12886-024-03488-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 05/20/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Although school screenings identify children with vision problems and issue referrals for medical treatment at an ophthalmic hospital, the effectiveness of this approach remains unverified. OBJECTIVE To investigate the impact of ophthalmic clinical services on the onset and progression of myopia in preschool children identified with vision impairment. METHODS Using data from the Shanghai Child and Adolescent Large-scale Eye Study (SCALE), this retrospective cohort study evaluated the visual development of children from three districts-Jing'an, Minhang, and Pudong-which are representative of geographic diversity and economic disparity in Shanghai's 17 districts. Initially, in 2015, the study encompassed 14,572 children aged 4-6 years, of whom 5,917 needed a referral. Our cohort consisted of 5,511 children who had two or more vision screenings and complete personal information over the follow-up period from January 2015 to December 2020. We divided these children into two groups based on their initial spherical equivalent (SE): a High-risk group (SE > -0.5 D) and a Myopia group (SE ≤ -0.5 D). Within each of these groups, we further categorized children into Never, Tardily, and Timely groups based on their referral compliance to compare the differences in the occurrence and progression of myopia. Cox proportional models were applied to estimate hazard ratios (HRs) for myopia incidence per person-years of follow-up in High-risk group. Generalized additive models(GAM) was used to calculating the progression for annual spherical equivalent changes in all children. RESULTS Of the 5,511 preschool children (mean age, 5.25 years; 52.24% male) who received a referral recommendation, 1,327 (24.08%) sought clinical services at an ophthalmic hospital. After six years of follow-up, 65.53% of children developed myopia. The six-year cumulative incidence of myopia in the Never, Tardily, and Timely groups was 64.76%, 69.31%, and 57.14%, respectively. These percentages corresponded to hazard ratios (HRs) of 1.31 (95% CI, 1.10-1.55) for the Tardily group and 0.55 (95% CI, 0.33-0.93) for the Timely group, compared with the Never group. The HRs were adjusted for age, sex, and SE at study entry. Interestingly, the Timely group showed significantly less SE progression than the other groups (P < 0.001), and SE progression was higher in the High-risk group (-0.33 ± 0.37D/year) than in children with myopia (-0.08 ± 0.55D/year). CONCLUSION Timely utilization of ophthalmic clinical services among children aged 4 to 6 years who fail school vision screenings can significantly reduce the incidence of myopia and slow SE progression.
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Affiliation(s)
- Pingping Lyu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, 200032, China
| | - Jingwen Hu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, 200032, China
| | - Yujie Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, 200032, China
| | - Jingjing Wang
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Xiangui He
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Huijing Shi
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, 200032, China.
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Zhang XJ, Zaabaar E, French AN, Tang FY, Kam KW, Tham CC, Chen LJ, Pang CP, Yam JC. Advances in myopia control strategies for children. Br J Ophthalmol 2024:bjo-2023-323887. [PMID: 38777389 DOI: 10.1136/bjo-2023-323887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 03/19/2024] [Indexed: 05/25/2024]
Abstract
Myopia has long been a global threat to public health. Timely interventions are likely to reduce the risk of vision-threatening complications. There are both established and rapidly evolving therapeutic approaches to slow myopia progression and/or delay its onset. The effective methods for slowing myopia progression include atropine eye-drops, defocus incorporated multiple segments (DIMS) spectacle lenses, spectacle lenses with highly aspherical lenslets target (HALT), diffusion optics technology (DOT) spectacle lenses, red light therapy (RLT), multifocal soft contact lenses and orthokeratology. Among these, 0.05% atropine, HALT lenses, RLT and +3.00 peripheral addition soft contact lenses yield over 60% reduction in myopia progression, whereas DIMS, DOT and MiSight contact lenses demonstrate at least 50% myopia control efficacy. 0.05% atropine demonstrates a more optimal balance of efficacy and safety than 0.01%. The efficacy of 0.01% atropine has not been consistent and requires further validation across diverse ethnicities. Combining atropine 0.01% with orthokeratology or DIMS spectacles yields better outcomes than using these interventions as monotherapies. Increased outdoor time is an effective public health strategy for myopia prevention while recent studies suggest that 0.05% low-concentration atropine and RLT therapy have promising potential as clinical myopia prevention interventions for high-risk groups. Myopia control spectacle lenses, being the least invasive, are safe for long-term use. However, when considering other approaches, it is essential to ensure proper instruction and regular follow-ups to maintain safety and monitor any potential complications. Ultimately, significant advances have been made in myopia control strategies, many of which have shown meaningful clinical outcomes. However, regular use and adequate safety monitoring over extended durations are imperative to foster confidence that can only come from extensive clinical experience.
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Affiliation(s)
- Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ebenezer Zaabaar
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Amanda Nicole French
- Discipline of Orthoptics, University of Sydney, Sydney, New South Wales, Australia
| | - Fang Yao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
- Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology, Hong Kong Children Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
- Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
- Department of Ophthalmology, Hong Kong Children Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
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Zhou S, Niu Y, Li X, Yue J, Zhang H. The knowledge structure and research trends between light and myopia: A bibliometric analysis from 1981 to 2024. Medicine (Baltimore) 2024; 103:e38157. [PMID: 38758893 PMCID: PMC11098238 DOI: 10.1097/md.0000000000038157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/16/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND This bibliometric analysis explored the knowledge structure of and research trends in the relationship between light and myopia. METHODS Relevant literature published from 1981 to 2024 was collected from the Web of Science Core Collection database. Visual maps were generated using CiteSpace and VOSviewer. We analyzed the included studies in terms of the annual publication count, countries, institutional affiliations, prolific authors, source journals, top 10 most cited articles, keyword co-occurrence, and cocitations. RESULTS A total of 525 papers examining the relationship between light and myopia published between 1981 and 2024 were collected. The United States ranked first in terms of the number of publications and actively engaged in international cooperation with other countries. The New England College of Optometry, which is located in the United States, was the most active institution and ranked first in terms of the number of publications. Schaeffel Frank was the most prolific author. The most active journal in the field was Investigative Ophthalmology & Visual Science. The most frequently cited paper in the included studies was written by Saw, SM and was published in 2002. The most common keywords in basic research included "refractive error," "longitudinal chromatic aberration," and "compensation." The most common keywords in clinical research mainly included "light exposure," "school," and "outdoor activity." The current research hotspots in this field are "progression," "refractive development," and "light exposure." The cocitation analysis generated 17 clusters. CONCLUSION This study is the first to use bibliometric methods to analyze existing research on the relationship between light and myopia. In recent years, the intensity and wavelength of light have become research hotspots in the field. Further research on light of different intensities and wavelengths may provide new perspectives in the future for designing more effective treatments and interventions to reduce the incidence of myopia.
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Affiliation(s)
- Shuaibing Zhou
- Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan Eye Hospital, Henan Eye Institution, Henan Key Laboratory for Ophthalmology and Visual Science, Zhengzhou University, Zhengzhou, China
| | - Yueyue Niu
- Henan University People’s Hospital, Henan Eye Hospital, Zhengzhou, China
| | - Xuejiao Li
- Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan Eye Hospital, Henan Eye Institution, Henan Key Laboratory for Ophthalmology and Visual Science, Zhengzhou University, Zhengzhou, China
- Department of Ophthalmology, Sanmenxia Central Hospital, Sanmenxia, China
| | - Juan Yue
- Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan Eye Hospital, Henan Eye Institution, Henan Key Laboratory for Ophthalmology and Visual Science, Zhengzhou University, Zhengzhou, China
| | - Hongmin Zhang
- Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan Eye Hospital, Henan Eye Institution, Henan Key Laboratory for Ophthalmology and Visual Science, Zhengzhou University, Zhengzhou, China
- Henan University People’s Hospital, Henan Eye Hospital, Zhengzhou, China
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9
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Ma R, Zhou L, Li W, Li Y, Hu D, Lu Y, Zhang C, Yi B. The Impact of Sunshine Duration on Myopia in Central China: Insights from Populational and Spatial Analysis in Hubei. Int J Gen Med 2024; 17:2129-2142. [PMID: 38766596 PMCID: PMC11102173 DOI: 10.2147/ijgm.s462734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose This study aimed to analyze myopia distribution in Hubei and the impact of regional Sunshine Duration on myopia in children and adolescents. Patients and Methods The Cross-sectional study included students (kindergarten to grade 12) through multistage cluster stratified sampling in 17 cities (103 areas) of Hubei, China, who underwent ophthalmic examinations from September 2021 to November 2021. The association of sunshine duration with the prevalence and distribution of myopia was analyzed. Using Moran's index to quantify the distribution relationship, a spatial analysis was constructed. Results A total of 435,996 students (53.33% male; mean age, 12.16±3.74 years) were included in the study. A negative association was identified between myopia prevalence and sunshine duration in the region, especially in population of primary students (r=-0.316, p<0.001). Each 1-unit increment in the sunshine duration was associated with a decreased risk of myopia prevalence (OR=0.996; 95% CI, 0.995-0.998; P <0.001). Regression showed a linear relationship between sunshine duration and myopia rates of primary school students [Prevalence%= (-0.1331*sunshine duration+47.73)%, p = 0.02]. Sunshine duration influenced the distribution of myopia rates among primary (Moran's I=-0.206, p<0.001) and junior high school (Moran's I=-0.183, p=0.002). Local spatial analysis showed that areas with low sunshine duration had high myopia prevalence concentration. Conclusion This study revealed sunshine duration associations with myopia prevalence at the regional and population levels. The results may emphasize the significance of promptly implementing myopia control in regions with poor sunshine. The effect of sunshine on myopia is pronounced in the early years of education, especially in primary students.
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Affiliation(s)
- Runting Ma
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Lianhong Zhou
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Wenping Li
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Yuanjin Li
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Diewenjie Hu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Yi Lu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Cancan Zhang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Beixi Yi
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
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Baksh J, Lee D, Mori K, Zhang Y, Torii H, Jeong H, Hou J, Negishi K, Tsubota K, Kurihara T. Myopia Is an Ischemic Eye Condition: A Review from the Perspective of Choroidal Blood Flow. J Clin Med 2024; 13:2777. [PMID: 38792319 PMCID: PMC11122110 DOI: 10.3390/jcm13102777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/02/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Myopia is a common refractive error that affects a large proportion of the population. Recent studies have revealed that alterations in choroidal thickness (ChT) and choroidal blood flow (ChBF) play important roles in the progression of myopia. Reduced ChBF could affect scleral cellular matrix remodeling, which leads to axial elongation and further myopia progression. As ChT and ChBF could be used as potential biomarkers for the progression of myopia, several recent myopia treatments have targeted alterations in ChT and ChBF. Our review provides a comprehensive overview of the recent literature review on the relationship between ChBF and myopia. We also highlight the importance of ChT and ChBF in the progression of myopia and the potential of ChT as an important biomarker for myopia progression. This summary has significant implications for the development of novel strategies for preventing and treating myopia.
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Affiliation(s)
- Jiaul Baksh
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Deokho Lee
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Kiwako Mori
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yan Zhang
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hidemasa Torii
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Heonuk Jeong
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Jing Hou
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Kazuo Tsubota
- Tsubota Laboratory, Inc., 34 Shinanomachi, Shinjuku-ku, Tokyo 160-0016, Japan
| | - Toshihide Kurihara
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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Lau J, Koh WL, Ng JS, Lee D, Peh CH, Lam J, Tan KK, Koh V. How can we better evaluate paediatric progression of myopia and associated risk factors? Lessons from the COVID-19 pandemic: A systematic review. Acta Ophthalmol 2024; 102:e257-e271. [PMID: 37786939 DOI: 10.1111/aos.15773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/29/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE During the COVID-19 pandemic, home-based and remote learning-particularly using electronic devices-was rapidly pushed out. Increased near-work, screen time exposure and lack of outdoor time are risk factors that contribute to childhood myopia, but it is difficult to adopt recommendations from prior publications as a consistent limitation in the literature is the heterogeneity of research methodology. This review seeks to systematically evaluate how observational studies published during the pandemic have quantified and measured risk factors and myopia in school-going children and adolescents. METHODS Three scientific databases (PubMed, CINAHL, Scopus) were systematically searched from March 2020 to April 2022. Findings from relevant studies were descriptively summarised in relation to the PICOS-based objective of the review. RESULTS The final sample of 13 studies included research from six countries and comprised 1 411 908 children and adolescents. The majority of studies (N = 10; 76.9%) used spherical equivalent refraction (SER) of -0.5 dioptres or lower as a common definition of myopia. Most studies (77.8%) measuring screen time exposure found it higher during COVID-19 compared to pre-COVID, but only one study used objective measurement of screen time. The average critical appraisal score of the sample was only 66.1%, with a considerable number of studies failing to identify and adjust for potential confounders. CONCLUSION Future studies should consider emergent objective and validated measures of risk factors, account for potential a priori confounders and covariates and ensure more representativeness in the sociodemographic makeup of their samples.
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Affiliation(s)
- Jerrald Lau
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Wei-Ling Koh
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Janelle Shaina Ng
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Daphne Lee
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cherie Hui Peh
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Janice Lam
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ker-Kan Tan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Victor Koh
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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12
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Zheng T, Fu W, Jiang S, Yang X. Inverse L-Shaped Association Between Body Mass Index and Myopia in Chinese Schoolchildren: A Pilot Study. J Multidiscip Healthc 2024; 17:1839-1846. [PMID: 38680876 PMCID: PMC11055557 DOI: 10.2147/jmdh.s458978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/09/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose The prevalence of obesity and myopia in young people is increasing worldwide; however, the association between body mass index (BMI) and myopia remains controversial. This study aimed to assess the association between BMI and myopia in Chinese schoolchildren. Patients and Methods In this study, the open data for analysis were obtained from DATADRYAD website (www.datadryad.org). A total of 3658 children were enrolled in this study. Logistic regression model was used to analyze the relationship between BMI and myopia. Results Compared with individuals with lower BMI Q1 (less than 25 kg/m2), the adjusted odds ratios (ORs) for BMI and myopia were 2.15 (95% confidence interval [CI]: 1.62-2.86) in Q2 (25.0-29.9 kg/m2) and 2.39 (95% CI: 1.37-4.18) in Q3 (30.0 kg/m2 or more). Moreover, the association between BMI and myopia exhibited an inverted L-shaped curve (nonlinear; p < 0.001). When the BMI was <25 kg/m2, an increased BMI was significantly associated with a higher risk of myopia (OR = 1.244 [95% CI: 1.211-1.277], p < 0.001). However, when the BMI was ≥25 kg/m2, the association lost its significance (OR = 1.063 [95% Cl: 0.964-1.171], p = 0.219). Conclusion This study found an inverted L-shaped association between BMI and myopia in Chinese schoolchildren. A higher BMI was associated with a higher risk of myopia reaching 25 kg/m2, after which an increase in BMI was no longer associated with an increased risk of myopia.
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Affiliation(s)
- Tianli Zheng
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People’s Republic of China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Science, Suzhou, Jiangsu, People’s Republic of China
| | - Weiwei Fu
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People’s Republic of China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Science, Suzhou, Jiangsu, People’s Republic of China
| | - Shuang Jiang
- The Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, People’s Republic of China
| | - Xiaodong Yang
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People’s Republic of China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Science, Suzhou, Jiangsu, People’s Republic of China
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13
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Liu G, Rong H, Liu Y, Wang B, Du B, Song D, Wei R. Effectiveness of repeated low-level red light in myopia prevention and myopia control. Br J Ophthalmol 2024:bjo-2023-324260. [PMID: 38631861 DOI: 10.1136/bjo-2023-324260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/23/2023] [Indexed: 04/19/2024]
Abstract
BACKGROUND/AIMS To compare the effects of repeated low-level red light (RLRL) treatment on axial length growth and refractive error changes in myopic and premyopic children. METHODS Subjects were assigned randomly to four subgroups: myopia-RLRL group (M-RL), myopia-control group (M-C), premyopia-RLRL group (PM-RL) and premyopia-control group (PM-C). Subjects in the RLRL group completed a 12-month treatment composed of a 3 min RLRL treatment session twice daily, with an interval of at least 4 hours, for 7 days per week. Visits were scheduled before and at 1-month, 3-month, 6-month, 9-month and 12-month follow-up after the treatment. Repeated-measures analysis of variance was used to compare the spherical equivalent refractive errors (SE) and axial length (AL) changes between the groups across the treatment period. RESULTS After 12 months of treatment, in the myopia group, SE and AL changes were -0.078±0.375 D and 0.033±0.123 mm for M-RL and -0.861±0.556 D and 0.415±0.171 mm for M-C; in the premyopia group, the progression of SE and AL was -0.181±0.417 D and 0.145±0.175 mm for PM-RL and -0.521±0.436 D and 0.292±0.128 mm for PM-C. PM-RL indicated a lower myopia incidence than PM-C (2.5% vs 19.4%). Additionally, the percentage of AL shortening in the M-RL was higher than that in the PM-RL before the 9-month follow-up. CONCLUSION RLRL effectively delayed myopia progression in children with myopia and reduced the incidence of myopia in premyopic children. Moreover, RLRL exhibited a stronger impact on myopic children compared with premyopic individuals.
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Affiliation(s)
- Guihua Liu
- Tianjin Medical University Eye Hospital, Tianjin, China
| | - Hua Rong
- Tianjin Medical University Eye Hospital, Tianjin, China
| | - Yipu Liu
- Tianjin Medical University Eye Hospital, Tianjin, China
| | - Biying Wang
- Tianjin Medical University Eye Hospital, Tianjin, China
| | - Bei Du
- Tianjin Medical University Eye Hospital, Tianjin, China
| | - Desheng Song
- Tianjin Medical University Eye Hospital, Tianjin, China
| | - Ruihua Wei
- Tianjin Medical University Eye Hospital, Tianjin, China
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Sun Y, Zhang X, Zheng Z, Dong F, Wang F, Zhou Z, Wang G. Toward early intervention based on age-specific vision checkups: A vision impairment survey in Yantai, China. Medicine (Baltimore) 2024; 103:e37805. [PMID: 38608049 PMCID: PMC11018203 DOI: 10.1097/md.0000000000037805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/14/2024] [Indexed: 04/14/2024] Open
Abstract
The prevalence of myopia among children and adolescents is currently rising to alarming levels (>80%) in China. This study used several routinely collected demographic factors to quantify myopia and glass-wearing rates for primary and secondary school students. We identified myopia risk factors and proposed new aspects for early intervention. This study was a cross-sectional survey of myopia and glass-wearing rates for students (6-18 years old) in Yantai, China. We collected both vision (vision acuity [VA] and spherical equivalence [SE]) and glass-wearing information to establish respective logistic models for quantifying myopia and glass-wearing rate. We further propose a joint decision region (VA, SE, age) to guide early intervention. Among 10,276 children, 63% had myopia (65% wore glasses). The prevalence of myopia increases with age and levels off during adulthood. Females had a higher overall prevalence rate than males (P < .001). The rural age mode (≈15.5) is about 2 years larger than the urban age (≈13.5) for myopia students. For the myopia rate, in the age ≤14.5, the linear age effect was significant (odds ratio [OR] = 1.73, P < .0001), males had a significant negative baseline effect at the start of schooling (vs. females) (OR = 0.68, P < .0001), and the urban group had a significant positive baseline effect (vs. rural) (OR = 1.39, P < .0001). The correlation between VA and SE increases with age and has a directional shift (from negative to positive) at ages 8 to 9. For the glass-wearing rate, age had a significant positive effect (OR = 1.25, P < .0001), VA had a significant negative effect (OR = 0.002, P < .0001), and body mass index had a slightly significant positive effect (OR = 1.02, P = .03). Urban female have a higher myopia rate than rural male at the start of schooling, and vocational high school has improved vision upon high school. Body mass index was not a significant factor for myopia. The myopia rate model is specific to age range (separated at 14.5 years old). Students of lower ages are less likely to wear glasses for correction, and this may require intervention. The temporal age-specific (VA, SE) correlations and joint distributions strengthen the speculation in the literature that age 8 to 9 is a critical intervention period and motivates us to propose a rigorous intervention decision region for (age, VA, and SE) which mainly applies for this tight age period.
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Affiliation(s)
- Yuelin Sun
- Yantai Center for Disease Control and Prevention, Laishan District, Yantai, China
| | - Xiaoyu Zhang
- Yantai Center for Disease Control and Prevention, Laishan District, Yantai, China
| | - Zhong Zheng
- Yantai Center for Disease Control and Prevention, Laishan District, Yantai, China
| | - Fengguang Dong
- Yantai Center for Disease Control and Prevention, Laishan District, Yantai, China
| | - Fei Wang
- Yantai Center for Disease Control and Prevention, Laishan District, Yantai, China
| | - Zilin Zhou
- Yantai Center for Disease Control and Prevention, Laishan District, Yantai, China
| | - Guiqiang Wang
- Yantai Center for Disease Control and Prevention, Laishan District, Yantai, China
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Noh YH, Jung KI. The Relationship between Myopia and Obesity in Adults. KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:137-146. [PMID: 38449306 PMCID: PMC11016688 DOI: 10.3341/kjo.2023.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/27/2024] [Accepted: 03/05/2024] [Indexed: 03/08/2024] Open
Abstract
PURPOSE To investigate the relationship between myopia and obesity through direct measurements of fat content. METHODS A cross-sectional study used a stratified, multistage survey, the Korea National Health and Nutrition Examination Survey (2008-2010). Subjects 19 years or older (n = 10,305) were included. Participants were divided into three groups according to refractive status: myopia (spherical equivalent [SE] ≤ -1.0 diopter [D]), emmetropia (-1.0 D < SE ≤ 1.0 D), and hyperopia (SE > 1.0 D). Obesity was investigated with assessment of fat mass and body mass index or waist circumference. Fat mass was measured with whole-body dual energy x-ray absorptiometry. Body fat percentage was calculated as (total fat mass / body weight × 100). RESULTS Higher obesity index was found in individuals with myopic eyes after adjustment for age, sex, education level, income status, physical activity, residence, and serum vitamin D level. The significant difference in total body fat percentages among myopia, emmetropia, and hyperopia was significant in the young age group (19-39 years, p < 0.05) but not in the middle age group (40-64 years) and the old age group (≥65 years). Individuals with a higher percentage of total body fat had greater odds ratios for myopia (fourth quartile of body fat; odds ratio, 1.352; 95% confidence interval, 1.178-1.551). CONCLUSIONS An association was found between adiposity and myopia in relatively young adults using direct measurements of fat mass.
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Affiliation(s)
- Young Ho Noh
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung In Jung
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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16
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Mutti DO, Sinnott LT, Cotter SA, Jones-Jordan LA, Kleinstein RN, Manny RE, Twelker JD, Zadnik K. Predicting the onset of myopia in children by age, sex, and ethnicity: Results from the CLEERE Study. Optom Vis Sci 2024; 101:179-186. [PMID: 38684060 PMCID: PMC11060695 DOI: 10.1097/opx.0000000000002127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
SIGNIFICANCE Clinicians and researchers would benefit from being able to predict the onset of myopia for an individual child. This report provides a model for calculating the probability of myopia onset, year-by-year and cumulatively, based on results from the largest, most ethnically diverse study of myopia onset in the United States. PURPOSE This study aimed to model the probability of the onset of myopia in previously nonmyopic school-aged children. METHODS Children aged 6 years to less than 14 years of age at baseline participating in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study who were nonmyopic and less hyperopic than +3.00 D (spherical equivalent) were followed up for 1 to 7 years through eighth grade. Annual measurements included cycloplegic autorefraction, keratometry, ultrasound axial dimensions, and parental report of children's near work and time spent in outdoor and/or sports activities. The onset of myopia was defined as the first visit with at least -0.75 D of myopia in each principal meridian. The predictive model was built using discrete time survival analysis and evaluated with C statistics. RESULTS The model of the probability of the onset of myopia included cycloplegic spherical equivalent refractive error, the horizontal/vertical component of astigmatism (J0), age, sex, and race/ethnicity. Onset of myopia was more likely with lower amounts of hyperopia and less positive/more negative values of J0. Younger Asian American females had the highest eventual probability of onset, whereas older White males had the lowest. Model performance increased with older baseline age, with C statistics ranging from 0.83 at 6 years of age to 0.92 at 13 years. CONCLUSIONS The probability of the onset of myopia can be estimated for children in the major racial/ethnic groups within the United States on a year-by-year and cumulative basis up to age 14 years based on a simple set of refractive error and demographic variables.
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Affiliation(s)
| | | | - Susan A Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California
| | | | - Robert N Kleinstein
- School of Optometry, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Ruth E Manny
- University of Houston College of Optometry, Houston, Texas
| | - J Daniel Twelker
- Department of Ophthalmology and Vision Science, University of Arizona, Tucson, Arizona; for the CLEERE Study
| | - Karla Zadnik
- The Ohio State University College of Optometry, Columbus, Ohio
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17
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Zhang J, Wang L, Guo L, Guo Y, Zhao F, Hu Y, Li Q, Du X, Deng X, Deng N, Yang X, Lu C. Effects of online family health education on myopia prevention in children by parental myopia: a randomized clinical trial. Clin Exp Optom 2024; 107:299-306. [PMID: 37263755 DOI: 10.1080/08164622.2023.2216840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 05/13/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023] Open
Abstract
CLINICAL RELEVANCE Online family health education may be effective for myopia prevention in children, and the effects may be different between children with myopic and non-myopic parents. BACKGROUND Myopia is a common cause of vision loss. The aims of this study were to evaluate the effects of online family health education on preventing the development of myopia in children, and to estimate whether the effects vary according to parental myopia. METHODS A cluster randomised trial including grade 1 and grade 2 children from 12 primary schools was conducted in Guangzhou, China. Weekly online family health education messages were sent to parents in the intervention group. Data collection included eye examinations of children and questionnaires completed by parents. RESULTS Among the 3123 children included at baseline (1703 boys [54.5%]; mean [SD] age, 6.83 [0.73] years), 2376 completed the follow-up after 3 years. The differences in the incidence of myopia and myopic shift between the study groups were not significant in total. However, the 3-year cumulative incidence rate of myopia in the intervention group (125 of 445 [28.1%]) was significantly lower than that in the control group (225 of 603 [37.3%]; difference, 9.2% [95% CI, -14.9% to -3.5%]; P = 0.001) among children with non-myopic parents. In parallel, among children with non-myopic parents, the mean myopic change in SER was less for the intervention group than for the control group (-1.10 D vs. -1.24 D; difference, 0.13 D [95% CI, 0.03 to 0.23 D]; P = 0.01). CONCLUSIONS Compared with children with myopic parents, online family health education was more effective in children with non-myopic parents. The incidence of myopia and myopic shift in refraction have been reduced in children with non-myopic parents. Further studies are needed to assess these differences by parental myopia.
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Affiliation(s)
- Jiayu Zhang
- Department of Medical Statistics and Epidemiology, Sun Yat-sen University, Guangzhou, China
| | - Lili Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, Sun Yat-sen University, Guangzhou, China
| | - Yangfeng Guo
- Department of Student Health Work, Health Promotion Center for Primary and Secondary Schools of Guangzhou Municipality, Guangzhou, China
| | - Feng Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yin Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Qian Li
- Department of Medical Statistics and Epidemiology, Sun Yat-sen University, Guangzhou, China
| | - Xueying Du
- Department of Student Health Work, Health Promotion Center for Primary and Secondary Schools of Guangzhou Municipality, Guangzhou, China
| | - Xueqing Deng
- Department of Medical Statistics and Epidemiology, Sun Yat-sen University, Guangzhou, China
| | - Nali Deng
- Department of Student Health Work, Health Promotion Center for Primary and Secondary Schools of Guangzhou Municipality, Guangzhou, China
| | - Xiao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, Sun Yat-sen University, Guangzhou, China
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18
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Modrzejewska M, Durajczyk M. The Relationship between Selected Parameters and the Occurrence of Premyopia in a Group of 1155 Children Aged 8 in Northwestern Poland. J Clin Med 2024; 13:1977. [PMID: 38610742 PMCID: PMC11012722 DOI: 10.3390/jcm13071977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/17/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Determination of the number of pupils at risk of developing pre-myopia and selected ophthalmic parameters in a group of 1155 children aged 8. Material: Ophthalmic examinations were performed in Polish 8-year-old, /1518 individuals/; 1155 of whom presented complete data for analysis. There was a total of 554 (47.9%) girls and 602 (52.1%) boys. Examination of the anterior and posterior segment of the eye, evaluation of accommodation, convergence, heterophoria, alignment of the eyeball, muscular balance with ocular mobility in 9 directions of gaze, and spatial vision were tested. Refraction was obtained under cycloplegia. Refractions (spherical equivalent, SE). were categorized as pre-myopia (-0.50 D-+0.75 D), myopia (≤-0.5 D), emmetropia (>-0.5 D to ≤+0.5 D), mildly hyperopia (>+0.5 D to ≤+2.0 D) and hyperopia (>+2.0 D). Data analysis was performed using Statistica 13.5 software: chi-squared, Pearson's, t-Student, and U Mann-Whitney tests. p-values of <0.05 were considered statistically significant. Results: Pre-myopia was diagnosed in as many as 704 subjects (60.9%) with a similar frequency among both girls-328 (46.6%)-and boys with 376 (53.4%). Conclusions: Current data indicates that the growing group of myopic individuals in many industrialized countries is the sixth most common cause of blindness. Further research is crucial to understand the factors underlying accommodative and binocular mechanisms for myopia development and progression and to make recommendations for targeted interventions to slow the progression of myopia in a group of early school children.
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19
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Chawla O, Singh A, Kumawat D, Chowdhury N, Kumar B. Systematic Review of Sleep Duration and Development of Myopia. Cureus 2024; 16:e56216. [PMID: 38618360 PMCID: PMC11016326 DOI: 10.7759/cureus.56216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/16/2024] Open
Abstract
There is a knowledge gap in the relationship between sleep duration and myopia. Since sleep duration is a modifiable risk factor, its association with the development and progression of myopia has implications for public health. This review was conducted in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The bibliographic databases of PubMed and Scopus were searched for published studies on the association between sleep duration and myopia. These databases were searched in December 2023 with no date or study design limits. The relevant literature was extracted and met the priori determined population (children, adolescents, and adults suffering from myopia with or without corrective glasses), intervention/exposure (sleep), and the outcome (various indicators of sleep especially sleep duration/bedtime/wake time and sleep quality). Data were gathered by gender, age, and refraction technique and standardized to the definition of myopia as refractive error ≥0.50 diopter. The relevant literature was extracted from these electronic databases using the keywords "sleep," "sleep duration," "bedtime," and "myopia." English language articles related to the topic were included. Articles that have discussed the role of risk factors for myopia but did not mention any relation to sleep were excluded. Sixteen studies were included after reviewing the relevant literature, and only six studies have shown a significant relationship between shorter duration of sleep and the development of myopia. This review suggests that apart from other environmental factors, sleep duration may have a role in developing myopia. Thus, increasing awareness about optimum sleep duration has a potential utility to reduce the development and progression of myopia.
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Affiliation(s)
- Omna Chawla
- Department of Physiology, Government Doon Medical College, Dehradun, IND
| | - Anupam Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Devesh Kumawat
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Nilotpal Chowdhury
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Barun Kumar
- Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
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20
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Yang JLX, Li DL, Chen J, Wang JJ, Du LL, Liu SC, He XG, Pan CW. Effect modification of time spent outdoors on the association between early childhood overweight and myopia: a one-year follow-up study. J Public Health (Oxf) 2024; 46:107-115. [PMID: 38264954 DOI: 10.1093/pubmed/fdae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/19/2023] [Accepted: 12/29/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND This study examined the moderating role of outdoor time on the relationship between overweight and myopia. METHODS The data for this study was obtained from a prospective study in Shanghai, where non-myopic children wore wristwear and were followed up for 1 year. Eye examinations were performed at each visit. The modification effect was assessed on the additive scale using multivariable logistic regression, and relative excess risk due to interaction was used to calculate the modification effect. RESULTS A total of 4683 non-myopic children were included with 32.20% being overweight at baseline. Following a 1-year period, 17.42% of children had myopia. When compared to those who spent <90 minutes outdoors, children who spent >120 had a relative risk of myopia onset that was reduced to 0.61. As time spent outdoors decreased, more risks of myopia onset were identified among overweight children than among normal children, the modification effect on the additive scale was -0.007, with ~70% of this effect attributed to the modifying influence of outdoor time. CONCLUSIONS Increasing outdoor time can reduce myopia more among overweight children than normal. Future interventions should focus on outdoor activities among overweight children to reduce myopia risks.
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Affiliation(s)
- Jin-Liu-Xing Yang
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
- Clinical Research Unit, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai, China
| | - Dan-Lin Li
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Jun Chen
- Clinical Research Unit, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai, China
| | - Jing-Jing Wang
- Clinical Research Unit, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai, China
| | - Lin-Lin Du
- Clinical Research Unit, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai, China
| | - Si-Chen Liu
- Clinical Research Unit, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai, China
| | - Xian-Gui He
- Clinical Research Unit, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, National Clinical Research Center for Eye Diseases, Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Chen-Wei Pan
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
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21
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Yu CY, Dong L, Li YF, Wei WB. Vitamin D and myopia: a review. Int Ophthalmol 2024; 44:95. [PMID: 38368573 DOI: 10.1007/s10792-024-03009-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 10/29/2023] [Indexed: 02/19/2024]
Abstract
Myopia is a worldwide public health problem of vision disorder caused by multiple factors, which has posed a huge socioeconomic burden, raising concerns about sight-threatening ocular complications. Vitamin D, as a kind of fat-soluble vitamin, related to time-spent-outdoors, has been considered by extensive studies to have potential relationship with myopia. We reviewed studies published in a decade which estimated the association of blood vitamin D status with myopia and summarized the universality and individuality of all research articles. Several research articles suggested the known environmental risk factors of myopia, including age, gender, ethnicity, education level, parental and school conditions, time-spent-outdoors, and sunlight exposure, and recent epidemiological studies demonstrate that increased vitamin D levels, by virtue of the extended outdoor time, may be an important modifiable factor and a protective effect that delay the progression of myopia in children and adolescents rather than in adults. The genetic studies have been conducted to get access to the evidence of gene polymorphism for explaining the association of serum vitamin D status and myopia, but the precise genetic interpretation of vitamin D and myopia remains unclear so far; on the other hand, the possible mechanisms are various like copolymerization mechanism, calcium homeostasis and imbalance of ciliary muscle function regulation, but nearly all of the investigators are inclined to remain skeptical. This article reviews the age-related epidemiological proofs, existent genetics correlations, possible underlying biological mechanisms and further values for the protective association between vitamin D and myopia, providing the possibility of prevention or postponement for myopia.
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Affiliation(s)
- Chu-Yao Yu
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Lane, Beijing, 100730, China
| | - Li Dong
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Lane, Beijing, 100730, China
| | - Yi-Fan Li
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Lane, Beijing, 100730, China
| | - Wen-Bin Wei
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Lane, Beijing, 100730, China.
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22
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Hansen NC, Hvid-Hansen A, Møller F, Bek T, Larsen DA, Jacobsen N, Kessel L. Two-Year Results of 0.01% Atropine Eye Drops and 0.1% Loading Dose for Myopia Progression Reduction in Danish Children: A Placebo-Controlled, Randomized Clinical Trial. J Pers Med 2024; 14:175. [PMID: 38392608 PMCID: PMC10890135 DOI: 10.3390/jpm14020175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 01/27/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
We investigated the two-year safety and efficacy of 0.1% loading dose and 0.01% low-dose atropine eye drops in Danish children for reduction in myopia progression in an investigator-initiated, placebo-controlled, double-masked, randomized clinical trial. Ninety-seven six- to twelve-year old myopic participants were randomized to 0.1% loading dose for six months and then 0.01% for eighteen months (loading dose group, N = 33), 0.01% for two years (0.01% group, N = 32) or placebo for two years (placebo, N = 32). Axial length (AL) and spherical equivalent refraction (SER) were primary outcomes. Secondary outcomes included adverse events and reactions, choroidal thickness, and other ocular biometrical measures. Outcomes were measured from baseline and at six-month intervals. Individual eyes nested by participant ID were analyzed with linear-mixed model analysis. Data were analyzed with intention-to-treat. Mean AL was 0.08 mm less (95% confidence interval (CI): -0.01; 0.17, p-value = 0.08) in the 0.1% loading dose and 0.10 mm less (95% CI: 0.01; 0.19, p-value = 0.02) in the 0.01% group after two years of treatment compared to placebo. Mean SER progression was 0.12 D (95% CI: -0.10; 0.33) less in the loading dose and 0.26 D (95% CI: 0.04; 0.48) less in the 0.01% groups after two years of treatment compared to placebo (p-value = 0.30 and 0.02, respectively). In total, 17 adverse events were reported in the second-year follow-up, and all were rated as mild. Adjusting for iris color did not affect treatment effect estimates. Intra-ocular pressure increased over two years comparably between all groups but remained within normal limits. Two-year treatment with 0.01% low-dose atropine eye drops is a safe and moderately efficacious intervention in Danish children for reducing myopia progression.
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Affiliation(s)
- Niklas Cyril Hansen
- Department of Ophthalmology, Copenhagen University Hospital-Rigshospitalet-Glostrup, DK-2600 Glostrup, Denmark
| | - Anders Hvid-Hansen
- Department of Ophthalmology, Copenhagen University Hospital-Rigshospitalet-Glostrup, DK-2600 Glostrup, Denmark
| | - Flemming Møller
- Department of Ophthalmology, University Hospital of Southern Denmark-Vejle Hospital, DK-7100 Vejle, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Dorte Ancher Larsen
- Department of Ophthalmology, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Nina Jacobsen
- Department of Ophthalmology, Copenhagen University Hospital-Rigshospitalet-Glostrup, DK-2600 Glostrup, Denmark
| | - Line Kessel
- Department of Ophthalmology, Copenhagen University Hospital-Rigshospitalet-Glostrup, DK-2600 Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, DK-2200 København N, Denmark
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23
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Biswas S, El Kareh A, Qureshi M, Lee DMX, Sun CH, Lam JSH, Saw SM, Najjar RP. The influence of the environment and lifestyle on myopia. J Physiol Anthropol 2024; 43:7. [PMID: 38297353 PMCID: PMC10829372 DOI: 10.1186/s40101-024-00354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/05/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Myopia, commonly known as near-sightedness, has emerged as a global epidemic, impacting almost one in three individuals across the world. The increasing prevalence of myopia during early childhood has heightened the risk of developing high myopia and related sight-threatening eye conditions in adulthood. This surge in myopia rates, occurring within a relatively stable genetic framework, underscores the profound influence of environmental and lifestyle factors on this condition. In this comprehensive narrative review, we shed light on both established and potential environmental and lifestyle contributors that affect the development and progression of myopia. MAIN BODY Epidemiological and interventional research has consistently revealed a compelling connection between increased outdoor time and a decreased risk of myopia in children. This protective effect may primarily be attributed to exposure to the characteristics of natural light (i.e., sunlight) and the release of retinal dopamine. Conversely, irrespective of outdoor time, excessive engagement in near work can further worsen the onset of myopia. While the exact mechanisms behind this exacerbation are not fully comprehended, it appears to involve shifts in relative peripheral refraction, the overstimulation of accommodation, or a complex interplay of these factors, leading to issues like retinal image defocus, blur, and chromatic aberration. Other potential factors like the spatial frequency of the visual environment, circadian rhythm, sleep, nutrition, smoking, socio-economic status, and education have debatable independent influences on myopia development. CONCLUSION The environment exerts a significant influence on the development and progression of myopia. Improving the modifiable key environmental predictors like time spent outdoors and engagement in near work can prevent or slow the progression of myopia. The intricate connections between lifestyle and environmental factors often obscure research findings, making it challenging to disentangle their individual effects. This complexity underscores the necessity for prospective studies that employ objective assessments, such as quantifying light exposure and near work, among others. These studies are crucial for gaining a more comprehensive understanding of how various environmental factors can be modified to prevent or slow the progression of myopia.
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Affiliation(s)
- Sayantan Biswas
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Antonio El Kareh
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Mariyem Qureshi
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
| | | | - Chen-Hsin Sun
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Janice S H Lam
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Raymond P Najjar
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
- Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore, Singapore.
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24
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Kim JM, Choi YJ. Nutritional intake, environmental factors, and their impact on myopia prevalence in Korean children aged 5-12 years. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:14. [PMID: 38287408 PMCID: PMC10823653 DOI: 10.1186/s41043-024-00506-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/13/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Myopia is a complex condition influenced by numerous factors, including genetic predisposition, environmental factors, and lifestyle choices. Although evidence indicates that certain dietary factors may influence the development of myopia, this relationship is still not completely understood and is a topic of ongoing research. METHODS This study analyzed the relationship between dietary habits, environmental factors, and the prevalence of myopia in a sample of 24,345 children aged 5-12 years from the seventh Korea National Health and Nutrition Examination Survey (KNHANES VII). The average daily intake of dietary nutrients associated with the refractive error status of the participants was analyzed using analysis of variance (GLM) and the Scheffe method for post-hoc comparison. Multiple logistic regression analysis was conducted between the participant's refractive error status and daily dietary nutrient intake, while taking into consideration the age, sex, BMI, parental myopia, and near-work hours. RESULTS The risk of myopia increased with age, especially notable between ages 11 and 12, and was higher in children with both parents having myopia. Dietary factors played a crucial role; children with myopia had significantly lower intake of fat, omega-3 fatty acids, and retinol but higher intake of other nutrients compared to emmetropic and hyperopic counterparts. High consumption of carbohydrates, protein, phosphorus, iron, potassium, and sodium was associated with increased myopia risk. High sodium intake was particularly associated with a 2.05-fold increased myopia risk. CONCLUSIONS This study highlights the significant role of diet and lifestyle choices in the development of myopia in children. Our findings suggest the importance of considering these specific factors in the management and prevention strategies for myopia, underscoring the need for targeted interventions in children's health and vision care.
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Affiliation(s)
- Jeong-Mee Kim
- Department of Visual Optics, Far East University, Eumseong, South Korea
| | - Yean-Jung Choi
- Department of Food and Nutrition, Sahmyook University, 815, Hwarang-ro, Nowon-gu, Seoul, 01795, South Korea.
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25
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Güemes-Villahoz N, Gómez de Liano R, Porras Ángel P, Talavero González P, Bella Gala R, Martín García B, Burgos Blasco B, Hernández García E, Chamorro Herrera M, Hernández-Verdejo JL, Ruiz-Pomeda A. Lifestyle Factors in Myopic Spanish Children. CHILDREN (BASEL, SWITZERLAND) 2024; 11:139. [PMID: 38397251 PMCID: PMC10887306 DOI: 10.3390/children11020139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Childhood myopia represents a global concern with increasing prevalence in recent decades. Lifestyle factors significantly impact myopia. AIM To evaluate lifestyle factors in myopic children from a metropolitan area in Europe. METHODS This was a descriptive study including myopic subjects aged 4-18 years. Patient demographic and clinical data were collected, including cycloplegic refraction in spherical equivalent refraction (SER) and axial length (AL). In addition, a questionnaire on lifestyle factors was conducted between September 2022 and April 2023. RESULTS A total of 321 myopic children were included, aged 10.72 ± 3.05 years, of whom 51.4% were boys, with SER -2.25 ± 1.9 D and AL 24.54 ± 0.98 mm. The mean age of myopia onset was 7.69 ± 3.05 years. A total of 59.8% had family history of myopia. Those children who had <2 h/day of screen time (on weekdays) presented SER -2 ± 1.91 D, compared to those who had >2 h/day, SER: -2.50 ±1.88 D (p = 0.009). Children who spent <2 h/day doing near work after school were less myopic compared to those who spent >2 h/day (SER: -1.75 ± 1.83 vs. SER: -2.75 ± 1.82, respectively, p = 0.03). However, no significant association was observed between SER and AL and time spent outdoors nor between SER and AL and academic performance (p > 0.05). CONCLUSIONS Screen time and near-work time appear to be lifestyle factors related to myopia.
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Affiliation(s)
- Noemí Güemes-Villahoz
- Department of Ophthalmology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdiSCC), C/Profesor Martin Lagos S/N, 28040 Madrid, Spain; (N.G.-V.); (R.G.d.L.); (P.P.Á.); (P.T.G.); (E.H.G.); (M.C.H.)
| | - Rosario Gómez de Liano
- Department of Ophthalmology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdiSCC), C/Profesor Martin Lagos S/N, 28040 Madrid, Spain; (N.G.-V.); (R.G.d.L.); (P.P.Á.); (P.T.G.); (E.H.G.); (M.C.H.)
| | - Paloma Porras Ángel
- Department of Ophthalmology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdiSCC), C/Profesor Martin Lagos S/N, 28040 Madrid, Spain; (N.G.-V.); (R.G.d.L.); (P.P.Á.); (P.T.G.); (E.H.G.); (M.C.H.)
- Optometry and Vision Department, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain; (R.B.G.); (B.M.G.); (J.L.H.-V.)
| | - Paula Talavero González
- Department of Ophthalmology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdiSCC), C/Profesor Martin Lagos S/N, 28040 Madrid, Spain; (N.G.-V.); (R.G.d.L.); (P.P.Á.); (P.T.G.); (E.H.G.); (M.C.H.)
| | - Rafael Bella Gala
- Optometry and Vision Department, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain; (R.B.G.); (B.M.G.); (J.L.H.-V.)
| | - Beatriz Martín García
- Optometry and Vision Department, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain; (R.B.G.); (B.M.G.); (J.L.H.-V.)
| | - Bárbara Burgos Blasco
- Department of Ophthalmology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdiSCC), C/Profesor Martin Lagos S/N, 28040 Madrid, Spain; (N.G.-V.); (R.G.d.L.); (P.P.Á.); (P.T.G.); (E.H.G.); (M.C.H.)
| | - Elena Hernández García
- Department of Ophthalmology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdiSCC), C/Profesor Martin Lagos S/N, 28040 Madrid, Spain; (N.G.-V.); (R.G.d.L.); (P.P.Á.); (P.T.G.); (E.H.G.); (M.C.H.)
| | - Marta Chamorro Herrera
- Department of Ophthalmology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdiSCC), C/Profesor Martin Lagos S/N, 28040 Madrid, Spain; (N.G.-V.); (R.G.d.L.); (P.P.Á.); (P.T.G.); (E.H.G.); (M.C.H.)
| | - José Luis Hernández-Verdejo
- Optometry and Vision Department, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain; (R.B.G.); (B.M.G.); (J.L.H.-V.)
| | - Alicia Ruiz-Pomeda
- Optometry and Vision Department, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain; (R.B.G.); (B.M.G.); (J.L.H.-V.)
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Erdinest N, Atar-Vardi M, London N, Landau D, Smadja D, Pras E, Lavy I, Morad Y. Treatment of Rapid Progression of Myopia: Topical Atropine 0.05% and MF60 Contact Lenses. Vision (Basel) 2024; 8:3. [PMID: 38391084 PMCID: PMC10885127 DOI: 10.3390/vision8010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/11/2024] [Accepted: 01/14/2024] [Indexed: 02/24/2024] Open
Abstract
This retrospective study evaluates the effectiveness of combining 0.05% atropine with MF60 contact lenses in managing rapid myopia progression in children over one year. The study involved three groups: the treatment group (TG) with 15 children (53% male, average age 12.9 ± 1.04), the MF group (MF) with 12 children (50% male, average age 12.8 ± 0.8) using only MF60 lenses, and the control group (CG) with 14 children (43% male, average age 12.1 ± 0.76). Baseline myopia and axial length (AL) were similar across groups, with the TG, MF, and CG showing -4.02 ± 0.70 D, -4.18 ± 0.89 D, -3.86 ± 0.99 D, and 24.72 ± 0.73 mm, 24.98 ± 0.70 mm, 24.59 ± 1.02 mm, respectively. Prior to the study, all groups exhibited significant myopia and AL progression, with no previous myopia control management. The treatment involved daily 0.05% atropine instillation, the use of MF60 lenses and increased outdoor activity. Biannual cycloplegic refraction and slit lamp evaluations confirmed no adverse reactions. After one year, the TG showed a significant reduction in myopia and AL progression (-0.43 ± 0.46 D, p < 0.01; 0.22 ± 0.23 mm, p < 0.01), whereas the CG showed minimal change (-1.30 ± 0.43 D, p = 0.36; 0.65 ± 0.35 mm, p = 0.533). The MF group also exhibited a notable decrease (-0.74 ± 0.45 D, p < 0.01; 0.36 ± 0.23 mm). Increased outdoor activity during the treatment year did not significantly impact myopia control, suggesting its limited additional effect in this cohort. The study concludes that the combination of 0.05% atropine and peripheral defocus soft contact lenses effectively controls myopia progression in children.
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Affiliation(s)
- Nir Erdinest
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel
- The Myopia Center, Petach Tikva 4900519, Israel
| | - Maya Atar-Vardi
- Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin 7033001, Israel
| | - Naomi London
- Private Practice, 5 Even Israel, Jerusalem 9422805, Israel
| | - David Landau
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel
| | - David Smadja
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel
| | - Eran Pras
- Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin 7033001, Israel
| | - Itay Lavy
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel
| | - Yair Morad
- The Myopia Center, Petach Tikva 4900519, Israel
- Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin 7033001, Israel
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Reidy MG, Hartwick ATE, Mutti DO. The association between pupillary responses and axial length in children differs as a function of season. Sci Rep 2024; 14:598. [PMID: 38182869 PMCID: PMC10770316 DOI: 10.1038/s41598-024-51199-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/02/2024] [Indexed: 01/07/2024] Open
Abstract
The association between pupillary responses to repeated stimuli and adult refractive error has been previously demonstrated. This study evaluated whether this association exists in children and if it varies by season. Fifty children aged 8-17 years (average: 11.55 ± 2.75 years, 31 females) with refractive error between + 1.51 and - 5.69 diopters (non-cycloplegic) participated (n = 27 in summer, and n = 23 in winter). The RAPDx pupilometer measured pupil sizes while stimuli oscillated between colored light and dark at 0.1 Hz in three sequences: (1) alternating red and blue, (2) red-only, and (3) blue-only. The primary outcome was the difference in pupillary responses between the blue-only and red-only sequences. Pupillary constriction was greater in response to blue light than to red for those with shorter eyes in summer (β = - 9.42, P = 0.034) but not in winter (β = 3.42, P = 0.54). Greater constriction comprised faster pupillary escape following red light onset and slower redilation following stimulus offset of both colors (P = 0.017, 0.036, 0.035 respectively). The association between axial length and children's pupillary responses in summer, but not winter may be explained by greater light-associated release of retinal dopamine in summer. Shorter eyes' more robust responses are consistent with greater light exposure inhibiting axial elongation and reducing myopia risk.
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Affiliation(s)
| | | | - Donald O Mutti
- The Ohio State University College of Optometry, Columbus, USA
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Wu HT, Shi XH, Dong L, Zhang RH, Li YT, Wei WB. Lens-induced myopization and body weight in young guinea pigs. BMC Ophthalmol 2024; 24:6. [PMID: 38172796 PMCID: PMC10763096 DOI: 10.1186/s12886-023-03271-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND To investigate the relationship between body weight and Axial length in guinea pigs. METHODS Forty pigmented guinea pigs were randomly divided into two groups, namely control group and negative lens-induced myopization (LIM) group. After measuring the baseline axial length and body weight (BW), guinea pigs of LIM group received bilateral negative lens-induced myopization using - 10.0 diopters lenses. One week later, the lenses were removed and biometric and ophthalmoscopic examinations were repeated. RESULTS Two groups of guinea pigs showed no statistical difference in initial body weight and eye axis length. Compared to the control group, the lens-induced group had a lower weight (P = 0.02) and a longer axial length (P < 0.01) at the end of study Neither at baseline nor at week 1 did AL correlate with BW in both groups (Control Baseline: r = 0.306, P = 0.19; Control Week1: r = 0.333, P = 0.15; LIM Baseline: r=-0.142, P = 0.55; LIM Week 1: r = 0.189, P = 0.42). Lens-induction had a significant effect on axial elongation (P < 0.01) while body weight had no impact on such aspect (P > 0.05). CONCLUSION In guinea pigs of the same age, axial length was not correlated with body weight. Also, baseline body weight had no impact on natural axial length growth or lens-induced myopia. Lens-induction caused a significant reduction in body weight gain.
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Affiliation(s)
- Hao-Tian Wu
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Lane, Beijing, 100730, China
| | - Xu-Han Shi
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Lane, Beijing, 100730, China
| | - Li Dong
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Lane, Beijing, 100730, China
| | - Rui-Heng Zhang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Lane, Beijing, 100730, China
| | - Yi-Tong Li
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Lane, Beijing, 100730, China
| | - Wen-Bin Wei
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Lane, Beijing, 100730, China.
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Piotr R, Robert R, Marek N, Michał I. Artificial intelligence enhanced ophthalmological screening in children: insights from a cohort study in Lubelskie Voivodeship. Sci Rep 2024; 14:254. [PMID: 38168543 PMCID: PMC10761970 DOI: 10.1038/s41598-023-50665-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
This study aims to investigate the prevalence of visual impairments, such as myopia, hyperopia, and astigmatism, among school-age children (7-9 years) in Lubelskie Voivodeship (Republic of Poland) and apply artificial intelligence (AI) in the detection of severe ocular diseases. A total of 1049 participants (1.7% of the total child population in the region) were examined through a combination of standardized visual acuity tests, autorefraction, and assessment of fundus images by a convolutional neural network (CNN) model. The results from this artificial intelligence (AI) model were juxtaposed with assessments conducted by two experienced ophthalmologists to gauge the model's accuracy. The results demonstrated myopia, hyperopia, and astigmatism prevalences of 3.7%, 16.9%, and 7.8%, respectively, with myopia showing a significant age-related increase and hyperopia decreasing with age. The AI model performance was evaluated using the Dice coefficient, reaching 93.3%, indicating that the CNN model was highly accurate. The study underscores the utility of AI in the early detection and diagnosis of severe ocular diseases, providing a foundation for future research to improve paediatric ophthalmic screening and treatment outcomes.
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Affiliation(s)
- Regulski Piotr
- Laboratory of Digital Imaging and Virtual Reality, Department of Dental and Maxillofacial Radiology, Medical University of Warsaw, Binieckiego 6 St., 02-097, Warsaw, Poland.
| | - Rejdak Robert
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, Lublin, Poland
| | | | - Iwański Michał
- Laboratory of Digital Imaging and Virtual Reality, Department of Dental and Maxillofacial Radiology, Medical University of Warsaw, Binieckiego 6 St., 02-097, Warsaw, Poland
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Zaabaar E, Zhang XJ, Zhang Y, Bui CHT, Tang FY, Kam KW, Szeto SKH, Young AL, Wong ICK, Ip P, Tham CC, Pang CP, Chen LJ, Yam JC. Light exposure therapy for myopia control: a systematic review and Bayesian network meta-analysis. Br J Ophthalmol 2023:bjo-2023-323798. [PMID: 38164527 DOI: 10.1136/bjo-2023-323798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/11/2023] [Indexed: 01/03/2024]
Abstract
AIMS To compare and rank the myopia control effects of different light wavelengths in children using a systematic review and Bayesian network meta-analysis (Bayesian NMA). METHODS The review protocol was registered with PROSPERO. We searched PubMed, EMBASE and MEDLINE for relevant clinical and animal studies published as of 2 February 2023. We included studies comparing red, violet or full-spectrum light with controls. Data extracted included descriptive statistics and study outcomes (axial length (AL) elongation and progression of spherical equivalent (SE) refraction). After quality assessment, estimates of treatment effect outcomes (mean differences (MDs) and 95% CIs) were first pooled for the animal and clinical studies in a traditional meta-analysis. To compare and rank the different light wavelengths, the Bayesian NMA was then conducted for all the included clinical studies (12 studies) and separately for only randomised controlled trials (8 studies). MDs, 95% credible intervals (CrIs) and ranks of the various light wavelengths were estimated in the Bayesian NMA. RESULTS When all clinical studies were included in the Bayesian NMA (12 studies), only red-light significantly slowed AL elongation, MD (95% CrI), -0.38 mm (-0.59 mm to -0.16 mm)/year and SE refraction progression, 0.72D (0.35D to 1.10D)/year compared with controls. It remained the only significant intervention when effect sizes from only RCTs (eight studies) were separately combined, (-0.28 mm (-0.40 mm to -0.15 mm)/year and 0.57D (0.22D to 0.92D)/year, for AL and SE refraction, respectively). CONCLUSION Myopia control efficacy varied among different wavelengths of light, with red light ranked as the most effective. PROSPERO REGISTRATION NUMBER Clinical studies: CRD42022368998; animal studies: CRD42022368671.
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Affiliation(s)
- Ebenezer Zaabaar
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Christine H T Bui
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Fang Yao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong SAR, China
| | - Simon K H Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong SAR, China
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
- Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology, Hong Kong Children Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong SAR, China
- Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
- Department of Ophthalmology, Hong Kong Children Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
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Qu Y, Huang H, Zhang H. Association between body mass index and myopia in the United States population in the National Health and Nutrition Examination Surveys 1999 to 2008: a cross-sectional study. Eur J Med Res 2023; 28:561. [PMID: 38049883 PMCID: PMC10696841 DOI: 10.1186/s40001-023-01542-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND This study investigated the association between body mass index (BMI) and myopia in the United States. METHODS This cross-sectional study included 8,000 participants from the 1999 to 2008 National Health and Nutrition Examination Survey (NHANES). BMI was classified into four groups: < 18.5, 18.5 - 24.9, 25-29.9, and > 29.9. Three diagnostic thresholds were used for myopia A\B\C: spherical equivalent ≤ -0.5\-0.75\-1 diopters in the right eye. Multivariate logistic regression analysis and smooth curve fitting were performed to evaluate the association between BMI and myopia. RESULTS The incidence of myopia was 39.4%. BMI was correlated with myopia, with each 1 kg/m2 increase in BMI associated with a 1% increase in the risk of myopia (OR, 1.01; 95% CI 1.01 1.02; p < 0.05). In myopia B, after adjusting for confounding factors, compared with the reference group (BMI 18.5-24.9), participants with a BMI of 25-29.9 and greater than 29.9 had a 14% and 25% increased risk of myopia, respectively (OR 1.14; 95% CI 1.01 1.29; p = 0.037, OR 1.25; 95% CI 1.08 1.44; p = 0.003), which was similar to the results for myopic A (OR, 1.15; 95% CI 1.02 1.3; p = 0.027, OR 1.19; 95% CI 1.03 1.37; p = 0.018) and myopia C (OR 1.15; 95% CI 1.01 1.31; p = 0.035, OR 1.18; 95% CI 1.01 1.37; p = 0.032). Moreover, there was a linear relationship between myopia and BMI (p for nonlinearity = 0.767). CONCLUSIONS Myopia using all three diagnostic thresholds was positively associated with higher BMI. This suggests a potential association between myopia and higher BMI in the American population, warranting further investigations.
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Affiliation(s)
- Yaohui Qu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Jinan, Shandong, China
| | - Huamin Huang
- The First Affiliated Hospital of Shandong First Medical University &, Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, Shandong, China
| | - Hongxing Zhang
- The First Affiliated Hospital of Shandong First Medical University &, Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, Shandong, China.
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Foley L, Prescott CR. Myopia Management: Outdoor Time to Reverse the Trend. Eye Contact Lens 2023; 49:511. [PMID: 37990440 DOI: 10.1097/icl.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Affiliation(s)
- Lindsay Foley
- Department of Ophthalmology, New York University Langone Health, New York, NY
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Salzano AD, Khanal S, Cheung NL, Weise KK, Jenewein EC, Horn DM, Mutti DO, Gawne TJ. Repeated Low-level Red-light Therapy: The Next Wave in Myopia Management? Optom Vis Sci 2023; 100:812-822. [PMID: 37890098 DOI: 10.1097/opx.0000000000002083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023] Open
Abstract
SIGNIFICANCE Exposure to long-wavelength light has been proposed as a potential intervention to slow myopia progression in children. This article provides an evidence-based review of the safety and myopia control efficacy of red light and discusses the potential mechanisms by which red light may work to slow childhood myopia progression.The spectral composition of the ambient light in the visual environment has powerful effects on eye growth and refractive development. Studies in mammalian and primate animal models (macaque monkeys and tree shrews) have shown that daily exposure to long-wavelength (red or amber) light promotes slower eye growth and hyperopia development and inhibits myopia induced by form deprivation or minus lens wear. Consistent with these results, several recent randomized controlled clinical trials in Chinese children have demonstrated that exposure to red light for 3 minutes twice a day significantly reduces myopia progression and axial elongation. These findings have collectively provided strong evidence for the potential of using red light as a myopia control intervention in clinical practice. However, several questions remain unanswered. In this article, we review the current evidence on the safety and efficacy of red light as a myopia control intervention, describe potential mechanisms, and discuss some key unresolved issues that require consideration before red light can be broadly translated into myopia control in children.
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Affiliation(s)
| | - Safal Khanal
- Department of Optometry and Vision Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nathan L Cheung
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Katherine K Weise
- Department of Optometry and Vision Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - Erin C Jenewein
- Pennsylvania College of Optometry, Salus University, Elkins Park, Pennsylvania
| | - Darryl M Horn
- Pennsylvania College of Optometry, Salus University, Elkins Park, Pennsylvania
| | - Donald O Mutti
- The Ohio State University College of Optometry, Columbus, Ohio
| | - Timothy J Gawne
- Department of Optometry and Vision Science, University of Alabama at Birmingham, Birmingham, Alabama
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Tong L, Chen J, Liu L, Kang M, Liao X, Ying P, Ling Q, Zou J, Wei H, Wang Y, Shao Y. Temporal effects of an original myopia song on school children's myopia and awareness: a 3-year prospective study. Clin Exp Optom 2023:1-7. [PMID: 37989320 DOI: 10.1080/08164622.2023.2251975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/22/2023] [Indexed: 11/23/2023] Open
Abstract
CLINICAL RELEVANCE Raising children's myopia prevention awareness and behaviour tends to exhibits a protective effect against myopia among schoolchildren. BACKGROUND To investigate the effect of an original myopia song in raising school children's awareness of healthier eye use behaviour and on myopia prevention. METHODS In this prospective randomised control study, two groups of students from one primary schools in Jiangxi, China, were enrolled and monitored from grade 3 to grade 6 (2016-2019). The primary outcome was the change in axial length (AL) after the intervention. Secondary outcomes included changes in spherical equivalent refraction (SER), near work and outdoor time, corrected near and distant visual acuity, visual discomfort score (VDS) and accommodative lag. RESULTS Four hundred students (193 females, 48.25%) aged 9.3 (range 8-10) years with emmetropia to moderate myopia were enrolled. Children in the myopia song group had a significantly shorter AL and less myopic refractive change than those in the control group (p = 0.04 and 0.02, respectively). Compared with the control group, children in the myopia song group spent less time on near work and more time outdoors (p = 0.04 and 0.04, respectively). At the final follow-up, the proportion of children with myopia was significantly lower in the myopia song group (30.5%) than in the control group (41%) (p = 0.03). No significant differences were found for the secondary outcomes, including corrected near and distant visual acuity, VDS and accommodative lag. CONCLUSIONS An original myopia song performed twice daily in primary schools appeared to have a modest effect on myopia control among school-aged children by changing their lifestyles in the long term.
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Affiliation(s)
- Liyang Tong
- Department of Ophthalmology, The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, Zhejiang, China
| | - Jun Chen
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Liqi Liu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Min Kang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xulin Liao
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, China
| | - Ping Ying
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qian Ling
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jie Zou
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hong Wei
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yixin Wang
- School of optometry and vision science, Cardiff University, Cardiff, Wales, UK
| | - Yi Shao
- Department of Ophthalmology, The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, Zhejiang, China
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China
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35
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Deng B, Li W, Chen Z, Zeng J, Zhao F. Temporal bright light at low frequency retards lens-induced myopia in guinea pigs. PeerJ 2023; 11:e16425. [PMID: 38025747 PMCID: PMC10655705 DOI: 10.7717/peerj.16425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Bright light conditions are supposed to curb eye growth in animals with experimental myopia. Here we investigated the effects of temporal bright light at very low frequencies exposures on lens-induced myopia (LIM) progression. Methods Myopia was induced by application of -6.00 D lenses over the right eye of guinea pigs. They were randomly divided into four groups based on exposure to different lighting conditions: constant low illumination (CLI; 300 lux), constant high illumination (CHI; 8,000 lux), very low frequency light (vLFL; 300/8,000 lux, 10 min/c), and low frequency light (LFL; 300/8,000 lux, 20 s/c). Refraction and ocular dimensions were measured per week. Changes in ocular dimensions and refractions were analyzed by paired t-tests, and differences among the groups were analyzed by one-way ANOVA. Results Significant myopic shifts in refractive error were induced in lens-treated eyes compared with contralateral eyes in all groups after 3 weeks (all P < 0.05). Both CHI and LFL conditions exhibited a significantly less refractive shift of LIM eyes than CLI and vLFL conditions (P < 0.05). However, only LFL conditions showed significantly less overall myopic shift and axial elongation than CLI and vLFL conditions (both P < 0.05). The decrease in refractive error of both eyes correlated significantly with axial elongation in all groups (P < 0.001), except contralateral eyes in the CHI group (P = 0.231). LFL condition significantly slacked lens thickening in the contralateral eyes. Conclusions Temporal bright light at low temporal frequency (0.05 Hz) appears to effectively inhibit LIM progression. Further research is needed to determine the safety and the potential mechanism of temporal bright light in myopic progression.
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Affiliation(s)
- Baodi Deng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Wentao Li
- Huizhou Third People’s Hospital, Guangzhou Medical University, Huizhou, China
| | - Ziping Chen
- Guangdong Light Visual Health Research Institute, Guangzhou, China
| | - Junwen Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Feng Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
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Chen Z, Gu D, Wang B, Kang P, Watt K, Yang Z, Zhou X. Significant myopic shift over time: Sixteen-year trends in overall refraction and age of myopia onset among Chinese children, with a focus on ages 4-6 years. J Glob Health 2023; 13:04144. [PMID: 37934967 PMCID: PMC10630697 DOI: 10.7189/jogh.13.04144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background Myopia or near-sightedness is a major cause of blindness in China and typically develops between the ages of 6-12 years. We aimed to investigate the change in refractive error and the age of myopia onset in Chinese children from 2005 to 2021. Methods We first conducted a series of cross-sectional studies to determine the refractive states and the age of myopia onset over time, after which we analysed longitudinal data to investigate the dose-response relationship between hyperopic reserve and future risk of myopia. The analysis was based on the refraction data of children aged 4-18 years who visited the Fudan University Eye and Ear, Nose, and Throat (FUEENT) Hospital, a large tertiary hospital in Shanghai, China, for eye examinations between 2005 and 2021. We examined the prevalence of hyperopia (spherical equivalent refractive error (SERE) >0.75D), pre-myopia (-0.50D < SERE ≤ 0.75D), and myopia (SERE ≤-0.50D), the average SERE for each age group at the initial visit, the average age of myopia onset, and the safety threshold of hyperopic reserve against myopia onset. Results We included 870 372 eligible patients aged 4-18 years who attended examination between 2005 and 2021, 567 893 (65.2%) of whom were myopic at their initial visit to FUEENT. The mean SERE decreased in most (n/N = 14/15) of the age groups over the 16 calendar years, with a mean SERE for the whole cohort decreasing from -1.01D (standard deviation (SD) = 3.46D) in 2005 to -1.30D (SD = 3.11D) in 2021. The prevalence of pre-myopia increased over the 16 years (P < 0.001), while those of myopia and hyperopia remained largely stable (both P > 0.05). We observed a significant decrease in the prevalence of hyperopia (2005: 65.4% vs 2021: 51.1%; P < 0.001) and a significant increase in the prevalence of pre-myopia (2005: 19.0% vs 2021: 26.5%; P < 0.001) and myopia (2005: 15.6% vs 2021: 22.4%; P < 0.001) in children aged 4-6 years. We found an earlier myopia onset over time, with the mean age of onset decreasing from 10.6 years in 2005 to 7.6 years in 2021 (P < 0.001). Children with a hyperopic reserve of less than 1.50D were at increased risk of developing myopia during a median follow-up of 1.3 years. Conclusions We found an overall myopic shift in SERE in Chinese children aged 4-18 years over the past 16 years, particularly in those aged 4-6 years. The mean age of myopia onset decreased by three years over the same period. The "safety threshold" of hyperopic reserve we identified may help target the high-risk population for early prevention.
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Affiliation(s)
- Zhi Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, 200031, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Dantong Gu
- Clinical Research and Achievement Translation Center, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Bingjie Wang
- School of Optometry and Vision Science, University of New South Wales, Australia
| | - Pauline Kang
- School of Optometry and Vision Science, University of New South Wales, Australia
| | - Kathleen Watt
- School of Optometry and Vision Science, University of New South Wales, Australia
| | - Zuyao Yang
- Division of Epidemiology, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, 200031, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
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Wang B, Watt K, Chen Z, Kang P. Predicting the child who will become myopic - can we prevent onset? Clin Exp Optom 2023; 106:815-824. [PMID: 37194117 DOI: 10.1080/08164622.2023.2202306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/06/2023] [Indexed: 05/18/2023] Open
Abstract
Myopia has become a global epidemic with significant public health impacts. Identifying the child at risk of developing myopia, i.e. the pre-myopic child and implementing strategies to prevent the onset of myopia, could significantly reduce the burden of myopia on an individual and society. This paper is a review of publications that have identified ocular characteristics of children at risk of future myopia development including a lower than age normal amount of hyperopia and accelerated axial length elongation. Risk factors associated with increased risk of myopia development such as education exposure and reduced outdoor time, and strategies that could be implemented to prevent myopia onset in children are also explored. The strong causal role of education and outdoor time on myopia development suggests that lifestyle modifications could be implemented as preventative measures to at-risk children and may significantly impact the myopia epidemic by preventing or delaying myopia onset and its associated ocular health consequences.
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Affiliation(s)
- Bingjie Wang
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Kathleen Watt
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Zhi Chen
- Department of Ophthalmology, Fudan University Eye and ENT Hospital, Shanghai, China
| | - Pauline Kang
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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Hussain A, Gopalakrishnan A, Scott H, Seby C, Tang V, Ostrin L, Chakraborty R. Associations between systemic melatonin and human myopia: A systematic review. Ophthalmic Physiol Opt 2023; 43:1478-1490. [PMID: 37568264 DOI: 10.1111/opo.13214] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE Experimental models have implicated the role of melatonin circadian rhythm disruption in refractive error development. Recent studies have examined melatonin concentration and its diurnal patterns on refractive error with equivocal results. This systematic review aimed to summarise the literature on melatonin circadian rhythms in myopia. RECENT FINDINGS PubMed, EMBASE, Web of Science, Scopus, ProQuest Central, LILACS, Cochrane and Medline databases were searched for papers between January 2010 and December 2022 using defined search terms. Seven studies measured melatonin and circadian rhythms in three biological fluids (blood serum, saliva and urine) in both myopes and non-myopes. Morning melatonin concentrations derived from blood serum varied significantly between studies in individuals aged 10-30 years, with a maximum of 89.45 pg/mL and a minimum of 5.43 pg/mL using liquid chromatography and mass spectrometry. The diurnal variation of salivary melatonin was not significantly different between myopes and emmetropes when measured every 4 h for 24 h and quantified with enzyme-linked immunosorbent assay. Significantly elevated salivary melatonin concentrations were reported in myopes compared with emmetropes, aged 18-30 years when measured hourly from evening until their habitual bedtime using liquid chromatography. However, the relationship between dim light melatonin onset and refractive group was inconsistent between studies. The 6-sulphatoxymelatonin concentration derived from overnight urine volume, measured using a double antibody radioimmunoassay, was found to be significantly lower in myopes (29.17 pg/mL) than emmetropes (42.51 pg/mL). SUMMARY The role of melatonin concentration and rhythm in myopia has not been studied extensively. This systematic review confirms conflicting findings across studies, with potential relationships existing. Future studies with uniform methodological approaches are required to ascertain the causal relationship between melatonin dysregulation and myopia in humans.
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Affiliation(s)
- Azfira Hussain
- Myopia Clinic, Unit of Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Aparna Gopalakrishnan
- Myopia Clinic, Unit of Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Hannah Scott
- Flinders Health and Medical Research Institute: Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Chris Seby
- Caring Futures Institute, Myopia and Visual Development Lab, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Victoria Tang
- Caring Futures Institute, Myopia and Visual Development Lab, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Lisa Ostrin
- College of Optometry, University of Houston, Houston, Texas, USA
| | - Ranjay Chakraborty
- Caring Futures Institute, Myopia and Visual Development Lab, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Zhao C, Ni Y, Zeng J. Effect of red-light therapy on retinal and choroidal blood perfusion in myopic children. Ophthalmic Physiol Opt 2023; 43:1427-1437. [PMID: 37431143 DOI: 10.1111/opo.13202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE To investigate the effect of repeated low-level red-light therapy (RLRLT) on retinal and choroidal blood perfusion in myopic children. METHODS Forty-seven myopic children (mean spherical equivalent refractive error [SE]: -2.31 ± 1.26 D; age range: 8.0-11.0 years) were enrolled and received RLRLT (power 2 mW, wavelength 650 nm) for 3 min twice a day, while 20 myopic children (SE: -2.75 ± 0.84 D; age range: 7.0-10.0 years) were included as a control group. All participants wore single-vision distance glasses. Refractive error, axial length (AL) and other biometric parameters were measured at baseline and during follow-up visits in the first, second and fourth weeks after initiation of treatment. Retinal thickness, subfoveal choroidal thickness (SFCT), total choroidal area (TCA), luminal area (LA), stromal area (SA) and choroidal vascularity index (CVI) were obtained using optical coherence tomography (OCT). The percentage retinal vascular density (VD%) and choriocapillaris flow voids (FV%) were measured using en-face OCT angiography. RESULTS After 4 weeks of treatment, a significant increase in SFCT was observed in the RLRLT group, with an average increase of 14.5 μm (95% confidence interval [CI]: 9.6-19.5 μm), compared with a decrease of -1.7 μm (95% CI: -9.1 to 5.7 μm) in the control group (p < 0.0001). However, no significant changes in retinal thickness or VD% were observed in either group (all p > 0.05). In the OCT images from the RLRLT group, no abnormal retinal morphology related to photodamage was observed. The horizontal scans revealed an increase in TCA, LA and CVI over time (all p < 0.05), while SA and FV% remained unchanged (both p > 0.05). CONCLUSIONS These findings indicate that RLRLT can enhance choroidal blood perfusion in myopic children, demonstrating a cumulative effect over time.
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Affiliation(s)
- Chang Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
| | - Yao Ni
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
| | - Junwen Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
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Agyekum S, Chan PP, Adjei PE, Zhang Y, Huo Z, Yip BHK, Ip P, Wong ICK, Zhang W, Tham CC, Chen LJ, Zhang XJ, Pang CP, Yam JC. Cost-Effectiveness Analysis of Myopia Progression Interventions in Children. JAMA Netw Open 2023; 6:e2340986. [PMID: 37917061 PMCID: PMC10623196 DOI: 10.1001/jamanetworkopen.2023.40986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/15/2023] [Indexed: 11/03/2023] Open
Abstract
Importance Several interventions exist for treating myopia progression in children. While these interventions' efficacy has been studied, their cost-effectiveness remains unknown and has not been compared. Objective To determine cost-effective options for controlling myopia progression in children. Design, Setting, and Participants In this cost-effectiveness analysis, a Markov model was designed to compare the cost-effectiveness of interventions for controlling myopia progression over 5 years from a societal perspective in a simulated hypothetical cohort of patients aged 10 years with myopia. Myopia interventions considered included atropine eye drops, 0.05% and 0.01%, defocus incorporated multiple segment spectacles, outdoor activity, soft contact lenses (daily disposable and multifocal), rigid gas-permeable contact lenses, progressive addition lenses, bifocal spectacle lenses, orthokeratology, highly aspherical lenslets (HALs), and red light therapy; all interventions were compared with single-vision lenses. Deterministic and probabilistic sensitivity analysis determined the association of model uncertainties with the cost-effectiveness. Costs were obtained from the charges of the Hospital Authority of Hong Kong and The Chinese University of Hong Kong Eye Center. Main Outcome and Measures The mean costs (in US dollars) per child included the cost of hospital visits, medications, and optical lenses. The outcomes of effectiveness were the annual spherical equivalent refraction (SER) and axial length (AL) reductions. Incremental cost-effectiveness ratios (ICERs) were calculated for each strategy relative to single-vision lenses over a time horizon of 5 years. Results Outdoor activity, atropine (0.05%), red light therapy, HALs, and orthokeratology were cost-effective. The ICER of atropine, 0.05%, was US $220/SER reduction; red light therapy, US $846/SER reduction; and HALs, US $448/SER reduction. Outdoor activity yielded a savings of US $5/SER reduction and US $8/AL reduction. Orthokeratology resulted in an ICER of US $2376/AL reduction. Conclusions and Relevance These findings suggest that atropine eye drops, 0.05%, and outdoor activity are cost-effective for controlling myopia progression in children. Though more expensive, red light therapy, HALs, and orthokeratology may also be cost-effective. The use of these interventions may help to control myopia in a cost-effective way.
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Affiliation(s)
- Sylvia Agyekum
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Poemen P. Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
- Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong SAR, China
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Prince E. Adjei
- School of Life Science, Department of Biomedical Engineering, University of Electronic Science and Technology, Chengdu, China
- Department of Computer Engineering, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zhaohua Huo
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Benjamin H. K. Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Patrick Ip
- Department of Pediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian C. K. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Wei Zhang
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology Tianjin Medical University, Tianjin, China
| | - Clement C. Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
- Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong SAR, China
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
- Department of Ophthalmology, Hong Kong Children Hospital, Hong Kong SAR. China
- Hong Kong Hub of Pediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong SAR, China
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
- Hong Kong Hub of Pediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
- Hong Kong Hub of Pediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jason C. Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong SAR, China
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
- Department of Ophthalmology, Hong Kong Children Hospital, Hong Kong SAR. China
- Hong Kong Hub of Pediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
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Clark R, Kneepkens SCM, Plotnikov D, Shah RL, Huang Y, Tideman JWL, Klaver CCW, Atan D, Williams C, Guggenheim JA. Time Spent Outdoors Partly Accounts for the Effect of Education on Myopia. Invest Ophthalmol Vis Sci 2023; 64:38. [PMID: 38010695 PMCID: PMC10683767 DOI: 10.1167/iovs.64.14.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023] Open
Abstract
Purpose The purpose of this study was to investigate if education contributes to the risk of myopia because educational activities typically occur indoors or because of other factors, such as prolonged near viewing. Methods This was a two-sample Mendelian randomization study. Participants were from the UK Biobank, Avon Longitudinal Study of Parents and Children, and Generation R. Genetic variants associated with years spent in education or time spent outdoors were used as instrumental variables. The main outcome measures were: (1) spherical equivalent refractive error attained by adulthood, and (2) risk of an early age-of-onset of spectacle wear (EAOSW), defined as an age-of-onset of 15 years or below. Results Time spent outdoors was found to have a small genetic component (heritability 9.8%) that tracked from childhood to adulthood. A polygenic score for time outdoors was associated with children's time outdoors; a polygenic score for years spent in education was inversely associated with children's time outdoors. Accounting for the relationship between time spent outdoors and myopia in a multivariable Mendelian randomization analysis reduced the size of the causal effect of more years in education on myopia to -0.17 diopters (D) per additional year of formal education (95% confidence interval [CI] = -0.32 to -0.01) compared with the estimate from a univariable Mendelian randomization analysis of -0.27 D per year (95% CI = -0.41 to -0.13). Comparable results were obtained for the outcome EAOSW. Conclusions Accounting for the effects of time outdoors reduced the estimated causal effect of education on myopia by 40%. These results suggest about half of the relationship between education and myopia may be mediated by children not being outdoors during schooling.
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Affiliation(s)
- Rosie Clark
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Sander C. M. Kneepkens
- Department of Ophthalmology, Erasmus University Medical Center, CA Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, CA Rotterdam, The Netherlands
- Generation R Study Group, Erasmus University Medical Center, CA Rotterdam, The Netherlands
| | - Denis Plotnikov
- Central Research Laboratory, Kazan State Medical University, Kazan, Russia
| | - Rupal L. Shah
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, United Kingdom
| | - Yu Huang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - J. Willem L. Tideman
- Department of Ophthalmology, Erasmus University Medical Center, CA Rotterdam, The Netherlands
- Department of Ophthalmology, Martini Hospital, RM Groningen, The Netherlands
| | - Caroline C. W. Klaver
- Department of Ophthalmology, Erasmus University Medical Center, CA Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, CA Rotterdam, The Netherlands
- Generation R Study Group, Erasmus University Medical Center, CA Rotterdam, The Netherlands
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
- Department of Ophthalmology, Radboud University Medical Center, GA Nijmegen, The Netherlands
| | - Denize Atan
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS81NU, United Kingdom
| | - Cathy Williams
- Centre for Academic Child Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS81NU, United Kingdom
| | - Jeremy A. Guggenheim
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - for the UK Biobank Eye and Vision Consortium
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
- Department of Ophthalmology, Erasmus University Medical Center, CA Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, CA Rotterdam, The Netherlands
- Generation R Study Group, Erasmus University Medical Center, CA Rotterdam, The Netherlands
- Central Research Laboratory, Kazan State Medical University, Kazan, Russia
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, United Kingdom
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Ophthalmology, Martini Hospital, RM Groningen, The Netherlands
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
- Department of Ophthalmology, Radboud University Medical Center, GA Nijmegen, The Netherlands
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS81NU, United Kingdom
- Centre for Academic Child Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS81NU, United Kingdom
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Harb EN, Sawai ES, Wildsoet CF. Indoor and outdoor human behavior and myopia: an objective and dynamic study. Front Med (Lausanne) 2023; 10:1270454. [PMID: 38020131 PMCID: PMC10643732 DOI: 10.3389/fmed.2023.1270454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Significance Myopia holds significant public health concern given its social, ocular disease and economic burdens. Although environmental factors are primarily to blame for the rapid rise in prevalence, key risk factors remain unresolved. Purpose The aim of this study was to objectively characterize, using a wearable technology, the temporal indoor and outdoor behavioral patterns and associated environmental lighting characteristics of young myopic and nonmyopic University students. Methods Participants were recruited to continuously wear an Actiwatch for 3 weeks, during either or both academic and non-academic periods. The device allows continuous recording of activity and incident light. Recorded illuminance levels were used as a proxy for outdoors (>1,000 lux), with the dynamics (interval frequency and duration) of indoor and outdoor activities, as well as lighting characteristics derived. In addition, participant input regarding near work was obtained daily. Participants were classified by both myopia and axial length status (based on collected refractive error and biometry data) for the purpose of data analysis. Result A total of 55 students, aged 18 to 25 years of age, participated. Overall, the dosing of indoor and outdoor activities was similar across participants, regardless of myopia status, during the academic period. Nonetheless, an apparent difference in the timing of outdoor activities was noted with myopes going outdoors later in the day, particularly during the weekend (p = 0.03). While a trend was observed between increased lighting levels experienced outdoors and shorter axial lengths, there was no significant relationship with myopia status. Noteworthy, participants generally significantly overestimated time spent outdoors, compared to Actiwatch-derived estimates of the same. Conclusion While the findings from this cohort of young adult students did not reveal substantial myopia-related differences in behavior, the power of a more objective and dynamic approach to quantifying behavior cannot be understated, providing argument for general adoption of wearable technologies in future clinical myopia studies.
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Affiliation(s)
- Elise N. Harb
- Herbert Wertheim School of Optometry and Vision Science, University of California at Berkeley, Berkeley, CA, United States
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Hansen NC, Hvid-Hansen A, Møller F, Bek T, Larsen DA, Jacobsen N, Kessel L. Safety and efficacy of 0.01% and 0.1% low-dose atropine eye drop regimens for reduction of myopia progression in Danish children: a randomized clinical trial examining one-year effect and safety. BMC Ophthalmol 2023; 23:438. [PMID: 37904082 PMCID: PMC10614417 DOI: 10.1186/s12886-023-03177-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/14/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND To investigate the efficacy and safety of 0.1% and 0.01% low-dose atropine eye drops in reducing myopia progression in Danish children. METHODS Investigator-initiated, placebo-controlled, double-masked, randomized clinical trial. Ninety-seven six- to twelve-year old myopic participants were randomized to 0.1% loading dose for six months followed by 0.01% for six months (loading dose group, Number (N) = 33), 0.01% for twelve months (0.01% group, N = 32) or vehicle for twelve months (placebo, N = 32). Primary outcomes were axial length and spherical equivalent refraction. Secondary outcomes included adverse events and reactions, choroidal thickness and ocular biometry. Outcomes were measured at baseline and three-month intervals. Data was analyzed with linear-mixed model analysis according to intention-to-treat. RESULTS Mean axial elongation was 0.10 mm less (95% confidence interval (CI): 0.17; 0.02, adjusted-p = 0.06) in the 0.1% loading dose and 0.07 mm less (95% CI: 0.15; 0.00, adjusted-p = 0.16) in the 0.01% group at twelve months compared to placebo. Mean spherical equivalent refraction progression was 0.24 D (95% CI: 0.05; 0.42) less in the loading dose and 0.19 D (95% CI: 0.00; 0.38) less in the 0.01% groups at twelve months, compared to placebo (adjusted-p = 0.06 and 0.14, respectively). A total of 108 adverse events were reported during the initial six-month loading dose period, primarily in the loading dose group, and 14 were reported in the six months following dose switching, all deemed mild except two serious adverse events, unrelated to the intervention. CONCLUSIONS Low-dose atropine eye drops are safe over twelve months in otherwise healthy children. There may be a modest but clinically relevant reduction in myopia progression in Danish children after twelve months treatment, but the effect was statistically non-significant after multiple comparisons adjustment. After dose-switching at six months the loading dose group approached the 0.01% group, potentially indicating an early "rebound-effect". TRIAL REGISTRATION this study was registered in the European Clinical Trials Database (EudraCT, number: 2018-001286-16) 05/11/2018 and first posted at www. CLINICALTRIALS gov (NCT03911271) 11/04/2019, prior to initiation.
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Affiliation(s)
- Niklas Cyril Hansen
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet-Glostrup, Valdemar Hansens Vej 1-23, DK-2600, Glostrup, Denmark.
| | - Anders Hvid-Hansen
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet-Glostrup, Valdemar Hansens Vej 1-23, DK-2600, Glostrup, Denmark
| | - Flemming Møller
- Department of Ophthalmology, University Hospital of Southern Denmark - Vejle Hospital, Beriderbakken 4, DK-7100, Vejle, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 167, DK-8200, Aarhus, Denmark
| | - Dorte Ancher Larsen
- Department of Ophthalmology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 167, DK-8200, Aarhus, Denmark
| | - Nina Jacobsen
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet-Glostrup, Valdemar Hansens Vej 1-23, DK-2600, Glostrup, Denmark
| | - Line Kessel
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet-Glostrup, Valdemar Hansens Vej 1-23, DK-2600, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3b 33.5, DK-2200, Copenhagen, Denmark
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Wang X, Sun Y, Wang K, Yang S, Luan C, Wu B, Zhang W, Hao R. Effects of blue light exposure on ocular parameters and choroidal blood perfusion in Guinea pig. Exp Eye Res 2023; 235:109619. [PMID: 37633324 DOI: 10.1016/j.exer.2023.109619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 08/03/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE To investigate the impact of different duration of blue light exposure on ocular parameters and choroidal blood perfusion in guinea pigs with lens-induced myopia. METHOD Three-week-old Guinea pigs were randomly assigned to different light-environment groups. All groups were subjected to 12-h light/dark cycle. The control (NC) group was conditioned without intervention. While lens-induced myopia (LIM) groups had a -10D lens placed in the right eye and 0D in the left eye. The guinea pigs were exposed to increasing periods of blue-light (420 nm) environment for 3,6,9,12 h per day. Changes in refraction, axial length (AL), the radius of corneal curvature (CCR), choroidal thickness (ChT), and choroidal blood perfusion (ChBP)were measured in both LIM-eye and fellow-eye during the second and fourth week of LIM duration. RESULTS During the first two weeks of the experiment, blue light exposure raised ChBP and ChT, and the effect of suppressing myopia was proportional to the duration of blue light exposure. However, in the fourth week of the experiment, prolonged blue light (12BL) exposure led to a reduction in retinal thickness and the increase in ChT and ChBP ceased. Shorter blue light exposure had a better effect on myopia suppression, with all blue light groups statistically different from the LIM group. CONCLUSION Exposure to blue-light appears to have the potential to improve ChBP and ChT, thereby inhibiting the development of myopia. we speculate that blue-light inhibits the development of myopia for reasons other than longitudinal chromatic aberration (LCA). However,long-term exposure to blue-light may have adverse effects on ocular development. The next step is to investigate in depth the mechanisms by which the rational use of blue light regulates choroidal blood flow, offering new hope for the treatment of myopia.
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Affiliation(s)
- Xiao Wang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, 300020, PR China; Tianjin Key Lab of Ophthalmology and Vision Science, Tianjin Eye Hospital, Tianjin, 300020, PR China
| | - Yifan Sun
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, 300020, PR China; Tianjin Key Lab of Ophthalmology and Vision Science, Tianjin Eye Hospital, Tianjin, 300020, PR China
| | - Kailei Wang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, 300020, PR China; Tianjin Key Lab of Ophthalmology and Vision Science, Tianjin Eye Hospital, Tianjin, 300020, PR China
| | - Shiqiao Yang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, 300020, PR China; Tianjin Key Lab of Ophthalmology and Vision Science, Tianjin Eye Hospital, Tianjin, 300020, PR China
| | - Changlin Luan
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, 300020, PR China; Tianjin Key Lab of Ophthalmology and Vision Science, Tianjin Eye Hospital, Tianjin, 300020, PR China
| | - Bin Wu
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, 300020, PR China; Tianjin Key Lab of Ophthalmology and Vision Science, Tianjin Eye Hospital, Tianjin, 300020, PR China; Nankai University Eye Institute, Nankai University Affiliated Eye Hospital, Nankai University, Tianjin, 300020, PR China
| | - Wei Zhang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, 300020, PR China; Tianjin Key Lab of Ophthalmology and Vision Science, Tianjin Eye Hospital, Tianjin, 300020, PR China; Nankai University Eye Institute, Nankai University Affiliated Eye Hospital, Nankai University, Tianjin, 300020, PR China.
| | - Rui Hao
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, 300020, PR China; Tianjin Key Lab of Ophthalmology and Vision Science, Tianjin Eye Hospital, Tianjin, 300020, PR China; Nankai University Eye Institute, Nankai University Affiliated Eye Hospital, Nankai University, Tianjin, 300020, PR China.
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Martínez-Albert N, Bueno-Gimeno I, Gené-Sampedro A. Risk Factors for Myopia: A Review. J Clin Med 2023; 12:6062. [PMID: 37763002 PMCID: PMC10532298 DOI: 10.3390/jcm12186062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/15/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
Due to the myopia prevalence increase worldwide, this study aims to establish the most relevant risk factors associated with its development and progression. A review search was carried out using PubMed, Web of Science, and Scopus databases to identify the main myopia risk factors. The inclusion criteria for the articles were those related to the topic, carried out in subjects from 5 to 30 years, published between January 2000 and May 2023, in English, and with the full text available. Myopia etiology has proven to be associated with both genetic and environmental factors as well as with gene-environment interaction. The risk of developing myopia increases in children with myopic parents (one parent ×2 times, two parents ×5 times). Regarding environmental factors, education is the main risk factor correlated with myopia prevalence increase. Further, several studies found that shorter distance (<30 cm) and longer time spent (>30 min) for near work increase the risk of myopia. Meanwhile, increased outdoor activity (>40 min/day) has been shown to be a key factor in reducing myopia incidence. In conclusion, the interventional strategy suggested so far to reduce myopia incidence is an increase in time outdoors and a reduction in the time spent performing near-work tasks.
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Affiliation(s)
| | - Inmaculada Bueno-Gimeno
- Department of Optics and Optometry and Vision Sciences, University of Valencia, 46100 Burjassot, Spain;
| | - Andrés Gené-Sampedro
- Department of Optics and Optometry and Vision Sciences, University of Valencia, 46100 Burjassot, Spain;
- Research Institute on Traffic and Road Safety (INTRAS), University of Valencia, 46022 Valencia, Spain
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Hönekopp A, Weigelt S. Using Light Meters to Investigate the Light-Myopia Association - A Literature Review of Devices and Research Methods. Clin Ophthalmol 2023; 17:2737-2760. [PMID: 37743889 PMCID: PMC10517690 DOI: 10.2147/opth.s420631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
With the increasing prevalence of myopia, evaluating its relationship with objective light exposure as a potential adjustable environmental factor in myopia development has been an emerging research field in recent years. From a thorough literature search, we identify ten wearable light meters from human studies on light exposure and myopia and present an overview of their parameters, thereby demonstrating the wide between-device variability and discussing its implications. We further identify 20 publications, including two reanalyses, reporting investigations of light-myopia associations with data from human subjects wearing light meters. We thoroughly review the publications with respect to general characteristics, aspects of data collection, participant population, as well as data analysis and interpretation, and also assess potential patterns regarding the absence or presence of light-myopia associations in their results. In doing so, we highlight areas in which more research is needed as well as several aspects that warrant consideration in the study of light exposure and myopia.
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Affiliation(s)
- Astrid Hönekopp
- Department of Rehabilitation Sciences, Research Unit Vision, Visual Impairments & Blindness, TU Dortmund University, Dortmund, Germany
| | - Sarah Weigelt
- Department of Rehabilitation Sciences, Research Unit Vision, Visual Impairments & Blindness, TU Dortmund University, Dortmund, Germany
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Tariq F, Mobeen R, Wang X, Lin X, Bao Q, Liu J, Gao H. Advances in myopia prevention strategies for school-aged children: a comprehensive review. Front Public Health 2023; 11:1226438. [PMID: 37655278 PMCID: PMC10466414 DOI: 10.3389/fpubh.2023.1226438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023] Open
Abstract
Myopia has significantly risen in East and Southeast Asia, and the pathological outcomes of this condition, such as myopic maculopathy and optic neuropathy linked to high myopia, have emerged as leading causes of irreversible vision loss. Addressing this issue requires strategies to reduce myopia prevalence and prevent progression to high myopia. Encouraging outdoor activities for schoolchildren and reducing near-work and screen time can effectively prevent myopia development, offering a safe intervention that promotes healthier habits. Several clinical approaches can be employed to decelerate myopia progression, such as administering low-dose atropine eye drops (0.05%), utilizing orthokeratology lenses, implementing soft contact lenses equipped with myopia control features, and incorporating spectacle lenses with aspherical lenslets. When choosing an appropriate strategy, factors such as age, ethnicity, and the rate of myopia progression should be considered. However, some treatments may encounter obstacles such as adverse side effects, high costs, complex procedures, or limited effectiveness. Presently, low-dose atropine (0.05%), soft contact lenses with myopia control features, and orthokeratology lenses appear as promising options for managing myopia. The measures mentioned above are not necessarily mutually exclusive, and researchers are increasingly exploring their combined effects. By advocating for a personalized approach based on individual risk factors and the unique needs of each child, this review aims to contribute to the development of targeted and effective myopia prevention strategies, thereby minimizing the impact of myopia and its related complications among school-aged children in affected regions.
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Affiliation(s)
- Farheen Tariq
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Rabia Mobeen
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia
| | - Xinhai Wang
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Xiao Lin
- Shandong University of Traditional Chinese Medicine, Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Qingdong Bao
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Jinhui Liu
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Hua Gao
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
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Repka MX, Weise KK, Chandler DL, Wu R, Melia BM, Manny RE, Kehler LAF, Jordan CO, Raghuram A, Summers AI, Lee KA, Petersen DB, Erzurum SA, Pang Y, Lenhart PD, Ticho BH, Beck RW, Kraker RT, Holmes JM, Cotter SA. Low-Dose 0.01% Atropine Eye Drops vs Placebo for Myopia Control: A Randomized Clinical Trial. JAMA Ophthalmol 2023; 141:756-765. [PMID: 37440213 PMCID: PMC10346510 DOI: 10.1001/jamaophthalmol.2023.2855] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/05/2023] [Indexed: 07/14/2023]
Abstract
Importance Controlling myopia progression is of interest worldwide. Low-dose atropine eye drops have slowed progression in children in East Asia. Objective To compare atropine, 0.01%, eye drops with placebo for slowing myopia progression in US children. Design, Setting, and Participants This was a randomized placebo-controlled, double-masked, clinical trial conducted from June 2018 to September 2022. Children aged 5 to 12 years were recruited from 12 community- and institution-based practices in the US. Participating children had low to moderate bilateral myopia (-1.00 diopters [D] to -6.00 D spherical equivalent refractive error [SER]). Intervention Eligible children were randomly assigned 2:1 to 1 eye drop of atropine, 0.01%, nightly or 1 drop of placebo. Treatment was for 24 months followed by 6 months of observation. Main Outcome and Measures Automated cycloplegic refraction was performed by masked examiners. The primary outcome was change in SER (mean of both eyes) from baseline to 24 months (receiving treatment); other outcomes included change in SER from baseline to 30 months (not receiving treatment) and change in axial length at both time points. Differences were calculated as atropine minus placebo. Results A total of 187 children (mean [SD] age, 10.1 [1.8] years; age range, 5.1-12.9 years; 101 female [54%]; 34 Black [18%], 20 East Asian [11%], 30 Hispanic or Latino [16%], 11 multiracial [6%], 6 West/South Asian [3%], 86 White [46%]) were included in the study. A total of 125 children (67%) received atropine, 0.01%, and 62 children (33%) received placebo. Follow-up was completed at 24 months by 119 of 125 children (95%) in the atropine group and 58 of 62 children (94%) in the placebo group. At 30 months, follow-up was completed by 118 of 125 children (94%) in the atropine group and 57 of 62 children (92%) in the placebo group. At the 24-month primary outcome visit, the adjusted mean (95% CI) change in SER from baseline was -0.82 (-0.96 to -0.68) D and -0.80 (-0.98 to -0.62) D in the atropine and placebo groups, respectively (adjusted difference = -0.02 D; 95% CI, -0.19 to +0.15 D; P = .83). At 30 months (6 months not receiving treatment), the adjusted difference in mean SER change from baseline was -0.04 D (95% CI, -0.25 to +0.17 D). Adjusted mean (95% CI) changes in axial length from baseline to 24 months were 0.44 (0.39-0.50) mm and 0.45 (0.37-0.52) mm in the atropine and placebo groups, respectively (adjusted difference = -0.002 mm; 95% CI, -0.106 to 0.102 mm). Adjusted difference in mean axial elongation from baseline to 30 months was +0.009 mm (95% CI, -0.115 to 0.134 mm). Conclusions and Relevance In this randomized clinical trial of school-aged children in the US with low to moderate myopia, atropine, 0.01%, eye drops administered nightly when compared with placebo did not slow myopia progression or axial elongation. These results do not support use of atropine, 0.01%, eye drops to slow myopia progression or axial elongation in US children. Trial Registration ClinicalTrials.gov Identifier: NCT03334253.
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Affiliation(s)
| | | | | | - Rui Wu
- Jaeb Center for Health Research, Tampa, Florida
| | | | - Ruth E. Manny
- University of Houston College of Optometry, Houston, Texas
| | | | | | - Aparna Raghuram
- Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Yi Pang
- Illinois College of Optometry, Chicago
| | | | | | - Roy W. Beck
- Jaeb Center for Health Research, Tampa, Florida
- Deputy Editor, JAMA Ophthalmology
| | | | | | - Susan A. Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton
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Zhu MH, Lin TN, Lin JH, Wen Q. Myopia among children and adolescents: an epidemiological study in Fuzhou City. Front Pediatr 2023; 11:1161329. [PMID: 37384308 PMCID: PMC10293673 DOI: 10.3389/fped.2023.1161329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/30/2023] [Indexed: 06/30/2023] Open
Abstract
Objective To provide a reference for the prevention and control of myopia by analyzing and discussing the findings of an epidemiological survey of the prevalence of myopia among children and adolescents in Fuzhou City from 2019 to 2021. Methods Participants for this cross-sectional study were drawn from Gulou District and Minqing County in Fuzhou City using cluster random sampling to account for differences in population density, economic development, and other environmental variables. Results Myopia was more prevalent in 2020 than in 2019, but by 2021 it had dropped to about the same level as in 2019. Myopia was more prevalent among girls than boys during the course of the study period, with a three-year prevalence of 44.72% for boys and 52.16% for girls. Mild myopia accounted for 24.14% of all cases, followed by moderate myopia at 19.62%, and severe myopia at 4.58%. Students in urban regions had a prevalence of myopia equivalent to that of students in the suburbs, and this prevalence rose with age. Conclusion Myopia was quite prevalent among children and adolescents in Fuzhou City, and was shown to be steadily rising as students progressed through the school system. This suggests that all levels of government, educational institutions, medical facilities, and concerned parents in Fujian Province should focus on the issue of myopia and collaborate to reduce the risk factors for the development of myopia in school-aged participants.
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Affiliation(s)
- Mei-hong Zhu
- Department of Ophthalmology, Huaqiao University Hospital, Fujian, China
| | - Tai-nan Lin
- Department of Ophthalmology, Fujian Provincial Governmental Hospital, Fujian, China
| | - Jing-hua Lin
- Department of Ophthalmology, Fujian Provincial Governmental Hospital, Fujian, China
| | - Qian Wen
- Department of Ophthalmology, Fujian Provincial Governmental Hospital, Fujian, China
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50
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Wu H, Peng T, Zhou W, Huang Z, Li H, Wang T, Zhang J, Zhang K, Li H, Zhao Y, Qu J, Lu F, Zhou X, Jiang J. Choroidal vasculature act as predictive biomarkers of long-term ocular elongation in myopic children treated with orthokeratology: a prospective cohort study. EYE AND VISION (LONDON, ENGLAND) 2023; 10:27. [PMID: 37280689 DOI: 10.1186/s40662-023-00345-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/03/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Despite receiving orthokeratology (ortho-k), the efficacy of retarding ocular elongation during myopia varies among myopic children. The current study aimed to investigate the early changes of choroidal vasculature at one month after ortho-k treatment and its association with one-year ocular elongation, as well as the role of such choroidal responses in predicting the one-year control efficacy of ortho-k treatment. METHODS A prospective cohort study was conducted in myopic children treated with ortho-k. Myopic children aged between 8 and 12 years who were willing to wear ortho-k lenses were recruited consecutively from the Eye Hospital of Wenzhou Medical University. Subfoveal choroidal thickness (SFCT), submacular total choroidal luminal area (LA), stromal area (SA), choroidal vascularity index (CVI), choriocapillaris flow deficit (CcFD) were evaluated by optical coherence tomography (OCT) and OCT angiography over a one-year period. RESULTS Fifty eyes from 50 participants (24 males) who finished one-year follow-ups as scheduled were included, with a mean age of 10.31 ± 1.45 years. The one-year ocular elongation was 0.19 ± 0.17 mm. The LA (0.03 ± 0.07 mm2), SA (0.02 ± 0.05 mm2) increased proportionally after one-month of ortho-k wear (both P < 0.01), as did the SFCT (10.62 ± 19.98 μm, P < 0.001). Multivariable linear regression analyses showed that baseline CVI (β = - 0.023 mm/1%, 95% CI: - 0.036 to - 0.010), one-month LA change (β = - 0.009 mm/0.01 mm2, 95% CI: - 0.014 to - 0.003), one-month SFCT change (β = - 0.035 mm/10 µm, 95% CI: - 0.053 to - 0.017) were independently associated with one-year ocular elongation during ortho-k treatment after adjusting with age and sex (all P < 0.01). The area under the receiver operating characteristic curve of prediction model including baseline CVI, one-month SFCT change, age, and sex achieved 0.872 (95% CI: 0.771 to 0.973) for discriminating children with slow or fast ocular elongation. CONCLUSIONS Choroidal vasculature is associated with ocular elongation during ortho-k treatment. Ortho-k treatment induces increases in choroidal vascularity and choroidal thickness as early as one month. Such early changes can act as predictive biomarkers of myopia control efficacy over a long term. The utilization of these biomarkers may help clinicians identify children who can benefit from ortho-k treatment, and thus has critical implications for the management strategies towards myopia control.
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Affiliation(s)
- Hao Wu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Tianli Peng
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Weihe Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Zihan Huang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Hongyu Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Tengfei Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Jingwei Zhang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Kou Zhang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Haoer Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Yunpeng Zhao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Jia Qu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences (2019RU025), Wenzhou, Zhejiang, China
| | - Fan Lu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences (2019RU025), Wenzhou, Zhejiang, China
| | - Xiangtian Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences (2019RU025), Wenzhou, Zhejiang, China.
| | - Jun Jiang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
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