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He T, Yin L, Zheng Q, He B, Xu Z, Hu T, Wu Y, Chen H, Yu J, Shen T. Survey on pattern of myopia in school children in Hangzhou after the COVID-19 pandemic: a school-based vision screening study. BMC Public Health 2024; 24:1850. [PMID: 38992612 DOI: 10.1186/s12889-024-19338-4] [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: 06/26/2023] [Accepted: 07/02/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Myopia is a major health issue around the world. Myopia in children has increased significantly during the COVID-19 pandemic in China, but reports are scarce on the prevalence of myopia following the pandemic. This study collected vision screening data of school children in China for five consecutive years to observe the changes in myopia after the pandemic and compare the observed prevalence of myopia before and after the pandemic. METHODS A school-based vision screening study used stratified samplings to collect the vision screening data in school children aged 6-13 from 45 primary schools in Hangzhou. Vision screening data including uncorrected visual acuity(UCVA) and spherical equivalent refraction(SER). Calculating the mean of SER and the prevalence of myopia and hyperopia from 2019 to 2023. RESULTS A total of 79,068 screening results (158,136 eyes) were included in the analysis. A substantial myopic shift (approximately -0.30 diopters [D] on average) was found in 2020 and 2021 compared with 2019 in all age groups and a substantial myopic shift (approximately 0.4 D on average) was found in 2022 compared with 2021. A slight myopic shift (approximately -0.14 D on average) was found in 2023 compared with 2022. The prevalence of myopia in all age groups was the highest for five years in 2020 or 2021, which was 31.3% for 6-year-olds, 43.0% for 7-year-olds, and 53.7% for 8-year-olds. A positive change in the prevalence rate of myopia was found at 6 years old (0.59%, 0.12%, 0.36%, 0.25%, p < 0.001). The change in prevalence rate in myopia was shifted slightly in children aged 10-13 years. Children aged 8 to 13 years had a slight increase in myopia prevalence from 2022 to 2023. The prevalence of hyperopia was low and stable in all grade groups, ranging from 0.7% to 2.2% over five years. CONCLUSION Myopia in children has increased rapidly during the COVID-19 pandemic. After the pandemic, the prevalence of myopia in children gradually decreased temporarily and then rebounded. Myopic shift was more apparent in younger children. Myopic shift in children may be related to the reduction of outdoor time, less light, and near work habits, and further research is needed.
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Affiliation(s)
- Ting He
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, CN, China
| | - Lei Yin
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, CN, China
| | - Qingqing Zheng
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, CN, China
| | - Bei He
- Hangzhou Xiaoshan Liuliqiao Hospital, Hangzhou, Zhejiang, CN, China
| | - Zhizi Xu
- Hangzhou Xiaoshan Liuliqiao Hospital, Hangzhou, Zhejiang, CN, China
| | - Tingting Hu
- Hangzhou Xiaoshan Liuliqiao Hospital, Hangzhou, Zhejiang, CN, China
| | - Yuanpeng Wu
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, CN, China
| | - Hu Chen
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, CN, China
| | - Jie Yu
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, CN, China
| | - Ting Shen
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, CN, China.
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Zeng D, Yang Y, Tang Y, Zhao L, Wang X, Yun D, Chen W, Shang Y, Xu A, Liao H, Zhang X, Lin D, Lin H. Shaping school for childhood myopia: the association between floor area ratio of school environment and myopia in China. Br J Ophthalmol 2024:bjo-2024-325448. [PMID: 38955480 DOI: 10.1136/bjo-2024-325448] [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: 02/29/2024] [Accepted: 05/27/2024] [Indexed: 07/04/2024]
Abstract
AIM To investigate the association of floor area ratio (FAR), an indicator of built environments, and myopia onset. METHODS This prospective cohort study recruited 136 753 children aged 6-10 years from 108 schools in Shenzhen, China at baseline (2016-2017). Refractive power was measured with non-cycloplegic autorefraction over a 2-year follow-up period. FAR was objectively evaluated using geographical information system technology. Mixed-effects logistic regression models were constructed to examine the association of FAR with a 2-year cumulative incidence of myopia among individuals without baseline myopia; multiple linear regression model, with a 2-year cumulative incidence rate of myopia at each school. RESULTS Of 101 624 non-myopic children (56.3% boys; mean (SE) age, 7.657±1.182 years) included in the study, 26 391 (26.0%) of them developed myopia after 2 years. In the individual-level analysis adjusting for demographic, socioeconomic and greenness factors, an IQR in FAR was associated with a decreased risk of 2-year myopia incidence (OR 0.898, 95% CI 0.866 to 0.932, p<0.001). Similar findings were observed in the analysis additionally adjusted for genetic and behavioural factors (OR 0.821, 95% CI 0.766 to 0.880, p<0.001). In the school-level, an IQR increase in FAR was found to be associated with a 2.0% reduction in the 2-year incidence rate of myopia (95% CI 1.3% to 2.6%, p<0.001). CONCLUSIONS Exposure to higher FAR was associated with a decreased myopia incidence, providing insights into myopia prevention through school built environments in China.
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Affiliation(s)
- Danqi Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yahan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yang Tang
- Department of Civil, Environmental and Geodetic Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Xun Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Dongyuan Yun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Wenben Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yuanjun Shang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Andi Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Huipeng Liao
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Xingying Zhang
- Key Laboratory of Radiometric Calibration and Validation for Environmental Satellites, Beijing, China
| | - Duoru Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, Hainan, China
- Center for Precision Medicine and Department of Genetics and Biomedical Informatics, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
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Xu S, Li L, Han W, Zhu Y, Hu Y, Li Z, Ruan Z, Zhou Z, Zhuo Y, Fu M, Yang X. Association Between Myopia and Pupil Diameter in Preschoolers: Evidence from a Machine Learning Approach Based on a Real-World Large-Scale Dataset. Ophthalmol Ther 2024; 13:2009-2022. [PMID: 38822998 PMCID: PMC11178758 DOI: 10.1007/s40123-024-00972-5] [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: 04/16/2024] [Accepted: 05/14/2024] [Indexed: 06/03/2024] Open
Abstract
INTRODUCTION Previous studies have explored the connections between various ocular biological parameters with myopia. Our previous study also found that pupil data can predict the myopic progression during the interventions for myopia. However, studies exploring the association between pupil diameter and myopia in preschoolers with myopia were lacking. Hence this study was aimed to investigate the association between pupil diameter and myopia in preschoolers with myopia based on a real-world, large-scale dataset. METHODS Data containing 650,671 preschoolers were collected from a total of 1943 kindergartens in Shenzhen, China. Refraction and pupil parameters were collected. After data filtering, the occurrence of myopia and its association with age, gender, pupil diameter, and other variables, were analyzed. Random forest (RF) and eXtreme gradient boosting (XGBoost) were selected from seven machine learning algorithms to build the model. The mean decrease accuracy (MDA), mean decrease Gini (MDG), and gain feature importance (GFI) techniques were employed to quantify the importance of pupil diameter and other features. RESULTS After the assessments, 51,325 valid records with complete pupil data were included, and 3468 (6.76%) were identified as myopia based on the calculated cycloplegic refraction. Preschoolers with myopia presented reduced pupil diameter and greater variation (5.00 ± 0.99 mm) compared to non-myopic preschoolers (6.22 ± 0.67 mm). A nonlinear relationship was found according to the scatterplots between pupil diameter and refraction (R2 = 0.14). Especially preschoolers with myopia had reduced pupil diameter compared to emmetropic preschoolers, but hyperope did not experience additional pupil enlargement. After adjusting for other covariates, this relationship is still consistent (P < 0.001). XGBoost and RF algorithms presented the highest performance and validated the importance of pupil diameter in myopia. CONCLUSIONS Based on a real-world large-scale dataset, the current study illuminated that preschoolers with myopia had a reduced pupil diameter compared to emmetropic preschoolers with a nonlinear pattern. Machine learning algorithms visualized and validated the pivotal role of pupil diameter in myopia. TRIAL REGISTRATION chictr.org Identifier: ChiCTR2200057391.
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Affiliation(s)
- Shengsong Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 Xianlie South Road, Yuexiu District, Guangzhou, China
| | - Linling Li
- Department of Ophthalmology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, 3012 Fuqiang Road, Futian District, Shenzhen, China
| | - Wenjing Han
- Department of Medical Imaging Technology, Yanjing Medical College, Capital Medical University, Beijing, China
| | - Yingting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 Xianlie South Road, Yuexiu District, Guangzhou, China
| | - Yin Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 Xianlie South Road, Yuexiu District, Guangzhou, China
| | - Zhidong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 Xianlie South Road, Yuexiu District, Guangzhou, China
| | - Zhenbang Ruan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 Xianlie South Road, Yuexiu District, Guangzhou, China
| | - Zhuandi Zhou
- Department of Ophthalmology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, 3012 Fuqiang Road, Futian District, Shenzhen, China
| | - Yehong Zhuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 Xianlie South Road, Yuexiu District, Guangzhou, China
| | - Min Fu
- Department of Ophthalmology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, 3012 Fuqiang Road, Futian District, Shenzhen, China.
| | - Xiao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 Xianlie South Road, Yuexiu District, Guangzhou, China.
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Xu X, Liu N, Yu W. No Evidence of an Association between Genetic Factors Affecting Response to Vitamin A Supplementation and Myopia: A Mendelian Randomization Study and Meta-Analysis. Nutrients 2024; 16:1933. [PMID: 38931287 PMCID: PMC11206965 DOI: 10.3390/nu16121933] [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: 04/10/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
The relationship between vitamin A supplementation and myopia has been a topic of debate, with conflicting and inconclusive findings. We aimed to determine whether there is a causal relationship between vitamin A supplementation and the risk of myopia using Mendelian randomization (MR) and meta-analytical methods. Genetic variants from the UK Biobank and FinnGen studies associated with the response to vitamin A supplementation were employed as instrumental variables to evaluate the causal relationship between vitamin A supplementation and myopia. Fixed-effects meta-analysis was then used to combine MR estimates from multiple sources for each outcome. The meta-analysis of MR results found no convincing evidence to support a direct causal relationship between vitamin A supplementation and myopia risk (odds ratio (OR) = 0.99, 95% confidence interval (CI) = 0.82-1.20, I2 = 0%, p = 0.40). The analysis of three out of the four sets of MR analyses indicated no direction of causal effect, whereas the other set of results suggested that higher vitamin A supplementation was associated with a lower risk of myopia (OR = 0.002, 95% CI 1.17 × 10-6-3.099, p = 0.096). This comprehensive MR study and meta-analysis did not find valid evidence of a direct association between vitamin A supplementation and myopia. Vitamin A supplementation may not have an independent effect on myopia, but intraocular processes associated with vitamin A may indirectly contribute to its development.
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Affiliation(s)
- Xiaotong Xu
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China;
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
- Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences, Wenzhou 325027, China
| | - Nianen Liu
- Fifth School of Clinical Medicine, Peking University, Beijing 100730, China;
- Department of Ophthalmology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Weihong Yu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
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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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Madronich S, Bernhard GH, Neale PJ, Heikkilä A, Andersen MPS, Andrady AL, Aucamp PJ, Bais AF, Banaszak AT, Barnes PJ, Bornman JF, Bruckman LS, Busquets R, Chiodo G, Häder DP, Hanson ML, Hylander S, Jansen MAK, Lingham G, Lucas RM, Calderon RM, Olsen C, Ossola R, Pandey KK, Petropavlovskikh I, Revell LE, Rhodes LE, Robinson SA, Robson TM, Rose KC, Schikowski T, Solomon KR, Sulzberger B, Wallington TJ, Wang QW, Wängberg SÅ, White CC, Wilson SR, Zhu L, Neale RE. Continuing benefits of the Montreal Protocol and protection of the stratospheric ozone layer for human health and the environment. Photochem Photobiol Sci 2024; 23:1087-1115. [PMID: 38763938 DOI: 10.1007/s43630-024-00577-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/09/2024] [Indexed: 05/21/2024]
Abstract
The protection of Earth's stratospheric ozone (O3) is an ongoing process under the auspices of the universally ratified Montreal Protocol and its Amendments and adjustments. A critical part of this process is the assessment of the environmental issues related to changes in O3. The United Nations Environment Programme's Environmental Effects Assessment Panel provides annual scientific evaluations of some of the key issues arising in the recent collective knowledge base. This current update includes a comprehensive assessment of the incidence rates of skin cancer, cataract and other skin and eye diseases observed worldwide; the effects of UV radiation on tropospheric oxidants, and air and water quality; trends in breakdown products of fluorinated chemicals and recent information of their toxicity; and recent technological innovations of building materials for greater resistance to UV radiation. These issues span a wide range of topics, including both harmful and beneficial effects of exposure to UV radiation, and complex interactions with climate change. While the Montreal Protocol has succeeded in preventing large reductions in stratospheric O3, future changes may occur due to a number of natural and anthropogenic factors. Thus, frequent assessments of potential environmental impacts are essential to ensure that policies remain based on the best available scientific knowledge.
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Affiliation(s)
- S Madronich
- National Center for Atmospheric Research, Boulder, CO, USA.
- Natural Resource Ecology Laboratory, USDA UV-B Monitoring and Research Program, Colorado State University, Fort Collins, CO, USA.
| | - G H Bernhard
- Biospherical Instruments Inc, San Diego, CA, USA
| | - P J Neale
- Smithsonian Environmental Research Center, Edgewater, MD, USA
| | - A Heikkilä
- Finnish Meteorological Institute, Helsinki, Finland
| | - M P Sulbæk Andersen
- Department of Chemistry and Biochemistry, California State University Northridge, Northridge, CA, USA
- Department of Chemistry, University of Copenhagen, Copenhagen, Denmark
| | - A L Andrady
- Department of Chemical and Biomolecular Engineering, North Carolina State University , Raleigh, NC, USA
| | - P J Aucamp
- Ptersa Environmental Consultants, Faerie Glen, South Africa
| | - A F Bais
- Laboratory of Atmospheric Physics, Department of Physics, Aristotle University, Thessaloniki, Greece
| | - A T Banaszak
- Unidad Académica de Sistemas Arrecifales, Instituto de Ciencias del Mar y Limnología, Universidad Nacional Autónoma de México, Puerto Morelos, Mexico
| | - P J Barnes
- Department of Biological Sciences and Environment Program, Loyola University New Orleans, New Orleans, LA, USA
| | - J F Bornman
- Food Futures Institute, Murdoch University, Perth, Australia
| | - L S Bruckman
- Department of Materials Science and Engineering, Reserve University, Cleveland, OH, USA
| | - R Busquets
- Chemical and Pharmaceutical Sciences, Kingston University London, Kingston Upon Thames, UK
| | - G Chiodo
- Institute for Atmospheric and Climate Science, ETH Zürich, Zurich, Switzerland
| | - D-P Häder
- Friedrich-Alexander University, Möhrendorf, Germany
| | - M L Hanson
- Department of Environment and Geography, University of Manitoba, Winnipeg, MB, Canada
| | - S Hylander
- Centre for Ecology and Evolution in Microbial Model Systems, Linnaeus University, Kalmar, Sweden
| | - M A K Jansen
- School of Biological, Earth and Environmental Sciences, University College, Cork, Ireland
| | - G Lingham
- Centre For Ophthalmology and Visual Science (Incorporating Lion's Eye Institute), University of Western Australia, Perth, Australia
- Centre for Eye Research Ireland, Environmental, Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - R M Lucas
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - R Mackenzie Calderon
- Cape Horn International Center, Puerto Williams, Chile
- Millennium Institute Biodiversity of Antarctic and Subantarctic Ecosystems BASE, Santiago, Chile
- Centro Universitario Cabo de Hornos, Universidad de Magallanes, O'Higgins 310, Puerto Williams, Chile
| | - C Olsen
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - R Ossola
- Department of Chemistry, Colorado State University, Fort Collins, CO, USA
| | - K K Pandey
- Indian Academy of Wood Science, Bengaluru, India
| | - I Petropavlovskikh
- Cooperative Institute for Research in Environmental Sciences, University of Colorado , Boulder, CO, USA
- NOAA Global Monitoring Laboratory, Boulder, CO, USA
| | - L E Revell
- School of Physical and Chemical Sciences, University of Canterbury, Christchurch, New Zealand
| | - L E Rhodes
- Faculty of Biology Medicine and Health, School of Biological Sciences, The University of Manchester, Manchester, UK
- Dermatology Centre, Salford Royal Hospital, Greater Manchester, UK
| | - S A Robinson
- Securing Antarctica's Environmental Future, University of Wollongong, Wollongong, Australia
- School of Earth, Atmospheric and Life Sciences, University of Wollongong, Wollongong, Australia
| | - T M Robson
- UK National School of Forestry, University of Cumbria, Ambleside Campus, UK
- Viikki Plant Science Centre, Faculty of Biological and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - K C Rose
- Department of Biological Sciences, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - T Schikowski
- IUF-Leibniz Research Institute for Environmental Medicine, Dusseldorf, Germany
| | - K R Solomon
- School of Environmental Sciences, University of Guelph, Guelph, Canada
| | - B Sulzberger
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Duebendorf, Switzerland
| | - T J Wallington
- Center for Sustainable Systems, School for Environment and Sustainability, University of Michigan, Ann Arbor, MI, USA
| | - Q-W Wang
- Institute of Applied Ecology, Chinese Academy of Sciences, Shenyang, China
| | - S-Å Wängberg
- Department of Marine Sciences, University of Gothenburg, Gothenburg, Sweden
| | | | - S R Wilson
- School of Earth, Atmospheric and Life Sciences, University of Wollongong, Wollongong, Australia
| | - L Zhu
- State Key Lab for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai, China
| | - R E Neale
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
- School of Public Health, University of Queensland, Brisbane, Australia.
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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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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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Sun W, Yu M, Wu J, Han X, Jan C, Song J, Jiang W, Xu Z, Wu Z, Xu J, Hu Y, Bi H. Pseudomyopia as an independent risk factor for myopia onset: a prospective cohort study among school-aged children. Br J Ophthalmol 2024; 108:873-878. [PMID: 37541767 PMCID: PMC11137461 DOI: 10.1136/bjo-2022-322330] [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: 08/03/2022] [Accepted: 07/09/2023] [Indexed: 08/06/2023]
Abstract
AIM To investigate whether pseudomyopia is an independent risk factor for myopia onset based on a population-based cohort study. METHODS Non-myopic children were recruited from schools in rural and urban settings of Shangdong province, China. Baseline examinations started in September 2020 and all participants were invited for a 6-month follow-up. Pseudomyopia was defined as spherical equivalent (SE) ≤-0.50 diopters (D) before cycloplegia and >-0.50D after cycloplegia. Myopia was defined as cycloplegic SE ≤-0.50D. RESULTS A total of 2328 children (baseline age: 4-17 years) were included in the final analysis. During the 6-month follow-up, 21.1% (355/1680) pseudomyopic eyes developed myopia, and 3.8% (110/2879) non-myopic and non-pseudomyopic eyes developed myopia. After adjusting for multiple myopia risk factors, including baseline cycloplegic SE, near work and outdoor time, pseudomyopia was found to be an independent risk factor for myopia onset (relative risk=2.52, 95% CI 1.86 to 3.42). Additionally, pseudomyopic children with more myopic cycloplegic SE (p<0.001), smaller difference between cycloplegic and non-cycloplegic SE (DIFF, p<0.001), and higher binocular amplitude of accommodation (p<0.001) had higher risk of myopia development. CONCLUSION This is an important longitudinal study to prove that pseudomyopia is an independent risk factor for myopia development among school-aged children.
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Affiliation(s)
- Wei Sun
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Affiliated Eye Hospital, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Mingkun Yu
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jianfeng Wu
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Shandong Institute of Children Health and Myopia Prevention and Control, Jinan, Shandong, China
| | - Xiaotong Han
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Catherine Jan
- Department of Ophthalmology and Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
| | - Jike Song
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Shandong Institute of Eye Disease, Jinan, Shandong, China
| | - Wenjun Jiang
- Shandong Institute of Eye Disease, Jinan, Shandong, China
| | - Zihang Xu
- Ophthalmology and Optometry Medical School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Ziyun Wu
- Ophthalmology and Optometry Medical School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jing Xu
- Affiliated Eye Hospital, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yuanyuan Hu
- Affiliated Eye Hospital, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Shandong Institute of Children Health and Myopia Prevention and Control, Jinan, Shandong, China
| | - Hongsheng Bi
- Affiliated Eye Hospital, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Shandong Institute of Eye Disease, Jinan, Shandong, China
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Liang R, Shi W, Li T, Gao H, Wan T, Li B, Zhou X. Effect of exogenous calcitriol on myopia development and axial length in guinea pigs with form deprivation myopia. Sci Rep 2024; 14:11382. [PMID: 38762668 PMCID: PMC11102427 DOI: 10.1038/s41598-024-62131-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/14/2024] [Indexed: 05/20/2024] Open
Abstract
The annual increase in myopia prevalence poses a significant economic and health challenge. Our study investigated the effect of calcitriol role in myopia by inducing the condition in guinea pigs through form deprivation for four weeks. Untargeted metabolomics methods were used to analyze the differences in metabolites in the vitreous body, and the expression of vitamin D receptor (VDR) in the retina was detected. Following form deprivation, the guinea pigs received intraperitoneal injections of calcitriol at different concentrations. We assessed myopia progression using diopter measurements and biometric analysis after four weeks. Results indicated that form deprivation led to a pronounced shift towards myopia, characterized by reduced choroidal and scleral thickness, disorganized collagen fibers, and decreased scleral collagen fiber diameter. Notably, a reduction in calcitriol expression in vitreous body, diminished vitamin D and calcitriol levels in the blood, and decreased VDR protein expression in retinal tissues were observed in myopic guinea pigs. Calcitriol administration effectively slowed myopia progression, preserved choroidal and scleral thickness, and prevented the reduction of scleral collagen fiber diameter. Our findings highlight a significant decrease in calcitriol and VDR expressions in myopic guinea pigs and demonstrate that exogenous calcitriol supplementation can halt myopia development, enhancing choroidal and scleral thickness and scleral collagen fiber diameter.
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Affiliation(s)
- Rongbin Liang
- Department of Ophthalmology, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201500, China
| | - Wenqing Shi
- Department of Ophthalmology, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201500, China
| | - Tao Li
- Department of Ophthalmology, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201500, China
| | - Hui Gao
- Department of Anatomy & Embryology, Maastricht University, Maastricht, The Netherlands
| | - Ting Wan
- Department of Ophthalmology, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201500, China
| | - Bing Li
- Department of Central Laboratory, Jinshan Hospital, Fudan University, Shanghai, China
| | - Xiaodong Zhou
- Department of Ophthalmology, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201500, China.
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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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Chen D, Du Y, Liu Y, Hong J, Yin X, Zhu Z, Wang J, Zhang J, Chen J, Zhang B, Du L, Yang J, He X, Xu X. Development and validation of a smartwatch algorithm for differentiating physical activity intensity in health monitoring. Sci Rep 2024; 14:9530. [PMID: 38664457 PMCID: PMC11045869 DOI: 10.1038/s41598-024-59602-6] [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: 06/07/2023] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
To develop and validate a machine learning based algorithm to estimate physical activity (PA) intensity using the smartwatch with the capacity to record PA and determine outdoor state. Two groups of participants, including 24 adults (13 males) and 18 children (9 boys), completed a sequential activity trial. During each trial, participants wore a smartwatch, and energy expenditure was measured using indirect calorimetry as gold standard. The support vector machine algorithm and the least squares regression model were applied for the metabolic equivalent (MET) estimation using raw data derived from the smartwatch. Exercise intensity was categorized based on MET values into sedentary activity (SED), light activity (LPA), moderate activity (MPA), and vigorous activity (VPA). The classification accuracy was evaluated using area under the ROC curve (AUC). The METs estimation accuracy were assessed via the mean absolute error (MAE), the correlation coefficient, Bland-Altman plots, and intraclass correlation (ICC). A total of 24 adults aged 21-34 years and 18 children aged 9-13 years participated in the study, yielding 1790 and 1246 data points for adults and children respectively for model building and validation. For adults, the AUC for classifying SED, MVPA, and VPA were 0.96, 0.88, and 0.86, respectively. The MAE between true METs and estimated METs was 0.75 METs. The correlation coefficient and ICC were 0.87 (p < 0.001) and 0.89, respectively. For children, comparable levels of accuracy were demonstrated, with the AUC for SED, MVPA, and VPA being 0.98, 0.89, and 0.85, respectively. The MAE between true METs and estimated METs was 0.80 METs. The correlation coefficient and ICC were 0.79 (p < 0.001) and 0.84, respectively. The developed model successfully estimated PA intensity with high accuracy in both adults and children. The application of this model enables independent investigation of PA intensity, facilitating research in health monitoring and potentially in areas such as myopia prevention and control.
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Affiliation(s)
- Daixi Chen
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 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, 200080, China
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, School of Medicine, Tongji University, National Clinical Research Center for Eye Diseases, Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200030, China
| | - Yuchen Du
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, School of Medicine, Tongji University, National Clinical Research Center for Eye Diseases, Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200030, China
| | - Yuan Liu
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of the Ministry of Education, East China Normal University, Shanghai, 200241, China
| | - Jun Hong
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of the Ministry of Education, East China Normal University, Shanghai, 200241, China
| | - Xiaojian Yin
- College of Economics and Management, Shanghai Institute of Technology, Shanghai, 201418, China
| | - Zhuoting Zhu
- Centre for Eye Research Australia, Ophthalmology, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Jingjing Wang
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, School of Medicine, Tongji University, National Clinical Research Center for Eye Diseases, Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200030, China
| | - Junyao Zhang
- Centre for Eye Research Australia, Ophthalmology, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Jun Chen
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, School of Medicine, Tongji University, National Clinical Research Center for Eye Diseases, Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200030, China
| | - Bo Zhang
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, School of Medicine, Tongji University, National Clinical Research Center for Eye Diseases, Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200030, China
| | - Linlin Du
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, School of Medicine, Tongji University, National Clinical Research Center for Eye Diseases, Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200030, China
| | - Jinliuxing Yang
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, School of Medicine, Tongji University, National Clinical Research Center for Eye Diseases, Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200030, China
| | - Xiangui He
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 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, 200080, China.
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, School of Medicine, Tongji University, National Clinical Research Center for Eye Diseases, Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200030, China.
| | - Xun Xu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 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, 200080, China.
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, School of Medicine, Tongji University, National Clinical Research Center for Eye Diseases, Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200030, China.
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Naik A, Karthikeyan SK, Ramesh JJ, Bhaskar S, Ganapathi CA, Biswas S. An Insight into Knowledge, Perspective, and Practices of Indian Optometrists towards Childhood Myopia. Vision (Basel) 2024; 8:22. [PMID: 38651443 PMCID: PMC11036249 DOI: 10.3390/vision8020022] [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: 02/18/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
The current understanding of clinical approaches and barriers in managing childhood myopia among Indian optometrists is limited. This research underscores the necessity and relevance of evidence-based practice guidelines by exploring their knowledge, attitude, and practice towards childhood myopia. A self-administered internet-based 26-item survey was circulated online among practicing optometrists in India. The questions assessed the demographics, knowledge, self-reported clinical practice behavior, barriers, source of information guiding their management, and extent of adult caregiver engagement for childhood myopia. Of 393 responses, a significant proportion of respondents (32.6-92.4%) were unaware of the ocular complications associated with high myopia, with less than half (46.5%) routinely performing ocular biometry in clinical practice. Despite the growing awareness of emerging myopia management options, the uptake remains generally poor, with single-vision distance full-correction spectacles (70.3%) being the most common mode of vision correction. Barriers to adopting optimal myopia care are medicolegal concerns, absence of clinical practice guidelines, and inadequate consultation time. Own clinical experience and original research articles were the primary sources of information supporting clinical practice. Most (>70%) respondents considered involving the adult caregiver in their child's clinical decision-making process. While practitioners' awareness and activity of newer myopia management strategies are improving, there is plenty of scope for its enhancement. The importance of evidence-based practice guidelines and continuing education on myopia control might help practitioners enhance their clinical decision-making skills.
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Affiliation(s)
- Archana Naik
- Department of Optometry, Netra Jyothi Institute of Allied Health Sciences, Udupi 576101, Karnataka, India; (A.N.); (S.K.K.); (S.B.)
- Aloka Vision Programme, Carl Zeiss India Pvt. Ltd., Bangalore 560099, Karnataka, India
| | - Siddharth K. Karthikeyan
- Department of Optometry, Netra Jyothi Institute of Allied Health Sciences, Udupi 576101, Karnataka, India; (A.N.); (S.K.K.); (S.B.)
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India;
| | - Jivitha Jyothi Ramesh
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India;
| | - Shwetha Bhaskar
- Department of Optometry, Netra Jyothi Institute of Allied Health Sciences, Udupi 576101, Karnataka, India; (A.N.); (S.K.K.); (S.B.)
- Aloka Vision Programme, Carl Zeiss India Pvt. Ltd., Bangalore 560099, Karnataka, India
| | - Chinnappa A. Ganapathi
- Department of Paediatric Ophthalmology, Prasad Netralaya, Udupi 576101, Karnataka, India;
| | - Sayantan Biswas
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
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15
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Díaz-Gómez S, Burgos-Martínez M, Sankaridurg P, Urkia-Solorzano A, Carballo-Álvarez J. Two-Year Myopia Management Efficacy of Extended Depth of Focus Soft Contact Lenses (MYLO) in Caucasian Children. Am J Ophthalmol 2024; 260:122-131. [PMID: 38056608 DOI: 10.1016/j.ajo.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 11/25/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE To evaluate the progression of myopia as assessed by change in axial length (AL) and spherical equivalent (SE) from baseline in Caucasian children wearing extended depth of focus soft contact lenses (CLs) compared to distance single-vision spectacles. DESIGN Prospective non-randomized comparative clinical trial. METHODS A total of 90 children (6-13 years of age) with SE ranging from -0.75 to -10.00 diopters (D) were recruited. Of these children, 45 were fitted with CLs (MYLO, mark´ennovy), whereas 45 children wore spectacles. Cycloplegic refraction was measured with an auto-refractometer (Topcon-TRK-2P) and AL with an IOLMaster-700 (Zeiss) at 6-month intervals. Subjective responses after 1 month of CL wear related to vision and comfort were determined using a questionnaire with a scale from 1 (very poor) to 10 (excellent). High-contrast visual acuity (HCVA) and contrast sensitivity (CS) were evaluated at baseline, 12, and 24 months. RESULTS After 2 years, mean change in SE/AL in the CL group was -0.62 ± 0.30 D/0.37 ± 0.04 mm and -1.13 ± 0.20 D/0.66 ± 0.03 mm in the spectacles group (P < .001). Cumulative absolute reduction in axial elongation (CARE) was 0.29 ± 0.06 mm. Difference in SE change was -0.50 ± 0.34 D. Although 100% of CL group had an AL increase ≤0.50 mm, all participants increased ≥0.50 mm in the spectacles group. In all, 53% of the CL group and 1% in the spectacles group showed a progression in SE ≤ -0.50D. All questionnaire items showed a mean value ≥9. There was a reduction logMAR HCVA in the CL compared to the spectacles group but it was less than 1 line (P < .001). CONCLUSIONS Use of MYLO CLs reduced axial elongation and myopia progression compared to use of distance single-vision spectacles.
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Affiliation(s)
- Sergio Díaz-Gómez
- From the Faculty of Optics and Optometry (S.D.-G., J.C.-A.), Complutense University of Madrid, Madrid, Spain; Miranza Centro Oftalmológico Integral (COI) (S.D.-G., A.U.-S.), Bilbao, Spain
| | | | - Padmaja Sankaridurg
- School of Optometry and Vision Science (P.S.)(,) University of New South Wales(,) Sydney, Australia
| | | | - Jesús Carballo-Álvarez
- From the Faculty of Optics and Optometry (S.D.-G., J.C.-A.), Complutense University of Madrid, Madrid, Spain.
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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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Pan W, Lan W. The Current and Future Landscape of the Childhood Myopia Epidemic in China-A Review. Ophthalmol Ther 2024; 13:883-894. [PMID: 38300487 PMCID: PMC10912377 DOI: 10.1007/s40123-024-00887-1] [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: 10/15/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
Over the last two decades, the prevalence of myopia has gradually increased in China. Numerous epidemiological studies suggest that education and inadequate time spent outdoors are the major causes of the current myopia epidemic. China is one of the few countries that has begun to address the myopia epidemic with a national-level strategy, implementing nationwide education reform, cost-reduction measurements, and dissemination of information on myopia prevention and control. These "natural experiments" will provide insights into areas that may face similar or potential myopia problems.
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Affiliation(s)
- Wei Pan
- Aier School of Ophthalmology, Central South University, AIER Mansion, No. 188 South Furong Road, Changsha, 410000, Hunan Province, China
| | - Weizhong Lan
- Aier School of Ophthalmology, Central South University, AIER Mansion, No. 188 South Furong Road, Changsha, 410000, Hunan Province, China.
- Hunan Province Optometry Engineering and Technology Research Center, Changsha, China.
- Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, China.
- Aier School of Optometry and Vision Science, Hubei University of Science and Technology, Xianning, China.
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18
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Lee SH, Tseng BY, Wang JH, Chiu CJ. Efficacy and Safety of Low-Dose Atropine on Myopia Prevention in Premyopic Children: Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1506. [PMID: 38592670 PMCID: PMC10932201 DOI: 10.3390/jcm13051506] [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: 01/16/2024] [Revised: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Early-onset myopia increases the risk of irreversible high myopia. Methods: This study systematically evaluated the efficacy and safety of low-dose atropine for myopia control in children with premyopia through meta-analysis using random-effects models. Effect sizes were calculated using risk ratios (RRs) with 95% confidence intervals (CIs). Comprehensive searches of PubMed, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov were conducted until 20 December 2023, without language restrictions. Results: Four studies involving 644 children with premyopia aged 4-12 years were identified, with atropine concentrations ranging from 0.01% to 0.05%. The analysis focused on myopia incidence and atropine-related adverse events. Lower myopia incidence (RR, 0.62; 95% CI, 0.40-0.97 D/y; p = 0.03) and reduction in rapid myopia shift (≥0.5 D/1y) (RR, 0.50; 95% CI, 0.26-0.96 D/y; p < 0.01) were observed in the 12-24-month period. Spherical equivalent and axial length exhibited attenuated progression in the atropine group. No major adverse events were detected in either group, whereas the incidence of photophobia and allergic conjunctivitis did not vary in the 12-24-month period. Conclusions: Our meta-analysis supports atropine's efficacy and safety for delaying myopia incidence and controlling progression in children with premyopia. However, further investigation is warranted due to limited studies.
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Affiliation(s)
- Ssu-Hsien Lee
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (S.-H.L.); (B.-Y.T.)
| | - Bor-Yuan Tseng
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (S.-H.L.); (B.-Y.T.)
| | - Jen-Hung Wang
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien 970, Taiwan;
| | - Cheng-Jen Chiu
- Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien 970, Taiwan
- Department of Ophthalmology, Hualien Tzu Chi Hospital, the Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
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19
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Liu Z, Sun Z, Du B, Gou H, Wang B, Lin Z, Ren N, Pazo EE, Liu L, Wei R. The Effects of Repeated Low-Level Red-Light Therapy on the Structure and Vasculature of the Choroid and Retina in Children with Premyopia. Ophthalmol Ther 2024; 13:739-759. [PMID: 38198054 PMCID: PMC10853097 DOI: 10.1007/s40123-023-00875-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/13/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION The purpose of this study was to explore the effects of repeated low-level red-light (RLRL) therapy on the structure and vasculature of the choroid and retina in Chinese children with premyopia. METHODS This study was a single-center randomized clinical trial. A total of 94 children with premyopia (- 0.50 D < spherical equivalent [SE] ≤ + 0.75 D) were randomly assigned to either the RLRL therapy or control group. Follow-up visits were planned at 1, 3, 6, 9, and 12 months. Optical coherence biometry was used to measure axial length (AL) and anterior segment parameters. Choroidal thickness (CT), retinal thickness (RT), superficial retinal vascular density (SRVD), deep retinal vascular density (DRVD), choriocapillaris perfusion area (CCPA), and choroidal vessel volume (CVV) were measured by optical coherence tomography angiography, centered on the foveal, parafoveal (ParaF), and perifoveal (PeriF) regions. RESULTS The thickening of the choroid was observed across the entire macular region at different time points in the RLRL therapy group. Relative to the baseline measurement, foveal CT significantly increased at the 1-month follow-up with RLRL therapy, with a mean (± standard deviation [SD]) adjusted change of 16.96 ± 19.87 μm. The greatest magnitude of foveal CT changes was observed at the 3-month visit (an increase of 19.58 ± 20.59 μm), with a slight reduction in the extent of foveal CT increase at the 6-month visit (an increase of 15.85 ± 23.77 μm). The second greatest CT increase was observed at the 9-month visit (an increase of 19.57 ± 35.51 μm), after which the extent of CT increase gradually decreased until the end of the study at the 12-month visit (an increase of 11.99 ± 32.66 μm). We also observed a significant increase in CT in the ParaF and PeriF areas in the RLRL group over 12 months. In contrast, CT across the entire macular region in the control group significantly decreased throughout the follow-up visits (all P < 0.05). Regarding the vascular parameters of the choroid, significant increases in CVV were observed primarily in the ParaF and PeriF regions of the choroid in the RLRL group. In comparison, the control group exhibited decreases in CVV throughout the entire area. Furthermore, notable elevations in CCPA were detected in the PeriF area of the choroid in the RLRL group during the 1-month (an increase of 0.40 mm2), 3-month (an increase of 0.25 mm2), and 12-month visits (an increase of 0.42 mm2) (all P < 0.05). In addition, no notable differences were observed between the groups regarding foveal RT and retinal vascular parameters throughout the 12 months (P > 0.05). Notably, RLRL therapy achieved a notable reduction in SE shift by 73.8%, a substantial decrease in AL change by 67.9%, and a significant reduction in myopia incidence by 45.1% within 1 year. CONCLUSION Our study demonstrated a significant increase in CT and flow in the RLRL-treated eyes throughout the 12-months of the study. Combined with its reduction in spherical equivalent progression and axial elongation, RLRL could be used as an effective therapy for preventing progression in premyopes. TRIAL REGISTRATION ChiCTR2200062028.
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Affiliation(s)
- Zhuzhu Liu
- 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, Tianjin, China
| | - Ziwen Sun
- 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, Tianjin, China
| | - Bei Du
- 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, Tianjin, China
| | - Huaixue Gou
- 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, Tianjin, China
| | - Biying Wang
- 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, Tianjin, China
| | - Zeya Lin
- 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, Tianjin, China
| | - Nuo Ren
- 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, Tianjin, China
| | - Emmanuel Eric Pazo
- 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, Tianjin, China
| | - Lin Liu
- 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, Tianjin, China.
| | - Ruihua Wei
- 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, Tianjin, China.
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20
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Li L, Yu Y, Zhuang Z, Wu Q, Lin S, Hu J. Circadian rhythm, ipRGCs, and dopamine signalling in myopia. Graefes Arch Clin Exp Ophthalmol 2024; 262:983-990. [PMID: 37864638 DOI: 10.1007/s00417-023-06276-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/01/2023] [Accepted: 10/09/2023] [Indexed: 10/23/2023] Open
Abstract
Myopia, a common ophthalmic disorder, places a high economic burden on individuals and society. Genetic and environmental factors influence myopia progression; however, the underlying mechanisms remain unelucidated. This paper reviews recent advances in circadian rhythm, intrinsically photosensitive retinal ganglion cells (ipRGCs), and dopamine (DA) signalling in myopia and proposes the hypothesis of a circadian rhythm brain retinal circuit in myopia progression. The search of relevant English articles was conducted in the PubMed databases until June 2023. Based on the search, emerging evidence indicated that circadian rhythm was associated with myopia, including circadian genes Bmal1, Cycle, and Per. In both humans and animals, the ocular morphology and physiology show rhythmic oscillations. Theoretically, such ocular rhythms are regulated locally and indirectly via the suprachiasmatic nucleus, which receives signal from the ipRGCs. Compared with the conventional retinal ganglion cells, ipRGCs can sense the presence of light because of specific expression of melanopsin. Light, together with ipRGCs and DA signalling, plays a crucial role in both circadian rhythm and myopia. In summary, regarding myopia progression, a circadian rhythm brain retinal circuit involving ipRGCs and DA signalling has not been well established. However, based on the relationship between circadian rhythm, ipRGCs, and DA signalling in myopia, we hypothesised a circadian rhythm brain retinal circuit.
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Affiliation(s)
- Licheng Li
- Department of Ophthalmology, The Second Affiliated Hospital of Fujian Medical University, Engineering Research Centre of Assistive Technology for Visual Impairment, Fujian Province University, Quanzhou, Fujian Province, China
| | - Yang Yu
- Department of Ophthalmology, The Second Affiliated Hospital of Fujian Medical University, Engineering Research Centre of Assistive Technology for Visual Impairment, Fujian Province University, Quanzhou, Fujian Province, China
| | - Zihao Zhuang
- Department of Ophthalmology, The Second Affiliated Hospital of Fujian Medical University, Engineering Research Centre of Assistive Technology for Visual Impairment, Fujian Province University, Quanzhou, Fujian Province, China
| | - Qi Wu
- Group of Neuroendocrinology, Garvan Institute of Medical Research, 384 Victoria St., Sydney, Australia
| | - Shu Lin
- Group of Neuroendocrinology, Garvan Institute of Medical Research, 384 Victoria St., Sydney, Australia.
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China.
| | - Jianmin Hu
- Department of Ophthalmology, The Second Affiliated Hospital of Fujian Medical University, Engineering Research Centre of Assistive Technology for Visual Impairment, Fujian Province University, Quanzhou, Fujian Province, China.
- The School of Medical Technology and Engineering, Fujian Medical University, Fuzhou, Fujian Province, China.
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21
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Yang Y, Liao H, Zhao L, Wang X, Yang X, Ding X, Li X, Jiang Z, Zhang X, Zhang Q, He H, Guo L, Lin H, Dong G, Spencer B, He M, Congdon N, Morgan IG, Lin H. Green Space Morphology and School Myopia in China. JAMA Ophthalmol 2024; 142:115-122. [PMID: 38175641 PMCID: PMC10767644 DOI: 10.1001/jamaophthalmol.2023.6015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/06/2023] [Indexed: 01/05/2024]
Abstract
Importance China has experienced both rapid urbanization and major increases in myopia prevalence. Previous studies suggest that green space exposure reduces the risk of myopia, but the association between myopia risk and specific geometry and distribution characteristics of green space has yet to be explored. These must be understood to craft effective interventions to reduce myopia. Objective To evaluate the associations between myopia and specific green space morphology using novel quantitative data from high-resolution satellite imaging. Design, Setting, and Participants This prospective cohort study included students grades 1 to 4 (aged 6 to 9 years) in Shenzhen, China. Baseline data were collected in 2016-2017, and students were followed up in 2018-2019. Data were analyzed from September 2020 to January 2022. Exposures Eight landscape metrics were calculated using land cover data from high-resolution Gaofen-2 satellite images to measure area, aggregation, and shape of green space. Main Outcome and Measures The 2-year cumulative change in myopia prevalence at each school and incidence of myopia at the student level after 2 years were calculated as main outcomes. The associations between landscape metrics and school myopia were assessed, controlling for geographical, demographic, and socioeconomic factors. Principal component analyses were performed to further assess the joint effect of landscape metrics at the school and individual level. Results A total of 138 735 students were assessed at baseline. Higher proportion, aggregation, and better connectivity of green space were correlated with slower increases in myopia prevalence. In the principal component regression, a 1-unit increase in the myopia-related green space morphology index (the first principal component) was negatively associated with a 1.7% (95% CI, -2.7 to -0.6) decrease in myopia prevalence change at the school level (P = .002). At the individual level, a 1-unit increase in myopia-related green space morphology index was associated with a 9.8% (95% CI, 4.1 to 15.1) reduction in the risk of incident myopia (P < .001), and the association remained after further adjustment for outdoor time, screen time, reading time, and parental myopia (adjusted odds ratio, 0.88; 95% CI, 0.80 to 0.97; P = .009). Conclusions and Relevance Structure of green space was associated with a decreased relative risk of myopia, which may provide guidance for construction and renovation of schools. Since risk estimates only indicate correlations rather than causation, further interventional studies are needed to assess the effect on school myopia of urban planning and environmental designs, especially size and aggregation metrics of green space, on school myopia.
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Affiliation(s)
- Yahan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Huipeng Liao
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
- Guangzhou Urban Planning and Design Survey Research Institute, Guangzhou, China
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xun Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - XiaoWei Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiaohu Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xuelong Li
- Centre for OPTical IMagery Analysis and Learning (OPTIMAL), Northwestern Polytechnical University, Xi’an, China
| | - Zhiyu Jiang
- Centre for OPTical IMagery Analysis and Learning (OPTIMAL), Northwestern Polytechnical University, Xi’an, China
| | - Xingying Zhang
- Key Laboratory of Radiometric Calibration and Validation for Environmental Satellites (LRCVES/CMA), National Satellite Meteorological Center, China Meteorological Administration (NSMC/CMA), Beijing, China
| | - Qingling Zhang
- School of Aeronautics and Astronautics, Sun Yat-sen University, Shenzhen, China
| | - Huagui He
- Guangzhou Urban Planning and Design Survey Research Institute, Guangzhou, China
| | - Liang Guo
- Guangzhou Urban Planning and Design Survey Research Institute, Guangzhou, China
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Guanghui Dong
- Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Bryan Spencer
- Department of Management, College of Business, City University of Hong Kong, Hong Kong, Special Administrative Region of China
| | - Mingguang He
- PolyU School of Optometry, Hong Kong Polytechnic University, Hong Kong, Special Administrative Region of China
| | - Nathan Congdon
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
- Orbis International, New York, New York
| | - Ian George Morgan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
- Research School of Biology, College of Medicine, Biology and Environment, Australian National University, Canberra, Australia
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, China
- Centre for Precision Medicine, Department of Genetics and Biomedical Informatics, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
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Cai C, Ma Y, He S, Meng C, Gu C, He J, Lhamo T, Draga D, Zhou C, Qiu Q. Influence of high altitude on choroid thickness, retinal thickness, and myopia: A cross-sectional study comparing adolescents in Shanghai and Tibet. Indian J Ophthalmol 2024; 72:S240-S247. [PMID: 38099385 DOI: 10.4103/ijo.ijo_1546_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/15/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE This study aimed to explore the influence of high altitude on myopia, macular choroidal thickness (mCT), and macular retinal thickness (mRT) in adolescents. METHODS Two schools, one in Shanghai (at sea level) and one in Shigatse, Tibet (more than 4000 m above sea level), were selected. Refractive error was measured by an autorefractor instrument and subjective refraction, and mCT and mRT were measured at three concentric circles by optical coherence tomography. Student's t -test, Chi-square test, and multiple linear regression analyses were used to analyze the data. RESULTS A total of 1114 participants (657 and 457 in Shanghai and Tibet, respectively) were enrolled in this cross-sectional study. The average age of the participants was 18.81 ± 1.10 years, and 44.34% were males. The spherical equivalent (SE) of adolescents in Shanghai was significantly lower than that of adolescents in Tibet (-4.14 ± 2.37 D and -2.12 ± 1.87 D, P < 0.01). The prevalence of myopia and high myopia among adolescents in Shanghai (94.52%, 19.48%) was significantly higher than those among adolescents in Tibet (44.74%, 2.41%) ( P < 0.01). The mCT of Tibetan adolescents was significantly thicker than that of Shanghai adolescents (295.80 ± 62.46 μm and 218.71 ± 61.42 μm, P < 0.01), especially the central mCT. The mRT of Tibetan adolescents was also thicker than that of Shanghai adolescents (301.42 ± 23.26 μm and 281.04 ± 12.24 μm, P < 0.01). CONCLUSIONS Compared with Shanghai adolescents, the choroid of Tibet adolescents is thicker, and the myopia prevalence is lower. It is speculated that increased altitude is associated with the thickening of mCT and a low myopia prevalence.
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Affiliation(s)
- Chunyang Cai
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
- National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, PR China
| | - Yingyan Ma
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
- National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, PR China
| | - Shuai He
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
- National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, PR China
| | - Chunren Meng
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
- National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, PR China
| | - Chufeng Gu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
- National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, PR China
| | - Jiangnan He
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
- Department of Preventative Ophthalmology, Shanghai Eye Diseases Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, PR China
| | - Thashi Lhamo
- Department of Ophthalmology, Shigatse People's Hospital, Shigatse, Tibet, PR China
| | - Deji Draga
- Department of Ophthalmology, Shigatse People's Hospital, Shigatse, Tibet, PR China
| | - Chuandi Zhou
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
- National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, PR China
| | - Qinghua Qiu
- Department of Ophthalmology, Shigatse People's Hospital, Shigatse, Tibet, PR China
- Department of Ophthalmology, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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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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Wen L, Liu H, Chen Z, Xu Q, Hu Z, Lan W, Yang Z. Effect of mount location on the quantification of light intensity in myopia study. BMJ Open Ophthalmol 2023; 8:e001409. [PMID: 38154910 PMCID: PMC10759099 DOI: 10.1136/bmjophth-2023-001409] [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: 07/21/2023] [Accepted: 12/19/2023] [Indexed: 12/30/2023] Open
Abstract
PURPOSE To investigate how the mounting location of wearable devices affects the measurement of light intensity. METHODS Two commercially available wearable devices, HOBO and Clouclip, were used to compare the effects of different mount locations on light intensity measurement. We assessed the consistency of the measurements of the two devices by placing a HOBO and a Clouclip simultaneously in 26 different light environments and measuring the light intensity. To simulate the real-life usage scenarios of the two devices, we had 29 participants wear two HOBOs-one on the wrist and the other on the chest-along with a Clouclip on their spectacles for 1 day; meanwhile, the light intensity was measured and analysed. RESULTS When under the same light environments, the light intensity measured by the Clouclip was 1.09 times higher than that by the HOBO, with an additional 82.62 units (r2=1.00, p<0.001). When simulating the real-life scenarios, the mean light intensity at the eye-level position was significantly lower than that at the chest position (189.13±665.78 lux vs 490.75±1684.29 lux, p<0.001) and the wrist position (189.13±665.78 lux vs 483.87±1605.50 lux, p<0.001). However, there was no significant difference in light intensity between the wrist and chest positions (483.87±1605.50 lux vs 490.75±1684.29 lux, p=1.00). Using a threshold of 1000 lux for outdoor exposure, the estimated light exposure at the eye-level position was significantly lower than that at the chest position (3.9% vs 7.8%, χ2=266.14, p<0.001) and the wrist position (3.9% vs 7.7%, χ2=254.25, p<0.001). CONCLUSIONS Our findings revealed significant variations in light exposure among the wrist, chest and eye position. Therefore, caution must be exercised when comparing results obtained from different wearable devices.
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Affiliation(s)
- Longbo Wen
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Changsha, China
- Hunan Province Optometry Engineering and Technology Research Center, Changsha, China
| | - Hong Liu
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Changsha, China
- Hunan Province Optometry Engineering and Technology Research Center, Changsha, China
| | - Zhao Chen
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Changsha, China
- Hunan Province Optometry Engineering and Technology Research Center, Changsha, China
| | - Qinglin Xu
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Changsha, China
- Hunan Province Optometry Engineering and Technology Research Center, Changsha, China
| | - Ziqi Hu
- Hunan Province Optometry Engineering and Technology Research Center, Changsha, China
| | - Weizhong Lan
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Changsha, China
- Guangzhou Aier Eye Hospital, Jinan University, Guangzhou, Guangdong, China
| | - Zhikuan Yang
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Changsha, China
- Hunan Province Optometry Engineering and Technology Research Center, Changsha, China
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Tapasztó B, Flitcroft DI, Aclimandos WA, Jonas JB, De Faber JTHN, Nagy ZZ, Kestelyn PG, Januleviciene I, Grzybowski A, Vidinova CN, Guggenheim JA, Polling JR, Wolffsohn JS, Tideman JWL, Allen PM, Baraas RC, Saunders KJ, McCullough SJ, Gray LS, Wahl S, Smirnova IY, Formenti M, Radhakrishnan H, Resnikoff S, Németh J. Myopia management algorithm. Annexe to the article titled Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute. Eur J Ophthalmol 2023:11206721231219532. [PMID: 38087768 DOI: 10.1177/11206721231219532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Myopia is becoming increasingly common in young generations all over the world, and it is predicted to become the most common cause of blindness and visual impairment in later life in the near future. Because myopia can cause serious complications and vision loss, it is critical to create and prescribe effective myopia treatment solutions that can help prevent or delay the onset and progression of myopia. The scientific understanding of myopia's causes, genetic background, environmental conditions, and various management techniques, including therapies to prevent or postpone its development and slow its progression, is rapidly expanding. However, some significant information gaps exist on this subject, making it difficult to develop an effective intervention plan. As with the creation of this present algorithm, a compromise is to work on best practices and reach consensus among a wide number of specialists. The quick rise in information regarding myopia management may be difficult for the busy eye care provider, but it necessitates a continuing need to evaluate new research and implement it into daily practice. To assist eye care providers in developing these strategies, an algorithm has been proposed that covers all aspects of myopia mitigation and management. The algorithm aims to provide practical assistance in choosing and developing an effective myopia management strategy tailored to the individual child. It incorporates the latest research findings and covers a wide range of modalities, from primary, secondary, and tertiary myopia prevention to interventions that reduce the progression of myopia.
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Affiliation(s)
- Beáta Tapasztó
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Daniel Ian Flitcroft
- Temple Street Children's Hospital, Dublin, Ireland
- Centre for Eye Research Ireland (CERI) Technological University, Dublin, Ireland
| | | | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | | | | | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Christina Nicolaeva Vidinova
- Department of Ophthalmology, Military Medical Academy, Sofia, Bulgaria
- Department of Optometry, Sofia University "St. Kliment Ohridski", Sofia, Bulgaria
| | | | - Jan Roelof Polling
- Department of Ophthalmology and Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Optometry and Orthoptics, University of Applied Science, Utrecht, The Netherlands
| | - James S Wolffsohn
- Optometry and Vision Science Research Group, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - J Willem L Tideman
- Department of Ophthalmology and Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department Ophthalmology, Martini Hospital, Groningen, The Netherlands
| | - Peter M Allen
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Rigmor C Baraas
- National Centre for Optics, Vision and Eye Care, University of South-Eastern Norway, Kongsberg, Norway
| | - Kathryn J Saunders
- Centre for Optometry and Vision Science, Ulster University, Coleraine, UK
| | - Sara J McCullough
- Centre for Optometry and Vision Science, Ulster University, Coleraine, UK
| | | | - Siegfried Wahl
- Institute for Ophthalmic Research, University Tübingen, Tübingen, Germany
- Carl Zeiss Vision International GmbH, Tübingen, Germany
| | | | - Marino Formenti
- Department of Physics, School of Science, University of Padova, Padova, Italy
| | - Hema Radhakrishnan
- Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
| | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- Brien Holden Vision Institute, Sydney, Australia
| | - János Németh
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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Cheng P, Zhang X, Zhou W, Xu J, Chen F, Qian D, Cao B. Prevalence and related factors of children myopia in Pudong New Area, Shanghai: a cross-sectional study. BMJ Open 2023; 13:e079330. [PMID: 38070885 PMCID: PMC10729255 DOI: 10.1136/bmjopen-2023-079330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES This study aimed to assess the prevalence and related factors of myopia among school-aged children after COVID-19 pandemic. DESIGN Cross-sectional study. SETTING Pudong New Area, Shanghai. PARTICIPANTS 1722 children aged 7-9 randomly selected from 8 primary schools were screened from 1 February 2023 to 30 April 2023. MAIN OUTCOME MEASURES Children's height, weight and eye parameters were examined. Myopia was defined as a cycloplegic spherical equivalent ≤-0.50 dioptres in either eye. A vision-related behaviour questionnaire was applied to investigate the associations between myopia and its risk factors. RESULTS Of the 1722 individuals enrolled, 25.6% (456) had myopia. After adjusting other characteristics, the following factors were associated with an increased rate of myopia: age (9 years vs 7 years, adjusted OR (AOR) 1.84, 95% CI 1.18 to 2.85, p=0.007), parental myopia status (both myopia vs none, AOR 5.66, 95% CI 3.71 to 8.63, p<0.001; one myopia vs none, AOR 2.92, 95% CI 1.93 to 4.42, p<0.001), reading books too close (yes vs no, AOR 1.58, 95% CI 1.20 to 2.08, p=0.001), writing with a tilted head (yes vs no, AOR 1.37, 95% CI 1.05 to 1.77, p=0.019), sleep patterns (early to bed late to rise vs early to bed early to rise, AOR 1.52, 95% CI 1.02 to 2.26, p=0.039). By contrast, a higher monthly household income and the habit of reading while lying down were associated with lower risk of myopia. CONCLUSIONS The prevalence of myopia is of concern among young school-aged children after COVID-19. Correcting eye use behaviour and improving sleep habits may reduce myopia. Also, gender differences should be considered in prevention strategies for children's myopia.
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Affiliation(s)
- Peng Cheng
- Eye and Dental Diseases Prevention & Treatment Center of Pudong New Area, Shanghai, China
| | - Xiaohua Zhang
- Eye and Dental Diseases Prevention & Treatment Center of Pudong New Area, Shanghai, China
- School of Public Health, Fudan University, Shanghai, China
| | - Wei Zhou
- Eye and Dental Diseases Prevention & Treatment Center of Pudong New Area, Shanghai, China
| | - Jiawei Xu
- Eye and Dental Diseases Prevention & Treatment Center of Pudong New Area, Shanghai, China
| | - Fangrong Chen
- Eye and Dental Diseases Prevention & Treatment Center of Pudong New Area, Shanghai, China
| | - Dan Qian
- Eye and Dental Diseases Prevention & Treatment Center of Pudong New Area, Shanghai, China
| | - Bin Cao
- Eye and Dental Diseases Prevention & Treatment Center of Pudong New Area, Shanghai, China
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Nilsen NG, Gilson SJ, Lindgren H, Kjærland M, Pedersen HR, Baraas RC. Seasonal and Annual Change in Physiological Ocular Growth of 7- to 11-Year-Old Norwegian Children. Invest Ophthalmol Vis Sci 2023; 64:10. [PMID: 38064230 PMCID: PMC10709800 DOI: 10.1167/iovs.64.15.10] [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: 08/11/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
Purpose To investigate seasonal and annual change in physiological eye growth in Norwegian school children. Methods Measurements of ocular biometry, non-cycloplegic spherical equivalent autorefraction (SER), and choroidal thickness (ChT) were obtained for 92 children (44 females) aged 7 to 11 years at four time points over a year (November 2019-November 2020). Seasons (3- and 5-month intervals) were classified as winter (November-January), winter-spring (January-June), and summer-autumn (June-November). Cycloplegic SER was obtained in January and used to group children. The seasonal and annual changes were tested with a linear mixed-effects model (P values were adjusted for multiple comparisons). Results All the children experienced annual ocular growth, irrespective of SER, but less so during the summer-autumn. The baseline SER was lower (P < 0.001), axial length (AL) was longer (P < 0.038), and choroids were thicker in 10- to 11-year-old than 7- to 8-year-old mild hyperopes (P = 0.002). Assuming mild hyperopes (n = 65) experience only physiological eye growth, modeling revealed seasonal and annual increases in AL across sex and age (P < 0.018), with less change during the summer-autumn than winter-spring. The 7- to 8-year-olds had a larger decrease annually and over winter-spring in SER (P ≤ 0.036) and in ChT over winter-spring than the 10- to 11-year-olds (P = 0.006). Conclusions There were significant seasonal and annual changes in AL in children who had physiological eye growth irrespective of age within this cohort. Annual changes in SER and seasonal choroidal thinning were only observed in 7- to 8-year-old children. This indicates continued emmetropization in 7- to 8-year-olds and a transition to maintaining emmetropia in 10- to 11-year-olds.
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Affiliation(s)
- Nickolai G. Nilsen
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Stuart J. Gilson
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Helene Lindgren
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Marianne Kjærland
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Hilde R. Pedersen
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Rigmor C. Baraas
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
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28
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Shen L, He W, Yang W, Yan W, Yang C. Effect of wearing peripheral focus-out glasses on emmetropization in Chinese children aged 6-8 years: study protocol for a 2-year randomized controlled intervention trial. Trials 2023; 24:746. [PMID: 37993963 PMCID: PMC10666424 DOI: 10.1186/s13063-023-07799-8] [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: 06/28/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Myopia is one of the most common eye diseases causing visual impairment and blindness, and the high prevalence in adolescents remains a major public health concern. Based on clinical studies using optical defocus to regulate ocular growth and refractive changes through visual feedback, we hypothesize that early wearing of peripheral myopic defocusing spectacles in children with high risk of myopia may slow the process of emmetropization and even prevent the onset of myopia by inducing more peripheral myopic defocus. The aim of this study is to investigate whether the wearing of peripheral focus-out glasses can be effective in delaying emmetropization in non-myopic children aged 6-8 years. METHODS The study is a 2-year randomized controlled trial. A total of 160 subjects will be randomized into the experimental group or the control group. The experimental group will be fitted with direct emmetropia with focus-out glasses (DEFOG) to guide the emmetropization process. The control group will not receive any treatment and will serve as a blank control group. The primary aim is to determine whether non-myopic children wearing DEFOG lenses are superior to those who do not receive any intervention on the progression of cycloplegic objective refraction over 2 years. DISCUSSION This is the first randomized controlled trial aiming at myopic prevention by non-invasive intervention in non-myopic children. This study aims to initially investigate whether wearing peripheral focus-out glasses can effectively delay the process of emmetropization in children aged 6-8 years with high risk of myopia, which might give potential clues for further exploration on early prevention of myopia. TRIAL REGISTRATION ClinicalTrials.gov NCT05689567. Registered on 10 January 2023.
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Affiliation(s)
- Li Shen
- Department of Ophthalmology, Children's Hospital of Fudan University, National Children's Medical Center, No. 399 Wanyuan Road, Shanghai, China
| | - Wennan He
- Department of Clinical Epidemiology & Clinical Trial Unit, Children's Hospital of Fudan University, National Children's Medical Center, No. 399 Wanyuan Road, Shanghai, China
| | - Weiming Yang
- Department of Ophthalmology, Children's Hospital of Fudan University, National Children's Medical Center, No. 399 Wanyuan Road, Shanghai, China
| | - Weili Yan
- Department of Clinical Epidemiology & Clinical Trial Unit, Children's Hospital of Fudan University, National Children's Medical Center, No. 399 Wanyuan Road, Shanghai, China.
| | - Chenhao Yang
- Department of Ophthalmology, Children's Hospital of Fudan University, National Children's Medical Center, No. 399 Wanyuan Road, Shanghai, China.
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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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Liu XN, Naduvilath TJ, Sankaridurg PR. Myopia and sleep in children-a systematic review. Sleep 2023; 46:zsad162. [PMID: 37381700 PMCID: PMC10639155 DOI: 10.1093/sleep/zsad162] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 05/22/2023] [Indexed: 06/30/2023] Open
Abstract
Worldwide, approximately one in three people are myopic or short-sighted. Myopia in children is of particular concern as younger onset age implies a higher risk of progression, and consequently greater risk of developing vision-threatening complications. The importance of sleep in children's health has long been acknowledged, but evidence for its role in childhood myopia is fairly new and mixed results were presented across studies. To facilitate better understanding of this relationship, a broad literature search, up to and including October 31, 2022, was performed using three databases (PubMed, Embase, and Scopus). Seventeen studies were included in the review, covering four main aspects of sleep, namely duration, quality, timing, and efficiency, and their associations with myopia in children. The present literature review discussed these studies, revealed potential limitations in their methodologies, and identified gaps that need to be addressed in the future. The review also acknowledges that current evidence is insufficient, and the role of sleep in childhood myopia is far from being fully understood. Future studies that primarily, objectively, and accurately assess sleep and myopia, taking other characteristics of sleep beyond duration into consideration, with a more diverse sample in terms of age, ethnicity, and cultural/environmental background, and control for confounders such as light exposure and education load are much needed. Although more research is required, myopia management should be a holistic approach and the inclusion of sleep hygiene in myopia education targeting children and parents ought to be encouraged.
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Affiliation(s)
- Xiao Nicole Liu
- School of Optometry and Vision Science, University of New South Wales, Sydney, SYD, Australia
- Brien Holden Vision Institute Limited, Sydney, SYD, Australia
| | - Thomas John Naduvilath
- School of Optometry and Vision Science, University of New South Wales, Sydney, SYD, Australia
- Brien Holden Vision Institute Limited, Sydney, SYD, Australia
| | - Padmaja R Sankaridurg
- School of Optometry and Vision Science, University of New South Wales, Sydney, SYD, Australia
- Brien Holden Vision Institute Limited, Sydney, SYD, Australia
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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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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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Zhang G, Jiang J, Qu C. Myopia prevention and control in children: a systematic review and network meta-analysis. Eye (Lond) 2023; 37:3461-3469. [PMID: 37106147 PMCID: PMC10630522 DOI: 10.1038/s41433-023-02534-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/29/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVES To analyse and compare the efficacy of different interventions for myopia prevention and control in children. METHODS We searched CNKI, VIP, Wan-Fang, CBM, Chinese Clinical Registry, PubMed, The Cochrane Library, Web of Science, Embase and ClinicalTrials.gov from inception to July 2022. We selected randomized controlled trials (RCTs) that included interventions to slow myopia progression in children. The main outcomes included mean annual change in axial length (AL) (millimetres/year) and in refraction (R) (dioptres/year). RESULTS A total of 80 RCTs (27103 eyes) were included. In comparison with control, orthokeratology (AL, -0.36 [-0.53, -0.20], P < 0.05; R, 0.56 [0.34, 0.77], P < 0.05), 1%Atropine (AL, -0.39 [-0.65, -0.13], P < 0.05; R, 0.54 [0.31, 0.77], P < 0.05), 0.01%Atropine + orthokeratology (AL, -0.47 [-0.80, -0.14], P < 0.05; R, 0.81 [0.43, 1.20], P < 0.05) could significantly slow the progression of myopia; in addition, progressive multi-focal spectacle lenses (PMSL) (0.42, [0.06, 0.79], P < 0.05), bifocal soft contact lenses (0.40, [0.03, 0.77], P < 0.05), 0.5%Atropine (0.67 [0.25, 1.10], P < 0.05), 0.1%Atropine (0.42 [0.15, 0.71], P < 0.05), 0.05%Atropine (0.57 [0.28, 0.86], P < 0.05), 0.01%Atropine (0.33 [0.15, 0.52], P < 0.05), 1%Atropine + bifocal spectacle lenses (BSL) (1.30 [0.54, 2.00], P < 0.05), 1%Atropine + PMSL (0.66 [0.23, 1.10], P < 0.05), 0.01%Atropine + single vision spectacle lenses (SVSL) (0.70 [0.23, 1.10], P < 0.05), 0.01%Atropine + orthokeratology (0.81 [0.43, 1.20], P < 0.05), BSL + Massage (0.85 [0.22, 1.50], P < 0.05), SVSL + Red light (0.59 [0.06, 0.79], P < 0.05) showed significant slowing effect on the increase in R. CONCLUSIONS This network meta-analysis suggests that the combined measures were most effective in AL and R, followed by Atropine.
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Affiliation(s)
- Guanghong Zhang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, CN, 611731, China
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, CN, 611731, China
- Sichuan Key Laboratory for Disease Gene Study, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, CN, 611731, China
| | - Jun Jiang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, CN, 611731, China
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, CN, 611731, China
- Sichuan Key Laboratory for Disease Gene Study, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, CN, 611731, China
| | - Chao Qu
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, CN, 611731, China.
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, CN, 611731, China.
- Sichuan Key Laboratory for Disease Gene Study, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, CN, 611731, China.
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Di Pierdomenico J, González-González R, Valiente-Soriano FJ, Galindo-Romero C, García-Ayuso D. Attitudes and knowledge of myopia management by Spanish optometrists. Int Ophthalmol 2023; 43:4247-4261. [PMID: 37596425 PMCID: PMC10520101 DOI: 10.1007/s10792-023-02835-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/27/2023] [Indexed: 08/20/2023]
Abstract
PURPOSE To investigate the knowledge, training and clinical practice of Spanish optometrists about preventing and controlling myopia progression. METHODS A web-based questionnaire was distributed to Spanish optometrists through social networks, optometric professional bodies and one of the major Spanish optometrists' associations to assess practitioner perception, understanding, and self-reported clinical practice behavior related to myopia diagnosis and management. RESULTS A total of 534 optometrists with a mean age of 40.8 ± 10.3 years completed the survey. Most respondents have been practicing optometry for more than 20 years (89.8%), report having actively treated childhood myopia (82.4%), and are very concerned about the increasing frequency of pediatric myopia in their daily practice (85.3%). Almost all of the respondents (97.3%) agreed that the efficacy of treatment is related to the age at which it is prescribed, and more than half (53.6%) considered a progression higher than - 0.50 and up to - 1.00D as the minimum necessary to consider a myopia management option. Respondents who reported actively managing childhood myopia considered orthokeratology, atropine and soft-defocus contact lenses the most effective myopia control interventions. However, the most frequently prescribed form of myopia correction by Spanish optometrists was single-vision spectacles, followed by orthokeratology and soft-defocus contact lenses. CONCLUSIONS Spanish optometrists are very active in the management of myopia, especially by fitting orthokeratology lenses or dual-focus soft contact lenses for myopia control, but there is still potential for improvement in the methodology they follow for both the diagnosis and management of myopia.
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Affiliation(s)
- Johnny Di Pierdomenico
- Facultad de Óptica y Optometría, Universidad de Murcia, Murcia, Spain
- Grupo de Investigación Oftalmología Experimental, Departamento de Oftalmología, Optometría, Otorrinolaringología y Anatomía Patológica, Facultad de Medicina, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB), Campus de Ciencias de la Salud, 30120, Murcia, España
| | | | - Francisco J Valiente-Soriano
- Facultad de Óptica y Optometría, Universidad de Murcia, Murcia, Spain
- Grupo de Investigación Oftalmología Experimental, Departamento de Oftalmología, Optometría, Otorrinolaringología y Anatomía Patológica, Facultad de Medicina, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB), Campus de Ciencias de la Salud, 30120, Murcia, España
| | - Caridad Galindo-Romero
- Facultad de Óptica y Optometría, Universidad de Murcia, Murcia, Spain
- Grupo de Investigación Oftalmología Experimental, Departamento de Oftalmología, Optometría, Otorrinolaringología y Anatomía Patológica, Facultad de Medicina, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB), Campus de Ciencias de la Salud, 30120, Murcia, España
| | - Diego García-Ayuso
- Facultad de Óptica y Optometría, Universidad de Murcia, Murcia, Spain.
- Grupo de Investigación Oftalmología Experimental, Departamento de Oftalmología, Optometría, Otorrinolaringología y Anatomía Patológica, Facultad de Medicina, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB), Campus de Ciencias de la Salud, 30120, Murcia, España.
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Alvarez-Peregrina C, Sanchez-Tena MA, Martinez-Perez C, Villa-Collar C, Ohlendorf A. Clinical Evaluation of MyoCare in Europe (CEME): study protocol for a prospective, multicenter, randomized, double-blinded, and controlled clinical trial. Trials 2023; 24:674. [PMID: 37848908 PMCID: PMC10580514 DOI: 10.1186/s13063-023-07696-0] [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: 06/29/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Myopia prevalence has been increasing in the last decades, and its pathological consequences, including myopic maculopathy and high myopia-associated optic neuropathy, are now one of the most common causes of visual impairment. It is estimated that by 2050, more than 50% of Europeans and Americans will be myopes, which is alarming due to the high morbidity of myopes over - 6.00D. Once myopia has appeared, there are different options with scientific evidence to try to slow the axial length growth. Ophthalmic lenses are the less invasive treatment to control myopia, and there is evidence about the efficacy of different designs, mainly in the Asiatic population. However, new designs have been launched, and it is not known if efficacy is the same between Asiatic and European subjects. Thus, we have set up a randomized, controlled, double-blind, and multicenter trial to investigate the efficacy of a new design of ophthalmic lenses for myopia control in European children. METHODS A 2-year prospective, multicenter, randomized controlled, and double-blind clinical trial is used to investigate the efficacy of a new design of ophthalmic lenses to slow the progression of myopia. Three hundred children aged from 6 to 13 years old will be recruited and randomly assigned to a study or control group. The study group will be composed of 150 children wearing MyoCare while the control group will be composed of 150 children wearing Clearview. The inclusion criteria will be myopia with a spherical equivalent between - 0.75D and - 5.00D, astigmatism < 1.50D, and anisometropia < 1.00D and having a historical evolution of at least - 0.50 The primary outcome is to compare the mean annual progression of the spherical equivalent between both groups. The secondary outcomes are axial length, choroidal thickness, phorias, and accommodative status of both groups. DISCUSSION This study will be the first randomized and controlled clinical trial in European children with spectacle lenses based on simultaneous competing defocus. The results will shed light on the clinical evidence of spectacle lenses relying on this new design for the management of myopia with results of efficacy in the non-Asiatic population. TRIAL REGISTRATION EU Clinical Trials Register (EudraCT) 2022-001696. Registered on 27 April 2022. CLINICALTRIALS gov NCT05919654. Registered on 26 June 2023.
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Affiliation(s)
- Cristina Alvarez-Peregrina
- Optometry and Vision Department, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain.
| | - Miguel Angel Sanchez-Tena
- Optometry and Vision Department, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
- ISEC LISBOA, Instituto Superior de Educação E Ciências, Lisbon, Portugal
| | | | - Cesar Villa-Collar
- Faculty of Biomedical and Health Science, European University of Madrid, Madrid, Spain
| | - Arne Ohlendorf
- ZEISS Group, Carl Zeiss Vision International GmbH, Turnstrasse 27, 73430, Aalen, Germany
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Lin S, Gong Q, Wang J, Gao H, Hong J, Guo Y, Zhang Y, Jiang D. The association between sleep duration and risk of myopia in Chinese school-aged children: a cross-sectional study. Sleep Breath 2023; 27:2041-2047. [PMID: 36797552 DOI: 10.1007/s11325-023-02794-4] [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: 09/25/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Myopia is one of the most commonly diagnosed refractive disorders worldwide. Identifying risk factors for myopia at an early age may help to characterize children who would benefit most from individualized lifestyle advice and early interventions. The influence of sleep duration on myopia risk remains controversial and thus needs to be evaluated. METHODS A population-based cross-sectional study of Chinese school-aged children was conducted. Information on sleep duration was derived. The association between sleep duration and myopia risk was investigated by logistic regression analysis. RESULTS Myopia prevalence among 9530 Chinese school-aged children was 75.4% and decreased from 84.9%, 76.5%, 65.8%, to 61.3% along with the extension of sleep duration. Univariate logistic regression found longer sleep duration of 8-9 h (OR = 0.58, 95% CI: 0.51-0.66), 9-10 h (OR = 0.34, 95% CI: 0.30-0.39), and ≥ 10 h (OR = 0.28, 95% CI: 0.24-0.33) were protective factors for myopia in all participants (P for trend < 0.001). In the multivariate analyses, sleep duration was inversely associated with the risk of myopia, and a dose-effect relationship was observed when the analysis was split by age category. CONCLUSIONS Long sleep duration was associated with decreased risk of myopia in Chinese school-aged children.
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Affiliation(s)
- Shujuan Lin
- School of Basic Medical Science, Putian University, Putian, China
- Key Laboratory of Translational Tumor Medicine in Fujian Province, Putian University, Putian, China
| | - Qinghai Gong
- Ningbo Municipal Center for Disease Control and Prevention, Yongfeng Road 237, Haishu District, Ningbo, 315010, China
| | - Jinghui Wang
- Ningbo Municipal Center for Disease Control and Prevention, Yongfeng Road 237, Haishu District, Ningbo, 315010, China
| | - Hua Gao
- Ningbo Municipal Center for Disease Control and Prevention, Yongfeng Road 237, Haishu District, Ningbo, 315010, China
| | - Jia Hong
- Ningbo Municipal Center for Disease Control and Prevention, Yongfeng Road 237, Haishu District, Ningbo, 315010, China
| | - Yanbo Guo
- Ningbo Municipal Center for Disease Control and Prevention, Yongfeng Road 237, Haishu District, Ningbo, 315010, China
| | - Yan Zhang
- Ningbo Municipal Center for Disease Control and Prevention, Yongfeng Road 237, Haishu District, Ningbo, 315010, China.
| | - Danjie Jiang
- Ningbo Municipal Center for Disease Control and Prevention, Yongfeng Road 237, Haishu District, Ningbo, 315010, China.
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Huang Y, Chen Z, Wang B, Zhao J, Zhou X, Qu X, Wang X, Zhou X. Chinese Parents' Perspective on Myopia: A Cross-Sectional Survey Study. Ophthalmol Ther 2023; 12:2409-2425. [PMID: 37314644 PMCID: PMC10265565 DOI: 10.1007/s40123-023-00743-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/23/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION The prevalence of myopia in young generations has dramatically increased over the years, especially in China. This study aims to understand Chinese parents' perspectives on myopia for further improvement of treatment compliance and informing future health planning and policy. METHODS This was a prospective cross-sectional survey study. A self-administrated, internet-based questionnaire was distributed to 2545 parents in China. Detailed information about the demographics, the awareness of myopia, related complications, and practices of myopia prevention and control of the respondents were collected. The distribution of answers was compared among different groups of children's age, children's refractions, and parents' residential locations. Relationships between parental cognition and behavior were also analyzed. RESULTS Eligible responses were returned by 2500 parents. A total of 55.1% of the respondents considered myopia as a disease and more than 70% of respondents did not realize pathological changes related to myopia. Most parents thought myopia could be prevented (82.0%) and controlled (75.2%), and these parents were more likely to take measures than the parents who did not think so (P < 0.001). The most common myopia control modality was spectacles (87.0%), among which single-vision spectacles are the most used (63.7%). CONCLUSIONS Knowledge about health risks related to myopia was lacking in Chinese parents and their practices of myopia control mainly involved single-vision glasses. Nationwide education for parents about myopia is needed to further advance outcomes of myopia prevention and control.
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Affiliation(s)
- Yangyi Huang
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Zhi Chen
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Bingjie Wang
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Jing Zhao
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Xueyi Zhou
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Xiaomei Qu
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Xiaoying Wang
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China.
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China.
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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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Li R, Zhang K, Li SM, Zhang Y, Tian J, Lu Z, Li H, Wang L, Wan X, Zhang F, Li L, Jin ZB, Wang N, Liu H. Implementing a digital comprehensive myopia prevention and control strategy for children and adolescents in China: a cost-effectiveness analysis. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 38:100837. [PMID: 37520278 PMCID: PMC10372367 DOI: 10.1016/j.lanwpc.2023.100837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/30/2023] [Accepted: 06/19/2023] [Indexed: 08/01/2023]
Abstract
Background Children and adolescents' myopia is a major public problem. Although the clinical effect of various interventions has been extensively studied, there is a lack of national-level and integral assessments to simultaneously quantify the economics and effectiveness of comprehensive myopia prevention and control programs. We aimed to compare the cost-effectiveness between traditional myopia prevention and control strategy, digital comprehensive myopia prevention and control strategy and school-based myopia screening program in China. Methods A Markov model was used to compare the cost-utility and cost-effectiveness among school-based myopia screening, traditional myopia prevention and control strategy, and digital comprehensive myopia prevention and control strategy among 6 to 18-year-old rural and urban schoolchildren. Parameters were collected from published sources. The primary outcomes were quality-adjusted life-year, disability-adjusted life-year, incremental cost-utility ratio, and incremental cost-effectiveness ratio. Extensive sensitivity analyses were performed to test the robustness and sensitivity of base-case analysis. Findings Compared with school-based myopia screening strategy, after implementing digital comprehensive myopia prevention and control strategy, the prevalence of myopia among 18-year-old students in rural and urban areas was reduced by 3.79% and 3.48%, respectively. The incremental cost-utility ratio per quality-adjusted life-year gained with the digital myopia management plan ($11,301 for rural setting, and $10,707 for urban setting) was less than 3 times the per capita gross domestic product in rural settings ($30,501) and less than 1 time the per capita gross domestic product in urban settings ($13,856). In cost-effectiveness analysis, the incremental cost-effectiveness ratio produced by digital comprehensive myopia management strategy ($37,446 and $41,814 per disability-adjusted life-year averted in rural and urban settings) slightly exceeded the cost-effectiveness threshold. When assuming perfect compliance, full coverage of outdoor activities and spectacles satisfied the cost-effectiveness threshold, and full coverage of outdoor activities produced the lowest cost ($321 for rural settings and $808 for urban settings). Interpretations Health economic evidence confirmed the cost-effectiveness of promoting digital comprehensive myopia prevention and control strategies for schoolchildren at the national level. Sufficient evidence provides an economic and public health reference for further action by governments, policy-makers and other myopia-endemic countries. Funding National Natural Science Foundation of China, NSFC (82171051), Beijing Natural Science Foundation (JQ20029), Capital Health Research and Development of Special (2020-2-1081), National Natural Science Foundation of China, NSFC (82071000), National Natural Science Foundation of China, NSFC (8197030562).
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Affiliation(s)
- Ruyue Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Kaiwen Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Shi-Ming Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yue Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Jiaxin Tian
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Zhecheng Lu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Huiqi Li
- School of Medical Technology, Beijing Institute of Technology, Beijing, 102488, China
| | - Liyuan Wang
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150000, China
| | - Xiuhua Wan
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Fengju Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Li Li
- Department of Ophthalmology, National Key Discipline of Pediatrics, Ministry of Education, Beijing Children's Hospital, Capital Medical University, Beijing, 100000, China
| | - Zi-Bing Jin
- Beijing Institute of Ophthalmology, Beijing, 100730, China
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing, 100730, China
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
- School of Medical Technology, Beijing Institute of Technology, Beijing, 102488, China
- National Institute of Health Data Science at Peking University, Beijing, 100000, China
| | - Hanruo Liu
- Beijing Institute of Ophthalmology, Beijing, 100730, China
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
- School of Medical Technology, Beijing Institute of Technology, Beijing, 102488, China
- National Institute of Health Data Science at Peking University, Beijing, 100000, China
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RaviChandran N, Teo ZL, Ting DSW. Artificial intelligence enabled smart digital eye wearables. Curr Opin Ophthalmol 2023; 34:414-421. [PMID: 37527195 DOI: 10.1097/icu.0000000000000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
PURPOSE OF REVIEW Smart eyewear is a head-worn wearable device that is evolving as the next phase of ubiquitous wearables. Although their applications in healthcare are being explored, they have the potential to revolutionize teleophthalmology care. This review highlights their applications in ophthalmology care and discusses future scope. RECENT FINDINGS Smart eyewear equips advanced sensors, optical displays, and processing capabilities in a wearable form factor. Rapid technological developments and the integration of artificial intelligence are expanding their reach from consumer space to healthcare applications. This review systematically presents their applications in treating and managing eye-related conditions. This includes remote assessments, real-time monitoring, telehealth consultations, and the facilitation of personalized interventions. They also serve as low-vision assistive devices to help visually impaired, and can aid physicians with operational and surgical tasks. SUMMARY Wearables such as smart eyewear collects rich, continuous, objective, individual-specific data, which is difficult to obtain in a clinical setting. By leveraging sophisticated data processing and artificial intelligence based algorithms, these data can identify at-risk patients, recognize behavioral patterns, and make timely interventions. They promise cost-effective and personalized treatment for vision impairments in an effort to mitigate the global burden of eye-related conditions and aging.
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Affiliation(s)
| | - Zhen Ling Teo
- Singapore National Eye Center, Singapore Eye Research Institute
| | - Daniel S W Ting
- AI and Digital Innovations
- Singapore National Eye Center, Singapore Eye Research Institute
- Duke-NUS Medical School, National University Singapore, Singapore
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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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Yi X, Wen L, Gong Y, Zhe Y, Luo Z, Pan W, Li X, Flitcroft DI, Yang Z, Lan W. Outdoor Scene Classrooms to Arrest Myopia: Design and Baseline Characteristics. Optom Vis Sci 2023; 100:543-549. [PMID: 37499167 DOI: 10.1097/opx.0000000000002046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
PURPOSE This study aimed to investigate the impact on childhood myopia of classrooms with spatial properties of classrooms resembling those of outdoor environments. This article describes the design, baseline characteristics, and the acceptability of this strategy. METHODS Classrooms had custom-made wallpaper installed with forest and sky scenes that had spatial frequency spectra comparable with outdoor environments (i.e., outdoor scene classrooms). Acceptability of this strategy was evaluated by questionnaires. Outcomes to access the efficacy include cumulative proportion of myopia, change of cycloplegic spherical equivalent refractive error, and axial length. RESULTS Ten classes, comprising 520 students, were randomly assigned into outdoor scene or tradition classrooms. There was no difference in refractive status between two groups (myopia/emmetropia/hyperopia, 16.3% vs. 49.4% vs. 34.2% in outdoor scene classrooms, 18.3% vs. 49.0% vs. 32.7% in traditional classrooms; P = .83). Compared with the traditional classrooms, 88.9% of teachers and 87.5% of students felt the outdoor scene classrooms enjoyable, 22.2% of teachers and 75.3% of students reported higher concentration, and 77.8% of teachers and 15.2% of students reported no change. In addition, 44.4% of teachers and 76.0% of students reported higher learning efficiency in the outdoor scene classrooms, and 55.6% of teachers and 18.3% of students reported no change. CONCLUSIONS Outdoor scene classrooms are appealing to teachers and students. Outcomes of the study will inform the efficacy of this strategy in Chinese children.
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Affiliation(s)
- Xin Yi
- Aier School of Ophthalmology, Central South University, Changsha, China
| | | | - Yongxiang Gong
- Lijiang Aier Eye Hospital, Aier Eye Hospital Group, Lijiang, China
| | - Yang Zhe
- Lijiang Aier Eye Hospital, Aier Eye Hospital Group, Lijiang, China
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Young DR, McKenzie TL, Eng S, Talarowski M, Han B, Williamson S, Galfond E, Cohen DA. Playground Location and Patterns of Use. J Urban Health 2023; 100:504-512. [PMID: 37155140 PMCID: PMC10322796 DOI: 10.1007/s11524-023-00729-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 05/10/2023]
Abstract
Playgrounds have features that benefit visitors, including opportunities to engage in outdoor physical activity. We surveyed 1350 adults visiting 60 playgrounds across the USA in Summer 2021 to determine if distance to the playground from their residence was associated with weekly visit frequency, length of stay, and transportation mode to the site. About 2/3 of respondents living within ½ mile from the playground reported visiting it at least once per week compared with 14.1% of respondents living more than a mile away. Of respondents living within ¼ mile of playgrounds, 75.6% reported walking or biking there. After controlling for socio-demographics, respondents living within ½ mile of the playground had 5.1 times the odds (95% CI: 3.68, 7.04) of visiting the playground at least once per week compared with those living further away. Respondents walking or biking to the playground had 6.1 times the odds (95% CI: 4.23, 8.82) of visiting the playground at least once per week compared with respondents arriving via motorized transport. For public health purposes, city planners and designers should consider locating playgrounds ½ mile from all residences. Distance is likely the most important factor associated with playground use.
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Affiliation(s)
- Deborah R Young
- Kaiser Permanente Southern California Research and Evaluation, 100 S Los Robles, 6th Floor, Pasadena, CA, 91101, USA.
| | - Thomas L McKenzie
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Sarah Eng
- Kaiser Permanente Southern California Research and Evaluation, 100 S Los Robles, 6th Floor, Pasadena, CA, 91101, USA
| | | | - Bing Han
- Kaiser Permanente Southern California Research and Evaluation, 100 S Los Robles, 6th Floor, Pasadena, CA, 91101, USA
| | - Stephanie Williamson
- Information Services, Research Programming Group, RAND Corporation, Santa Monica, CA, USA
| | | | - Deborah A Cohen
- Kaiser Permanente Southern California Research and Evaluation, 100 S Los Robles, 6th Floor, Pasadena, CA, 91101, USA
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He X, Wang J, Zhu Z, Xiang K, Zhang X, Zhang B, Chen J, Yang J, Du L, Niu C, Leng M, Huang J, Liu K, Zou H, He M, Xu X. Effect of Repeated Low-level Red Light on Myopia Prevention Among Children in China With Premyopia: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e239612. [PMID: 37099298 PMCID: PMC10134010 DOI: 10.1001/jamanetworkopen.2023.9612] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/09/2023] [Indexed: 04/27/2023] Open
Abstract
Importance Myopia is a global concern, but effective prevention measures remain limited. Premyopia is a refractive state in which children are at higher risk of myopia, meriting preventive interventions. Objective To assess the efficacy and safety of a repeated low-level red-light (RLRL) intervention in preventing incident myopia among children with premyopia. Design, Setting, and Participants This was a 12-month, parallel-group, school-based randomized clinical trial conducted in 10 primary schools in Shanghai, China. A total of 139 children with premyopia (defined as cycloplegic spherical equivalence refraction [SER] of -0.50 to 0.50 diopter [D] in the more myopic eye and having at least 1 parent with SER ≤-3.00 D) in grades 1 to 4 were enrolled between April 1, 2021, and June 30, 2021; the trial was completed August 31, 2022. Interventions Children were randomly assigned to 2 groups after grade stratification. Children in the intervention group received RLRL therapy twice per day, 5 days per week, with each session lasting 3 minutes. The intervention was conducted at school during semesters and at home during winter and summer vacations. Children in the control group continued usual activities. Main Outcomes and Measures The primary outcome was the 12-month incidence rate of myopia (defined as SER ≤-0.50 D). Secondary outcomes included the changes in SER, axial length, vision function, and optical coherence tomography scan results over 12 months. Data from the more myopic eyes were analyzed. Outcomes were analyzed by means of an intention-to-treat method and per-protocol method. The intention-to-treat analysis included participants in both groups at baseline, while the per-protocol analysis included participants in the control group and those in the intervention group who were able to continue the intervention without interruption by the COVID-19 pandemic. Results There were 139 children (mean [SD] age, 8.3 [1.1] years; 71 boys [51.1%]) in the intervention group and 139 children (mean [SD] age, 8.3 [1.1] years; 68 boys [48.9%]) in the control group. The 12-month incidence of myopia was 40.8% (49 of 120) in the intervention group and 61.3% (68 of 111) in the control group, a relative 33.4% reduction in incidence. For children in the intervention group who did not have treatment interruption secondary to the COVID-19 pandemic, the incidence was 28.1% (9 of 32), a relative 54.1% reduction in incidence. The RLRL intervention significantly reduced the myopic shifts in terms of axial length and SER compared with the control group (mean [SD] axial length, 0.30 [0.27] mm vs 0.47 [0.25] mm; difference, 0.17 mm [95% CI, 0.11-0.23 mm]; mean [SD] SER, -0.35 [0.54] D vs -0.76 [0.60] D; difference, -0.41 D [95% CI, -0.56 to -0.26 D]). No visual acuity or structural damage was noted on optical coherence tomography scans in the intervention group. Conclusions and Relevance In this randomized clinical trial, RLRL therapy was a novel and effective intervention for myopia prevention, with good user acceptability and up to 54.1% reduction in incident myopia within 12 months among children with premyopia. Trial Registration ClinicalTrials.gov Identifier: NCT04825769.
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Affiliation(s)
- Xiangui He
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Jingjing Wang
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
| | - Zhuoting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Division of Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Kaidi Xiang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Xinzi Zhang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Bo Zhang
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
| | - Jun Chen
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
| | - Jinliuxing Yang
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
| | - Linlin Du
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
| | - Chunjin Niu
- Department of Ophthalmology Prevention, Changning Center for Disease Control and Prevention, Shanghai, China
| | - Mei Leng
- Department of Teaching and Research, Changning Institute of Education, Shanghai, China
| | - Jiannan Huang
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
| | - Kun Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Haidong Zou
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Division of Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Xun Xu
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Engineering Center for Visual Science and Photomedicine, Shanghai, China
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Young D, McKenzie TL, Eng S, Talarowski M, Han B, Williamson S, Galfond E, Cohen DA. Playgrounds Location and Patterns of Use. RESEARCH SQUARE 2023:rs.3.rs-2697497. [PMID: 36993744 PMCID: PMC10055650 DOI: 10.21203/rs.3.rs-2697497/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Playgrounds have features that benefit visitors, including opportunities to engage in outdoor physical activity. We surveyed 1350 adults visiting 60 playgrounds across the U.S. in Summer 2021 to determine if distance to the playground from their residence was associated with weekly visit frequency, length of stay, and transportation mode to the site. About 2/3 of respondents living within ½ mile from the playground reported visiting it at least once per week compared with 14.1% of respondents living more than a mile away. Of respondents living within ¼ mile of playgrounds, 75.6% reported walking or biking there. After controlling for socio-demographics, respondents living within ½ mile of the playground had 5.1 times the odds (95% CI: 3.68, 7.04) of visiting the playground at least once per week compared with those living further away. Respondents walking or biking to the playground had 6.1 times the odds (95% CI: 4.23, 8.82) of visiting the playground at least once per week compared with respondents arriving via motorized transport. For public health purposes, city planners and designers should consider locating playgrounds ½ mile from all residences. Distance is likely the most important factor associated with playground use.
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Affiliation(s)
| | | | - Sarah Eng
- Kaiser Permanente Southern California
| | | | - Bing Han
- Kaiser Permanente Southern California
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Shneor E, Ostrin LA, Doron R, Benoit JS, Levine J, Davidson K, Gordon-Shaag A. Baseline characteristics in the Israel refraction, environment, and devices (iREAD) study. Sci Rep 2023; 13:2855. [PMID: 36806309 PMCID: PMC9938253 DOI: 10.1038/s41598-023-29563-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/07/2023] [Indexed: 02/19/2023] Open
Abstract
The purpose of this study is to present baseline data from a longitudinal study assessing behavioral factors in three groups of boys in Israel with varying myopia prevalence. Ultra-Orthodox (N = 57), religious (N = 67), and secular (N = 44) Jewish boys (age 8.6 ± 1.4 years) underwent cycloplegic autorefraction and axial-length measurement. Time-outdoors and physical-activity were assessed objectively using an Actiwatch. Ocular history, educational factors, and near-work were assessed with a questionnaire. Group effects were tested and mixed effects logistic and linear regression were used to evaluate behaviors and their relationship to myopia. The prevalence of myopia (≤ - 0.50D) varied by group (ultra-Orthodox: 46%, religious: 25%, secular: 20%, P < 0.021). Refraction was more myopic in the ultra-Orthodox group (P = 0.001). Ultra-Orthodox boys learned to read at a younger age (P < 0.001), spent more hours in school (P < 0.001), spent less time using electronic devices (P < 0.001), and on weekdays, spent less time outdoors (P = 0.02). Increased hours in school (OR 1.70) and near-work (OR 1.22), increased the odds of myopia. Being ultra-Orthodox (P < 0.05) and increased near-work (P = 0.007) were associated with a more negative refraction. Several factors were associated with the prevalence and degree of myopia in young boys in Israel, including being ultra-Orthodox, learning to read at a younger age, and spending more hours in school.
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Affiliation(s)
- Einat Shneor
- Department of Optometry, Hadassah Academic College, Haniviim St. 37, 9101001, Jerusalem, Israel.
| | - Lisa A. Ostrin
- grid.266436.30000 0004 1569 9707College of Optometry, University of Houston, Houston, TX 77004 USA
| | - Ravid Doron
- grid.443085.e0000 0004 0366 7759Department of Optometry, Hadassah Academic College, Haniviim St. 37, 9101001 Jerusalem, Israel
| | - Julia S. Benoit
- grid.266436.30000 0004 1569 9707Texas Institute for Measurement, Evaluation, and Statistics, Houston, TX 77004 USA
| | - Jonathan Levine
- grid.443085.e0000 0004 0366 7759Department of Optometry, Hadassah Academic College, Haniviim St. 37, 9101001 Jerusalem, Israel
| | - Kevin Davidson
- grid.266436.30000 0004 1569 9707Texas Institute for Measurement, Evaluation, and Statistics, Houston, TX 77004 USA
| | - Ariela Gordon-Shaag
- grid.443085.e0000 0004 0366 7759Department of Optometry, Hadassah Academic College, Haniviim St. 37, 9101001 Jerusalem, Israel
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Yam JC, Zhang XJ, Zhang Y, Yip BHK, Tang F, Wong ES, Bui CHT, Kam KW, Ng MPH, Ko ST, Yip WW, Young AL, Tham CC, Chen LJ, Pang CP. Effect of Low-Concentration Atropine Eyedrops vs Placebo on Myopia Incidence in Children: The LAMP2 Randomized Clinical Trial. JAMA 2023; 329:472-481. [PMID: 36786791 PMCID: PMC9929700 DOI: 10.1001/jama.2022.24162] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/13/2022] [Indexed: 02/15/2023]
Abstract
Importance Early onset of myopia is associated with high myopia later in life, and myopia is irreversible once developed. Objective To evaluate the efficacy of low-concentration atropine eyedrops at 0.05% and 0.01% concentration for delaying the onset of myopia. Design, Setting, and Participants This randomized, placebo-controlled, double-masked trial conducted at the Chinese University of Hong Kong Eye Centre enrolled 474 nonmyopic children aged 4 through 9 years with cycloplegic spherical equivalent between +1.00 D to 0.00 D and astigmatism less than -1.00 D. The first recruited participant started treatment on July 11, 2017, and the last participant was enrolled on June 4, 2020; the date of the final follow-up session was June 4, 2022. Interventions Participants were assigned at random to the 0.05% atropine (n = 160), 0.01% atropine (n = 159), and placebo (n = 155) groups and had eyedrops applied once nightly in both eyes over 2 years. Main Outcomes and Measures The primary outcomes were the 2-year cumulative incidence rate of myopia (cycloplegic spherical equivalent of at least -0.50 D in either eye) and the percentage of participants with fast myopic shift (spherical equivalent myopic shift of at least 1.00 D). Results Of the 474 randomized patients (mean age, 6.8 years; 50% female), 353 (74.5%) completed the trial. The 2-year cumulative incidence of myopia in the 0.05% atropine, 0.01% atropine, and placebo groups were 28.4% (33/116), 45.9% (56/122), and 53.0% (61/115), respectively, and the percentages of participants with fast myopic shift at 2 years were 25.0%, 45.1%, and 53.9%. Compared with the placebo group, the 0.05% atropine group had significantly lower 2-year cumulative myopia incidence (difference, 24.6% [95% CI, 12.0%-36.4%]) and percentage of patients with fast myopic shift (difference, 28.9% [95% CI, 16.5%-40.5%]). Compared with the 0.01% atropine group, the 0.05% atropine group had significantly lower 2-year cumulative myopia incidence (difference, 17.5% [95% CI, 5.2%-29.2%]) and percentage of patients with fast myopic shift (difference, 20.1% [95% CI, 8.0%-31.6%]). The 0.01% atropine and placebo groups were not significantly different in 2-year cumulative myopia incidence or percentage of patients with fast myopic shift. Photophobia was the most common adverse event and was reported by 12.9% of participants in the 0.05% atropine group, 18.9% in the 0.01% atropine group, and 12.2% in the placebo group in the second year. Conclusions and Relevance Among children aged 4 to 9 years without myopia, nightly use of 0.05% atropine eyedrops compared with placebo resulted in a significantly lower incidence of myopia and lower percentage of participants with fast myopic shift at 2 years. There was no significant difference between 0.01% atropine and placebo. Further research is needed to replicate the findings, to understand whether this represents a delay or prevention of myopia, and to assess longer-term safety. Trial Registration Chinese Clinical Trial Registry: ChiCTR-IPR-15006883.
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Affiliation(s)
- Jason C. Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Eye Hospital, Hong Kong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong
| | - Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Benjamin H. K. Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Fangyao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Emily S. Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Eye Hospital, Hong Kong
- Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong
| | - Christine H. T. Bui
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - Mandy P. H. Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Simon T. Ko
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong
| | - Wilson W.K. Yip
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - Alvin L. Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - Clement C. Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Eye Hospital, Hong Kong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Myopia: why the retina stops inhibiting eye growth. Sci Rep 2022; 12:21704. [PMID: 36522540 PMCID: PMC9755470 DOI: 10.1038/s41598-022-26323-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
In myopia, the eye grows too long, and the image projected on the retina is poorly focused when subjects look at a distance. While the retina normally controls eye growth by visual processing, it seems to give up during myopia development. But what has changed? To determine whether the sharp image is in front or behind the retinal plane, a comparison of image sharpness in red and blue would provide a reliable cue because focal planes are about 1.3 D apart due to longitudinal chromatic aberration (LCA). However, up to now, it could not be demonstrated that the retina does, in fact, such a comparison. We used a new approach: movies were digitally filtered in real time to present either the blue channel of the RGB color format unfiltered while green and red were blurred ("blue in focus"), or the red channel was unfiltered while green and blue were blurred ("red in focus") accordingly to the human LCA function. Here we show that, even though filtered movies looked similar, eyes became significantly shorter when the movie was sharp in the red plane but became longer when it was presented sharp in the blue plane. Strikingly, the eyes of young subjects who were already myopic did not respond at all-showing that their retina could no longer decode the sign of defocus based on LCA. Our findings resolve a long-standing question as to how the human retina detects the sign of defocus. It also suggests a new non-invasive strategy to inhibit early myopia development: keeping the red image plane on a computer screen sharp but low pass filtering the blue.
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Li SM, Ran AR, Kang MT, Yang X, Ren MY, Wei SF, Gan JH, Li L, He X, Li H, Liu LR, Wang Y, Zhan SY, Atchison DA, Morgan I, Wang N. Effect of Text Messaging Parents of School-Aged Children on Outdoor Time to Control Myopia: A Randomized Clinical Trial. JAMA Pediatr 2022; 176:1077-1083. [PMID: 36155742 PMCID: PMC9513710 DOI: 10.1001/jamapediatrics.2022.3542] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Myopia in school-aged children is a public health issue worldwide; consequently, effective interventions to prevent onset and progression are required. OBJECTIVE To investigate whether SMS text messages to parents increase light exposure and time outdoors in school-aged children and provide effective myopia control. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted in China from May 2017 to May 2018, with participants observed for 3 years. Of 528 965 primary school-aged children from Anyang, 3113 were randomly selected. Of these, 268 grade 2 schoolchildren were selected and randomly assigned to SMS and control groups. Data were analyzed from June to December 2021. INTERVENTIONS Parents of children in the SMS group were sent text messages twice daily for 1 year to take their children outdoors. All children wore portable light meters to record light exposure on 3 randomly selected days (2 weekdays and 1 weekend day) before and after the intervention. MAIN OUTCOMES AND MEASURES The co-primary outcomes were change in axial length (axial elongation) and change in spherical equivalent refraction (myopic shift) from baseline as measured at the end of the intervention and 3 years later. A secondary outcome was myopia prevalence. RESULTS Of 268 grade 2 schoolchildren, 121 (45.1%) were girls, and the mean (SD) age was 8.4 (0.3) years. Compared with the control group, the SMS intervention group demonstrated greater light exposure and higher time outdoors during weekends, and the intervention had significant effect on axial elongation (coefficient, 0.09; 95% CI, 0.02-0.17; P = .01). Axial elongation was lower in the SMS group than in the control group during the intervention (0.27 mm [95% CI, 0.24-0.30] vs 0.31 mm [95% CI, 0.29-0.34]; P = .03) and at year 2 (0.39 mm [95% CI, 0.35-0.42] vs 0.46 mm [95% CI, 0.42-0.50]; P = .009) and year 3 (0.30 mm [95% CI, 0.27-0.33] vs 0.35 mm [95% CI, 0.33-0.37]; P = .005) after the intervention. Myopic shift was lower in the SMS group than in the control group at year 2 (-0.69 diopters [D] [95% CI, -0.78 to -0.60] vs -0.82 D [95% CI, -0.91 to -0.73]; P = .04) and year 3 (-0.47 D [95% CI, -0.54 to -0.39] vs -0.60 D [95% CI, -0.67 to -0.53]; P = .01) after the intervention, as was myopia prevalence (year 2: 38.3% [51 of 133] vs 51.1% [68 of 133]; year 3: 46.6% [62 of 133] vs 65.4% [87 of 133]). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, SMS text messages to parents resulted in lower axial elongation and myopia progression in schoolchildren over 3 years, possibly through increased outdoor time and light exposure, showing promise for reducing myopia prevalence. TRIAL REGISTRATION Chinese Clinical Trial Registry Identifier: ChiCTR-IOC-17010525.
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Affiliation(s)
- Shi-Ming Li
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - An-Ran Ran
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Meng-Tian Kang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Xiaoyuan Yang
- Department of Ophthalmology, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Ming-Yang Ren
- School of Mathematical Sciences, Chinese Academy of Sciences, Beijing, China,Key Laboratory of Big Data Mining and Knowledge Management, Chinese Academy of Sciences, Beijing, China
| | - Shi-Fei Wei
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Jia-He Gan
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Lei Li
- Anyang Eye Hospital, Anyang, China
| | - Xi He
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - He Li
- Anyang Eye Hospital, Anyang, China
| | | | | | - Si-Yan Zhan
- Department of Epidemiology and Health Statistics, School of Public Health, Peking University, Beijing, China
| | - David A. Atchison
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Ian Morgan
- Research School of Biology, Australian National University, Canberra, Australia
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
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