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Li F, Ye X, Li M, Nie Q, Wang H, Zhang G, Dong L, Wang C, Wu L, Liu H, Wang L, Peng C, Zhang J. Enhanced ophthalmic bioavailability and stability of atropine sulfate via sustained release particles using polystyrene sulfonate resin. Int J Pharm 2024; 660:124294. [PMID: 38823467 DOI: 10.1016/j.ijpharm.2024.124294] [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: 02/02/2024] [Revised: 05/17/2024] [Accepted: 05/29/2024] [Indexed: 06/03/2024]
Abstract
Atropine sulfate (ATS) eye drops at low concentrations constitute a limited selection for myopia treatment, with challenges such as low ophthalmic bioavailability and inadequate stability. This study proposes a novel strategy by synthesizing ophthalmic sodium polystyrene sulfonate resin (SPSR) characterized by a spherical shape and uniform size for cationic exchange with ATS. The formulation of ATS@SPSR suspension eye drops incorporates xanthan gum and hydroxypropyl methylcellulose (HPMC) as suspending agents. In vitro studies demonstrated that ATS@SPSR suspension eye drops exhibited sustained release characteristics, and tropic acid, its degradation product, remained undetected for 30 days at 40 °C. The ATS levels in the tear fluids and aqueous humor of New Zealand rabbits indicated a significant increase in mean residence time (MRT) and area under the drug concentration-time curve (AUC0-12h) for ATS@SPSR suspension eye drops compared to conventional ATS eye drops. Moreover, safety assessment confirmed the non-irritating nature of ATS@SPSR suspension eye drops in rabbit eyes. In conclusion, the cation-responsive sustained-release ATS@SPSR suspension eye drops enhanced the bioavailability and stability of ATS, offering a promising avenue for myopia treatment.
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Affiliation(s)
- Falan Li
- College of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China; Yangtze Delta Drug Advanced Research Institute, Nantong 226133, China; Jiangsu Yunshi Pharmaceutical Technology Co. Ltd., Nantong 226133, China
| | - Xinyue Ye
- College of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China; Yangtze Delta Drug Advanced Research Institute, Nantong 226133, China; Jiangsu Yunshi Pharmaceutical Technology Co. Ltd., Nantong 226133, China
| | - Mingwei Li
- College of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China; Yangtze Delta Drug Advanced Research Institute, Nantong 226133, China; Jiangsu Yunshi Pharmaceutical Technology Co. Ltd., Nantong 226133, China
| | - Qin Nie
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201210, China
| | - Huihui Wang
- Yangtze Delta Drug Advanced Research Institute, Nantong 226133, China; Jiangsu Yunshi Pharmaceutical Technology Co. Ltd., Nantong 226133, China
| | - Guoqing Zhang
- Jiangsu Yunshi Pharmaceutical Technology Co. Ltd., Nantong 226133, China
| | - Liyun Dong
- College of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China; Yangtze Delta Drug Advanced Research Institute, Nantong 226133, China; Jiangsu Yunshi Pharmaceutical Technology Co. Ltd., Nantong 226133, China
| | - Caifen Wang
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201210, China
| | - Li Wu
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201210, China
| | - Hongfei Liu
- Jiangsu University, Zhenjiang 212000, China; Jiangsu Yunshi Pharmaceutical Technology Co. Ltd., Nantong 226133, China.
| | - Lifeng Wang
- Yangtze Delta Drug Advanced Research Institute, Nantong 226133, China.
| | - Can Peng
- College of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China.
| | - Jiwen Zhang
- College of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China; Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201210, China; Yangtze Delta Drug Advanced Research Institute, Nantong 226133, China; Jiangsu Yunshi Pharmaceutical Technology Co. Ltd., Nantong 226133, China.
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Foo LL, Tan CS, Noel B, Htoon HM, Najjar RP, Kathrani B, Sabanayagam C, Saw SM. Factors influencing myopia stabilisation in young myopic adult Singaporeans. Br J Ophthalmol 2024; 108:884-888. [PMID: 37640399 DOI: 10.1136/bjo-2023-323680] [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: 04/15/2023] [Accepted: 07/23/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE To evaluate factors influencing stabilisation of myopia in the Singapore Cohort of Risk factors for Myopia. METHODS We evaluated the longitudinal natural history of 424 myopic participants from 1999 to 2022. The outcome was the change in myopia from the adolescence follow-up visit (aged 12-19 years) to the adulthood follow-up visit (aged 26-33 years). Association of predictive factors, including baseline spherical error, gender, ethnicity, parental myopia, time outdoor, near work and age at adolescence, was examined with the dichotomous outcome of adult myopia progression (≤ -1.00 dioptres (D) over 10 years) using multiple logistic regression and progression in linear regression models. RESULTS For the primary outcome, the mean rate of progression of the outcome was found to be -0.04±0.09 D per year from the adolescent to the adulthood follow-up visits. 82.3% (95% CI 78.3% to 85.8%) had myopia stabilisation, with progression of less than 1.00 D over 10 years while 61.3% (95% CI 56.5% to 66.0%) of the subjects had progression of less than 0.50 D. In logistic regression models, both male gender (p=0.035) and non-Chinese ethnicity (p=0.032) were more likely to achieve myopia stabilisation while in linear multivariate regression models, males had a significantly slower degree of myopia progression (p=0.021). CONCLUSION 5 in 6 Singaporean young adults had myopia stabilisation. Male gender is 2 times and non-Chinese ethnicities are 2.5 times more likely to achieve myopia stabilisation. However, a proportion of myopes continue to exhibit a clinically significant degree of progression in adulthood.
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Affiliation(s)
- Li Lian Foo
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Chuen-Seng Tan
- National University Singapore Saw Swee Hock School of Public Health, Singapore
| | - Brennan Noel
- Johnson & Johnson Vision, Jacksonville, Florida, USA
| | | | - Raymond P Najjar
- Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
- National University Singapore Saw Swee Hock School of Public Health, Singapore
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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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Erdinest N, Atar-Vardi M, Lavy I, London N, Landau D, Pras E, Morad Y. Effective Decrease in Myopia Progression With Two Mechanisms of Management. J Pediatr Ophthalmol Strabismus 2024; 61:204-210. [PMID: 38112389 DOI: 10.3928/01913913-20231120-01] [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: 12/21/2023]
Abstract
PURPOSE To ascertain the effectiveness of 0.01% atropine treatment to inhibit myopia progression and the possible additive potency with peripheral defocus contact lenses over 3 years and the rebound effect 1 year after cessation of treatment. METHODS This prospective study included 127 children aged 8 to 5 years, divided into three treatment groups: 0.01% atropine and single-vision spectacles (At+SV, n = 36), 0.01% atropine and peripheral defocus contact lens (At+PDCL, n = 30), and 0.01% atropine and dual-focus contact lens (At+DF, n = 25). A control group was prescribed single-vision spectacles (n = 36). Cycloplegic spherical equivalence refraction was measured every 6 months during 3 years of treatment and 1 year after cessation. RESULTS Myopia progression decreased over 3 years of treatment, more during the second and third years than the first year, to a statistically significant degree in the atropine groups (P < .01): in the first, second, and third years, respectively, -0.42 ± 0.34, -0.19 ± 0.18, -0.22 ± 0.19 diopters (D) in the At+SV group, -0.26 ± 0.21, -0.14 ± 0.37, and -0.15 ± 0.31 D in the At+PDCL group, and -0.22 ± 0.15, -0.15 ± 0.22, and -0.11 ± 0.14 D in the At+DF group. Myopia progressed 1 year after cessation of treatment: -0.29 ± 0.28 D in the At+SV group, -0.13 ± 0.28 D in the At+PDCL group, and -0.09 ± 0.18 D in the At+DF group. After 3 years, there was no statistically significant difference in myopia progression between the At+SV and At+PDCL or At+DF groups (P < .05). CONCLUSIONS Low-dose atropine has been substantiated in this cohort as an effective treatment to decelerate myopia progression over 3 years, more effective in the second and third years of treatment. The combination treatment did not exhibit a statistically significant advantage over monotherapy in this cohort. The At+DF group exhibited a statistically lower rebound effect than the At+SV group. [J Pediatr Ophthalmol Strabismus. 2024;61(3):204-210.].
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Wang JD, Liu MR, Chen CX, Cao K, Zhang Y, Zhu XH, Wan XH. Effects of atropine eyedrops at ten different concentrations for myopia control in children: A systematic review on meta-analysis. Eur J Ophthalmol 2024:11206721241229317. [PMID: 38377951 DOI: 10.1177/11206721241229317] [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: 02/22/2024]
Abstract
PURPOSE To estimate the effect of atropine eyedrops at different concentrations for myopia control in children. METHODS We conducted a Bayesian random-effects network meta-analysis based on randomized controlled trials (RCT). Primary outcomes include changes in spherical equivalent error (SER) and changes in axial length (AL), mean difference (MD) together with 95% credible interval (CrI) were used to evaluate the efficacy. RESULTS 28 RCTs (6608 children) were included in this review. Comparing ten atropine eyedrops (0.0025%, 0.005%, 0.01%, 0.02%, 0.025%, 0.05%, 0.1%, 0.25%, 0.5% and 1% concentrations) with the placebo, the MDs and 95%CrIs of changes in SER are -0.006 (-0.269, 0.256) D, 0.216 (-0.078, 0.508) D, 0.146 (0.094, 0.199) D, 0.167 (0.039, 0.297) D, 0.201 (0.064, 0.341) D, 0.344 (0.251, 0.440) D, 0.255 (0.114, 0.396) D, 0.296 (0.140, 0.452) D, 0.331 (0.215, 0.447) D, and 0.286 (0.195, 0.337) D, respectively. The MDs and 95%CrIs of changes in AL are -0.048 (-0.182, 0.085) mm, -0.078 (-0.222, 0.066) mm, -0.095 (-0.130, -0.060) mm, -0.096 (-0.183, -0.009) mm, -0.083 (-0.164, -0.004) mm, -0.114 (-0.176, -0.056) mm, -0.134 (-0.198, -0.032) mm, -0.174 (-0.315, -0.061) mm, -0.184 (-0.291, -0.073) mm, and -0.171 (-0.203, -0.097) mm, respectively.Whether evaluated by SER or AL, 1% concentration ranks first in efficacy, but the risk of photophobia is 17 times higher than 0.01% concentration. CONCLUSIONS 0.01% or higher concentration atropine eyedrops are effective for myopia control, while 0.0025% and 0.005% concentrations may not. As the concentration increases, the effect tends to increase, 1% concentration may have the strongest effect.
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Affiliation(s)
- Jin-Da Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Mei-Rui Liu
- School of Public Health, North China University of Science and Technology, Hebei, Beijing, China
| | - Chang-Xi Chen
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yun Zhang
- Jianguomen Community Health Service Center, Beijing, China
| | - Xiao-Hong Zhu
- Xicheng District Maternal and Child Health Hospital of Beijing, Beijing, China
| | - Xiu-Hua Wan
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Zambrano Peralta P, Ortiz Quito M, Guerrero Ortiz F, Cervantes Anaya L. Orthokeratology vs. orthokeratology combined with atropine for the control of myopia in children: systematic review. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:568-576. [PMID: 37619667 DOI: 10.1016/j.oftale.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/20/2023] [Indexed: 08/26/2023]
Abstract
The purpose of this investigation is to determine the efficacy of orthokeratology (OK) compared to orthokeratology combined with atropine (AOK) for the control of myopia in children. A systematic review that included systematic reviews with meta-analyses, as well as randomized and controlled clinical trials, was carried out in the PubMed, Web of Science, Scopus, Cochrane Library, ProQuest, Taylor & Francis, Science Direct databases, as well as a manual search. Of the Q1-Q4 journals of the Scimago Journal & Country Rank, published in the last 5 years in English and Spanish. Eighteen studies that met the eligibility criteria were considered. The articles selected included 6,866 patients for analysis, where orthokeratology combined with 0.01% atropine was found to be more effective due to its ability to reduce the progression of myopia and axial elongation. In our investigation, it was determined that there could be an additive effect in the combination of 0.01% atropine with orthokeratology in a period of 1-2 years of treatment in patients with mild myopia; however, more multiethnic studies should be carried out, in where a correct evaluation of the progression of myopia, genetic and environmental factors that may influence the results is considered.
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Affiliation(s)
| | - M Ortiz Quito
- Universidad Católica de Cuenca, Sede Matriz, Cuenca, Ecuador
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Kim S, Babiuch A, Xiao H, Williamson A. Comparison of Myopia Progression among Myopic Children with Intermittent Exotropia and No Strabismus. Optom Vis Sci 2023; 100:508-514. [PMID: 37543745 DOI: 10.1097/opx.0000000000002047] [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: 08/07/2023] Open
Abstract
SIGNIFICANCE Myopia is a highly prevalent condition in the pediatric population that is commonly comorbid with intermittent exotropia. Our study found a trend toward significance in the reduction of myopia progression with strabismus correction surgery. Further investigations characterizing the interaction between myopia and strabismus may help inform future management guidelines. PURPOSE This study describes and compares myopic progression in the pediatric population with and without intermittent exotropia and its interaction with corrective strabismus surgery. METHODS This study analyzed a retrospective cohort of 1239 pediatric myopic patients who were evaluated by pediatric ophthalmologists and optometrists at a tertiary care center from 2012 to 2020. The main outcome measures were the trends in refractive error over time in those with and without intermittent exotropia as well as trends in those who did and did not undergo strabismus surgery. RESULTS A total of 275 patients (22%) were identified to have intermittent exotropia, and 12 (4.4%) from this group underwent surgical correction in the study period. No statistically significant difference was identified in myopic progression between those with intermittent exotropia and those without strabismus, and no difference was found in mean annual spherical equivalent change between intermittent exotropia patients who did not undergo surgery compared with those who did. CONCLUSIONS Pediatric myopic patients generally experience progression in the condition for several years independent of concurrent intermittent exotropia. Corrective strabismus surgery was not found to alter the natural history of myopia in children, although a reduction in myopic progression in surgically treated patients trended toward significance. Increases in the prevalence of different treatment strategies will necessitate further studies to determine best practices for this population.
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Affiliation(s)
- Suzie Kim
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | | | - Huijun Xiao
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
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Zhu MH, Lin TN, Lin JH, Wen Q. Myopia among children and adolescents: an epidemiological study in Fuzhou City. Front Pediatr 2023; 11:1161329. [PMID: 37384308 PMCID: PMC10293673 DOI: 10.3389/fped.2023.1161329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/30/2023] [Indexed: 06/30/2023] Open
Abstract
Objective To provide a reference for the prevention and control of myopia by analyzing and discussing the findings of an epidemiological survey of the prevalence of myopia among children and adolescents in Fuzhou City from 2019 to 2021. Methods Participants for this cross-sectional study were drawn from Gulou District and Minqing County in Fuzhou City using cluster random sampling to account for differences in population density, economic development, and other environmental variables. Results Myopia was more prevalent in 2020 than in 2019, but by 2021 it had dropped to about the same level as in 2019. Myopia was more prevalent among girls than boys during the course of the study period, with a three-year prevalence of 44.72% for boys and 52.16% for girls. Mild myopia accounted for 24.14% of all cases, followed by moderate myopia at 19.62%, and severe myopia at 4.58%. Students in urban regions had a prevalence of myopia equivalent to that of students in the suburbs, and this prevalence rose with age. Conclusion Myopia was quite prevalent among children and adolescents in Fuzhou City, and was shown to be steadily rising as students progressed through the school system. This suggests that all levels of government, educational institutions, medical facilities, and concerned parents in Fujian Province should focus on the issue of myopia and collaborate to reduce the risk factors for the development of myopia in school-aged participants.
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Affiliation(s)
- Mei-hong Zhu
- Department of Ophthalmology, Huaqiao University Hospital, Fujian, China
| | - Tai-nan Lin
- Department of Ophthalmology, Fujian Provincial Governmental Hospital, Fujian, China
| | - Jing-hua Lin
- Department of Ophthalmology, Fujian Provincial Governmental Hospital, Fujian, China
| | - Qian Wen
- Department of Ophthalmology, Fujian Provincial Governmental Hospital, Fujian, China
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Hussain A, Gopalakrishnan A, Chowdhury S, Agarkar S. Effectiveness of 0.01% atropine in anisomyopic children. Indian J Ophthalmol 2023; 71:2109-2114. [PMID: 37203091 PMCID: PMC10391398 DOI: 10.4103/ijo.ijo_2762_22] [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: 05/20/2023] Open
Abstract
Purpose To investigate the change in ocular parameters of anisomyopic children treated with 0.01% atropine. Methods This retrospective study analyzed the data of anisomyopic children who underwent comprehensive examination at a tertiary eye center in India. Anisomyopic subjects (difference of ≥1.00 D) of age 6-12 years who were treated with 0.01% atropine or prescribed regular single vision spectacle and had follow-ups of more than 1 year were included. Results Data from 52 subjects were included. No difference was observed in the mean rate of change of spherical equivalent (SE) of more myopic eyes between 0.01% atropine (-0.56 D; 95% confidence interval [CI]: -0.82, -0.30) and single vision lens wearers (-0.59 D; 95% CI: -0.80, -0.37; P = 0.88). Similarly, insignificant change in the mean SE of less myopic eyes was noted between the groups (0.01% atropine group, -0.62 D; 95% CI: -0.88, -0.36 vs. single vision spectacle wearer group, -0.76 D; 95% CI: -1.00, -0.52; P = 0.43). None of the ocular biometric parameters showed any difference between the two groups. Though anisomyopic cohort treated with 0.01% atropine revealed a significant correlation between the rate of change of mean SE and axial length in both eyes (more myopic eyes, r = -0.58; P = 0.001 and less myopic eyes, r = -0.82; P < 0.001) compared to single vision spectacle wearer group, the change was not significant. Conclusion Administration of 0.01% atropine had minimal effect on reducing the rate of myopia progression in anisomyopic eyes.
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Affiliation(s)
- Azfira Hussain
- Myopia Clinic, Unit of Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Aparna Gopalakrishnan
- Myopia Clinic, Unit of Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Saurav Chowdhury
- Myopia Clinic, Unit of Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sumita Agarkar
- Department of Pediatric Ophthalmology, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Wang W, Zhang F, Yu S, Ma N, Huang C, Wang M, Wei L, Zhang J, Fu A. Prevention of myopia shift and myopia onset using 0.01% atropine in premyopic children - a prospective, randomized, double-masked, and crossover trial. Eur J Pediatr 2023:10.1007/s00431-023-04921-5. [PMID: 36944782 DOI: 10.1007/s00431-023-04921-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/23/2023]
Abstract
This study aims to evaluate the efficacy of 0.01% atropine eye drops in preventing myopia shift and myopia onset in premyopic children. A prospective, randomized, double-masked, placebo-controlled, and crossover trial was conducted over 13 months. Sixty premyopic children aged 6-12 years with cycloplegic spherical equivalent refraction (SER) > - 0.75 D and ≤ + 0.50 D in both eyes were assigned in a 1:1 ratio to receive one drop of 0.01% atropine or placebo once nightly for 6 months (period 1), followed by a 1-month recovery period. Then, the 0.01% atropine group was crossed over to the placebo group, and the latter was crossed over to the 0.01% atropine group for another 6 months (period 2). The primary outcomes were changes in SER and axial length (AL), and the secondary outcomes were the proportion of myopia onset (SER ≤ - 0.75D) and fast myopic shift (change in SER ≤ - 0.25D) in the two periods. Generalized estimating equation (GEE) model performed a statistically significant treatment effect of 0.01% atropine compared with placebo (pSER = 0.02, pAL < 0.001), with a mean SER and AL difference of 0.20D (- 0.15 ± 0.26D vs. - 0.34 ± 0.34D) and 0.11 mm (0.17 ± 0.11 mm vs. 0.28 ± 0.14 mm) in period 1, and 0.17D (- 0.18 ± 0.24D vs. - 0.34 ± 0.31D) and 0.10 mm (0.15 ± 0.15 mm vs. 0.24 ± 0.11 mm) in period 2. The GEE model showed that the proportion of myopia onset (p = 0.004) and fast myopic shift (p = 0.009) was significantly lower in the 0.01% atropine group than that in the placebo group. The period effect was not statistically significant (all p > 0.05). A total of 0.01% atropine significantly prevented myopic shift, axial elongation, and myopia onset in premyopic schoolchildren in central Mainland China. CONCLUSION Within the limits of only two consecutive 6-month observation period, 0.01% atropine eye drops effectively prevented myopic shift, axial elongation, and myopia onset in premyopic children. TRIAL REGISTRATION This trial was registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR2000034760). Registered 18 July 2020. WHAT IS KNOWN • Minimal studies on interventions for pre-myopia, despite the International Myopia Institute stating that preventing myopia is an "even more valuable target" for science and practice than reducing progression after onset. WHAT IS NEW • A total of 0.01% atropine eye drops may safely and effectively reduce the proportion of myopia onset and fast myopic shift in premyopic schoolchildren.
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Affiliation(s)
- Weiqun Wang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Fengyan Zhang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Shiao Yu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Nana Ma
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Congcong Huang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Ming Wang
- Beijing Aier Intech Eye Hospital, Beijing, 100021, China
| | - Li Wei
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Junjie Zhang
- Henan Eye Institute, Henan Provincial People's Hospital, Zhengzhou, 450000, China
| | - Aicun Fu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China.
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Yam JC, Zhang XJ, Kam KW, Chen LJ, Tham CC, Pang CP. Myopia control and prevention: From lifestyle to low-concentration atropine. The 2022 Josh Wallman Memorial Lecture. Ophthalmic Physiol Opt 2023; 43:299-310. [PMID: 36857025 DOI: 10.1111/opo.13118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 03/02/2023]
Abstract
The purpose of this study was to explore the findings from the Hong Kong Children Eye Study and the Low Concentration Atropine for Myopia Progression (LAMP-1) Study. The incidence of myopia among schoolchildren in Hong Kong more than doubled during the COVID-19 pandemic, with outdoor time decreased significantly and screen time increased. The change in lifestyle during the COVID-19 pandemic aggravated myopia development. Low-concentration atropine (0.05%, 0.025% and 0.01%) is effective in reducing myopia progression with a concentration-related response. This concentration-dependent response was maintained throughout a 3-year follow-up period, and all low concentrations were well tolerated. An age-dependent effect was observed in each treatment group with 0.05%, 0.025% and 0.01% atropine. Younger age was associated with a poor treatment response to low-concentration atropine. Additionally, low-concentration atropine induced choroidal thickening along a concentration-dependent response throughout the treatment period. During the third year, continued atropine treatment achieved a better effect across all concentrations compared with the washout regimen. Stopping treatment at an older age and receiving lower concentration were associated with a smaller rebound effect. However, differences in the rebound effect were clinically small across all the three concentrations studied.
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Affiliation(s)
- Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong, China.,Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China.,Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong, China.,Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China.,Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
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Zhang M, Qiu W, An M, Sun Y, Zhang Z, Yu C. Analysis of the reports of low-concentration atropine in controlling myopia in children. J Fr Ophtalmol 2023; 46:239-248. [PMID: 36797093 DOI: 10.1016/j.jfo.2022.09.024] [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: 07/27/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 02/16/2023]
Abstract
PURPOSE To evaluate the efficacy of 0.01% atropine to slow the progression of myopia in children. METHODS We searched PubMed, Embase, ClinicalTrials.gov, CNKI, Cqvip and Wan fang databases from inception to January 2022, including RCTs (randomized controlled trials) and non-RCTs (non-randomized controlled trials). The search strategy was 'myopia' OR 'refractive error' and 'atropine.' Two researchers independently reviewed the articles, and stata12.0 was used for meta-analysis. The Jadad score was used to assess the quality of RCT, and the Newcastle-Ottawa scale was used for non-RCTs. RESULTS Five RCTs and two non-RCTs (1 prospective non-randomized controlled study, 1 retrospective cohort study) were identified (including 1000 eyes). Results of the meta-analysis showed statistical heterogeneity among the 7 included studies (P=0. 026, I2 =47.1%). According to different durations of atropine use - 4 months, 6 months and greater than 8 months, subgroup analysis results showed that the axial elongation of all experimental groups relative to control groups were respectively -0.03mm (95% [CI], (confidence interval), -0.07 to 0.01), -0.07mm (95% [CI], -0.10 to -0.05), -0.09mm (95% [CI], -0.12 to -0.06). Each P was greater than 0.05, which indicated that there is little heterogeneity among the subgroups. CONCLUSIONS In this meta-analysis of the short-term efficacy of atropine in myopia patients, it was found that there was little heterogeneity when grouped by usage time. It is suggested that the use of atropine in the treatment of myopia is not only related to its concentration but also related to the duration of use.
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Affiliation(s)
- M Zhang
- School of Basic Medical Sciences, Qingdao University, Qingdao 266071, China.
| | - W Qiu
- Qingdao Municipal Hospital, Qingdao, China.
| | - M An
- Qingdao Municipal Hospital, Qingdao, China.
| | - Y Sun
- School of Basic Medical Sciences, Qingdao University, Qingdao 266071, China.
| | - Z Zhang
- School of Basic Medical Sciences, Qingdao University, Qingdao 266071, China.
| | - C Yu
- School of Basic Medical Sciences, Qingdao University, Qingdao 266071, China.
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13
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Hvid-Hansen A, Jacobsen N, Hjortdal J, Møller F, Ozenne B, Kessel L. Low-Dose Atropine Induces Changes in Ocular Biometrics in Myopic Children: Exploring Temporal Changes by Linear Mixed Models and Contribution to Treatment Effect by Mediation Analyses. J Clin Med 2023; 12:jcm12041605. [PMID: 36836139 PMCID: PMC9966043 DOI: 10.3390/jcm12041605] [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: 01/20/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
This study aimed to investigate changes in non-cycloplegic ocular biometrics during the initial six months of treatment with a 0.1% atropine loading dose and 0.01% atropine compared with a placebo and analyze their contribution to the treatment effect on cycloplegic spherical equivalent (SE) progression. The study was based on a randomized, double-masked, placebo-controlled, multicenter trial evaluating a 0.1% atropine six-month loading dose and 0.01% atropine in reducing myopic progression in Danish children. The treatment phase was 24 months, and the washout phase was 12 months. Parameters measured included changes in axial length (AL), anterior chamber depth (ACD), lens thickness (LT), vitreous chamber depth (VCD), and choroidal thickness (ChT), while cycloplegic SE and lens power were calculated. Longitudinal changes and contributions to treatment effects were analyzed using constrained linear mixed models and mediation analyses, respectively. After six months, AL was 0.13 mm shorter (95% confidence interval [CI], -0.18 to -0.07 [adjusted p < 0.001]) and 0.06 mm shorter (95% CI, -0.11 to -0.01 [adjusted p = 0.060]) with a 0.1% atropine loading dose and 0.01% atropine, respectively, compared to the placebo group. Similar concentration-dependent changes were found with ACD, LT, VCD, ChT, and cycloplegic SE. Although the treatment effects trended toward concentration-dependent responses, only the treatment effect mediated by AL at three months differed significantly between 0.01% atropine and a 0.1% atropine loading dose (adjusted p = 0.023). Several ocular biometrics, including AL, ACD, and LT, changed dose-dependently during low-dose atropine treatment. Moreover, the treatment effect of atropine on SE progression was mediated by a subset of ocular biometrics, mainly AL, with trends toward concentration dependency and distributional shifts over time.
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Affiliation(s)
- Anders Hvid-Hansen
- Department of Ophthalmology, Copenhagen University Hospital—Rigshospitalet-Glostrup, DK-2600 Glostrup, Denmark
- Correspondence:
| | - Nina Jacobsen
- Department of Ophthalmology, Copenhagen University Hospital—Rigshospitalet-Glostrup, DK-2600 Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, DK-2200 København N, Denmark
| | - Jesper Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Flemming Møller
- Department of Ophthalmology, University Hospital of Southern Denmark—Vejle Hospital, DK-7100 Vejle, Denmark
| | - Brice Ozenne
- Department of Public Health, Section of Biostatistics, University of Copenhagen, DK-1014 København K, Denmark
- Neurobiology Research Unit, Copenhagen University Hospital—Rigshospitalet, DK-2200 København N, Denmark
| | - Line Kessel
- Department of Ophthalmology, Copenhagen University Hospital—Rigshospitalet-Glostrup, DK-2600 Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, DK-2200 København N, Denmark
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14
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Hvid-Hansen A, Jacobsen N, Møller F, Bek T, Ozenne B, Kessel L. Myopia Control with Low-Dose Atropine in European Children: Six-Month Results from a Randomized, Double-Masked, Placebo-Controlled, Multicenter Study. J Pers Med 2023; 13:jpm13020325. [PMID: 36836559 PMCID: PMC9960354 DOI: 10.3390/jpm13020325] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/16/2023] Open
Abstract
The effect and safety of low-dose atropine in myopia control have not been studied in randomized, placebo-controlled trials outside Asia. We investigated the efficacy and safety of 0.1% atropine loading dose and 0.01% atropine compared with a placebo in a European population. Investigator-initiated, randomized, double-masked, placebo-controlled, equal-allocation, multicenter study comparing 0.1% atropine loading dose (six months) followed by 0.01% atropine (18 months), 0.01% atropine (24 months), and placebo (24 months). Participants were monitored for a 12-months washout period. Outcome measures were axial length (AL), cycloplegic spherical equivalent (SE), photopic and mesopic pupil size, accommodation amplitude, visual acuity, intraocular pressure (IOP), and adverse reactions and events. We randomized 97 participants (mean [standard deviation] age, 9.4 [1.7] years; 55 girls (57%) and 42 boys (43%)). After six months, AL was 0.13 mm shorter (95% confidence interval [CI], -0.18 to -0.07 [adjusted p < 0.001]) with 0.1% atropine loading dose and 0.06 mm shorter (95% CI, -0.11 to -0.01 [adjusted p = 0.06]) with 0.01% atropine than in the placebo group. We observed similar dose-dependent changes in SE, pupil size, accommodation amplitude, and adverse reactions. No significant differences in visual acuity or IOP were found between groups, and no serious adverse reactions were reported. We found a dose-dependent effect of low-dose atropine in European children without adverse reactions requiring photochromatic or progressive spectacles. Our results are comparable to those observed in East Asia, indicating that results on myopia control with low-dose atropine are generalizable across populations with different racial backgrounds.
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Affiliation(s)
- Anders Hvid-Hansen
- Department of Ophthalmology, Copenhagen University Hospital—Rigshospitalet-Glostrup, DK-2600 Glostrup, Denmark
- Correspondence:
| | - Nina Jacobsen
- Department of Ophthalmology, Copenhagen University Hospital—Rigshospitalet-Glostrup, DK-2600 Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, DK-2200 København N, Denmark
| | - Flemming Møller
- Department of Ophthalmology, University Hospital of Southern Denmark—Vejle Hospital, DK-7100 Vejle, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Brice Ozenne
- Department of Public Health, Section of Biostatistics, University of Copenhagen, DK-1014 København K, Denmark
- Neurobiology Research Unit, Copenhagen University Hospital—Rigshospitalet, DK-2200 København N, Denmark
| | - Line Kessel
- Department of Ophthalmology, Copenhagen University Hospital—Rigshospitalet-Glostrup, DK-2600 Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, DK-2200 København N, Denmark
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15
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Foo LL, Lim GYS, Lanca C, Wong CW, Hoang QV, Zhang XJ, Yam JC, Schmetterer L, Chia A, Wong TY, Ting DSW, Saw SM, Ang M. Deep learning system to predict the 5-year risk of high myopia using fundus imaging in children. NPJ Digit Med 2023; 6:10. [PMID: 36702878 PMCID: PMC9879938 DOI: 10.1038/s41746-023-00752-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023] Open
Abstract
Our study aims to identify children at risk of developing high myopia for timely assessment and intervention, preventing myopia progression and complications in adulthood through the development of a deep learning system (DLS). Using a school-based cohort in Singapore comprising of 998 children (aged 6-12 years old), we train and perform primary validation of the DLS using 7456 baseline fundus images of 1878 eyes; with external validation using an independent test dataset of 821 baseline fundus images of 189 eyes together with clinical data (age, gender, race, parental myopia, and baseline spherical equivalent (SE)). We derive three distinct algorithms - image, clinical and mix (image + clinical) models to predict high myopia development (SE ≤ -6.00 diopter) during teenage years (5 years later, age 11-17). Model performance is evaluated using area under the receiver operating curve (AUC). Our image models (Primary dataset AUC 0.93-0.95; Test dataset 0.91-0.93), clinical models (Primary dataset AUC 0.90-0.97; Test dataset 0.93-0.94) and mixed (image + clinical) models (Primary dataset AUC 0.97; Test dataset 0.97-0.98) achieve clinically acceptable performance. The addition of 1 year SE progression variable has minimal impact on the DLS performance (clinical model AUC 0.98 versus 0.97 in primary dataset, 0.97 versus 0.94 in test dataset; mixed model AUC 0.99 versus 0.97 in primary dataset, 0.95 versus 0.98 in test dataset). Thus, our DLS allows prediction of the development of high myopia by teenage years amongst school-going children. This has potential utility as a clinical-decision support tool to identify "at-risk" children for early intervention.
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Affiliation(s)
- Li Lian Foo
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Gilbert Yong San Lim
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Carla Lanca
- grid.418858.80000 0000 9084 0599Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL), Instituto Politécnico de Lisboa, Lisboa, Portugal ,grid.10772.330000000121511713Comprehensive Health Research Center (CHRC), Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Chee Wai Wong
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore ,grid.415572.00000 0004 0620 9577Asia Pacific Eye Centre, Gleneagles Hospital, Singapore, Singapore
| | - Quan V. Hoang
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ,grid.21729.3f0000000419368729Dept. of Ophthalmology, Columbia University, Columbia, SC USA
| | - Xiu Juan Zhang
- grid.10784.3a0000 0004 1937 0482Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Jason C. Yam
- grid.10784.3a0000 0004 1937 0482Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China ,grid.490089.c0000 0004 1803 8779Hong Kong Eye Hospital, Hong Kong, China ,grid.415197.f0000 0004 1764 7206Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China ,grid.10784.3a0000 0004 1937 0482Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China ,Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong, China
| | - Leopold Schmetterer
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Audrey Chia
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Tien Yin Wong
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Daniel S. W. Ting
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Seang-Mei Saw
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Marcus Ang
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
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Wang S, Ji Y, Bai W, Ji Y, Li J, Yao Y, Zhang Z, Jiang Q, Li K. Advances in artificial intelligence models and algorithms in the field of optometry. Front Cell Dev Biol 2023; 11:1170068. [PMID: 37187617 PMCID: PMC10175695 DOI: 10.3389/fcell.2023.1170068] [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: 02/27/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
The rapid development of computer science over the past few decades has led to unprecedented progress in the field of artificial intelligence (AI). Its wide application in ophthalmology, especially image processing and data analysis, is particularly extensive and its performance excellent. In recent years, AI has been increasingly applied in optometry with remarkable results. This review is a summary of the application progress of different AI models and algorithms used in optometry (for problems such as myopia, strabismus, amblyopia, keratoconus, and intraocular lens) and includes a discussion of the limitations and challenges associated with its application in this field.
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Affiliation(s)
- Suyu Wang
- Department of Ophthalmology, The Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
- The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Yuke Ji
- Department of Ophthalmology, The Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
- The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Wen Bai
- Department of Ophthalmology, The Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
- The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Yun Ji
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jiajun Li
- Department of Ophthalmology, The Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
- The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Yujia Yao
- Department of Ophthalmology, The Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
- The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Ziran Zhang
- Department of Ophthalmology, The Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
- The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Qin Jiang
- Department of Ophthalmology, The Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
- The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing, China
- *Correspondence: Qin Jiang, ; Keran Li,
| | - Keran Li
- Department of Ophthalmology, The Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
- The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing, China
- *Correspondence: Qin Jiang, ; Keran Li,
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Cho H, Seo Y, Han SH, Han J. Factors Related to Axial Length Elongation in Myopic Children Who Received 0.05% Atropine Treatment. J Ocul Pharmacol Ther 2022; 38:703-708. [PMID: 36269657 DOI: 10.1089/jop.2022.0036] [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: 01/05/2023] Open
Abstract
Purpose: To evaluate the longitudinal changes of axial length (AL) and factors associated with AL growth in myopic children receiving 0.05% atropine. Methods: This single-center retrospective study included children aged 4-13 years with myopia of at least -0.5 diopters (D) treated with 0.05% atropine eye drops from November 2016 to May 2021. Predictive factors for AL change were evaluated using linear mixed models. Results: Among 109 patients (218 eyes), 58 (53.2%) were male and the mean age at treatment was 8.5 ± 2.0 years. At baseline measurement, the mean spherical equivalent was -4.05 ± 2.34 diopters (D), and AL was 25.00 ± 0.97 mm. The mean follow-up duration was 25.4 (12-58) months, and the mean AL elongation was 0.23 ± 0.17 mm/year during the follow-up periods. AL shortening of ≥0.05 mm at subsequent visit occurred in 18 patients (26 eyes). The mean AL change in the group without initial AL shortening was statistically larger than that in the group with initial AL shortening (0.26 ± 0.16 mm/year vs. 0.02 ± 0.17 mm/year, P < 0.001). In linear mixed model, the age at atropine treatment and initial AL shortening were significantly associated with respect to AL growth (beta coefficient: -0.032 and -0.122, respectively, P < 0.001 for both). Conclusions: Our study found that older age and initial AL shortening are predictors of favorable response after 0.05% atropine treatment. Children with AL shortening at initial subsequent visit may be associated with good long-term response, and younger children may require higher concentration of atropine for optimal response.
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Affiliation(s)
- Hyuna Cho
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yuri Seo
- Institute of Vision Research, Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Sueng-Han Han
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jinu Han
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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18
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Comparisons of Three Methods for Myopia Control in Adolescents. J Ophthalmol 2022; 2022:9920002. [PMID: 36211597 PMCID: PMC9536993 DOI: 10.1155/2022/9920002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 12/03/2022] Open
Abstract
Objective A rising trend in electronic use has increased the prevalence of myopia in adolescents, but the optimal approach to controlling myopia remains undetermined. Here, we explored the effects of common single vision (SV) spectacle lenses combined with 0.01% atropine eye drops (SV + A), orthokeratology (OK) lenses, and peripheral defocus (PD) spectacle lenses on myopia control in adolescents. Methods Totally 150 myopic adolescent patients (300 eyes) receiving treatment at The First People's Hospital of Chenzhou City were enrolled. According to doctors' advice and guardians' wishes, the patients were divided into SV + A group, OK group, and PD group, with each group consisting of 50 cases (100 eyes). The spherical equivalent, axial length, accommodative response index (accommodative sensitivity and accommodative lag), and intraocular pressure were compared before and after 12 months of wearing lenses, and the complications were recorded. Results Before wearing lenses, there was no statistical significance in baseline characteristics such as age, gender, and spherical equivalent among the three groups (P > 0.05). After wearing lenses, the increase in spherical equivalent and axial length in the SV + A and OK groups were lower than in the PD group (P < 0.05), and the SV + A group had the lowest axial length growth. Compared with the SV + A group, accommodative sensitivity was much higher and accommodative lag was significantly lower in the OK and PD groups (P < 0.01). In addition, there was no significant difference in intraocular pressure before and after wearing lenses among the three groups (P > 0.05). Though the OK group patients had more complications, the difference was not statistically significant (P > 0.05). Conclusion SV + A, OK, and PD lenses can effectively control the progression of myopia in adolescents, but SV + A and OK lenses exhibited more significant effects.
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Shi Y. Effect of Atropine Eye Drops Combined with VR-Based Binocular Visual Function Balance Training for Prevention and Control of Juvenile Myopia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:4159996. [PMID: 36147642 PMCID: PMC9489366 DOI: 10.1155/2022/4159996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/26/2022] [Accepted: 08/08/2022] [Indexed: 11/20/2022]
Abstract
Purpose This study mainly analyzes the efficacy of 0.01% atropine eye drops (low-dose atropine (LDA)) combined with virtual reality (VR)-based binocular visual function (BVF) balance training in the prevention and control of juvenile myopia. Methods One hundred and thirty-six juvenile myopia patients admitted between November 2018 to November 2021 were selected, including 76 cases (research group) receiving LDA + VR-based BVF balance training and 60 cases (control group) treated by LDA intervention alone. Visual acuity (VA; naked vision), ocular parameters (pupil diameter (PD), axial length (AXL), and diopter), intraocular pressure (IOP), accommodation facility, clinical efficacy, and incidence of adverse reactions were observed, compared, and analyzed in both groups. Results After analysis, it was found that the research group showed significantly higher naked vision and PD while statistically lower D after intervention than the corresponding preinterventional parameters than the control group. While AXL showed no statistical difference between the groups and within groups. The IOP also differed insignificantly between groups, but the post-treatment accommodation facility was better in the research group compared with the baseline (before treatment) and control group. In terms of curative effects, an obviously higher total effective rate was determined in the research group. In addition, the two groups showed no significant difference in the incidence of adverse reactions. Conclusions LDA + VR-based BVF balance training deserves clinical popularization, as it can prevent and control myopia among teenagers, with better adjusting effects on eye function and certain safety.
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Affiliation(s)
- Yuping Shi
- Chengdu Aier Eye Hospital, Chengdu 610041, Sichuan, China
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Chen CW, Yao JY. RNA sequence analysis identified bone morphogenetic protein-2 (BMP2) as a biomarker underlying form deprivation myopia. Biochem Biophys Rep 2022; 30:101261. [PMID: 35494490 PMCID: PMC9043376 DOI: 10.1016/j.bbrep.2022.101261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose Form deprivation myopia (FDM) is an urgent public issue characterized by pathological changes, but the underlying mechanism remained unclear. The aim was to investigate bone morphogenetic proteins (BMPs) utilizing the pathogenesis of FDM. Material and methods Gene expression omnibus (GEO) database was used to analyze one mRNA profile (GSE89325) of FDM. Sixteen retina samples (8 FDM and 8 controls) were randomly divided into seven groups for differential gene expression analysis in R. software. The gene pathway and protein-protein interaction (PPI) analysis were performed by the DAVID and STRING databases. Cytoscape was used to draw the PPI network. The gene ontology (GO) enrichment and Kyoto encyclopedia of genes and Genomes (KEGG) analysis were determined to achieve gene annotation and visualization. Results A total of 18420 differentially expressed genes (DEGs) were identified associated with FDM. The only non-significant gene (BEND6) was separately analyzed between two groups. Thirteen hub genes were discovered, ACVR1, ACVR2A, ACVR2B, RGMB, BMPR2, BMPR1A, BMP2, BMPR1B, CHRD, PTH, PTH1R, PTHLH, and WNT9A. The expression alteration in FDM were mainly enriched in cytokine-cytokine, and neuroactive ligand receptor interaction pathways. BMP2 was the key gene in myopia progression. Conclusions Of clinical perspective, our findings reveal that expression of BMP2 as an underlying mechanism of FDM, providing an insight for therapeutic interventions. BMP2 is a novel biomarker of myopia. Neuroactive ligand receptor interaction has some potential clinical applications. Estimating gene changes could become one of methods for myopia prevention.
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Gao Y, Yu Y. The effect of 0.01% atropine on ocular axial elongation for myopia children: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29409. [PMID: 35665735 PMCID: PMC9276353 DOI: 10.1097/md.0000000000029409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/17/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Orthokeratology (OK) has a significant effect on the control of myopia progression, and has been accepted by doctors and patients. A small number of studies have shown that the combination of OK and atropine can enhance myopia control. However, owing to individual differences, research groups, drug concentrations, and research design differences, the safety and effectiveness of the combined treatment still need to be verified. Therefore, the present meta-analysis aimed to determine the effect of 0.01% atropine on ocular axial elongation in myopic children. METHODS We searched the PubMed, Cochrane Library, and CBM databases from inception to March 1, 2022. Meta-analysis will be conducted using STATA version 14.0 and Review Manager version 5.3 softwares. We calculated the weighted mean differences (WMD) to analyze the change in ocular axial length (AL) between orthokeratology combined with 0.01% atropine (OKA) and OK alone. Cochran's Q-statistic and I2 test were used to evaluate the potential heterogeneity between studies. A sensitivity analysis was performed to evaluate the influence of single studies on the overall estimate. We will also perform subgroup and meta-regression analyses to investigate potential sources of heterogeneity. We will conduct Begger's funnel plots and Egger's linear regression tests to investigate the publication bias. RESULTS This systematic review aimed to determine the effect of 0.01% atropine on ocular axial elongation in children with myopia. CONCLUSIONS These findings provide helpful evidence for the effect of 0.01% atropine on ocular axial elongation in myopic children.
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Affiliation(s)
- Yue Gao
- Guangzhou Tianhe Shixian Ophthalmology Clinic Co., Ltd, Guangzhou, China
| | - Yan Yu
- Ophthalmology Department of the First Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, China
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22
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One-year analysis of the refractive stability, axial elongation and related factors in a high myopia population after Implantable Collamer Lens implantation. Int Ophthalmol 2022; 42:3295-3302. [PMID: 35590026 DOI: 10.1007/s10792-022-02328-z] [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: 11/10/2021] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the refractive stability, axial length (AL) changes and their related factors in a high myopia population after Implantable Collamer Lens (ICL) implantation. METHODS This prospective study included 116 eyes of 116 patients divided into several groups based on the spherical equivalent refractive error (SE)-SE > - 6 D, - 12 ≤ SE < - 6 D and SE < - 12 D groups-and AL-AL < 28 mm and AL ≥ 28 mm groups. The uncorrected and corrected distance visual acuity, refraction, AL and intraocular pressure were followed for 1 year. RESULTS SE changed from - 11.53 ± 5.25 D preoperatively to - 0.33 ± 0.70 D at 1 week, and further changed to - 0.48 ± 0.77 D at 1 year after ICL implantation, with average progression being - 0.15 ± 0.37 D from 1 week to 1 year after surgery. AL changed from 27.95 ± 2.33 mm preoperatively to 27.98 ± 2.36 mm 1 year after surgery, with an average axial elongation of 0.03 ± 0.12 mm. The mean axial elongation rate was 0.05 mm/year in the SE < - 12 D group, being significantly faster than the other refractive groups (P < 0.05); it was 0.06 mm/year in the AL ≥ 28 mm group, being significantly faster than the AL < 28 mm group (P < 0.05). CONCLUSION Patients with high myopia and long AL showed a continuous myopic progression and axial elongation at an adult age one year after ICL surgery, especially in those with myopia higher than - 12.00 D and AL longer than 28.00 mm.
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Yoon J, Ha SG, Suh Y, Kim SH. Efficacy of Low-dose Atropine Eyedrops in Myopic Progression in Elementary School Children. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2022. [DOI: 10.3341/jkos.2022.63.5.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: We analyzed the effects of low-dose atropine on myopic progression in elementary schoolchildren aged 6-11 years.Methods: Medical records were retrospectively reviewed before and after 6 months of low-dose atropine eyedrops. Myopia was defined as a spherical equivalent < -1 diopter. Low-dose atropine eyedrops (atropine sulfate 0.125% [w/v]) and artificial tear eyedrops (sodium hyaluronate 0.1% [w/v]) immediately afterwards were applied to both eyes daily, and all children regularly visited us for measurement of refractive power, axial length, pupil diameter, and near-point accommodation. symptoms (headache, light sensitivity, near-work disturbance, allergic reaction, dry eye, and poor night vision) were recorded.Results: A total of 116 patients were included. Atropine was prescribed for 65 patients, the remaining 51 patients constituted the control group. In the atropine group, the mean age was 10.2 ± 1.8 years and 23 patients (35.4%) were male. At the initial visit, the mean refractive power was -4.7 ± 2.1 diopters (D) (-1.0 to -10.5) and the mean axial length was 24.95 ± 1.02 mm (22.58-27.99). At the 6-month follow-up, the change of refractive power was -0.9 ± 1.1 D (-0.75 to -4.75) and the change of axial length was 0.47 ± 0.39 mm (0.01-1.6). However, 6 months after application of low-dose atropine eyedrops, the change of refractive power was -0.1 ± 0.2 D (0 to -0.25) and the change of mean axial length was 0.15 ± 0.23 mm (0-1.05). The mean pupil diameter was 6.7 ± 0.6 mm (5.3-9.3) and the near accommodation point was 6.1 ± 2.0 cm (3.1-11.0). Two patients (3.1%) complained of near-work disturbance but none stopped taking the eyedrops.Conclusions: Significant decreases in the changes of refractive power and axial length were evident in myopic elementary schoolchildren after low-dose atropine therapy. Low-dose atropine attenuates myopic progression without severe complications.
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Yu Y, Liu J. The effect of 0.01% atropine and orthokeratology on ocular axial elongation for myopia children: A meta-analysis (a PRISMA-compliant article). Medicine (Baltimore) 2022; 101:e29191. [PMID: 35550467 PMCID: PMC9276445 DOI: 10.1097/md.0000000000029191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/09/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES This meta-analysis aimed to identify the therapeutic effect of 0.01% atropine with orthokeratology on ocular axial elongation for myopia children. METHODS We searched PubMed, Cochrane Library, and CBM databases from inception to July 1st, 2021. Meta-analysis was conducted using STATA version 14.0 and Review Manager version 5.3 softwares. We calculated the weighted mean differences to analyze the change of ocular axial length (AL) between orthokeratology combined with 0.01% atropine (OKA) and) alone. The Cochran's Q-statistic and I2 test were used to evaluate potential heterogeneity between studies. To evaluate the influence of single studies on the overall estimate, a sensitivity analysis was performed. We also performed sub group and meta-regression analyses to investigate potential sources of heterogeneity. We conducted Begger funnel plots and Egger linear regression tests to investigate publication bias. RESULTS Nine studies that met all inclusion criteria were included in this meta-analysis. A total of 191 children in OKA group and 196 children in orthokeratology (OK) group were assessed. The pooled summary weighted mean differences of AL change was -0.90 (95% CI = -1.25-0.55) with statistical significance (t = -5.03, P < .01), which indicated there was obvious difference between OKA and OK in myopic children. Subgroup analysis also showed that OKA treatment resulted in significantly less axial elongation compared to OK treatment alone according to SER. We found no evidence for publication bias. CONCLUSIONS Our meta-analysis indicates 0.01% atropine atropine is effective in slowing axial elongation in myopia children with orthokeratology.
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Affiliation(s)
- Yan Yu
- Ophthalmology Department of the First Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, China
| | - Jiasu Liu
- Ophthalmology Department of the Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, China
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25
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Kassam I, Foo LL, Lanca C, Xu L, Hoang QV, Cheng CY, Hysi P, Saw SM. The potential of current polygenic risk scores to predict high myopia and myopic macular degeneration in multi-ethnic Singapore adults. Ophthalmology 2022; 129:890-902. [DOI: 10.1016/j.ophtha.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/26/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022] Open
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Li Y, Zhu L, Wang R, Yang X, Jiang X, Lu T. Guided meditation for vision acuity training on adolescent myopia: study protocol for an open-label, prospective, multicenter, randomized controlled trial. Trials 2022; 23:16. [PMID: 34991689 PMCID: PMC8734215 DOI: 10.1186/s13063-021-05922-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 12/07/2021] [Indexed: 12/04/2022] Open
Abstract
Background Currently, the population with myopia climbs steadily, and is developing toward younger age, posing a great concern to the health of adolescents. Myopia in severe cases can cause irreversible consequences such as glaucoma, blindness, and other complications. At present, the solutions for myopia are glasses, medication, and surgery. This study aims to investigate the role of a physiotherapy category based on guided meditation for vision acuity training on adolescent myopia. Methods This is a prospective, randomized, multicenter clinical trial. One thousand one hundred forty primary and secondary school students aged 8–18 years old from 27 schools will be recruited and randomly divided into an experimental and a control group at a ratio of 2:1 in two phases, with a training period of 30 days in each phase and a follow-up period of 3 months. No interventions will be conducted during the follow-up period, nor will other interventions employed. Inclusion criteria will meet the diagnostic criteria for simple myopia and −6.00D ≤ spherical lenses ≤ −0.50D and cylindrical lenses ≤1.50D. The primary observation index will be to compare the statistical differences in distant visual acuity between the two groups; the secondary observation indexes will be ocular symptoms (mainly including eye fatigue, dryness, pain, double vision, neck pain, thought disorders, and lags in response), diopter, and astigmatism. Discussion The purpose of this two-phase trial is to compare the clinical effectiveness of focused vision-guided meditation with Chinese eye exercises that are also non-pharmacological, non-invasive interventions for myopia, and to maximize the benefit to the subjects. The results will indicate whether the training based on focused vision-guided meditation has the ability to improve distant visual acuity, relieve ocular symptoms, and ameliorate diopter. In addition, this trial will provide clinical efficacy of the training, which is expected to provide meaningful data for vision rehabilitation. At the same time, the vision acuity training method, which is permeated with the concept of Traditional Chinese Medicine (TCM) rehabilitation and health maintenance, will be applied to achieve the goal of preventing or alleviating myopic development and reducing myopia rate. Trial registration Chinese Clinical Trial Registry ChiCTR2000038642. Registered on 26 September 2020
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Affiliation(s)
- Yibo Li
- Beijing University of Chinese Medicine, 11 Beisanhuan Dong Lu, Chaoyang District, Beijing, China
| | - Lili Zhu
- Beijing University of Chinese Medicine, 11 Beisanhuan Dong Lu, Chaoyang District, Beijing, China
| | - Raoying Wang
- Beijing University of Chinese Medicine, 11 Beisanhuan Dong Lu, Chaoyang District, Beijing, China
| | - Xingyue Yang
- Beijing University of Chinese Medicine, 11 Beisanhuan Dong Lu, Chaoyang District, Beijing, China
| | - Xinqi Jiang
- Beijing University of Chinese Medicine, 11 Beisanhuan Dong Lu, Chaoyang District, Beijing, China
| | - Tao Lu
- Beijing University of Chinese Medicine, 11 Beisanhuan Dong Lu, Chaoyang District, Beijing, China.
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Foo LL, Lanca C, Wong CW, Ting D, Lamoureux E, Saw SM, Ang M. Cost of Myopia Correction: A Systematic Review. Front Med (Lausanne) 2021; 8:718724. [PMID: 34926485 PMCID: PMC8677936 DOI: 10.3389/fmed.2021.718724] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
Myopia is one of the leading causes of visual impairment globally. Despite increasing prevalence and incidence, the associated cost of treatment remains unclear. Health care spending is a major concern in many countries and understanding the cost of myopia correction is the first step eluding to the overall cost of myopia treatment. As cost of treatment will reduce the burden of cost of illness, this will aid in future cost-benefit analysis and the allocation of healthcare resources, including considerations in integrating eye care (refractive correction with spectacles) into universal health coverage (UHC). We performed a systematic review to determine the economic costs of myopia correction. However, there were few studies for direct comparison. Costs related to myopia correction were mainly direct with few indirect costs. Annual prevalence-based direct costs for myopia ranged from $14-26 (USA), $56 (Iran) and $199 (Singapore) per capita, respectively (population: 274.63 million, 75.15 million and 3.79 million, respectively). Annually, the direct costs of contact lens were $198.30-$378.10 while spectacles and refractive surgeries were $342.50 and $19.10, respectively. This review provides an insight to the cost of myopia correction. Myopia costs are high from nation-wide perspectives because of the high prevalence of myopia, with contact lenses being the more expensive option. Without further interventions, the burden of illness of myopia will increase substantially with the projected increase in prevalence worldwide. Future studies will be necessary to generate more homogenous cost data and provide a complete picture of the global economic cost of myopia.
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Affiliation(s)
- Li Lian Foo
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Carla Lanca
- Singapore Eye Research Institute, Singapore, Singapore.,Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL), Instituto Politécnico de Lisboa, Lisboa, Portugal.,Comprehensive Health Research Center (CHRC), Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Daniel Ting
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.,NUS Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
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Three-Year Clinical Trial of Low-Concentration Atropine for Myopia Progression Study: Continued Versus Washout: Phase 3 Report. Ophthalmology 2021; 129:308-321. [PMID: 34627809 DOI: 10.1016/j.ophtha.2021.10.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE (1) To compare the efficacy of continued and stopping treatment for 0.05%, 0.025%, and 0.01% atropine during the third year. (2) To evaluate the efficacy of continued treatment over 3 years. (3) To investigate the rebound phenomenon and its determinants after cessation of treatment. DESIGN A randomized, double-masked extended trial. PARTICIPANTS A total of 350 of 438 children aged 4 to 12 years originally recruited into the Low-Concentration Atropine for Myopia Progression (LAMP) study. METHODS At the beginning of the third year, children in each group were randomized at a 1:1 ratio to continued treatment and washout subgroups. Cycloplegic spherical equivalent (SE) refraction and axial length (AL) were measured at 4-month intervals. MAIN OUTCOME MEASURES Changes in SE and AL between groups. RESULTS A total of 326 children completed 3 years of follow-up. During the third year, SE progression and AL elongation were faster in the washout subgroups than in the continued treatment groups across all concentrations: -0.68 ± 0.49 diopters (D) versus -0.28 ± 0.42 D (P < 0.001) and 0.33 ± 0.17 mm versus 0.17 ± 0.14 mm (P < 0.001) for the 0.05%; -0.57 ± 0.38 D versus -0.35 ± 0.37 D (P = 0.004) and 0.29 ± 0.14 mm versus 0.20 ± 0.15 mm (P = 0.001) for the 0.025%; -0.56 ± 0.40 D versus -0.38 ± 0.49 D (P = 0.04) and 0.29 ± 0.15 mm versus 0.24 ± 0.18 mm (P = 0.13) for the 0.01%. Over the 3-year period, SE progressions were -0.73 ± 1.04 D, -1.31 ± 0.92 D, and -1.60 ± 1.32 D (P = 0.001) for the 0.05%, 0.025%, and 0.01% groups in the continued treatment subgroups, respectively, and -1.15 ± 1.13 D, -1.47 ± 0.77 D, and -1.81 ± 1.10 D (P = 0.03), respectively, in the washout subgroup. The respective AL elongations were 0.50 ± 0.40 mm, 0.74 ± 0.41 mm, and 0.89 ± 0.53 mm (P < 0.001) for the continued treatment subgroups and 0.70 ± 0.47 mm, 0.82 ± 0.37 mm, and 0.98 ± 0.48 mm (P = 0.04) for the washout subgroup. The rebound SE progressions during washout were concentration dependent, but their differences were clinically small (P = 0.15). Older age and lower concentration were associated with smaller rebound effects in both SE progression (P < 0.001) and AL elongation (P < 0.001). CONCLUSIONS During the third year, continued atropine treatment achieved a better effect across all concentrations compared with the washout regimen. 0.05% atropine remained the optimal concentration over 3 years in Chinese children. The differences in rebound effects were clinically small across all 3 studied atropine concentrations. Stopping treatment at an older age and lower concentration are associated with a smaller rebound.
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Mitsukawa T, Suzuki Y, Momota Y, Suzuki S, Yamada M. Effects of 0.01% Atropine Instillation Assessed Using Swept-Source Anterior Segment Optical Coherence Tomography. J Clin Med 2021; 10:jcm10194384. [PMID: 34640402 PMCID: PMC8509630 DOI: 10.3390/jcm10194384] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 01/16/2023] Open
Abstract
In this paper, we assessed the short-term effects of 0.01% atropine eye drops on anterior segment parameters by performing ocular biometry using a swept-source anterior segment optical coherence tomography system (AS-OCT). We recruited 17 healthy volunteers (10 men and 7 women aged 24–35 years) with no history of eye disease. Participants without accommodative demand demonstrated significant mydriasis 1 h after the atropine instillation (4.58 ± 0.77 to 5.41 ± 0.83 mm). Pupil diameters with a 5 diopter (D) accommodative stimulus at 1 h (4.70 ± 1.13 mm) and 24 h (4.05 ± 1.06 mm) after atropine instillation were significantly larger than those at baseline (3.71 ± 0.84 mm). Barring pupil diameter, no other biometric parameters significantly changed at any point in time after atropine instillation without accommodative demand. However, with an accommodative stimulus, anterior chamber depth (ACD) at 1 h and posterior curvature of the lens at 1 and 24 h were both significantly larger than those before atropine instillation. Using AS-OCT, we detected a slight decrease in the accommodation response of ocular biometric components evoked by 0.01% atropine instillation. Morphologically, our measurements suggested a change in the ACD and horizontal radius of the lens’ posterior surface curvatures due to the subtle reduction of accommodation.
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Affiliation(s)
| | - Yumi Suzuki
- Correspondence: ; Tel.: +81-422-47-5511; Fax: +81-422-46-9309
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Leng L, Zhang J, Xie S, Ding W, Ji R, Tian Y, Long K, Yu H, Guo Z. Effect of Sunshine Duration on Myopia in Primary School Students from Northern and Southern China. Int J Gen Med 2021; 14:4913-4922. [PMID: 34483681 PMCID: PMC8409785 DOI: 10.2147/ijgm.s328281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background To assess the current myopia prevalence rate and evaluate the effect of sunshine duration on myopia among primary school students in the north and south of China. Methods This prospective cross-sectional study pooled data from 9171 primary school students (grades from 1 to 6) from four cities in the north and south of China. National Geomatics Center of China (NGCC) and China Meteorological Administration provided data about altitude, latitude, longitude, average annual temperature, and average annual sunshine duration. Non-cycloplegic refraction was recorded, and prevalence rates in primary school students and factors associated with myopia were analyzed. Univariate and multivariate logistic regression models were used to determine the independent association of risk factors of myopia. Results The overall myopia prevalence was 28.0%, from 7.5% to 50.6% for first and sixth grades, respectively. Low, moderate and high myopia significantly increased with school grades from 7.30% to 35.0%, 0.3% to 13.60% and 0.00% to 1.9%, respectively. Multiple regression analysis revealed that longer average cumulative daylight hours were connected to lower myopia prevalence in primary school students (OR, 0.721; 95% CI, [0.593–0.877]; P=0.001), whereas girls and higher grade was independently associated with higher myopia prevalence (girls: β=0.189; OR, 1.208; 95% CI, [1.052–1.387]; P=0.007; higher grade: β=0.502; OR, 1.652; 95% CI, [1.580–1.726]; P<0.001). Conclusion This study demonstrated that myopia was highly prevalent in southern Chinese cities over northern ones, linked to shorter light exposure, higher education level, and female gender. Such findings reinforced the beneficial impact of daylight exposure with a protective role against myopia development.
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Affiliation(s)
- Lin Leng
- Department of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, 266071, Shandong Province, People's Republic of China
| | - Jiafan Zhang
- Department of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, 266071, Shandong Province, People's Republic of China
| | - Sen Xie
- Department of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510000, Guangdong Province, People's Republic of China
| | - Wenzhi Ding
- Department of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, 266071, Shandong Province, People's Republic of China
| | - Rongyuan Ji
- Department of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, 266071, Shandong Province, People's Republic of China
| | - Yuyin Tian
- Department of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, 266071, Shandong Province, People's Republic of China
| | - Keli Long
- Department of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, 266071, Shandong Province, People's Republic of China
| | - Hongliang Yu
- Department of Ophthalmology, Shenyang Eye Docloud Internet Hospital, Shenyang, 110000, Liaoning Province, People's Republic of China
| | - Zhen Guo
- Department of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, 266071, Shandong Province, People's Republic of China
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Foo LL, Ng WY, Lim GYS, Tan TE, Ang M, Ting DSW. Artificial intelligence in myopia: current and future trends. Curr Opin Ophthalmol 2021; 32:413-424. [PMID: 34310401 DOI: 10.1097/icu.0000000000000791] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Myopia is one of the leading causes of visual impairment, with a projected increase in prevalence globally. One potential approach to address myopia and its complications is early detection and treatment. However, current healthcare systems may not be able to cope with the growing burden. Digital technological solutions such as artificial intelligence (AI) have emerged as a potential adjunct for myopia management. RECENT FINDINGS There are currently four significant domains of AI in myopia, including machine learning (ML), deep learning (DL), genetics and natural language processing (NLP). ML has been demonstrated to be a useful adjunctive for myopia prediction and biometry for cataract surgery in highly myopic individuals. DL techniques, particularly convoluted neural networks, have been applied to various image-related diagnostic and predictive solutions. Applications of AI in genomics and NLP appear to be at a nascent stage. SUMMARY Current AI research is mainly focused on disease classification and prediction in myopia. Through greater collaborative research, we envision AI will play an increasingly critical role in big data analysis by aggregating a greater variety of parameters including genomics and environmental factors. This may enable the development of generalizable adjunctive DL systems that could help realize predictive and individualized precision medicine for myopic patients.
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Affiliation(s)
- Li Lian Foo
- Singapore National Eye Centre, Singapore Eye Research Institute
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Wei Yan Ng
- Singapore National Eye Centre, Singapore Eye Research Institute
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | | | - Tien-En Tan
- Singapore National Eye Centre, Singapore Eye Research Institute
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Daniel Shu Wei Ting
- Singapore National Eye Centre, Singapore Eye Research Institute
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
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32
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Jonas JB, Ang M, Cho P, Guggenheim JA, He MG, Jong M, Logan NS, Liu M, Morgan I, Ohno-Matsui K, Pärssinen O, Resnikoff S, Sankaridurg P, Saw SM, Smith EL, Tan DTH, Walline JJ, Wildsoet CF, Wu PC, Zhu X, Wolffsohn JS. IMI Prevention of Myopia and Its Progression. Invest Ophthalmol Vis Sci 2021; 62:6. [PMID: 33909032 PMCID: PMC8083117 DOI: 10.1167/iovs.62.5.6] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The prevalence of myopia has markedly increased in East and Southeast Asia, and pathologic consequences of myopia, including myopic maculopathy and high myopia-associated optic neuropathy, are now some of the most common causes of irreversible blindness. Hence, strategies are warranted to reduce the prevalence of myopia and the progression to high myopia because this is the main modifiable risk factor for pathologic myopia. On the basis of published population-based and interventional studies, an important strategy to reduce the development of myopia is encouraging schoolchildren to spend more time outdoors. As compared with other measures, spending more time outdoors is the safest strategy and aligns with other existing health initiatives, such as obesity prevention, by promoting a healthier lifestyle for children and adolescents. Useful clinical measures to reduce or slow the progression of myopia include the daily application of low-dose atropine eye drops, in concentrations ranging between 0.01% and 0.05%, despite the side effects of a slightly reduced amplitude of accommodation, slight mydriasis, and risk of an allergic reaction; multifocal spectacle design; contact lenses that have power profiles that produce peripheral myopic defocus; and orthokeratology using corneal gas-permeable contact lenses that are designed to flatten the central cornea, leading to midperipheral steeping and peripheral myopic defocus, during overnight wear to eliminate daytime myopia. The risk-to-benefit ratio needs to be weighed up for the individual on the basis of their age, health, and lifestyle. The measures listed above are not mutually exclusive and are beginning to be examined in combination.
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Affiliation(s)
- Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Department of Ophthalmology and Visual Science, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Pauline Cho
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jeremy A Guggenheim
- School of Optometry & Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Ming Guang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yatsen University, Guangzhou, China.,Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Monica Jong
- Brien Holden Vision Institute, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Discipline of Optometry and Vision Science, University of Canberra, Australia
| | - Nicola S Logan
- School of Optometry, Aston University, Birmingham, United Kingdom
| | - Maria Liu
- School of Optometry, University of California, Berkeley, Berkeley, California, United States
| | - Ian Morgan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yatsen University, Guangzhou, China.,Research School of Biology, College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Olavi Pärssinen
- Department of Ophthalmology, Central Hospital of Central Finland, Jyväskylä, Finland.,Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Serge Resnikoff
- Brien Holden Vision Institute, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Padmaja Sankaridurg
- Brien Holden Vision Institute, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Eye & Retina Surgeons, Singapore, Singapore.,Duke-NUS Medical School, Singapore
| | - Earl L Smith
- Brien Holden Vision Institute, Sydney, Australia.,College of Optometry, University of Houston, Houston, Texas, United States
| | - Donald T H Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Department of Ophthalmology and Visual Science, Duke-NUS Graduate Medical School, Singapore, Singapore.,Eye & Retina Surgeons, Singapore, Singapore
| | - Jeffrey J Walline
- The Ohio State University College of Optometry, Columbus, Ohio, United States
| | - Christine F Wildsoet
- School of Optometry, University of California, Berkeley, Berkeley, California, United States
| | - Pei-Chang Wu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Xiaoying Zhu
- Biological and Vision Sciences, State University of New York, College of Optometry, New York, New York, United States
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33
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Kaiti R, Shyangbo R, Sharma IP, Dahal M. Review on current concepts of myopia and its control strategies. Int J Ophthalmol 2021; 14:606-615. [PMID: 33875955 PMCID: PMC8025164 DOI: 10.18240/ijo.2021.04.19] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022] Open
Abstract
Myopia poses a significant burden on the healthcare system, economy and quality of life. It is an emerging global public health challenge and requires interventions to delay or stop onset and progression. With changing times and evidence, the concepts of myopia are changing along with the treatment and control strategies. Behavioural modifications including increased outdoors time and reduced near work, optical and pharmaceutical management options are reviewed. This paper presents a current overview on the concepts of myopia, and is expected to summarize updates on myopia control methods.
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Affiliation(s)
- Raju Kaiti
- Nepal Eye Hospital, Kathmandu 44600, Nepal
| | | | - Indra Prasad Sharma
- Gyalyum Kesang Choeden Wangchuck National Eye Center, JDW National Referral Hospital, Thimpu 11001, Bhutan
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34
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Chen LJ, Li FF, Lu SY, Zhang XJ, Kam KW, Tang SM, Tam PO, Yip WW, Young AL, Tham CC, Pang CP, Yam JC. Association of polymorphisms in ZFHX1B, KCNQ5 and GJD2 with myopia progression and polygenic risk prediction in children. Br J Ophthalmol 2021; 105:1751-1757. [PMID: 33811038 DOI: 10.1136/bjophthalmol-2020-318708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/10/2021] [Accepted: 03/19/2021] [Indexed: 11/03/2022]
Abstract
AIMS To assess the association of single-nucleotide polymorphisms (SNPs) with myopia progression for polygenic risk prediction in children. METHODS Six SNPs (ZC3H11B rs4373767, ZFHX1B rs13382811, KCNQ5 rs7744813, MET rs2073560, SNTB1 rs7839488 and GJD2 rs524952) were analysed in 1043 school children, who completed 3-year follow-up, using TaqMan genotyping assays. SNP associations with progression in spherical equivalent (SE) were analysed by logistic regression. Polygenic risk scores (PRS) were applied for computing the sum of the risk alleles of multiple SNPs corresponding to myopia progression, weighted by the effect sizes of corresponding SNPs. RESULTS GJD2 rs524952 showed significant association with fast progression (OR=1.32, 95% CI 1.10 to 1.59; p=0.003) and KCNQ5 rs7744813 had nominal association (OR=1.32, 95% CI 1.04 to 1.67; p=0.02). In quantitative traits locus analysis, GJD2 rs524952 and KCNQ5 rs7744813 were associated with progression in SE (β=-0.038 D/year, p=0.008 and β=-0.042 D/year, p=0.02) and axial elongation (β=0.016 mm/year, p=0.01 and β=0.017 mm/year, p=0.027). ZFHX1B rs13382811 also showed nominal association with faster progression in SE (β=-0.041 D/year, p=0.02). PRS analysis showed that children with the highest PRS defined by rs13382811, rs7744813 and rs524952 had a 2.26-fold of increased risk of fast myopia progression (p=4.61×10-5). PRS was also significantly associated with SE progression (R2=1.6%, p=3.15×10-5) and axial elongation (R2=1.2%, p=2.6×10-4). CONCLUSIONS In this study, multi-tiered evidence suggested SNPs in ZFHX1B, KCNQ5 and GJD2 as risk factors for myopia progression in children. Additional attention and appropriate interventions should be given for myopic children with high-risk PRS as defined by GJD2 rs524952, KCNQ5 rs7744813 and ZFHX1B rs13382811.
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Affiliation(s)
- Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China .,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
| | - Fen Fen Li
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shi Yao Lu
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Shu Min Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology, First Affiliated Hospital of Fujian Medical University, Xiamen, China
| | - Pancy Os Tam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Wilson Wk Yip
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China .,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong, China
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35
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Foo LL, Ang M, Wong CW, Ohno-Matsui K, Saw SM, Wong TY, Ting DS. Is artificial intelligence a solution to the myopia pandemic? Br J Ophthalmol 2021; 105:741-744. [PMID: 33712483 DOI: 10.1136/bjophthalmol-2021-319129] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Li Lian Foo
- Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
| | - Kyoko Ohno-Matsui
- Ophthalmology and Visual Science, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | | | - Tien Yin Wong
- Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
| | - Daniel S Ting
- Singapore National Eye Centre, Singapore .,Ophthalmology and Visual Sciences Department, Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
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36
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Li FF, Zhang Y, Zhang X, Yip BHK, Tang SM, Kam KW, Young AL, Chen LJ, Tham CC, Pang CP, Yam JC. Age Effect on Treatment Responses to 0.05%, 0.025%, and 0.01% Atropine: Low-Concentration Atropine for Myopia Progression Study. Ophthalmology 2021; 128:1180-1187. [PMID: 33422558 DOI: 10.1016/j.ophtha.2020.12.036] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To investigate the effect of age at treatment and other factors on treatment response to atropine in the Low-Concentration Atropine for Myopia Progression (LAMP) Study. DESIGN Secondary analysis from a randomized trial. PARTICIPANTS Three hundred fifty children aged 4 to 12 years who originally were assigned to receive 0.05%, 0.025%, or 0.01% atropine or placebo once daily, and who completed 2 years of the LAMP Study, were included. In the second year, the placebo group was switched to the 0.05% atropine group. METHODS Potential predictive factors for change in spherical equivalent (SE) and axial length (AL) over 2 years were evaluated by generalized estimating equations in each treatment group. Evaluated factors included age at treatment, gender, baseline refraction, parental myopia, time outdoors, diopter hours of near work, and treatment compliance. Estimated mean values and 95% confidence intervals (CIs) of change in SE and AL over 2 years also were generated. MAIN OUTCOME MEASURES Factors associated with SE change and AL change over 2 years were the primary outcome measures. Associated factors during the first year were secondary outcome measures. RESULTS In 0.05%, 0.025%, and 0.01% atropine groups, younger age was the only factor associated with SE progression (coefficient of 0.14, 0.15, and 0.20, respectively) and AL elongation (coefficient of -0.10, -0.11, and -0.12, respectively) over 2 years; the younger the age, the poorer the response. At each year of age from 4 to 12 years across the treatment groups, higher-concentration atropine showed a better treatment response, following a concentration-dependent effect (Ptrend <0.05 for each age group). In addition, the mean SE progression in 6-year-old children receiving 0.05% atropine (-0.90 diopter [D]; 95% CI, -0.99 to -0.82) was similar to that of 8-year-old children receiving 0.025% atropine (-0.89 D; 95% CI, -0.94 to -0.83) and 10-year-old children receiving 0.01% atropine (-0.92 D; 95% CI, -0.99 to -0.85). All concentrations were well tolerated in all age groups. CONCLUSIONS Younger age is associated with poor treatment response to low-concentration atropine at 0.05%, 0.025%, and 0.01%. Among concentrations studied, younger children required the highest 0.05% concentration to achieve similar reduction in myopic progression as older children receiving lower concentrations.
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Affiliation(s)
- Fen Fen Li
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiujuan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Benjamin Hon Kei Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong
| | - Shu Min Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China; Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China; Hong Kong Eye Hospital, Hong Kong SAR, China; Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong SAR, China.
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37
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Li FF, Lu SY, Tang SM, Kam KW, Pancy O S T, Yip WWK, Young AL, Tham CC, Pang CP, Yam JC, Chen LJ. Genetic associations of myopia severities and endophenotypes in children. Br J Ophthalmol 2020; 105:1178-1183. [PMID: 32816751 DOI: 10.1136/bjophthalmol-2020-316728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/20/2020] [Accepted: 07/07/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the associations of multiple single-nucleotide polymorphisms (SNPs) with the severities and endophenotypes of myopia in children. METHODS A total of 3300 children aged 5-10 years were recruited: 137 moderate and high myopia (SE≤-3.0D), 670 mild myopia (-3.0D<SE≤-0.5D) and 2493 controls (SE>-0.5D). 13 SNPs in 13 genes/loci were selected for genotyping in all subjects using TaqMan assays. Associations between each SNP with myopia severities and ocular traits (spherical equivalent (SE), axial length (AL) and corneal radius (CR)) were analysed. RESULTS When compared with controls, SNPs ZC3H11B rs4373767 (OR=1.15, p=0.038), BICC1 rs7084402 (OR=1.18, p=0.005) and GJD2 rs524952 (OR=1.14, p=0.025) showed nominal associations with overall myopia. ZC3H11B rs4373767 and BICC1 rs7084402 showed stronger associations with moderate and high myopia (rs4373767: OR=1.42, p=0.018; rs7084402: OR=1.33, p=0.025), while GJD2 rs524952 had a stronger association with mild myopia (OR=1.14, p=0.025). GJD2 rs524952 also showed a difference between emmetropia and hyperopia (p=0.018). In quantitative trait locus analysis, ZC3H11B rs4373767, KCNQ5 rs7744813 and GJD2 rs524952 were correlated with both myopic SE (β=-0.09, p=0.03; β=-0.12, p=0.007; β=-0.13, p=0.0006, respectively) and AL (β=0.07, p=0.002; β=0.09, p=0.0008; β=0.07, p=0.0003, respectively). SNTB1 rs7839488 was correlated with both AL (β=0.07, p=0.005) and CR (β=0.02, p=0.006). Moreover, ZC3H11B rs4373767-T (β=0.006; p=0.018), KCNQ5 rs7744813-A (β=0.007; p=0.015) and GJD2 rs524952-T (β=0.009; p=0.0006) were correlated with AL-CR ratio. CONCLUSIONS AND RELEVANCE ZC3H11B and BICC1 are genetic risk factors for moderate and high myopia, while ZC3H11B, KCNQ5, SNTB1 and GJD2 confer risk to excessive AL in children.
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Affiliation(s)
- Fen Fen Li
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Shi Yao Lu
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Shu Min Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Tam Pancy O S
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Wilson W K Yip
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China .,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
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38
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Li FF, Kam KW, Zhang Y, Tang SM, Young AL, Chen LJ, Tham CC, Pang CP, Yam JC. Differential Effects on Ocular Biometrics by 0.05%, 0.025%, and 0.01% Atropine: Low-Concentration Atropine for Myopia Progression Study. Ophthalmology 2020; 127:1603-1611. [PMID: 32525048 DOI: 10.1016/j.ophtha.2020.06.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/23/2020] [Accepted: 06/02/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate changes in ocular biometrics in groups receiving 0.05%, 0.025%, and 0.01% atropine compared with placebo over 1 year based on the Low-Concentration Atropine for Myopia Progression (LAMP) study. DESIGN Double-blinded, randomized, placebo-controlled trial. PARTICIPANTS Three hundred eighty-three children aged 4 to 12 years who were assigned randomly to receive 0.05%, 0.025%, 0.01% atropine, or placebo once daily in both eyes and completed the first year of the LAMP study. METHODS Cycloplegic spherical equivalent (SE), axial length (AL), corneal curvature (K), and anterior chamber depth (ACD) were measured by IOLMaster. Corneal astigmatism and lens power were calculated. The ocular biometric parameter changes were compared among groups. Contributions to SE progression from ocular parameters were determined and compared among groups. MAIN OUTCOME MEASURES Changes in ocular biometrics and their associations with the changes in SE. RESULTS Over 1 year, changes in AL were 0.20 ± 0.25 mm, 0.29 ± 0.20 mm, 0.36 ± 0.29 mm, and 0.41 ± 0.22 mm in the 0.05% atropine, 0.025% atropine, 0.01% atropine, and placebo groups, respectively (P < 0.001), with a concentration-dependent response. Corneal power remained stable, and its changes were similar across all atropine concentrations: -0.02 ± 0.14 diopter (D), -0.01 ± 0.14 D, -0.01 ± 0.12 D, and 0.01 ± 0.14 D in the 0.05% atropine, 0.025% atropine, 0.01% atropine, and placebo groups, respectively (P = 0.10). Lens power decreased over time in each concentration, but its changes also were similar across all concentrations: -0.31 ± 0.43 D, -0.38 ± 0.47 D, -0.40 ± 0.43 D, and -0.41 ± 0.43 D in the 0.05% atropine, 0.025% atropine, 0.01% atropine, and placebo groups, respectively (P = 0.24). Changes in ACD remained similar across all concentrations (P = 0.41). The contributions to SE progression from the ocular biometric changes after adjusting for age and gender in each concentration were similar across all groups (P > 0.05). CONCLUSIONS Low-concentrations of atropine (0.05%, 0.025%, and 0.01%) have no clinical effect on corneal or lens power. Antimyopic effects of low-concentration atropine act mainly on reducing AL elongation, and therefore could reduce the risk of subsequent myopia complications.
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Affiliation(s)
- Fen Fen Li
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shu Min Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China; Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China; Hong Kong Eye Hospital, Hong Kong SAR, China.
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39
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Navel V, Beze S, Dutheil F. COVID-19, sweat, tears… and myopia? Clin Exp Optom 2020; 103:555. [PMID: 32396988 PMCID: PMC7273058 DOI: 10.1111/cxo.13086] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Valentin Navel
- Translational Approach to Epithelial Injury and Repair, GReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France.,Ophthalmology, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Steven Beze
- Ophthalmology, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Frédéric Dutheil
- Physiological and Psychosocial Stress, LaPSCo, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France.,Preventive and Occupational Medicine, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Witty Fit, Clermont-Ferrand, France
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40
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Deduction of Novel Genes Potentially Involved in the Effects of Very Low Dose Atropine (0.003%) Treatment on Corneal Epithelial Cells Using Next-Generation Sequencing and Bioinformatics Approaches. ACTA ACUST UNITED AC 2019; 55:medicina55090589. [PMID: 31540331 PMCID: PMC6780702 DOI: 10.3390/medicina55090589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 12/19/2022]
Abstract
Background and Objectives: Atropine is a nonselective muscarinic antagonist which has been used to prevent worsening of myopia in children. Different concentrations of atropine were used for myopia, ranging from 0.01% to 1.0%. However, there are still potential toxicity of different doses of atropine to the cornea. Here, we present a study of investigating novel genes potentially involved in the effects of very low dose atropine treatment (0.003%) on corneal epithelial cells using next-generation sequencing (NGS) and bioinformatics approaches. Materials and Methods: Human corneal epithelial cells were treated with 0.003% atropine, cultured until confluence, and RNA extracted for differential expression profiling of mRNA and microRNA (miRNA) between control and atropine-treated corneal epithelial cells. The functional enrichment analysis for differentially expressed genes was performed using two bioinformatics databases, including Database for Annotation, Visualization and Integrated Discovery (DAVID) and Ingenuity® Pathway Analysis (IPA). In addition, potential miRNA-mRNA interactions involved in atropine-treated corneal epithelial cells were predicted and validated using different miRNA target prediction databases. Results: Our results showed 0.003% atropine might suppress the apoptosis of corneal epithelial cells, potentially through Ras and protein kinase A signaling pathways. We also validated the possible miRNA regulations by using TargetScan and miRDB databases. Hsa-miR-651-3p-EPHA7, hsa-miR-3148-TMEM108 and hsa-miR-874-5p-TBX6 were validated as possible miRNA regulations involved in corneal epithelial cells treated with 0.003% atropine. Conclusions: These findings may contribute novel insights into therapeutic strategies for treating cornea with 0.003% atropine.
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Nagaraja H, Mehta JS, Zhou X, Yam JC, Lam DS. Will SMILE Become the New Benchmark of Corneal Laser Refractive Surgery? Asia Pac J Ophthalmol (Phila) 2019; 8:351-354. [PMID: 31567435 PMCID: PMC6784770 DOI: 10.1097/01.apo.0000579956.14784.91] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/06/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Harsha Nagaraja
- International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, P.R. China
- C-MER (Shenzhen) Dennis Lam Eye Hospital, 1 Tairan 9th Rd, Futian, Shenzhen, China
| | - Jodhbir S. Mehta
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China
| | | | - Jason C. Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong
| | - Dennis S.C. Lam
- International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, P.R. China
- C-MER (Shenzhen) Dennis Lam Eye Hospital, 1 Tairan 9th Rd, Futian, Shenzhen, China
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