Nearwork-induced transient myopia and parental refractive error

Protocol for a parallel assignment prospective, randomised, double-blinded, placebo-controlled trial to evaluate the efficacy of 0.01% atropine for near work-induced transient myopia and myopic progression in China

INTRODUCTION

Assessment of near work-induced transient myopia (NITM) is important for permanent myopia development and progression. Atropine eye drop has been reported to be beneficial in reducing initial NITM and slowing down myopic progression. This study aimed to investigate the efficacy of 0.01% atropine in treating NITM and its possible association with the progression of refractive change in Chinese myopic children.

METHODS AND ANALYSIS

The study is designed as a parallel assignment prospective, randomised, double-blinded, placebo-controlled trial conducted at He Eye Specialist Hospital in Shenyang, China. One hundred fifty participants will be randomly assigned in a 1:1 ratio to receive 0.01% atropine or placebo eye drop once nightly bilaterally for 1 year. Initial NITM, cycloplegic refraction, axial length, best-corrected visual acuity, intraocular pressure and pupil diameter will be measured at baseline, 4 weeks, 12 weeks, 24 weeks, 36 weeks and 48 weeks. Visual Function Questionnaire will be administered at baseline and each follow-up visit. Adverse events also will be monitored and documented at each subsequent follow-up visit.

ETHICS AND DISSEMINATION

A parallel assignment prospective, randomised, double-blinded, placebo-controlled trial to evaluate the efficacy of 0.01% atropine for near work-induced transient myopia and myopic progression registered on 10 September 2023. Ethics approval number: IRB (2023) K025.01. The study's findings will be shared regardless of the effect's direction.

TRIAL REGISTRATION NUMBER

NCT06034366.

Generational Difference of Axial Length and Its Risk Factors in Urban and Rural China

Purpose

To compare the axial length difference (ALD) and the estimated generational axial length shift (ALS) from parents to their children and its risk factors in urban and rural China.

Methods

Participants were enrolled from two longitudinal cohort studies, the Beijing Myopia Progression Study (BMPS) and the Handan Offspring Myopia Study (HOMS). Ocular biometry was performed in both parents and their children. ALD was defined as the difference between the children's axial length and the corresponding parental axial length. Generational ALS was estimated according to a binominal prediction model at 18 years of age.

Results

237 and 380 urban and rural Chinese children (6–17 years) and their parents from the BMPS and HOMS, respectively, were enrolled. Children's axial length was estimated to be closest to the parental axial length at 11 and 9 years of age in the urban and rural areas, respectively; the estimated generational ALS would be 1.53 and 0.57 mm, respectively. Multivariable regression analysis revealed that older children (urban β = 0.26, p < 0.001; rural β = 0.11, p < 0.001) and males had larger ALD (urban β = 0.55, p < 0.001; rural β = 0.52, p < 0.001) in both areas. Furthermore, urban children with more educated parents (fathers: β = −0.30, p=0.002; mothers: β = −0.29, p=0.004) and more outdoor activity (β = −0.23, p=0.006) had a less ALD.

Conclusions

The urban generational axial length shift was estimated to be approximately 1 mm longer than that of the rural area. These results suggest different environmental effects on the ocular development in these two populations of Chinese children.

Use of Topical 0.01% Atropine for Controlling Near Work-Induced Transient Myopia: A Randomized, Double-Masked, Placebo-Controlled Study

Purpose: To investigate the efficacy and safety of topical low-concentration (0.01%) atropine for controlling near work-induced transient myopia (NITM) in a young Chinese population. Methods: This was a randomized, double-blinded, placebo-controlled study. The participants were randomly divided into the 0.5% hydroxypropyl-methylcellulose-treated group (control group) or 0.01% atropine-treated group (study group). Participants' pulse rate, respiration rate, intraocular pressure, pupil diameter, and magnitude of initial NITM were evaluated at baseline and on day 7 and 14 during treatment. In addition, ocular discomfort and adverse effects were recorded. Results: Of the initial 176 participants, 145 (82.4%) completed the 14-day treatment and all evaluations. At baseline, no difference in the magnitude of initial NITM was observed between the control and study groups (P = 0.826). However, the magnitude of initial NITM of the study group was significantly lower at both day 7 (-0.11 ± 0.227 D) and day 14 (0.076 ± 0.183 D) after treatment initiation, compared with the magnitude of initial NITM in the control group (P < 0.001). No serious complications were observed. However, significantly larger pupil diameters were noted on day 7 and 14 in the study group than in the control group (P < 0.001). Conclusions: We speculate that daily topical 0.01% atropine application effectively reduced the magnitude of initial NITM, without any serious complications. The minimal pupil dilation induced by the treatment was acceptable. Low-concentration atropine may be useful in clinical settings as treatment for young patients with NITM.

Eye exercises of acupoints: their impact on myopia and visual symptoms in Chinese rural children

BACKGROUND

Chinese traditional "eye exercises of acupoints" have been advocated as a compulsory measure to reduce visual symptoms, as well as to retard the development of refractive error, among Chinese students for decades. The exercises are comprised of a 5-min, bilateral eye acupoint self-massage. This study evaluated the possible effect of these eye exercises among Chinese rural students.

METHODS

Eight hundred thirty-six students (437 males, 52.3 %), aged 10.6 ± 2.5 (range 6-17) years from the Handan Offspring Myopia Study (HOMS) who completed the eye exercises and vision questionnaire, the convergence insufficiency symptom survey (CISS) questionnaire, and had a cycloplegic refraction were included in this study.

RESULTS

121 (14.5 %) students (64 males, 52.9 %) performed the eye exercises of acupoints in school. The multiple odds ratio (OR) and 95 % confidence interval (CI) for those having a "serious attitude" towards performing the eye exercises (0.12, 0.03-0.49) demonstrated a protective effect for myopia, after adjusting for the children's age, gender, average parental refractive error, and the time spent on near work and outdoor activity. The more frequently, and the more seriously, the students performed the eye exercises each week, the less likely was their chance of being myopic (OR, 95 % CI: 0.17, 0.03-0.99), after adjusting for the same confounders. However, neither the "seriousness of attitude" of performing the eye exercises (multiple β coefficients: -1.58, p = 0.23), nor other related aspects of these eye exercises, were found to be associated with the CISS score in this sample.

CONCLUSIONS

The traditional eye exercises of acupoints appeared to have a modest protective effect on myopia among these Chinese rural students aged 6-17 years. However, no association between the eye exercises and near vision symptoms was found.

Eye exercises of acupoints: their impact on refractive error and visual symptoms in Chinese urban children

Background

Traditional Chinese eye exercises of acupoints involve acupoint self-massage. These have been advocated as a compulsory measure to reduce ocular fatigue, as well as to retard the development of myopia, among Chinese school children. This study evaluated the impact of these eye exercises among Chinese urban children.

Methods

409 children (195 males, 47.7%), aged 11.1 ± 3.2 (range 6–17) years, from the Beijing Myopia Progression Study (BMPS) were recruited. All had completed the eye exercise questionnaire, the convergence insufficiency symptom survey (CISS), and a cycloplegic autorefraction. Among these, 395 (96.6%) performed the eye exercises of acupoints. Multiple logistic regressions for myopia and multiple linear regressions for the CISS score (after adjusting for age, gender, average parental refractive error, and time spent doing near work and outdoor activity) for the different items of the eye exercises questionnaire were performed.

Results

Only the univariate odds ratio (95% confidence interval) for “seriousness of attitude” towards performing the eye exercises of acupoints (0.51, 0.33-0.78) showed a protective effect towards myopia. However, none of the odds ratios were significant after adjusting for the confounding factors. The univariate and multiple β coefficients for the CISS score were -2.47 (p = 0.002) and -1.65 (p = 0.039), -3.57 (p = 0.002) and -2.35 (p = 0.042), and -2.40 (p = 0.003) and -2.29 (p = 0.004), for attitude, speed of exercise, and acquaintance with acupoints, respectively, which were all significant.

Conclusions

The traditional Chinese eye exercises of acupoints appeared to have a modest effect on relieving near vision symptoms among Chinese urban children aged 6 to 17 years. However, no remarkable effect on reducing myopia was observed.