Prevalence of fundus tessellation and its associated factors in Chinese children and adolescents with high myopia

Study of corneal and retinal thicknesses at five years after FS-LASIK and SMILE for myopia

BACKGROUND

This study aimed to observe corneal and retinal thicknesses at 5 years after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) for myopia, investigate the effect of epithelial remodeling on refractive status and visual quality, and compare retinal thicknesses among fundus tessellation grades.

METHODS

Patients who received FS-LASIK or SMILE 5 years before were enrolled in this cross-sectional study. After 1:1 propensity score matching, each surgical group obtained 177 patients (177 eyes). Examinations including visual acuity, refraction, corneal and retinal thicknesses, corneal higher-order aberrations (HOAs), and fundus photography were performed in this visit at 5 years after surgery. The Quality of Vision (QoV) questionnaire was used to assess visual symptoms and overall satisfaction. Corneal and retinal thicknesses between groups were compared, contributing factors were analyzed, and correlations with postoperative refractive status, HOAs, QoV scores and overall satisfaction were evaluated.

RESULTS

The discrepancy of epithelial thickness between central and pericentral zones in FS-LASIK group was larger than that in SMILE group, which was negatively correlated with postoperative spherical equivalent (SE), positively correlated with spherical aberration (all P < 0.05), but not correlated with QoV scores and overall satisfaction (all P > 0.05) in both surgical groups. There was no statistical difference in stromal thickness and total corneal thickness (all P > 0.05). Most annuluses of epithelial and stromal thicknesse were linearly related to preoperative SE (all P < 0.05). The macular thickness, ganglion cell complex thickness, and retinal nerve fiber layer thickness exhibited comparable values between two surgical groups and four fundus tessellation grades, with no significant association observed with postoperative SE (all P > 0.05).

CONCLUSION

The tendency that epithelial thickness in central zone was thicker than peripheral zone was more obvious at 5 years after FS-LASIK compared to SMILE. This uneven distribution of epithelial thickness might play a role in myopic regression and the changes in HOAs, especially in patients with high myopia, but it had little effect on patients' subjective visual quality and satisfaction. Retinal thicknesses were not affected by these two surgical methods, and they did not appear to be the clinical indicators for myopic regression or fundus tessellation progression.

Tessellated fundus occurs earlier than myopia in children aged 3-6 years

BACKGROUND/OBJECTIVES

Tessellated fundus can exist in normal healthy eyes. This study aims to evaluate the occurrence and influencing factors of tessellated fundus in preschool children aged 3-6 years.

SUBJECTS/METHODS

This kindergarten-based cross-sectional study included 1716 children with an age range of 3-6 years. All participants underwent a comprehensive eye examination and a questionnaire. According to the number of quadrants occupied by tessellated fundus around the optic disc in fundus photographs, it was divided into four grades.

RESULTS

600 (35.0%) children had peripapillary tessellation. According to the spherical equivalent (SE), the subjects were divided into three groups: Hyperopia group (SE > + 0.75D, n = 1194)；Pre-myopia group (-0.50D < SE ≤ + 0.75D, n = 455); Myopia group (SE ≤ -0.50D, n = 67). The proportion of peripapillary tessellated fundus was 33.0%, 38.0%, 50.7% respectively. According to the regression analysis, in the non-myopia group (Pre-myopia group and Hyperopia group), the occurrence of peripapillary tessellated fundus was associated with longer axial length (OR, 1.566; 95% CI: 1.229-1.996, p < 0.001) and larger corneal radius of curvature (OR, 1.837; 95% CI: 1.006-3.354, p = 0.048). However, in Pre-myopia group, the corneal radius of curvature was not associated with the occurrence of peripapillary tessellated fundus (p = 0.830). In Hyperopia group, the corneal radius of curvature was associated with the occurrence of peripapillary tessellated fundus (OR, 2.438; 95% CI: 1.160-5.122, p = 0.019).

CONCLUSIONS

The occurrence of peripapillary tessellated fundus is more than 30% in 3-6 year old preschool children. Tessellated fundus can also occur in non-myopic children, and is related to the length of axial length and large radius of corneal curvature.

Factors associated with pathologic myopia onset and progression: A systematic review and meta-analysis

PURPOSE

To synthesise evidence across studies on factors associated with pathologic myopia (PM) onset and progression based on the META-analysis for Pathologic Myopia (META-PM) classification framework.

METHODS

Findings from six longitudinal studies (5-18 years) were narratively synthesised and meta-analysed, using odds ratio (OR) as the common measure of association. All studies adjusted for baseline myopia, age and sex at a minimum. The quality of evidence was rated using the Grades of Recommendation, Assessment, Development and Evaluation framework.

RESULTS

Five out of six studies were conducted in Asia. There was inconclusive evidence of an independent effect (or lack thereof) of ethnicity and sex on PM onset/progression. The odds of PM onset increased with greater axial length (pooled OR: 2.03; 95% CI: 1.71-2.40; p < 0.001), older age (pooled OR: 1.07; 1.05-1.09; p < 0.001) and more negative spherical equivalent refraction, SER (OR: 0.77; 0.68-0.87; p < 0.001), all of which were supported by an acceptable level of evidence. Fundus tessellation was found to independently increase the odds of PM onset in a population-based study (OR: 3.02; 2.58-3.53; p < 0.001), although this was only supported by weak evidence. There was acceptable evidence that greater axial length (pooled OR: 1.23; 1.09-1.39; p < 0.001), more negative SER (pooled OR: 0.87; 0.83-0.92; p < 0.001) and higher education level (pooled OR: 3.17; 1.36-7.35; p < 0.01) increased the odds of PM progression. Other baseline factors found to be associated with PM progression but currently supported by weak evidence included age (pooled OR: 1.01), severity of myopic maculopathy (OR: 3.61), intraocular pressure (OR: 1.62) and hypertension (OR: 0.21).

CONCLUSIONS

Most PM risk/prognostic factors are not supported by an adequate evidence base at present (an indication that PM remains understudied). Current factors for which an acceptable level of evidence exists (limited in number) are unmodifiable in adults and lack personalised information. More longitudinal studies focusing on uncovering modifiable factors and imaging biomarkers are warranted.

A Novel Grading System for Diffuse Chorioretinal Atrophy in Pathologic Myopia

INTRODUCTION

This study aims to quantitatively assess diffuse chorioretinal atrophy (DCA) in pathologic myopia and establish a standardized classification system utilizing artificial intelligence.

METHODS

A total of 202 patients underwent comprehensive examinations, and 338 eyes were included in the study. The methodology involved image preprocessing, sample labeling, employing deep learning segmentation models, measuring and calculating the area and density of DCA lesions. Lesion severity of DCA was graded using statistical methods, and grades were assigned to describe the morphology of corresponding fundus photographs. Hierarchical clustering was employed to categorize diffuse atrophy fundus into three groups based on the area and density of diffuse atrophy (G1, G2, G3), while high myopic fundus without diffuse atrophy was designated as G0. One-way analysis of variance (ANOVA) and nonparametric tests were conducted to assess the statistical association with different grades of DCA.

RESULTS

On the basis of the area and density of DCA, the condition was classified into four grades: G0, G1 (0 < density ≤ 0.093), G2 (0.093 < density ≤ 0.245), and G3 (0.245 < density ≤ 0.712). Fundus photographs depicted a progressive enlargement of atrophic lesions, evolving from punctate-shaped to patchy with indistinct boundaries. DCA atrophy lesions exhibited a gradual shift in color from brown-yellow to yellow-white, originating from the temporal side of the optic disc and extending towards the macula, with severe cases exhibiting widespread distribution throughout the posterior pole. Patients with DCA were significantly older [34.00 (27.00, 48.00) vs 29.00 (26.00, 34.00) years], possessed a longer axial length (28.85 ± 1.57 vs 27.11 ± 1.01 mm), and exhibited a more myopic spherical equivalent [- 13.00 (- 16.00, - 10.50) vs - 9.09 ± 2.41 D] compared to those without DCA (G0) (all P < 0.001). In eyes with DCA, a trend emerged as grades increased from G1 to G3, showing associations with older age, longer axial length, deeper myopic spherical equivalent, larger area of parapapillary atrophy, and increased fundus tessellated density (all P < 0.001).

CONCLUSIONS

The novel grading system for DCA, based on assessments of area and density, serves as a reliable measure for evaluating the severity of this condition, making it suitable for widespread application in the screening of pathologic myopia.

ASSOCIATION OF TESSELLATION DENSITY WITH PROGRESSION OF AXIAL LENGTH AND REFRACTION IN CHILDREN: An Artificial Intelligence-Assisted 4-Year Study

PURPOSE

To investigate fundus tessellation density (TD) and its association with axial length (AL) elongation and spherical equivalent (SE) progression in children.

METHODS

The school-based prospective cohort study enrolled 1,997 individuals aged 7 to 9 years in 11 elementary schools in Mojiang, China. Cycloplegic refraction and biometry were performed at baseline and 4-year visits. The baseline fundus photographs were taken, and TD, defined as the percentage of exposed choroidal vessel area in the photographs, was quantified using an artificial intelligence-assisted semiautomatic labeling approach. After the exclusion of 330 ineligible participants because of loss to follow-up or ineligible fundus photographs, logistic models were used to assess the association of TD with rapid AL elongation (>0.36 mm/year) and SE progression (>1.00 D/year).

RESULTS

The prevalence of tessellation was 477 of 1,667 (28.6%) and mean TD was 0.008 ± 0.019. The mean AL elongation and SE progression in 4 years were 0.90 ± 0.58 mm and -1.09 ± 1.25 D. Higher TD was associated with longer baseline AL (β, 0.030; 95% confidence interval: 0.015-0.046; P < 0.001) and more myopic baseline SE (β, -0.017; 95% confidence interval: -0.032 to -0.002; P = 0.029). Higher TD was associated with rapid AL elongation (odds ratio, 1.128; 95% confidence interval: 1.055-1.207; P < 0.001) and SE progression (odds ratio, 1.123; 95% confidence interval: 1.020-1.237; P = 0.018).

CONCLUSION

Tessellation density is a potential indicator of rapid AL elongation and refractive progression in children. TD measurement could be a routine to monitor AL elongation.

Association between Fundus Tessellation and Contrast Sensitivity in Myopic Eyes

PURPOSE

To assess the association of fundus tessellation with contrast sensitivity, Quality of Vision questionnaire, and other factors at five years postcorneal refractive surgery.

METHODS

This is a cross-sectional study. Both eyes of 98 subjects (196 eyes) who received femtosecond laser in situ keratomileusis (FS-LASIK) or small incision lenticular extraction (SMILE) five years prior were enrolled in this study. Fundus tessellation was imaged using wide-angle fundus photographs and graded into four categories with the assistance of the ETDRS grid. Photopic and mesopic contrast sensitivity were measured under the best correction. The Quality of Vision (QoV) questionnaire was used to assess visual symptoms.

RESULTS

Fundus tessellation was classified as follows: 19 eyes were grade 0 (9.7%), 28 eyes were grade 1 (14.3%), 59 eyes were grade 2 (30.1%), and 90 eyes were grade 3 (45.9%). Higher degrees of fundus tessellation were associated with lower photopic contrast sensitivity, a significant difference was observed at spatial frequencies of 6cpd (p = 0.030, grade 1 >grade 3 p = 0.011). Higher degrees of fundus tessellation were also associated with lower mesopic contrast sensitivity, a significant difference was observed at spatial frequencies of 18cpd (p = 0.011, grade 0 >grade 3 p = 0.012). The preoperative degree of myopia was positively associated with fundus tessellation grade (p < 0.001). However, in linear mixed-effect model analysis, no significant influence of parameters (contrast sensitivity, preoperative myopia, and QoV scores) upon different tessellation grades was found (p > 0.05).

CONCLUSIONS

Patients with moderate and high myopia were more likely to have higher grades of fundus tessellation. Higher degree of fundus tessellation associates with lower contrast sensitivity. Patients with moderate and high myopia should be concerned with retinal-choroidal changes. Contrast sensitivity could be a clinical sign for progression of tessellation and used to screen for early retinal-choroidal changes to prevent pathologic myopia.

DeepGraFT: A novel semantic segmentation auxiliary ROI-based deep learning framework for effective fundus tessellation classification

Fundus tessellation (FT) is a prevalent clinical feature associated with myopia and has implications in the development of myopic maculopathy, which causes irreversible visual impairment. Accurate classification of FT in color fundus photo can help predict the disease progression and prognosis. However, the lack of precise detection and classification tools has created an unmet medical need, underscoring the importance of exploring the clinical utility of FT. Thus, to address this gap, we introduce an automatic FT grading system (called DeepGraFT) using classification-and-segmentation co-decision models by deep learning. ConvNeXt, utilizing transfer learning from pretrained ImageNet weights, was employed for the classification algorithm, aligning with a region of interest based on the ETDRS grading system to boost performance. A segmentation model was developed to detect FT exits, complementing the classification for improved grading accuracy. The training set of DeepGraFT was from our in-house cohort (MAGIC), and the validation sets consisted of the rest part of in-house cohort and an independent public cohort (UK Biobank). DeepGraFT demonstrated a high performance in the training stage and achieved an impressive accuracy in validation phase (in-house cohort: 86.85 %; public cohort: 81.50 %). Furthermore, our findings demonstrated that DeepGraFT surpasses machine learning-based classification models in FT classification, achieving a 5.57 % increase in accuracy. Ablation analysis revealed that the introduced modules significantly enhanced classification effectiveness and elevated accuracy from 79.85 % to 86.85 %. Further analysis using the results provided by DeepGraFT unveiled a significant negative association between FT and spherical equivalent (SE) in the UK Biobank cohort. In conclusion, DeepGraFT accentuates potential benefits of the deep learning model in automating the grading of FT and allows for potential utility as a clinical-decision support tool for predicting progression of pathological myopia.

Clinical Features of Fundus Tessellation and Its Relationship with Myopia: A Systematic Review and Meta-analysis

INTRODUCTION

This study aims to assess the existing literature on fundus tessellation (FT), focusing on its prevalence, associated factors, distribution, and progression.

METHODS

Systemic methods were employed to search and gather published literature on FT from databases such as the National Library of Medicine (PubMed), Web of Science (WOS), and Elsevier on July 1, 2023. The quality of the studies was evaluated using the Newcastle-Ottawa Scale (NOS) and the Healthcare Research and Quality (AHRQ) criteria. A meta-analysis was conducted to compare tessellated and normal fundus with respect to age, gender, axial length, and spherical equivalent.

RESULTS

The systematic review included 23 articles, encompassing a total of 3053 eyes in the meta-analysis. The prevalence of FT varied from 43.00 to 94.35%. The severity of FT was significantly associated with older age, male sex, lower body weight index, longer axial length, larger peripapillary atrophy, thinner choroid, thinner sclera, and larger corneal radius of curvature, suggesting a potential progression pattern. Notably, FT was observed predominantly in the macular and peripapillary regions. The meta-analysis revealed that tessellated fundus tended to be associated with older age (mean difference [MD] 4.76, 95% confidence interval [CI] 1.71-7.80, P < 0.01), longer axial length (MD 0.86, 95% CI 0.70-1.02, P < 0.01), and a lower spherical equivalent (MD - 1.16, 95% CI - 1.68 to 0.65, P < 0.01) compared to normal fundus. However, there was no significant difference in the proportion of males between individuals with tessellated and normal fundus (odds ratio [OR] 1.12, 95% CI 0.89-1.42, P = 0.32).

CONCLUSIONS

Overall, this systematic review and meta-analysis shed light on the prevalence, characteristics, and factors associated with FT, offering valuable insights for clinicians and researchers in the field of ophthalmology.

STUDY REGISTRATION

The study protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023442486).

Fundus Tessellated Density of Pathologic Myopia

PURPOSE

The study aimed to quantitatively evaluate the fundus tessellated density (FTD) in different categories of pathologic myopia (PM) using fundus photographs with the application of artificial intelligence.

METHODS

A retrospective review of 407 PM (META-PM, Category 2-Category 4) eyes was conducted, employing a biomimetic mechanism of human vision and integrated image processing technologies for FTD extraction and calculation. Different regions of interest were analyzed, including circle O4.5 (optic disc centered, diameter of 4.5 mm) and circle M1.0, M3.0, M6.0 (macular centered, diameter of 1.0, 3.0, and 6.0 mm), using 2 partitioning methods ("X" and "+"). The density of patchy (Category 3) or macular atrophy (Category 4) areas was quantified. Univariate and multivariate linear regression analyses were performed to assess the association with FTD.

RESULTS

The mean FTD of total PM eyes was 0.283, ranging from 0.002 to 0.500, and demonstrating a negative correlation with the PM category. In multivariate analysis, age was found to be significantly associated with FTD ( P <0.05), while axial length did not show a significant association. Fundus tessellation of circle O4.5 and circle M6.0 displayed associations with the FTD across different PM categories. The "X" partitioning method better fit the circle M6.0 region, while both methods were suitable for the circle O4.5 region. After excluding the patchy and macular atrophic areas, the mean FTD values were 0.346 in Category 2, 0.261 in Category 3, and 0.186 in Category 4.

CONCLUSIONS

The study revealed a decreasing trend in FTD values across different categories of PM, regardless of the presence or absence of patchy or macular atrophic areas. Quantifying FTD in PM could be a valuable tool for improving the existing PM classification system and gaining insights into the origin of posterior staphyloma and visual field defects in high myopia.

Prevalence of Fundus Tessellation and Its Screening Based on Artificial Intelligence in Chinese Children: the Nanjing Eye Study

INTRODUCTION

To investigate the prevalence of fundus tessellation (FT), and the threshold for screening FT using an artificial intelligence (AI) technology in Chinese children.

METHODS

The Nanjing Eye Study was a population-based cohort study conducted in children born between September 2011 and August 2012 in Yuhuatai District of Nanjing. The data presented in this paper were obtained in 2019, when these children were 7 years old and underwent 45° non-mydriatic fundus photography. FT in whole fundus, macular area, and peripapillary area was manually recognized from fundus photographs and classified into three grades. Fundus tessellation density (FTD) in these areas was obtained by calculating the average exposed choroid area per unit area using artificial intelligence (AI) technology based on fundus photographs. The threshold for screening FT using FTD was determined using receiver operating characteristic (ROC) curve analysis.

RESULTS

Among 1062 enrolled children (mean [± standard deviation] spherical equivalent: - 0.28 ± 0.70 D), the prevalence of FT was 42.18% in the whole fundus (grade 1: 36.53%; grade 2: 5.08%; grade 3: 0.56%), 45.57% in macular area (grade 1: 43.5%; grade 2: 1.60%; grade 3: 0.50%), and 49.72% in peripapillary area (grade 1: 44.44%; grade 2: 4.43%; grade 3: 0.85%), respectively. The threshold value of FTD for screening severe FT (grade ≥ 2) was 0.049 (area under curve [AUC] 0.985; sensitivity 98.3%; specificity 92.3%) in the whole fundus, 0.069 (AUC 0.987; sensitivity 95.5%; specificity 96.2%) in the macular area, and 0.094 (AUC 0.980; sensitivity 94.6%; specificity 94.2%) in the peripapillary area, respectively.

CONCLUSION

Fundus tessellation affected approximately 40 in 100 children aged 7 years in China, indicating the importance and necessity of early FT screening. The threshold values of FTD provided by this study had high accuracy for detecting severe FT and might be applied for rapid screening.

Role of corneal radius of curvature in early identification of fundus tessellation in children with low myopia

AIM

To assess the role of the corneal radius of curvature (CR) in the identification of fundus tessellation in children with low myopia.

METHODS

In the cross-sectional study, students aged 9-12 years from 24 primary schools in Shanghai were enrolled by cluster sampling. Participants underwent measurements including cycloplegic refraction and axial length. Fundus images and choroidal thickness were obtained by swept-source optical coherence tomography. Fundus tessellation was classified into four grades according to fundus photographs.

RESULTS

A total of 1127 children with low myopia (spherical equivalence (SE) >-3.00 dioptre (D) but ≤-0.50 D) were included, with a mean age of 10.29±0.60 years and a mean SE of -1.44±0.69 D. Fundus tessellation was found in 591 (52.4%) cases (grade 1: 428, 38.0%; grade 2: 128, 11.4%; grade 3: 35, 3.1%). Choroidal thickness decreased as fundus tessellation grade increased (p trend <0.001). According to regression analysis, higher fundus tessellation grade was independently associated with larger CR (OR, 7.499; 95% CI 2.279 to 24.675, p=0.001). For those with CR >7.9 mm, along with CR, degree and proportion of fundus tessellation increased sharply.

CONCLUSION

Fundus tessellation existed in more than half of children with low myopia. Preliminary fundus photography conducted in children with low myopia with large CR would be necessary and beneficial to the early management of myopic fundus changes. Trial registration number NCT02980445.

Myopic Vascular Changes Revealed by Optical Tomography Angiography and Their Association with Myopic Fundus Manifestations

INTRODUCTION

We aimed to quantify and evaluate fundal vascular changes at different severities of myopia using optical tomography angiography (OCTA) and explore their association with fundus changes captured by ultra-widefield (UWF) fundus cameras.

METHODS

Seventy-four participants with myopia were enrolled in the study and underwent basic ophthalmic examination, OCTA, and UWF fundus photography. Multiple parameters were obtained using OCTA (flow area, structure thickness, and vessel density) and UWF fundus cameras (tessellation and parapapillary atrophy [PPA]).

RESULTS

The right eye of 30 participants with low and moderate myopia and 44 participants with high myopia (HM) were included. Patients with HM had a larger flow area of the outer retina (FA-OR) and a smaller thickness of choroid (TC). Axial length was significantly correlated with retinal and choroidal flow area and thickness in the different zones. The PPA area was positively correlated with FA-OR and negatively correlated with TC. Tessellation exhibited different levels of correlation with OCTA parameters regarding the flow area, thickness, and vessel density of the fundal layers, mainly in the inner retina.

CONCLUSION

FA-OR and TC exhibited sensitive changes in patients with HM and axial elongation; therefore, they could serve as predictive OCTA biomarkers. The PPA and tessellation were connected to the vascular and structural changes revealed by OCTA.

Prevalence and associated factors of myopia among school students in Shenyang, China: a cross-sectional study

Background

In recent years, the prevalence of myopia has increased significantly and caused great concern. Nevertheless, an estimate of myopia in the student population in Shenyang, Liaoning Province, China is still lacking. This study aims to determine the prevalence of myopia among students in Shenyang and investigate the associated factors affecting myopia development.

Methods

Standard logarithmic visual acuity chart and automatic computerized optometry under non-ciliary muscle paralysis were used to test the students' naked visual acuity of their right and left eyes. The included students were organized to fill in questionnaires on WeChat to collect the factors affecting myopia.

Results

A total of 34,644 students with a median age of 11.9 years were examined, including 17,563 males and 17,081 females. The overall prevalence of myopia was 60%, with a prevalence of 45% for mild myopia, 13% for moderate myopia, and 1.9% for high myopia. The sex, high educational stage, family history of myopia, doing homework after school or reading and writing for more than 2 h were associated with a higher risk of myopia, while doing eye exercises twice a day or more, going outdoors during recess, reading and writing with eyes more than one foot from books, and sleeping more than 8 h a day were associated factors for preventing myopia. The associated factors influencing myopia vary among different subgroups.

Conclusion

The prevalence of myopia in Shenyang is at a high level. In addition to sex, high educational stage and genetic factors, environmental factors including length of eye usage, eye exercises, outdoor activities, eye working distance, and sleep duration are associated with myopia prevalence. Therefore, it is recommended that the occurrence and development of myopia can be prevented by controlling the above environmental factors.

Application of Artificial Intelligence to Quantitative Assessment of Fundus Tessellated Density in Young Adults with Different Refractions

INTRODUCTION

The aim of this study was to quantitatively assess fundus tessellated density (FTD) and associated factors by artificial intelligence (AI) in young adults.

METHODS

A total of 1,084 undergraduates (age, 17-23 years old) were enrolled in November 2021. The students were divided into three groups according to axial length (AL): group 1 (AL <24.0 mm, n = 155), group 2 (24 mm ≤ AL <26 mm, n = 578), and group 3 (AL ≥26 mm, n = 269). FTD was calculated by extracting the fundus tessellations as the regions of interest (circle 1, diameter of 3.0 mm; circle 2, diameter of 6.0 mm) and then calculating the average exposed choroid area per unit area of fundus.

RESULTS

Among 1,084 students, 1,002 (92.5%) students' FTDs were extracted. The mean FTD was 0.06 ± 0.06 (range, 0-0.40). In multivariate analysis, FTD was significantly associated with male sex, longer AL, thinner subfoveal choroid thickness (SFCT), increased choriocapillaris vessel density (VD), and decreased deeper choroidal VD (all p < 0.05). In circle 1 (diameter of 3.0 mm) and circle 2 (diameter of 6.0 mm), analysis of variance showed that the FTD of the nasal region (p < 0.05) was significantly larger than that of the superior, inferior, and temporal regions.

CONCLUSION

AI-based imaging processing could improve the accuracy of fundus tessellation diagnosis. FTD was significantly associated with a longer AL, thinner SFCT, increased choriocapillaris VD, and decreased deeper choroidal VD.

Machine Learning-Based Integration of Metabolomics Characterisation Predicts Progression of Myopic Retinopathy in Children and Adolescents

Myopic retinopathy is an important cause of irreversible vision loss and blindness. As metabolomics has recently been successfully applied in myopia research, this study sought to characterize the serum metabolic profile of myopic retinopathy in children and adolescents (4-18 years) and to develop a diagnostic model that combines clinical and metabolic features. We selected clinical and serum metabolic data from children and adolescents at different time points as the training set (n = 516) and the validation set (n = 60). All participants underwent an ophthalmologic examination. Untargeted metabolomics analysis of serum was performed. Three machine learning (ML) models were trained by combining metabolic features and conventional clinical factors that were screened for significance in discrimination. The better-performing model was validated in an independent point-in-time cohort and risk nomograms were developed. Retinopathy was present in 34.2% of participants (n = 185) in the training set, including 109 (28.61%) with mild to moderate myopia. A total of 27 metabolites showed significant variation between groups. After combining Lasso and random forest (RF), 12 modelled metabolites (mainly those involved in energy metabolism) were screened. Both the logistic regression and extreme Gradient Boosting (XGBoost) algorithms showed good discriminatory ability. In the time-validation cohort, logistic regression (AUC 0.842, 95% CI 0.724-0.96) and XGBoost (AUC 0.897, 95% CI 0.807-0.986) also showed good prediction accuracy and had well-fitted calibration curves. Three clinical characteristic coefficients remained significant in the multivariate joint model (p < 0.05), as did 8/12 metabolic characteristic coefficients. Myopic retinopathy may have abnormal energy metabolism. Machine learning models based on metabolic profiles and clinical data demonstrate good predictive performance and facilitate the development of individual interventions for myopia in children and adolescents.

Efficacy of a Deep Learning System for Screening Myopic Maculopathy Based on Color Fundus Photographs

INTRODUCTION

The maculopathy in highly myopic eyes is complex. Its clinical diagnosis is a huge workload and subjective. To simply and quickly classify pathologic myopia (PM), a deep learning algorithm was developed and assessed to screen myopic maculopathy lesions based on color fundus photographs.

METHODS

This study included 10,347 ocular fundus photographs from 7606 participants. Of these photographs, 8210 were used for training and validation, and 2137 for external testing. A deep learning algorithm was trained, validated, and externally tested to screen myopic maculopathy which was classified into four categories: normal or mild tessellated fundus, severe tessellated fundus, early-stage PM, and advanced-stage PM. The area under the precision-recall curve, the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, and Cohen's kappa were calculated and compared with those of retina specialists.

RESULTS

In the validation data set, the model detected normal or mild tessellated fundus, severe tessellated fundus, early-stage PM, and advanced-stage PM with AUCs of 0.98, 0.95, 0.99, and 1.00, respectively; while in the external-testing data set of 2137 photographs, the model had AUCs of 0.99, 0.96, 0.98, and 1.00, respectively.

CONCLUSIONS

We developed a deep learning model for detection and classification of myopic maculopathy based on fundus photographs. Our model achieved high sensitivities, specificities, and reliable Cohen's kappa, compared with those of attending ophthalmologists.

Progression of Vision in Chinese School-Aged Children Before and After COVID-19

Objectives: To investigate the changes of vision, including the prevalence of myopia, hyperopia, poor vision, and the spherical equivalent refraction (SER), in school-aged children before and after the pandemic of Coronavirus Disease 2019 (COVID-19).

Methods: A school-based vision screening study was performed on children in 133 primary schools in Wuhan. This study was conducted in 4 consecutive years (2018–2021).

Results: A total of 468,094 children (936,188 eyes) were recruited, 255,863 (54.7%) were boys. The SER decreased in 2020 compared to other years after the age of 10. A positive myopia shift was found in younger children aged 6 (0.1 D), 7 (0.05D), and 8 (0.03 D) in 2020 compared to 2019. The progression of vision has improved slightly in 2021. Among the students included in the study, 33.7% were myopia.

Conclusion: The vision of older children decreased significantly during the COVID-19. After the pandemic, there is still a high risk for them. In the future, the focus on vision prevention and control should move forward to preschool children.

A curriculum learning-based fully automated system for quantification of the choroidal structure in highly myopic patients

Objective. An automated tool for choroidal segmentation and quantitative analysis under pathological conditions is currently lacking, hindering the exploration of choroidal structural changes in fundus diseases. This study aims to create a fully automated deep learning system for the quantitative analysis of the choroid with pathological changes, and to apply the system in analyzing the correlation between the choroidal structure and the severity of high myopia. Approach. A total of 2590 optical coherence tomography B-scan images of 1424 eyes of 1029 patients of high myopia from 3 hospitals were collected. We developed a curriculum learning-based system, including a two-stage U-net (TSU-net) and a post-process module for segmentation of the choroid, to calculate mean choroidal thickness (MCT) and choroidal vascularity index (CVI). The output of the images was statistically analyzed to explore the associations among MCT, CVI and the clinical characteristics of the patients. Main results. The Dice coefficient and IoU measures of choroid segmentation were 0.9221 and 0.8575, respectively. In a human-machine comparison, the system performed faster and better than a senior ophthalmologist. Statistical analysis demonstrated that, MCT is correlated with age, scan region, axial length, maculopathy type, and CVI, and CVI is correlated with scan region and MCT. Significance. A fully automated choroidal structural quantification system was developed. Clinical evaluation demonstrated that severity of high myopia is closely related to MCT but shows only a low correlation with CVI, suggesting that CVI may have little applicability in eyes with large anatomical structural variations. Future quantitative analysis of choroidal structure of large samples will enable exploration of the pathogenesis of additional fundus diseases.

Efficacy and safety of traditional Chinese medicine decoction in the treatment of adolescent myopia: A protocol for systematic review and network meta-analysis

BACKGROUND

Adolescent myopia has become a major public health problem in Asian countries and even the world. Due to its unstable prognosis and numerous complications, it has caused serious social and economic burden. As a common treatment in Asia, Chinese medicine has been shown to be effective in controlling the development of myopia, but its evidence-based medical evidence is not sufficient. Therefore, the purpose of this study is to evaluate the efficacy and safety of traditional Chinese medicine (TCM) in the treatment of adolescent myopia through network meta-analysis, and to provide evidence for clinical and scientific research.

METHODS

We searched seven databases for randomized controlled trials of TCM decoction for adolescent myopia, including PubMed, the Cochrane Library, EMbase, China National Knowledge Infrastructure, China Biological Medicine, Chinese Scientific Journals Database, and wan-fang databases, from the date of the establishment of each database to January 31, 2022. The network meta-analysis will be implemented through Aggregate Data Drug Information System 1.16.8 and Stata 13.0 software. Primary outcomes include distant vision, intraocular pressure, and diopter. Mean differences or odds ratios will be used for statistical analysis. We will ensure the reliability of the results through node-split model and heterogeneity analysis. In addition, the Cochrane Collaboration's tool and Grading of Recommendations Assessment, Development and Evaluation system will be used for the methodological quality and the evidence quality.

RESULTS

This study will provide reliable evidence for the clinical selection of TCM decoction in the treatment of adolescent myopia.

CONCLUSION

The results of this study will evaluate the efficacy and safety of TCM decoction in the treatment of adolescent myopia, and provide decision-making references for future clinical and scientific research.

ETHICS AND DISSEMINATION

This study did not require ethical approval. We will disseminate our findings by publishing results in a peer-reviewed journal.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/VXQUP.

High-Resolution Image Analysis Reveals a Decrease in Lens Thickness and Cone Density in a Cohort of Young Myopic Patients

Purpose: To study the association between axial length (AL) and the thickness of the lens, retina, choroid, and cone density with swept-source optical coherence tomography (SS-OCT) and an adaptive optics (AO) fundus camera.

Design: A prospective cross-sectional study.

Methods: This study included 136 eyes in 68 subjects. SS-OCT was used to quantify the thickness of the lens, ganglion cell complex (GCC) layer, inner nuclear layer (INL), outer retinal layer (ORL), and choroid layer. Adaptive optics was used to quantify spatial features of the cone photoreceptors, including density, spacing, regularity, and dispersion. The associations among the AL and the thickness of lens, retina, choroid, and cone features were evaluated with linear regression.

Results: With the severity of myopia, the increased AL was associated with thinning of the lens (P < 0.001, 95% CI: −100.42 to −49.76). The thickness of the ORL and choroid decreased significantly (all P < 0.001), whereas the thickness of the GCC and INL decreased only in the outer ring (both P < 0.01). There was a significant correlation between the cone density/spacing and AL (both P < 0.001). Although cone density was reduced from 25,160/mm² to 19,134/mm² in the inner region and from 17,458/mm² to 13,896/mm² in the outer region, the best-corrected visual acuity (BCVA) was 20/20 or greater.

Conclusions: We found that the lens thickness (LT), ORL, and cone density decreased in myopia. While decreasing cone density and ORL thickness should be related to axial elongation, decreasing of LT might imply intrinsic physical accommodation. These results provide further morphological changes of myopia.

Study on the Optic Nerve Fiber Layer Thickness and Changes in Blood Flow in Myopic Children

Objective

The present study aims to observe the optic nerve fiber layer thickness and blood flow density in the papillary area and investigate the effects of axial length (AL) and the refractive state of the optic papilla blood flow density in children with different refractive conditions.

Methods

The present study was a clinical control study. The right eyes of 204 minors aged 6-17 years were studied. The eyes were divided into four groups according to myopic refractive states. OCTA analyzed the data to compare the radial peripapillary capillary (RPC) density and the difference in the retinal nerve fiber layer (RNFL) thickness adjacent to the optic papilla between the four refraction groups.

Results

The intra-optic disc blood flow density was significantly and negatively correlated with the AL and was negatively correlated with the AL in the inferior temporal quadrants. The RNFL in the superior, nasal, and inferior quadrants was negatively correlated with the AL. The RNFL in the temporal quadrant was positively correlated with the AL.

Conclusion

Our present study revealed that aAs myopia increased and the AL grew in children, the blood density of the entire image of the optic papilla, in the optic disc, and the retinal capillaries in the inferior parapapillary and temporal quadrant would change significantly. With increasing AL, a significant decrease in the intra-disc and para-disc RNFL was observed in the superior, nasal, and inferior quadrants, while a substantial increase in RNFL was observed in the temporal quadrant.