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Chow AHY, Mungalsingh MA, Thai D, Selimos Z, Yan SK, Xu H, Jones DA. Suitability of multifunction devices Myah and Myopia Master for monitoring myopia progression in children and adults. Ophthalmic Physiol Opt 2024; 44:1017-1030. [PMID: 38760986 DOI: 10.1111/opo.13332] [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: 12/22/2023] [Revised: 04/22/2024] [Accepted: 04/28/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE To assess the feasibility of using multifunction instruments to measure axial length for monitoring myopia progression in children and adults. METHODS Axial length was measured in 60 children (aged 6-18 years) and 60 adults (aged 19-50 years) with multifunction instruments (Myah and Myopia Master) and stand-alone biometers (Lenstar LS900 and IOLMaster 700). Repeatability (measurements by the same examiner) and reproducibility (measurements by different examiners) were computed as the within-subject standard deviation (Sw) and 95% limits of agreement (LoA). Inter-instrument agreement was computed as intraclass correlation coefficients. The threshold for detecting myopic progression was taken as 0.1 mm. Measures were repeated only in children following the administration of 1% tropicamide to determine the impact of cycloplegia on axial length. RESULTS Overall, the IOLMaster 700 had the best repeatability in children (0.014 mm) and adults (0.009 mm). Repeatability Sw values for all devices ranged from 0.005 to 0.021 mm (children) and 0.003 to 0.016 mm (adults). In children, reproducibility fell within 0.1 mm 95% of the time for the Myah, Myopia Master and IOLMaster 700. Agreement among all devices was classified as excellent (ICC 0.999; 95% CI 0.998-0.999), but the 95% LoA among the Myah, Myopia Master and Lenstar LS900 was ≥0.1 mm. Cycloplegia had no statistically significant effect on axial length (all p > 0.13). CONCLUSIONS The Myah and Myopia Master multifunction instruments demonstrated good repeatability and reproducibility, and their accuracy was comparable to stand-alone biometers. Axial length measurements using different instruments can be considered interchangeable but should be compared with some caution. Accurate axial length measurements can be obtained without cycloplegia. The multifunction instruments Myah and Myopia Master are as well suited for monitoring myopia progression in children as the stand-alone biometers IOLMaster 700 and Lenstar LS900.
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Affiliation(s)
- Amy H Y Chow
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
- Centre for Eye and Vision Research, Hong Kong, SAR China
| | - Melanie A Mungalsingh
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Danny Thai
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Zoe Selimos
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Sarah Kathryn Yan
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Hellen Xu
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Deborah A Jones
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
- Centre for Eye and Vision Research, Hong Kong, SAR China
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Sun L, Qi X, Song L, Ning Y, Zeng X, Ding G, Li X, Li J, Wei N, Hua N, Qian X. Longitudinal Changes in Refractive Development in Highly Hyperopic Children: A 2.6-11.2 Year Follow-up of Preschoolers Diagnosed with High Hyperopia. Curr Eye Res 2024; 49:768-775. [PMID: 38616539 DOI: 10.1080/02713683.2024.2336162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/20/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE This study aims to elucidate the longitudinal refractive and ocular biometric alterations in preschool children with high hyperopia who underwent early interventions. METHODS We conducted a retrospective analysis of preschool children diagnosed with high hyperopia at Tianjin Medical University Eye Hospital between 2011 and 2023. Inclusion criteria required an initial examination with cycloplegic refraction, bilateral spherical equivalent power (SE) ≥ +5.00D with a difference <1.00D, a minimum two-year follow-up, and at least three ocular biometric measurements. The annual axial growth rate evaluated emmetropization in highly hyperopic children. We applied Restricted Cubic Spline (RCS) models to explore potential nonlinear relationships between age and spherical equivalent, axial length, corneal curvature, and axial length-to-corneal curvature ratio. Additionally, Mixed-effects models were employed to investigate factors associated with changes in refractive error and axial length. RESULTS The study enrolled 60 eligible subjects, with a median initial diagnosis age of 3.5 years (IQR, 2.8-4.9 years) and a median last visit age of 9.3 years (IQR, 8.1-10.8 years). The average follow-up duration was 5.7 years. RCS analysis revealed notable nonlinear changes in spherical equivalent power, axial length, and axial length-to-corneal curvature ratio, although corneal curvature displayed no statistically significant nonlinear trend. Factors affecting SE changes included the presence of strabismus, the use of cycloplegia, baseline SE, and age. Conversely, changes in axial length solely correlated with baseline axial length and age. CONCLUSION Highly hyperopic preschool children undergoing early intervention display a marked emmetropization tendency, though most still remain moderately to highly hyperopic, with the progression of refractive changes showing non-uniform patterns with respect to age.
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Affiliation(s)
- Ling Sun
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xiaoli Qi
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Linlin Song
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Yuxian Ning
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xiaoyu Zeng
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Gang Ding
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xue Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Jing Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Nan Wei
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Ning Hua
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xuehan Qian
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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Jiang L, Du Z, Sun W, Zhu S, Xiong L, Fang X, Zhou J, Zhang Q, Lei X, Zeng Q, Wang Z, Hu Y. Associations between corneal curvature and other anterior segment biometrics in young myopic adults. Sci Rep 2024; 14:8305. [PMID: 38594402 PMCID: PMC11004108 DOI: 10.1038/s41598-024-59037-z] [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: 12/28/2023] [Accepted: 04/05/2024] [Indexed: 04/11/2024] Open
Abstract
To investigate the associations between corneal curvature (CC) and other anterior segment biometrics in young myopic adults. In this retrospective multi-center study, 7893 young myopic adults were included. CC and other anterior segment biometrics were measured by Scheimpflug imaging (Pentacam). CC was defined as SimK at central 3 mm area, and other anterior segment biometrics included white-to-white corneal diameter (WTW), central corneal thickness (CCT), corneal volume (CV) at 3 mm, 5 mm, and 7 mm area, anterior corneal astigmatism (ACA), posterior corneal astigmatism (PCA), anterior corneal eccentricity (ACE) and asphericity (ACAP), posterior corneal eccentricity (PCE) and asphericity (PCAP), anterior chamber depth (ACD), and anterior chamber volume (ACV). Univariate regression analyses were used to assess the associations between CC and other anterior segment biometrics, and multivariate regression analyses were further performed to adjusted for age, gender and spherical equivalent. CC was higher in patients of female gender and higher myopia (all P < 0.05). Eyes in higher CC quartiles had lower WTW, thinner CCT, lower CV at 3 mm and 5 mm, lower ACD, and lower ACV (all P < 0.001), but had larger ACA, larger PCA, less PCE and less PCAP (all P < 0.001), compared to eyes in lower CC quartiles. The trends of CV at 7 mm, ACE and ACAP were inconsistent in different CC quartiles. After adjusting for age, gender and spherical equivalent with multivariate linear regression, CC was positively correlated to CV at 7 mm (βs = 0.069), ACA (βs = 0.194), PCA (βs = 0.187), ACE (βs = 0.072), PCAP (βs = 0.087), and ACD (βs = 0.027) (all P < 0.05), but was negatively correlated to WTW (βs = - 0.432), CCT (βs = - 0.087), CV-3 mm (βs = - 0.066), ACAP (βs = - 0.043), PCE (βs = - 0.062), and ACV (βs = - 0.188) (all P < 0.05). CC was associated with most of the other anterior segment biometrics in young myopic adults. These associations are important for better understanding of the interactions between different anterior segment structures in young myopic patients, and are also useful for the exploration of the pathogenesis of myopia.
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Affiliation(s)
- Li Jiang
- Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hospital), Wuhan, China
- Refractive Surgery Center, Hankou Aier Eye Hospital, Wuhan, China
| | - Zijing Du
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Wei Sun
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Shanqing Zhu
- Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou, China
| | - Lu Xiong
- Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou, China
| | - Xuejun Fang
- Refractive Surgery Center, Shenyang Aier Eye Hospital, Shenyang, China
| | - Jin Zhou
- Refractive Surgery Center, Chengdu Aier Eye Hospital, Chengdu, China
| | - Qingsong Zhang
- Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hospital), Wuhan, China
| | - Xiaohua Lei
- Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hospital), Wuhan, China
- Refractive Surgery Center, Hankou Aier Eye Hospital, Wuhan, China
| | - Qingyan Zeng
- Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hospital), Wuhan, China.
- Refractive Surgery Center, Hankou Aier Eye Hospital, Wuhan, China.
| | - Zheng Wang
- Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou, China.
| | - Yijun Hu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
- Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou, China.
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Bullimore MA, Brennan NA. Juvenile-onset myopia-who to treat and how to evaluate success. Eye (Lond) 2024; 38:450-454. [PMID: 37709925 PMCID: PMC10858167 DOI: 10.1038/s41433-023-02722-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 07/26/2023] [Accepted: 08/25/2023] [Indexed: 09/16/2023] Open
Abstract
The risk of eye diseases such as myopic macular degeneration increases with the level of myopia, but there is no safe level of myopia and the burden of lower degrees of myopia remains considerable. Effective treatments are available that slow progression and thus limit the final degree of myopia. In this review, the rationale for slowing progression is summarized, and a case made for treating all myopic children. Measurement of refractive error and axial length is reviewed, stressing the precision of optical biometry, but also the need for cycloplegic autorefraction. The factors influencing progression are considered and the available tools for interpretation of progression rate are discussed. Finally, the need to set attainable treatment goals is emphasized.
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Wolffsohn JS. 2022 Glenn A. Fry Award lecture: Enhancing clinical assessment for improved ophthalmic management. Optom Vis Sci 2024; 101:12-24. [PMID: 38350054 DOI: 10.1097/opx.0000000000002102] [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: 02/15/2024] Open
Abstract
ABSTRACT Detailed clinical assessment is critical to allow sensitive evaluation of the eye and its management. As technology advances, these assessment techniques can be adapted and refined to improve the detection of pathological changes of ocular tissue and their impact on visual function. Enhancements in optical medical devices including spectacle, contact, and intraocular lenses have allowed for a better understanding of the mechanism and amelioration of presbyopia and myopia control. Advancements in imaging technology have enabled improved quantification of the tear film and ocular surface, informing diagnosis and treatment strategies. Miniaturized electronics, large processing power, and in-built sensors in smartphones and tablets capacitate more portable assessment tools for clinicians, facilitate self-monitoring and treatment compliance, and aid communication with patients. This article gives an overview of how technology has been used in many areas of eye care to improve assessments and treatment and provides a snapshot of some of my studies validating and using technology to inform better evidence-based patient management.
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Vera-Diaz FA, Jnawali A, Panorgias A, Bex PJ, Kerber KL. Baseline metrics that may predict future myopia in young children. Ophthalmic Physiol Opt 2023; 43:466-481. [PMID: 36892148 PMCID: PMC10416753 DOI: 10.1111/opo.13113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE We used baseline data from the PICNIC longitudinal study to investigate structural, functional, behavioural and heritable metrics that may predict future myopia in young children. METHODS Cycloplegic refractive error (M) and optical biometry were obtained in 97 young children with functional emmetropia. Children were classified as high risk (HR) or low risk (LR) for myopia based on parental myopia and M. Other metrics included axial length (AXL), axial length/corneal radius (AXL/CR) and refractive centile curves. RESULTS Based on the PICNIC criteria, 46 children (26 female) were classified as HR (M = +0.62 ± 0.44 D, AXL = 22.80 ± 0.64 mm) and 51 (27 female) as LR (M = +1.26 ± 0.44 D, AXL = 22.77 ± 0.77 mm). Based on centiles, 49 children were HR, with moderate agreement compared with the PICNIC classification (k = 0.65, p < 0.01). ANCOVA with age as a covariate showed a significant effect for AXL (p < 0.01), with longer AXL and deeper anterior chamber depth (ACD) (p = 0.01) in those at HR (differences AXL = 0.16 mm, ACD = 0.13 mm). Linear regression models showed that central corneal thickness (CCT), ACD, posterior vitreous depth (PVD) (=AXL - CCT - ACD-lens thickness (LT)), corneal radius (CR) and age significantly predicted M (R = 0.64, p < 0.01). Each 1.00 D decrease in hyperopia was associated with a 0.97 mm elongation in PVD and 0.43 mm increase in CR. The ratio AXL/CR significantly predicted M (R = -0.45, p < 0.01), as did AXL (R = -0.25, p = 0.01), although to a lesser extent. CONCLUSIONS Although M and AXL were highly correlated, the classification of pre-myopic children into HR or LR was significantly different when using each parameter, with AXL/CR being the most predictive metric. At the end of the longitudinal study, we will be able to assess the predictability of each metric.
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Affiliation(s)
| | | | | | - Peter J. Bex
- College of Science, Northeastern University, Boston, Massachusetts, USA
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Shah R, Edgar DF, Evans BJW. Worsening vision at age 4-5 in England post-COVID: Evidence from a large database of vision screening data. Ophthalmic Physiol Opt 2023; 43:454-465. [PMID: 36866712 DOI: 10.1111/opo.13112] [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: 09/28/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE Myopia prevalence has increased in the UK at age 10-16y, but little is known about younger children. We hypothesise that if the 'myopia epidemic' is affecting young children, then there will be increasing rates of bilateral reduced unaided vision (V) at vision screenings of children 4-5 years of age. METHODS Retrospective anonymised data from computerised vision screening at age 4-5 years were analysed from serial cross-sectional data. Refractive error is not assessed in UK vision screening, so vision was investigated. Data were only included from schools that screened every year from 2015/16 to 2021/22. The criterion used was unaided monocular logMAR (automated letter-by-letter scoring) vision >0.20 in both the right and left eyes, so as to maximise the chances of detecting bilateral, moderate myopia rather than amblyopia. RESULTS Anonymised raw data were obtained for 359,634 screening episodes from 2075 schools. Once schools were excluded where data were not available for every year and data were cleaned, the final database comprised 110,076 episodes. The proportion (percentage and 95% CI) failing the criterion from 2015/16 to 2021/22 were 7.6 (7.2-8.0), 8.5 (8.1-8.9), 7.5 (7.1-7.9), 7.8 (7.4-8.2), 8.7 (8.1-9.2), 8.5 (7.9-9.0) and 9.3 (8.8-9.7), respectively. The slope of the regression line showed a trend for increasing rates of reduced bilateral unaided vision, consistent with increasing frequency of myopia (p = 0.06). A decreasing linear trendline was noted for children 'Under Professional Care'. CONCLUSIONS For children 4-5 years of age, there were signs of reduced vision over the last 7 years in England. Consideration of the most likely causes support the hypothesis of increasing myopia. The increase in screening failures highlights the importance of eye care in this young population.
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Affiliation(s)
- Rakhee Shah
- Institute of Optometry, London, UK.,Centre for Applied Vision Research, City, University of London, London, UK
| | - David F Edgar
- Institute of Optometry, London, UK.,Centre for Applied Vision Research, City, University of London, London, UK
| | - Bruce J W Evans
- Institute of Optometry, London, UK.,Centre for Applied Vision Research, City, University of London, London, UK
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Rozema JJ. Refractive development I: Biometric changes during emmetropisation. Ophthalmic Physiol Opt 2023; 43:347-367. [PMID: 36740946 DOI: 10.1111/opo.13094] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/15/2022] [Accepted: 01/03/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE Although there are many reports on ocular growth, these data are often fragmented into separate parameters or for limited age ranges. This work intends to create an overview of normal eye growth (i.e., in absence of myopisation) for the period before birth until 18 years of age. METHODS The data for this analysis were taken from a search of six literature databases using keywords such as "[Parameter] & [age group]", with [Parameter] the ocular parameter under study and [age group] an indication of age. This yielded 34,409 references that, after screening of title, abstract and text, left 294 references with usable data. Where possible, additional parameters were calculated, such as the Bennett crystalline lens power, whole eye power and axial power. RESULTS There were 3422 average values for 17 parameters, calculated over a combined total of 679,398 individually measured or calculated values. The age-related change in refractive error was best fitted by a sum of four exponentials (r2 = 0.58), while all other biometric parameters could be fitted well by a sum of two exponentials and a linear term ('bi-exponential function'; r2 range: 0.64-0.99). The first exponential of the bi-exponential fits typically reached 95% of its end value before 18 months, suggesting that these reached genetically pre-programmed passive growth. The second exponentials reached this point between 4 years of age for the anterior curvature and well past adulthood for most lenticular dimensions, suggesting that this part represents the active control underlying emmetropisation. The ocular components each have different growth rates, but growth rate changes occur simultaneously at first and then act independently after birth. CONCLUSIONS Most biometric parameters grow according to a bi-exponential pattern associated with passive and actively modulated eye growth. This may form an interesting reference to understand myopisation.
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Affiliation(s)
- Jos J Rozema
- Visual Optics Lab Antwerp (VOLANTIS), Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium.,Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium.,Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
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Lingham G, Loughman J, Kuzmenko S, Biba M, Flitcroft DI. Will treating progressive myopia overwhelm the eye care workforce? A workforce modelling study. Ophthalmic Physiol Opt 2022; 42:1092-1102. [PMID: 35726623 PMCID: PMC9543528 DOI: 10.1111/opo.13019] [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: 01/28/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 11/28/2022]
Abstract
Purpose Treatments for myopia progression are now available, but implementing these into clinical practice will place a burden on the eye care workforce. This study estimated the full‐time equivalent (FTE) workforce required to implement myopia control treatments in the UK and Ireland. Methods To estimate the number of 6‐ to 21‐year‐olds with myopia, two models utilising separate data sources were developed. The examination‐based model used: (1) the number of primary care eye examinations conducted annually and (2) the proportion of these that are for myopic young people. The prevalence‐based model used epidemiological data on the age‐specific prevalence of myopia. The proportion of myopic young people progressing ≥0.25 dioptres (D)/year or ≥0.50 D/year was obtained from Irish electronic health records and the recommended review schedule from clinical management guidelines. Results Using the examination and prevalence models, respectively, the estimated number of young people with myopia was 2,469,943 and 2,235,713. The extra workforce required to provide comprehensive myopia management for this target population was estimated at 226–317 FTE at the 0.50 D/year threshold and 433–630 FTE at the 0.25 D/year threshold. Extra visits required for myopia control treatment represented approximately 2.6% of current primary eye care examinations versus 13.6% of hospital examinations. Conclusions Implementing new myopia control treatments in primary care settings over the medium‐term is unlikely to overwhelm the eye care workforce completely. Further increases to workforce, upskilling of current workforce and tools to reduce chair time will help to ensure sustainability of the eye care workforce into the future.
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Affiliation(s)
- Gareth Lingham
- Centre for Eye Research Ireland, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - James Loughman
- Centre for Eye Research Ireland, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - Stella Kuzmenko
- Centre for Eye Research Ireland, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - Matilda Biba
- Centre for Eye Research Ireland, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - Daniel Ian Flitcroft
- Centre for Eye Research Ireland, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland.,Department of Ophthalmology, Children's University Hospital, Dublin, Ireland
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The Evolution and the Impact of Refractive Errors on Academic Performance: A Pilot Study of Portuguese School-Aged Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9060840. [PMID: 35740777 PMCID: PMC9221706 DOI: 10.3390/children9060840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/25/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022]
Abstract
The relationship between vision and academic performance has been discussed for a long time, with special emphasis on visual factors associated with learning problems. The objective of this pilot study is to obtain an initial idea about the evolution and the impact of refractive errors on school-aged children. A visual examination was performed on 252 children between the ages of 6 and 11 years, which consisted of objective refraction, subjective refraction, and accommodative and binocular tests. No significant differences were observed regarding the refractive state when taking academic performance into account (p > 0.05). However, it was determined that academic performance was better among children with a negative spherical equivalent. Studies with a larger sample size must be conducted to verify the results that were attained in this present pilot study, and these must likewise look at possible ways in which strategies can be implemented in schools to reduce myopia progression.
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Dragomirova M, Antonova A, Stoykova S, Mihova G, Grigorova D. Myopia in Bulgarian school children: prevalence, risk factors, and health care coverage. BMC Ophthalmol 2022; 22:248. [PMID: 35658918 PMCID: PMC9166668 DOI: 10.1186/s12886-022-02471-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/24/2022] [Indexed: 12/17/2022] Open
Abstract
Abstract
Background
The prevalence of myopia has increased in recent years, with changes being dynamic and uneven in different regions. The purpose of this study is to evaluate the prevalence of visual impairment caused by myopia in Bulgarian school children, associated risk factors, and health care coverage.
Methods
A cross-sectional study among 1401 children (mean age 10.38, standard deviation 2.70) is conducted in three locations in Bulgaria from 2016 to 2020. Refractive error is measured with an auto-refractor in the absence of cycloplegia, the visual acuity is assessed without refractive error correction. A paper-based preliminary questionnaire is used to collect data on previous eye examinations, prescribed optical vision correction, regularity of wearing corrective glasses and risk factors.
Results
Children with myopic objective refraction ≤ -0.75 D and decimal visual acuity ≤ 0.8 on at least one of the eyes are 236 out of 1401 or 16.85%. The prevalence of myopia varies depending on age, geographical location, and school profile. The rate of myopic children in age group 6–10 is 14.2% compared to 19.9% in age group 11–15. The prevalence of myopic children in the urban populations is 31.4% (capital) and 19.9% (medium-sized town) respectively, and only 8.4% in the rural population. Our results show 53% increase of the prevalence of myopia in the age group 11–15 compared to a 2009 report. The analysis of data associated with health care coverage factors of all myopic pupils shows that 71.6% had a previous eye examination, 43.2% have prescription for corrective glasses, 27.5% wear their glasses regularly. Risk factors for higher odds of myopia are gender (female), age (adolescence), and parents with impaired vision. Residence in a small town and daily sport activities correspond to lower odds for myopia. The screen time (time in front of the screen calculated in hours per day) is self-reported and is not associated with increased odds of myopia when accounted for the other risk factors.
Conclusions
The prevalence of myopia in this study is higher compared to previous studies in Bulgaria. Additional studies would be helpful in planning adequate prevention and vision care.
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Kearney S, Strang NC, Lewsey J, Azuara-Blanco A, Jonuscheit S. Socio-economic differences in accessing NHS spectacles amongst children with differing refractive errors living in Scotland. Eye (Lond) 2022; 36:773-780. [PMID: 33875827 PMCID: PMC8956614 DOI: 10.1038/s41433-021-01536-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 03/02/2021] [Accepted: 04/06/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND/OBJECTIVES Adults living in more deprived areas are less likely to attend an eye examination, resulting in greater visual impairment from undiagnosed eye disease and a widening of health inequalities. It is unknown if the introduction of free NHS eye examinations and help with spectacle costs has benefited children in Scotland. This study aimed to explore factors associated with accessing NHS spectacles including level of deprivation, refractive error, urbanity and age. SUBJECTS/METHODS NHS-financed General Ophthalmic Services (GOS) 3 supplement the cost of spectacles for children under 16 years. Administrative data on the spectacle refraction dispensed were obtained from Information Services Division (ISD) for mainland Scotland, 2018, and categorised by: Emmetropes/low hyperopes (reference group), myopes and moderate/high hyperopes. Data were linked to the Scottish Index of Multiple Deprivation (SIMD) quintile. RESULTS Data included 108, 043 GOS 3 claims. Greater deprivation was associated with greater GOS 3 claims p = 0.041. This was most evident in emmetropic/low hyperopic children and in moderate/high hyperopic children. GOS 3 claims in the myopes group increased with age across all SIMD and decreased with age in the moderate/high hyperope group (all p < 0.001). GOS 3 claims were not associated with urbanity for all Health Boards (p = 0.13). CONCLUSIONS Children in areas of greater deprivation and in more rural areas are not disadvantaged in accessing NHS spectacles. This did not vary by refractive error group. This suggests that health policy in Scotland is accessible to those from all deprivation levels and refractive errors.
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Affiliation(s)
- Stephanie Kearney
- grid.5214.20000 0001 0669 8188Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Niall C. Strang
- grid.5214.20000 0001 0669 8188Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Jim Lewsey
- grid.8756.c0000 0001 2193 314XInstitute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Augusto Azuara-Blanco
- grid.4777.30000 0004 0374 7521Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Sven Jonuscheit
- grid.5214.20000 0001 0669 8188Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
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13
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Gopalakrishnan A, Hussaindeen JR, Sivaraman V, Swaminathan M, Wong YL, Armitage JA, Gentle A, Backhouse S. Prevalence of myopia among urban and suburban school children in Tamil Nadu, South India: findings from the Sankara Nethralaya Tamil Nadu Essilor Myopia (STEM) Study. Ophthalmic Physiol Opt 2022; 42:345-357. [PMID: 35019150 PMCID: PMC9304285 DOI: 10.1111/opo.12943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/13/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To report the baseline prevalence of myopia among school children in Tamil Nadu, South India from a prospective cohort study. METHODS Children between the ages of 5 and 16 years from 11 schools in two districts of Tamil Nadu underwent vision screening. All children underwent visual acuity assessment using a Pocket Vision Screener followed by non-cycloplegic open-field autorefraction (Grand Seiko WAM-5500). Myopia was defined as a spherical equivalent (SE) refraction of ≤-0.75 D and high myopia was defined as SE ≤ -6.00 D. Distribution of refraction, biometry and factors associated with prevalence of myopia were the outcome measures. RESULTS A total of 14,699 children completed vision screening, with 2% (357) of them having ocular abnormalities other than refractive errors or poor vision despite spectacle correction. The remaining 14,342 children (7557 boys; 52.69%) had a mean age of 10.2 (Standard Deviation [SD] 2.8) years. A total of 2502 had myopia in at least one eye, a prevalence of 17.5% (95% CI: 14.7-20.5%), and 74 (0.5%; 95% CI: 0.3-0.9%) had high myopia. Myopia prevalence increased with age (p < 0.001), but sex was not associated with myopia prevalence (p = 0.24). Mean axial length (AL; 23.08 (SD = 0.91) mm) and mean anterior chamber depth (ACD; 3.45 (SD = 0.27) mm) positively correlated with age (p < 0.001). The mean flat (K1; 43.37 (SD = 1.49) D) and steep (K2; 44.50 (SD = 1.58) D) corneal curvatures showed negative correlation with age (p = 0.02 and p < 0.001, respectively). In the multivariable logistic regression, older age and urban school location had higher odds for prevalence of myopia. CONCLUSION The baseline prevalence of myopia among 5- to 16-year-old children in South India is larger than that found in previous studies, indicating that myopia is becoming a major public health problem in this country.
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Affiliation(s)
- Aparna Gopalakrishnan
- Myopia Clinic, Sankara Nethralaya, Unit of Medical Research Foundation, Chennai, India.,School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | | | - Viswanathan Sivaraman
- Myopia Clinic, Sankara Nethralaya, Unit of Medical Research Foundation, Chennai, India
| | - Meenakshi Swaminathan
- Myopia Clinic, Sankara Nethralaya, Unit of Medical Research Foundation, Chennai, India
| | - Yee Ling Wong
- R&D AMERA, Essilor International, Singapore, Singapore
| | - James A Armitage
- School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Alex Gentle
- School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Simon Backhouse
- School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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The Prevalence of Myopia in Children in Spain: An Updated Study in 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312375. [PMID: 34886101 PMCID: PMC8656604 DOI: 10.3390/ijerph182312375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/04/2021] [Accepted: 11/16/2021] [Indexed: 02/06/2023]
Abstract
Background: In recent years, there was a significant increase in myopia incidence worldwide. However, it is still not clear how it affects Spanish children. Since 2016, this research team analyzed myopia prevalence and risk in 9668 children aged between 5 and 7 years. It was shown that the prevalence rates increased from 16.8% in 2016 to 20.4% in 2019. The objective of this study is to update the prevalence rate of myopia in Spain in 2020 and analyze the risk and prevention factors of myopia. Methods: The participants underwent an optometric examination, and a questionnaire on their lifestyle, family history, and geographical origin was carried out. Finally, data were analyzed using the SPSS version 27 program. Results: 1601 children from various Autonomous Communities of Spain were examined. In 2020 the myopia rates did not increase compared to 2019 (p < 0.05), although the number of hyperopes decreased and the number of emmetropes increased. Regarding age, the prevalence of myopia increased progressively over the years (p < 0.001). There was no association between gender and myopia (p > 0.05). There was a link between the time spent in near vision and family history with the prevalence of myopia (p < 0.05). Conclusions: The prevalence of myopia in Spain in children between 5 and 7 years old increased significantly between 2016 and 2020.
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Leighton RE, Breslin KM, Saunders KJ, McCullough SJ. An evaluation of the IOLMaster 700 and its agreement with the IOLMaster v3 in children. Ophthalmic Physiol Opt 2021; 42:48-58. [PMID: 34761427 DOI: 10.1111/opo.12918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the repeatability and reproducibility of the swept-source optical coherence tomographer Zeiss IOLMaster 700 and compare its outputs with those obtained using partial coherence interferometry (Zeiss IOLMaster v3) in a healthy, paediatric population. METHODS This is a cross-sectional, observational study. Examiner 1 took two sets of biometric measurements (axial length [AL], mean corneal radius of curvature [Kmean ], anterior chamber depth [ACD] and lens thickness [LT]) using the IOLMaster 700, and one set of measurements (AL, Kmean and ACD) using the IOLMaster v3. Examiner 2 took one full set of measurements using the IOLMaster 700. Mean differences and 95% limits of agreement (LOA) were calculated, and Bland and Altman plots used to explore repeatability and reproducibility of the IOLMaster 700 alongside establishing its agreement with the IOLMaster v3. RESULTS Mean participant age was 7.52 ± 0.58 years. Repeatability analyses demonstrated small mean differences and narrow 95% LOA for AL (0.001, -0.013 to 0.015 mm), Kmean (0.002, -0.020 to 0.024 mm), ACD (-0.003, -0.031 to 0.024 mm) and LT (0.001, -0.024 to 0.026 mm), respectively. Similarly, small mean differences and narrow 95% LOA established excellent reproducibility (AL 0.001, -0.016 to 0.018 mm; Kmean -0.001, -0.027 to 0.025 mm; ACD -0.010, -0.041 to 0.021 mm; LT 0.002, -0.016 to 0.020 mm). The IOLMaster 700 and IOLMaster v3 demonstrated good agreement with small mean differences and narrow 95% LOA (AL 0.009, -0.034 to 0.052 mm; Kmean 0.016, -0.013 to 0.044 mm; ACD 0.134, 0.055 to 0.212 mm). CONCLUSIONS When used within a paediatric population, these data demonstrate the IOLMaster 700 to be highly repeatable and reproducible for measures of AL, Kmean , ACD and LT. There is excellent inter-instrument agreement between the IOLMaster 700 and IOLMaster v3 for measures of AL and Kmean . ACD measurements show weaker agreement. These data will be useful when considering reports from population-based studies of refractive error and clinical myopia research.
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Affiliation(s)
- Rebecca E Leighton
- Centre for Optometry and Vision Science, School of Biomedical Sciences, Ulster University, Coleraine, UK
| | - Karen Mm Breslin
- Centre for Optometry and Vision Science, School of Biomedical Sciences, Ulster University, Coleraine, UK
| | - Kathryn J Saunders
- Centre for Optometry and Vision Science, School of Biomedical Sciences, Ulster University, Coleraine, UK
| | - Sara J McCullough
- Centre for Optometry and Vision Science, School of Biomedical Sciences, Ulster University, Coleraine, UK
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16
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Cui J, Fu J, Li L, Chen W, Meng Z, Su H, Yao Y, Dai W. Prevalence and pattern of refractive error and visual impairment among schoolchildren: the Lhasa childhood eye study. BMC Ophthalmol 2021; 21:363. [PMID: 34641830 PMCID: PMC8513166 DOI: 10.1186/s12886-021-02134-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 09/23/2021] [Indexed: 11/25/2022] Open
Abstract
Background Early and effective ocular screening may help to eliminate treatable eye disorders. The Lhasa Childhood Eye Study (LCES) revealed the particular prevalence of refractive error and visual impairment in grade one schoolchildren (starting age of 6 years old) in Lhasa. Methods This is a cross-sectional part of school-based cohort study. One thousand nine hundred forty-three children were enrolled (median age, 6.78 years, range, 5.89 to 10.32). Each child underwent general and ocular examinations, including logarithm of the minimum angle of resolution (logMAR) visual acuity, cycloplegic autorefraction, and slit-lamp biomicroscopy evaluation. Multivariate and correlation analyses were performed to evaluate the association between refractive error with gender and ethnics. Results The prevalence of visual impairment (logMAR visual acuity ≥0.3 in the better-seeing eye) of uncorrected, presenting and best-corrected visual acuity (BCVA) was 12.2, 11.7 and 2.7%, respectively. Refractive error presented in 177 (78.0%) out of 227 children with bilateral visual impairment. Myopia (spherical equivalent refractor [SER] ≤ − 0.50 diopter [D] in either eye) was present in 4.7% children when measured after cycloplegic autorefraction. Hyperopia (SER ≥ + 2.00 D) affected 12.1% children. Hyperopia was significantly associated with female gender (P<0.001). Astigmatism (cylinder value ≤ − 0.75 D) was present in 44.8% children. In multivariate regression and correlation analysis, SER had no significant difference between ethnic groups. Conclusion The Lhasa Childhood Eye Study is the first school-based cohort study to reveal the prevalence and pattern of refractive error and visual impairment in Lhasa. Effective strategies such as corrective spectacles should be considered to alleviate treatable visual impairment.
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Affiliation(s)
- Jiantao Cui
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
| | - Jing Fu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China.
| | - Lei Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
| | - Weiwei Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China.,Beijing Institute of Ophthalmology, Beijing, China
| | - Zhaojun Meng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
| | - Han Su
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
| | - Yao Yao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
| | - Wei Dai
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
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Rauscher FG, Francke M, Hiemisch A, Kiess W, Michael R. Ocular biometry in children and adolescents from 4 to 17 years: a cross-sectional study in central Germany. Ophthalmic Physiol Opt 2021; 41:496-511. [PMID: 33960004 DOI: 10.1111/opo.12814] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/25/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate ocular biometry in a large paediatric population as a function of age and sex in children of European descent. METHODS Children were examined as part of the LIFE Child Study (Leipzig Research Centre for Civilization Disease), a population-based study in Leipzig, Germany. Altogether, 1907 children, aged from 4 to 17 years, were examined with the Lenstar LS 900. Data from the right eye was analysed for axial length, central corneal thickness, flat and steep corneal radii, aqueous depth, lens thickness and vitreous depth. Wavefront-based autorefraction was employed for analysis. RESULTS Axial length increased in girls from 21.6 mm (4 years) up to 23.4 mm (17 years); this increase (0.174 mm per year) was statistically significant up to age 14 (23.3 mm). Axial length increased in boys from 22.2 mm (4 years) up to 23.9 mm (17 years); this increase (0.178 mm per year) was statistically significant up to age 10 (23.3 mm). No change was observed for central corneal thickness (average: girls 550 µm; boys 554 µm). Corneal curvature in girls was somewhat flatter at age 4 (7.70 mm) compared to age 10 (7.78 mm), whereas it was constant in boys (7.89 mm). Aqueous depth at age 4 was 2.73 mm for girls and 2.86 mm for boys, with the same rate of increase per year (girls: 0.046 mm; boys: 0.047 mm) from age 4 to 10. At age 17, aqueous depth was 3.06 mm in girls and 3.20 mm in boys. Lens thickness was reduced from age 4 (3.75 mm) to age 10 (3.47 mm) in girls and from age 4 (3.73 mm) to age 10 (3.44 mm) in boys, with the same rate of decrease per year of 0.046 and 0.047 mm, respectively. At age 17, lens thickness was 3.52 mm in girls and 3.50 mm in boys. Vitreous depth at age 4 was 14.51 mm for girls and 15.08 mm for boys; with 0.156 mm (girls) or 0.140 mm (boys) increase per year until age 14 (girls: 16.08 mm; boys: 16.48 mm). At age 17, vitreous depth was 16.29 mm in girls and 16.62 mm in boys. CONCLUSIONS Eye growth (axial length) in girls showed a lag of about four years compared to boys. Aqueous depth increase matches the lens thickness decrease from ages 4 to 10 years in girls and boys. Lens thickness minimum is reached at 11 years in girls and at 12 years in boys. All dimensions of the optical ocular components are closely correlated with axial length. These data may serve as normative values for the assessment of eye growth in central European children and will provide a basis for monitoring refractive error development.
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Affiliation(s)
- Franziska G Rauscher
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany.,Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
| | - Mike Francke
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany.,Paul-Flechsig-Institute of Brain Research, Leipzig University, Leipzig, Germany
| | - Andreas Hiemisch
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany.,Department of Women and Child Health, University Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Leipzig, Germany
| | - Wieland Kiess
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany.,Department of Women and Child Health, University Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Leipzig, Germany
| | - Ralph Michael
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany.,Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
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18
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Morgan IG, Rose KA. Myopia: is the nature‐nurture debate finally over? Clin Exp Optom 2021; 102:3-17. [DOI: 10.1111/cxo.12845] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/10/2018] [Accepted: 09/12/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Ian G Morgan
- Research School of Biology, Australian National University, Canberra, Australian Capital Territory, Australia,
- State Key Laboratory of Ophthalmology and Division of Preventive Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat‐Sen University, Guangzhou, China,
| | - Kathryn A Rose
- Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia,
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Demir P, Baskaran K, Theagarayan B, Gierow P, Sankaridurg P, Macedo AF. Refractive error, axial length, environmental and hereditary factors associated with myopia in Swedish children. Clin Exp Optom 2021; 104:595-601. [PMID: 33689658 DOI: 10.1080/08164622.2021.1878833] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Clinical relevance: Investigation of refractive errors amongst Swedish schoolchildren will help identify risk factors associated with myopia development.Background: Genetic and hereditary aspects have been linked with the development of myopia. Nevertheless, in the case of 'school myopia' some authors suggest that environmental factors may affect gene expression, causing school myopia to soar. Additional understanding about which environmental factors play a relevant role can be gained by studying refractive errors in countries like Sweden, where prevalence of myopia is expected to be low.Methods: Swedish schoolchildren aged 8-16 years were invited to participate. Participants underwent an eye examination, including cycloplegic refraction and axial length (AL) measurements. Predictors such as time spent in near work, outdoor activities and parental myopia were obtained using a questionnaire. Myopia was defined as spherical equivalent refraction (SER) ≤ -0.50D and hyperopia as SER ≥ +0.75D.Results: A total of 128 children (70 females and 58 males) participated in this study with mean age of 12.0 years (SD = 2.4). Based on cycloplegic SER of the right eye, the distribution of refractive errors was: hyperopia 48.0% (CI95 = 38.8-56.7), emmetropia 42.0% (CI95 = 33.5-51.2) and myopia 10.0%. (CI95 = 4.4-14.9). The mean AL was 23.1 mm (SD = 0.86), there was a correlation between SER and AL, r = -0.65 (p < 0.001). Participants with two myopic parents had higher myopia and increased axial length than those with one or no myopic parents. The mean time spent in near work, outside of school, was 5.3 hours-per-day (SD = 3.1), and mean outdoor time reported was 2.6 hours-per-day (SD = 2.2) for all the participants. The time spent in near work and outdoor time were different for different refractive error categories.Conclusion: The prevalence of myopia amongst Swedish schoolchildren is low. Hereditary and environmental factors are associated with refractive error categories. Further studies with this sample are warranted to investigate how refractive errors and environmental factors interact over time.
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Affiliation(s)
- Pelsin Demir
- Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | | | | | - Peter Gierow
- Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Padmaja Sankaridurg
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Antonio Filipe Macedo
- Medicine and Optometry, Linnaeus University, Kalmar, Sweden.,Center of Physics - Optometry and Vision Science, University of Minho, Braga, Portugal
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Lin Z, Vasudevan B, Gao T, Zhou H, Ciuffreda KJ, Liang Y. Refractive change and incidence of myopia among rural Chinese children: the Handan Offspring Myopia Study. Br J Ophthalmol 2021; 106:628-632. [PMID: 33441318 DOI: 10.1136/bjophthalmol-2020-317811] [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: 09/07/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 11/04/2022]
Abstract
PURPOSE To assess the refractive change and incidence of myopia, as well as their risk factors, among Chinese rural children aged 6-17 years. METHODS Children who completed the baseline vision examination of the Handan Offspring Myopia Study were re-examined, including both cycloplegic and non-cyloplegic autorefraction, with a mean follow-up time of 42.4±1.47 months. RESULTS A total of 601 children (68.5%) who completed both baseline and the follow-up examinations were enrolled. The cumulative refractive change and axial length change were -0.53±1.03 diopter and 0.39±0.46 mm (-0.15 diopter/year and 0.11 mm/year), respectively. A hundred and five out of the 469 non-myopic children at baseline become myopic at the follow-up, yielding a cumulative myopia incidence of 22.4% (95% CI: 18.6% to 26.2%), or annual myopia incidence of 6.3%. After adjustment, younger age (β=0.08, p<0.001), more myopic baseline refraction (β=0.31, p<0.001), larger difference between cycloplegic and non-cycloplegic refraction (β=-0.20, p=0.007) and more myopic paternal refraction (β=0.09, p=0.007) were found to be associated with more rapid myopic refractive change. More myopic baseline refraction (relative risk (RR), 95% CI: 0.19, 0.13-0.28, p<0.001) and more myopic paternal refraction (RR, 95% CI: 0.92, 0.84-1.00, p=0.039) were also associated with myopia incidence. CONCLUSION Relatively low myopic refractive change and myopia incidence were found in this study cohort. Children's refraction and paternal refraction were associated with both myopic refractive change and myopia incidence. Such information will be helpful for further comparisons in other rural versus urban areas of China, and other countries.
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Affiliation(s)
- Zhong Lin
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | | | | | - Hongjia Zhou
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Kenneth J Ciuffreda
- Department of Biological and Vision Sciences, SUNY College of Optometry, New York, NY, USA, New York, NY, USA
| | - Yuanbo Liang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China .,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
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21
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Reimelt C, Wolff N, Hölling H, Mogwitz S, Ehrlich S, Roessner V. The Underestimated Role of Refractive Error (Hyperopia, Myopia, and Astigmatism) and Strabismus in Children With ADHD. J Atten Disord 2021; 25:235-244. [PMID: 30371126 DOI: 10.1177/1087054718808599] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To examine the association of refractive error (myopia, hyperopia, astigmatism) and strabismus with ADHD. Method: Based on data from the large, representative, epidemiological sample of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study (N = 13,488), the associations of myopia, hyperopia, astigmatism, and strabismus with ADHD were examined, with and without consideration of other common ADHD risk factors. Results: In single logistic regression models, all examined forms of refractive error and strabismus showed an association with ADHD. After controlling for confounding variables, results remained stable and showed an increased risk for ADHD in children with hyperopia, astigmatism, and strabismus compared with the control group. Only the association between myopia and ADHD in children was not significant. Conclusion: Hyperopia, astigmatism, and strabismus seem to be independently associated with ADHD. Health care professionals in different medical fields should consider this association to adequately diagnose and treat affected children.
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22
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Harrington SC, O'Dwyer V. Ocular biometry, refraction and time spent outdoors during daylight in Irish schoolchildren. Clin Exp Optom 2019; 103:167-176. [PMID: 31187504 DOI: 10.1111/cxo.12929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 04/10/2019] [Accepted: 04/23/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Previous studies have investigated the relationship between ocular biometry and spherical equivalent refraction in children. This is the first such study in Ireland. The effect of time spent outdoors was also investigated. METHODS Examination included cycloplegic autorefraction and non-contact ocular biometric measures of axial length, corneal radius and anterior chamber depth from 1,626 children in two age groups: six to seven years and 12 to 13 years, from 37 schools. Parents/guardians completed a participant questionnaire detailing time spent outdoors during daylight in summer and winter. RESULTS Ocular biometric data were correlated with spherical equivalent refraction (axial length: r = -0.64, corneal radius: r = 0.07, anterior chamber depth: r = -0.33, axial length/corneal radius ratio: r = -0.79, all p < 0.0001). Participants aged 12-13 years had a longer axial length (6-7 years 22.53 mm, 12-13 years 23.50 mm), deeper anterior chamber (6-7 years 3.40 mm, 12-13 years 3.61 mm), longer corneal radius (6-7 years 7.81 mm, 12-13 years 7.87 mm) and a higher axial length/corneal radius ratio (6-7 years 2.89, 12-13 years 2.99), all p < 0.0001. Controlling for age: axial length was longer in boys (boys 23.32 mm, girls 22.77 mm), and non-White participants (non-White 23.21 mm, White 23.04 mm); corneal radius was longer in boys (boys 7.92 mm, girls 7.75 mm); anterior chamber was deeper in boys (boys 3.62 mm, girls 3.55 mm, p < 0.0001), and axial length/corneal radius ratios were higher in non-White participants (non-White 2.98, White 2.94, p < 0.0001). Controlling for age and ethnicity, more time outdoors in summer was associated with a less myopic refraction, shorter axial length, and lower axial length/corneal radius ratio. Non-White participants reported spending significantly less time outdoors than White participants (p < 0.0001). CONCLUSION Refractive error variance in schoolchildren in Ireland was best explained by variation in the axial length/corneal radius ratio with higher values associated with a more myopic refraction. Time spent outdoors during daylight in summer was associated with shorter axial lengths and a less myopic spherical equivalent refraction in White participants. Strategies to promote daylight exposure in wintertime is a study recommendation.
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Affiliation(s)
- Síofra C Harrington
- School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Veronica O'Dwyer
- School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
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Donaldson LA, Karas M, O'Brien D, Woodhouse JM. Findings from an opt-in eye examination service in English special schools. Is vision screening effective for this population? PLoS One 2019; 14:e0212733. [PMID: 30856194 PMCID: PMC6411105 DOI: 10.1371/journal.pone.0212733] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 02/10/2019] [Indexed: 12/04/2022] Open
Abstract
Our objective was to present the findings of an opt-in, school-based eye care service for children attending 11 special schools in England and use these findings to determine whether a vision screening programme would be appropriate for this population. Data from eye examinations provided to 949 pupils (mean age 10.7 years) was analysed to determine the prevalence and aetiology of visual deficiencies and reported eye care history. For 46.2% (n = 438) of pupils, a visual deficiency was recorded. 12.5% of all the children seen (n = 119) had a visual deficiency that was previously undiagnosed. Referral for a medical opinion was made for 3.1% (n = 29) of pupils seen by the service. Spectacle correction was needed for 31.5% (n = 299) of pupils; for 12.9% (122) these were prescribed for the first time. 3.7% (n = 11) of parents/carers of pupils needing spectacles chose not to use the spectacle dispensing service offered in school. Eye care history was available for 847 pupils (89.3%). Of the pupils for whom an eye care history was available, 44% (n = 373) reported no history of any previous eye care and10.7% (n = 91) reported a history of attending a community optical practice/opticians. Only one pupil from the school entry 4–5 age group (0.6% of age group n = 156) would have passed vision screening using current Public Health England screening guidelines. Children with a diagnosis of autism were significantly less likely to be able to provide a reliable measurement of visual acuity. This study supports previously published evidence of a very high prevalence of visual problems in children with the most complex needs and a significant unmet need in this group. It demonstrates routine school entry vision screening using current Public Health England guidelines is not appropriate for this group of children and very low uptake of community primary eye care services.
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Affiliation(s)
| | | | | | - J Margaret Woodhouse
- School of Optometry & Vision Sciences, Cardiff University, Cardiff, United Kingdom
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24
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Cho P, Tan Q. Myopia and orthokeratology for myopia control. Clin Exp Optom 2018; 102:364-377. [PMID: 30380591 DOI: 10.1111/cxo.12839] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 12/18/2022] Open
Abstract
The prevalence of myopia in children is increasing worldwide and is viewed as a major public health concern. This increase has driven interest in research into myopia prevention and control in children. Although there is still uncertainty in the risk factors underlying differences in myopia prevalence between ethnic groups, rates in children of East Asian descent are typically higher regardless of where they live. Mounting evidence also suggests that myopia prevalence in children increases with age. Earlier commencement and more rigorous education systems in these countries, resulting in more time spent on near-work activities and less time on outdoor activities, may be responsible for the earlier age of myopia onset. However, to date, the mechanisms regulating myopia onset and progression are still poorly understood. Findings from several studies have shown orthokeratology to be effective in slowing axial elongation and it is a well-accepted treatment, particularly in East Asian regions. While our understanding of this treatment has increased in the last decade, more work is required to answer questions, including: How long should the treatment be continued? Is there a rebound effect? Should the amount of myopia control be increased? To whom and when should the treatment be offered? Practitioners are now faced with the need to carefully guide and advise parents on whether and when to undertake a long somewhat complex intervention, which is costly, both in time and money. In the near future, a greater demand for effective prophylaxis against childhood myopia is envisaged. Other than orthokeratology, atropine therapy has been shown to be effective in slowing myopia progression. While its mechanism of control is also not fully understood, it is likely that it acts via a different mechanism from orthokeratology. Thus, a combined treatment of orthokeratology and atropine may have great potential to maximise the effectiveness of myopia control interventions.
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Affiliation(s)
- Pauline Cho
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
| | - Qi Tan
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
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Moon JS, Shin SY. The diluted atropine for inhibition of myopia progression in Korean children. Int J Ophthalmol 2018; 11:1657-1662. [PMID: 30364238 DOI: 10.18240/ijo.2018.10.13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022] Open
Abstract
AIM To evaluate the efficacy and safety of three different concentrations of diluted atropine for the control of myopia in Korean children, and to assess the risk factors associated with rapid myopia progression. METHODS A total of 285 children, with refractive errors within the range of -6 diopters (D) between 5 and 14 years of age were included. After using 0.01%, or 0.025%, or 0.05% atropine, for about 1y, changes in refraction, axial lengths and frequency of adverse events were analyzed. Logistic regression analyses were performed to evaluate the risk factors associated with rapid myopia progression. RESULTS The changes in the mean spherical equivalent values were -0.134 D/mo in the before atropine group, -0.070 D/mo in the 0.01% atropine group, -0.047 D/mo in the 0.025% atropine group, and -0.019 D/mo in the 0.05% atropine group, with significant differences between the groups (P<0.001). The axial elongation was 0.046 mm/mo, 0.037 mm/mo, 0.025 mm/mo, and 0.019 mm/mo respectively, with significant differences between the groups (P=0.003). The incidence of photophobia and near vision difficulty was not different among the three atropine groups (P=0.425 and P=0.356, respectively). Multivariate logistic regression analyses showed that only highly myopic parents were a significant predictive factor of rapid myopia progression in Korean children (odds ratio, 8.155; 95% confidence interval, 3.626-18.342; P<0.001). CONCLUSION Treatment with 0.01%, 0.025% and 0.05% atropine solution inhibits myopia progression in Korean children in a dose-dependent manner. Children with highly myopic parents preferentially shows a rapid myopia progression rate.
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Affiliation(s)
- Ji-Sun Moon
- Department of Ophthalmology, National Medical Center, 245 Euljiro, Jung-gu, Seoul 04564, Republic of Korea
| | - Sun Young Shin
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul 06591, Republic of Korea
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Harrington SC, Stack J, Saunders K, O'Dwyer V. Refractive error and visual impairment in Ireland schoolchildren. Br J Ophthalmol 2018; 103:1112-1118. [PMID: 30315130 PMCID: PMC6678142 DOI: 10.1136/bjophthalmol-2018-312573] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/03/2018] [Accepted: 09/15/2018] [Indexed: 11/04/2022]
Abstract
Aim To report refractive error prevalence and visual impairment in Republic of Ireland (henceforth 'Ireland') schoolchildren. Methods The Ireland Eye Study examined 1626 participants (881 boys, 745 girls) in two age groups, 6–7 years (728) and 12–13 years (898), in Ireland between June 2016 and January 2018. Participating schools were selected by stratified random sampling, representing a mix of school type (primary/postprimary), location (urban/rural) and socioeconomic status (disadvantaged/advantaged). Examination included monocular logarithm of the minimum angle of resolution (logMAR) presenting visual acuity (with spectacles if worn) and cycloplegic autorefraction (1% Cyclopentolate Hydrochloride). Parents completed a questionnaire to ascertain participants’ lifestyle. Results The prevalence of myopia (spherical equivalent refraction (SER): ≤−0.50 D), hyperopia (SER: ≥+2.00 D) and astigmatism (≤−1.00 DC) among participants aged 6–7 years old was 3.3%, 25% and 19.2%, respectively, and among participants aged 12–13 years old was 19.9%, 8.9% and 15.9%, respectively. Astigmatic axes were predominately with-the-rule. The prevalence of ‘better eye’ presenting visual impairment (≥0.3 logMAR, with spectacles, if worn) was 3.7% among younger and 3.4% among older participants. Participants in minority groups (Traveller and non-white) were significantly more likely to present with presenting visual impairment in the ‘better eye’. Conclusions The Ireland Eye Study is the first population-based study to report on refractive error prevalence and visual impairment in Ireland. Myopia prevalence is similar to comparable studies of white European children, but the levels of presenting visual impairment are markedly higher than those reported for children living in Northern Ireland, suggesting barriers exist in accessing eye care.
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Affiliation(s)
- Siofra Christine Harrington
- School of Physics and Clinical and Optometric Sciences, College of Science and Health, Dublin Institute of Technology, Dublin, Ireland
| | - Jim Stack
- Waterford Institute of Technology, Waterford, Ireland
| | - Kathryn Saunders
- School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland
| | - Veronica O'Dwyer
- School of Physics and Clinical and Optometric Sciences, Dublin Institute of Technology, Dublin, Ireland
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Theophanous C, Modjtahedi BS, Batech M, Marlin DS, Luong TQ, Fong DS. Myopia prevalence and risk factors in children. Clin Ophthalmol 2018; 12:1581-1587. [PMID: 30214142 PMCID: PMC6120514 DOI: 10.2147/opth.s164641] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Purpose To evaluate the prevalence and risk factors for pediatric myopia in a contemporary American cohort. Methods A cross-sectional study of pediatric patients enrolled in the Kaiser Permanente Southern California health plan was done. Eligible patients were 5- to 19-years old between January 1, 2008, through December 31, 2013, and received an ophthalmologic or optometric refraction. Electronic medical records were reviewed for demographic data, refraction results, and exercise data. Prevalence and relative risks of myopia (defined as ≤-1.0 diopter) were characterized. Age, sex, race/ethnicity, median neighborhood income, and minutes of exercise per day were examined as risk factors. Results There were 60,789 patients who met the inclusion criteria, of which 41.9% had myopia. Myopia was more common in older children (14.8% in 5- to 7-year olds, 59.0% in 17- to 19-year olds). Asian/Pacific Islander patients (OR 1.64, CI 1.58-1.70) had an increased rate of myopia compared to White patients as did African Americans to a lesser extent (OR 1.08, CI 1.03-1.13). Median neighborhood household income of $25,000-40,000 was associated with lower rates of myopia (OR 0.90, CI 0.83-0.97) compared to median neighborhood household incomes less than $25,000. Having at least 60 min of daily exercise was associated with lower prevalence of myopia (OR 0.87, CI 0.85-0.89). Discussion Myopia was common in this large and diverse Southern Californian pediatric cohort. The prevalence of myopia increases with age. Asian children are at highest risk for myopia. Exercise is associated with a lower rate of myopia and represents an important potentially modifiable risk factor that may be a target for future public health efforts.
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Affiliation(s)
- Christos Theophanous
- Department of Ophthalmology, Southern California Medical Group, Los Angeles, CA, USA
| | - Bobeck S Modjtahedi
- Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, CA, USA, .,Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, CA, USA,
| | - Michael Batech
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - David S Marlin
- Department of Ophthalmology, Southern California Medical Group, Los Angeles, CA, USA
| | - Tiffany Q Luong
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - Donald S Fong
- Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, CA, USA, .,Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, CA, USA, .,Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
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Cruickshank FE, Logan NS. Optical ‘dampening’ of the refractive error to axial length ratio: implications for outcome measures in myopia control studies. Ophthalmic Physiol Opt 2018; 38:290-297. [DOI: 10.1111/opo.12457] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/19/2018] [Indexed: 11/26/2022]
Affiliation(s)
| | - Nicola S. Logan
- School of Optometry, Life and Health Sciences; Aston University; Birmingham UK
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Donaldson L, Subramanian A, Conway ML. Eye care in young children: a parent survey exploring access and barriers. Clin Exp Optom 2018; 101:521-526. [PMID: 29635865 DOI: 10.1111/cxo.12683] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 02/23/2018] [Accepted: 02/27/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND A questionnaire was designed to investigate the attitudes of parents toward eye care for their young children (4-6-year-olds) and possible barriers to accessing eye care for this age group. An exploration was undertaken to determine whether these beliefs and barriers are influenced by certain demographic factors such as ethnicity, level of parental income, level of parental education, confidence with speaking English and a reported family history of eye problems. METHODS A total of 1,317 questionnaires (hard copies) were distributed to parents of children in primary school reception and year one classes (ages four to six) from 14 schools across five London boroughs. Ninety online surveys were sent to parents at two further London schools. All questionnaires were anonymous. RESULTS A total of 384 completed questionnaires were analysed (27 per cent response rate). Three hundred and thirty-eight parents (24 per cent) completed the 'parental knowledge' section of the questionnaire. Of all responses, 65 per cent (n = 249) were from parents whose children attended a school where a program of school entry vision screening took place. Of these, 15 per cent (n = 36) of parents reported that they were aware of the screening program. Barriers to accessing eye care for their children were reported by 38 per cent (n = 153) of parents/carers who responded. Twelve per cent (n = 47) reported not knowing how to access an eye test for their child and 12 per cent (n = 47) reported that they were concerned their child would be given glasses that were not needed. When compared to parents from White ethnic groups, parents from African/Afro-Caribbean ethnic groups were more likely to report not knowing how to access an age-appropriate eye test for their child (p = 0.001). Parents of African/Afro-Caribbean ethnic origins were statistically more likely to report barriers to eye care (p = 0.001). CONCLUSION The study provides evidence of some parental misconceptions around eye care for young children and some barriers to access. Possible solutions to this are discussed.
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Affiliation(s)
- Lisa Donaldson
- School of Health Sciences, City Division of Optometry & Visual Sciences, University of London, London, UK
| | - Ahalya Subramanian
- School of Health Sciences, City Division of Optometry & Visual Sciences, University of London, London, UK
| | - Miriam L Conway
- School of Health Sciences, City Division of Optometry & Visual Sciences, University of London, London, UK
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Prevalence and Related Factors for Myopia in School-Aged Children in Qingdao. J Ophthalmol 2018; 2018:9781987. [PMID: 29507811 PMCID: PMC5817287 DOI: 10.1155/2018/9781987] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 12/10/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the prevalence and related factors for myopia in school-aged children in the Economic and Technological Development Zone of Qingdao, Eastern China. Methods A total of 4890 (aged 10 to 15 years) students were initially enrolled in this study. 3753 (76.75%) students with completed refractive error and questionnaire data were analyzed. The children underwent a comprehensive eye examination. Multiple logistic regression models were applied to assess possible factors associated with myopia. Results The prevalence of myopia increased as the children's grade increased (χ2 = 560.584, P < 0.001). Low myopia was the main form of myopia in adolescent students (30.22%). With the growth of age, students spent significantly more time on near work (P = 0.03) and less time on outdoor activity (P < 0.001). In multivariate models, only the following variables were significantly associated with myopia: age, two myopic parents, outdoor activity time, and continuous near work without 5 min rest. Conclusions The prevalence of myopia increased as the grade increased. Age, two myopic parents, and continuous near work time without 5 min rest were risk factors for myopia. Outdoor activities had protective effect for myopia.
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Laughton DS, Sheppard AL, Davies LN. Refraction during incipient presbyopia: The Aston Longitudinal Assessment of Presbyopia (ALAP) study. JOURNAL OF OPTOMETRY 2018; 11:49-56. [PMID: 28599911 PMCID: PMC5777924 DOI: 10.1016/j.optom.2017.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 02/09/2017] [Accepted: 02/24/2017] [Indexed: 06/01/2023]
Abstract
PURPOSE To investigate non-cycloplegic changes in refractive error prior to the onset of presbyopia. METHODS The Aston Longitudinal Assessment of Presbyopia (ALAP) study is a prospective 2.5 year longitudinal study, measuring objective refractive error using a binocular open-field WAM-5500 autorefractor at 6-month intervals in participants aged between 33 and 45 years. RESULTS From the 58 participants recruited, 51 participants (88%) completed the final visit. At baseline, 21 participants were myopic (MSE -3.25±2.28 DS; baseline age 38.6±3.1 years) and 30 were emmetropic (MSE -0.17±0.32 DS; baseline age 39.0±2.9 years). After 2.5 years, 10% of the myopic group experienced a hypermetropic shift (≥0.50 D), 5% a myopic shift (≥0.50 D) and 85% had no significant change in refraction (<0.50 D). From the emmetropic group, 10% experienced a hypermetropic shift (≥0.50 D), 3% a myopic shift (≥0.50 D) and 87% had no significant change in refraction (<0.50 D). In terms of astigmatism vectors, other than J45 (p<0.001), all measures remained invariant over the study period. CONCLUSION The incidence of a myopic shift in refraction during incipient presbyopia does not appear to be as large as previously indicated by retrospective research. The changes in axis indicate ocular astigmatism tends towards the against-the-rule direction with age. The structural origin(s) of the reported myopic shift in refraction during incipient presbyopia warrants further investigation.
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Affiliation(s)
- Deborah S Laughton
- Ophthalmic Research Group, Life & Health Sciences, Aston University, Birmingham, UK
| | - Amy L Sheppard
- Ophthalmic Research Group, Life & Health Sciences, Aston University, Birmingham, UK
| | - Leon N Davies
- Ophthalmic Research Group, Life & Health Sciences, Aston University, Birmingham, UK.
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Lin Z, Gao TY, Vasudevan B, Ciuffreda KJ, Liang YB, Jhanji V, Fan SJ, Han W, Wang NL. Near work, outdoor activity, and myopia in children in rural China: the Handan offspring myopia study. BMC Ophthalmol 2017; 17:203. [PMID: 29149871 PMCID: PMC5693484 DOI: 10.1186/s12886-017-0598-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The near work and outdoor activity are the most important environmental risk factors for myopia. However, data from Chinese rural children are relatively rare and remain controversial. Therefore, the purpose of this study was to evaluate the relationship of both near work and outdoor activities with refractive error in rural children in China. METHODS In this cross-sectional study, 572 (65.1%) of 878 children (6-18 years of age) were included from the Handan Offspring Myopia Study (HOMS). Information from the parents on these children, as well as the parent's non-cycloplegic refraction, were obtained from the database of the Handan Eye Study conducted in the years 2006-2007. A comprehensive vision examination, including cycloplegic refraction, and a related questionnaire, were assessed on all children. RESULTS The overall time spent on near work and outdoor activity in the children was 4.8 ± 1.6 and 2.9 ± 1.4 h per day, respectively. Myopic children spent more time on near work (5.0 ± 1.7 h vs.4.7 ± 1.6 h, p = 0.049), while no significant difference was found in outdoor activity hours (2.8 ± 1.3 h vs. 3.0 ± 1.4 h, p = 0.38), as compared to non-myopic children. In the multiple logistic analysis, in general, no association between near work and myopia was found after adjusting for the children's age, gender, parental refractive error, parental educational level, and daily outdoor activity hours [odds ratio (OR), 95% confidence interval (CI): 1.10, 0.94-1.27]. However, a weak protective effect of the outdoor activity on myopia was found (OR, 95% CI: 0.82, 0.70-0.96), after adjusting for similar confounders. CONCLUSIONS In general, no association between near work and myopia was found, except for the high near work subgroup with moderate outdoor activity levels. A weak protective effect of outdoor activity on myopia in Chinese rural children was observed.
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Affiliation(s)
- Zhong Lin
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No. 270 West College Road, Wenzhou, Zhejiang, 325027, China
| | | | | | - Kenneth J Ciuffreda
- Department of Biological and Vision Sciences, SUNY College of Optometry, New York, NY, USA
| | - Yuan Bo Liang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No. 270 West College Road, Wenzhou, Zhejiang, 325027, China. .,Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK.
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Su Jie Fan
- Handan Eye Hospital, Handan, Hebei, China
| | - Wei Han
- Handan Eye Hospital, Handan, Hebei, China
| | - Ning Li Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Wielkiewicz RM. Myopia is an Adaptive Characteristic of Vision: Not a Disease or Defect. REVIEW OF GENERAL PSYCHOLOGY 2016. [DOI: 10.1037/gpr0000090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This article proposes that myopia (nearsightedness) is an adaptive characteristic of human vision. Most theories of the evolution of vision assume myopia is a disease or defect that would have resulted in decreased reproductive fitness in the absence of modern corrective lenses. In contrast, the present article argues that myopic individuals may have played important roles in hunter–gatherer groups such as making tools and weapons, and identifying medicinal plants, contributing to individual and group survival. This idea is called the “adaptive myopia hypothesis.” Evidence favoring this hypothesis is reviewed in the context of the metatheory of evolutionary psychology.
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Abstract
PURPOSE The aim of this study is to compare the changes in myopia prevalence among Portuguese first-year university students in 2002 and 2014 at the University of Minho. METHODS The refractive status and axial length of first-year students at the School of Sciences, University of Minho, were measured in 2014. Refractive error was measured with subjective refraction under cycloplegia and axial length was measured by optical biometry. The data were compared with those obtained from a similar cohort of 111 students in 2002. Myopia was defined as a mean spherical equivalent of ≤-0.50D. A survey was conducted to know the routine of the participants. They were asked how many hours per week (hrs/wk) they had spent, on average in the previous year, watching TV, using the computer, studying, participating in manual hobbies, and participating in outdoor activities. RESULTS In 2014, 75 students were assessed (15 male and 60 female) with a mean age (mean ± SD) of 19.8 ± 1.6 years (ranging from 18 to 24 years). The mean refractive error M (spherical equivalent) was -0.77 ± 1.79D and the axial length was 23.74 ± 1.19 mm. The prevalence of myopia was 41.3% (31 of 75). In 2002, the mean refractive error M was 0.01 ± 1.53D, the axial length was 23.40 ± 0.93 mm, and the myopia prevalence was 23.4% (26 of 111). The differences between myopia prevalence and mean refractive error are statistically significant (p < 0.05). A statistically significant increase in the number of hrs/wk spent on near activities (p < 0.05) was found. CONCLUSIONS In 12 years, the prevalence of myopia among first-year university students at the School of Sciences of the University of Minho rose from 23.4 to 41.3%. This increase in myopia prevalence could be related to the lifestyle changes of the studied population.
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Hua WJ, Jin JX, Wu XY, Yang JW, Jiang X, Gao GP, Tao FB. Elevated light levels in schools have a protective effect on myopia. Ophthalmic Physiol Opt 2016; 35:252-62. [PMID: 25913873 DOI: 10.1111/opo.12207] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 03/02/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE To determine whether elevated light levels in classrooms in rural areas can protect school-age children from myopia onset or myopia progression. METHODS A total of 317 subjects from 1713 eligible students aged six to 14 in four schools located in northeast China participated in the study. Students received a comprehensive eye examination including cycloplegic refraction and ocular biometry, which included axial length (AL), anterior chamber depth (ACD), and corneal curvature (CC) measurement, and completed a questionnaire. The intervention arm included 178 students in two schools with rebuilt elevated lighting systems and the control arm included 139 students in which lighting systems were unchanged. Results for the two arms were compared with a Wilcoxon rank sum test, a chi-squared test or a t-test, as appropriate. Factors that might help explain any differences were explored with multivariate linear regression analysis. RESULTS The median average illuminance of blackboards and desks and uniformity of desk lighting were significantly improved, however, the uniformity of blackboard lighting declined after intervention. At baseline, the mean refraction, AL, CC, ACD and myopia prevalence between the two arms were not significantly different. After 1 year, compared with the control arm the intervention arm had a lower incidence of new myopia onset (4% vs 10%; p = 0.029), a smaller decrease in refractive error among no myopic subjects (-0.25 dioptre [D] vs -0.47 D; p = 0.001), and shorter axial growth for both non-myopic (0.13 vs 0.18 mm; p = 0.023) and myopic subjects (0.20 vs 0.27 mm; p = 0.0001). Multivariate linear regression analysis showed the intervention program, lower hyperopic baseline refraction, lower father's education level, longer time sleeping and less time in screen-viewing activities were associated with less refractive shift in the direction of myopia in non-myopic children. For myopic subjects, myopia progression was significantly associated with family income only. The intervention program and older age had a protective effect on axial growth for both myopic and non-myopic subjects. The father's education level and sleep duration were significantly associated with axial growth in non-myopic children. CONCLUSIONS Elevated light levels in classrooms have a significant effect on myopia onset, decreases in refraction, and axial growth; if the findings of lighting intervention are reproduced in future studies, the ambient light levels in schools should be improved.
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Affiliation(s)
- Wen-Juan Hua
- School of Public Health, Anhui Medical University, Hefei, China
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Galvis V, López-Jaramillo P, Tello A, Castellanos-Castellanos YA, Camacho PA, Cohen DD, Gómez-Arbeláez D, Merayo-Lloves J. Is myopia another clinical manifestation of insulin resistance? Med Hypotheses 2016; 90:32-40. [PMID: 27063082 DOI: 10.1016/j.mehy.2016.02.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 02/08/2016] [Indexed: 12/28/2022]
Abstract
Myopia is a multifactorial visual refraction disease, in which the light rays from distant objects are focused in front of retina, causing blurry vision. Myopic eyes are characterized by an increased corneal curvature and/or ocular axial length. The prevalence of myopia has increased in recent decades, a trend that cannot be attributed exclusively to genetic factors. Low and middle income countries have a higher burden of refractive error, which we propose could be a consequence of a shorter exposure time to a westernized lifestyle, a phenomenon that may also explain the rapid increase in cardiometabolic diseases, such as diabetes, among those populations. We suggest that interactions between genetic, epigenetic and a rapidly changing environment are also involved in myopia onset and progression. Furthermore, we discuss several possible mechanisms by which insulin resistance may promote abnormal ocular growth and myopia to support the hypothesis that insulin resistance and hyperinsulinemia are involved in its pathogenesis, providing a link between trends in myopia and those of cardiometabolic diseases. There is evidence that insulin have direct ocular growth promoting effects as well an indirect effect via the induction of insulin-like growth factors leading to decreases insulin-like growth factor-binding protein, also implicated in ocular growth.
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Affiliation(s)
- Virgilio Galvis
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia; Fundación Oftalmológica de Santander - FOSCAL, Floridablanca, Santander, Colombia
| | - Patricio López-Jaramillo
- Fundación Oftalmológica de Santander - FOSCAL, Floridablanca, Santander, Colombia; Instituto MASIRA, Facultad de Ciencias de la Salud, Universidad de Santander (UDES), Bucaramanga, Santander, Colombia.
| | - Alejandro Tello
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia; Departamento de Cirugía, Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Santander, Colombia
| | | | - Paul Anthony Camacho
- Fundación Oftalmológica de Santander - FOSCAL, Floridablanca, Santander, Colombia
| | - Daniel Dylan Cohen
- Fundación Oftalmológica de Santander - FOSCAL, Floridablanca, Santander, Colombia; Instituto MASIRA, Facultad de Ciencias de la Salud, Universidad de Santander (UDES), Bucaramanga, Santander, Colombia
| | - Diego Gómez-Arbeláez
- Fundación Oftalmológica de Santander - FOSCAL, Floridablanca, Santander, Colombia
| | - Jesús Merayo-Lloves
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, Spain
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Global trends in myopia management attitudes and strategies in clinical practice. Cont Lens Anterior Eye 2016; 39:106-16. [PMID: 26895778 DOI: 10.1016/j.clae.2016.02.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/03/2016] [Accepted: 02/03/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE Myopia is a global public health issue; however, no information exists as to how potential myopia retardation strategies are being adopted globally. METHODS A self-administrated, internet-based questionnaire was distributed in six languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy and adoption of available strategies, and reasons for not adopting specific strategies. RESULTS Of the 971 respondents, concern was higher (median 9/10) in Asia than in any other continent (7/10, p<0.001) and they considered themselves more active in implementing myopia control strategies (8/10) than Australasia and Europe (7/10), with North (4/10) and South America (5/10) being least proactive (p<0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by increased time outdoors and pharmaceutical approaches, with under-correction and single vision spectacles felt to be the least effective (p<0.05). Although significant intra-regional differences existed, overall most practitioners 67.5 (±37.8)% prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients. The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (35.6%), inadequate information (33.3%) and the unpredictability of outcomes (28.2%). CONCLUSIONS Regardless of practitioners' awareness of the efficacy of myopia control techniques, the vast majority still prescribe single vision interventions to young myopes. In view of the increasing prevalence of myopia and existing evidence for interventions to slow myopia progression, clear guidelines for myopia management need to be established.
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Rudnicka AR, Kapetanakis VV, Wathern AK, Logan NS, Gilmartin B, Whincup PH, Cook DG, Owen CG. Global variations and time trends in the prevalence of childhood myopia, a systematic review and quantitative meta-analysis: implications for aetiology and early prevention. Br J Ophthalmol 2016; 100:882-890. [PMID: 26802174 PMCID: PMC4941141 DOI: 10.1136/bjophthalmol-2015-307724] [Citation(s) in RCA: 312] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/01/2015] [Accepted: 01/02/2016] [Indexed: 12/28/2022]
Abstract
The aim of this review was to quantify the global variation in childhood myopia prevalence over time taking account of demographic and study design factors. A systematic review identified population-based surveys with estimates of childhood myopia prevalence published by February 2015. Multilevel binomial logistic regression of log odds of myopia was used to examine the association with age, gender, urban versus rural setting and survey year, among populations of different ethnic origins, adjusting for study design factors. 143 published articles (42 countries, 374 349 subjects aged 1–18 years, 74 847 myopia cases) were included. Increase in myopia prevalence with age varied by ethnicity. East Asians showed the highest prevalence, reaching 69% (95% credible intervals (CrI) 61% to 77%) at 15 years of age (86% among Singaporean-Chinese). Blacks in Africa had the lowest prevalence; 5.5% at 15 years (95% CrI 3% to 9%). Time trends in myopia prevalence over the last decade were small in whites, increased by 23% in East Asians, with a weaker increase among South Asians. Children from urban environments have 2.6 times the odds of myopia compared with those from rural environments. In whites and East Asians sex differences emerge at about 9 years of age; by late adolescence girls are twice as likely as boys to be myopic. Marked ethnic differences in age-specific prevalence of myopia exist. Rapid increases in myopia prevalence over time, particularly in East Asians, combined with a universally higher risk of myopia in urban settings, suggest that environmental factors play an important role in myopia development, which may offer scope for prevention.
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Affiliation(s)
- Alicja R Rudnicka
- Population Health Research Institute, St George's, University of London, London, UK
| | | | - Andrea K Wathern
- Population Health Research Institute, St George's, University of London, London, UK
| | - Nicola S Logan
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Bernard Gilmartin
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, London, UK
| | - Derek G Cook
- Population Health Research Institute, St George's, University of London, London, UK
| | - Christopher G Owen
- Population Health Research Institute, St George's, University of London, London, UK
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McCullough SJ, O’Donoghue L, Saunders KJ. Six Year Refractive Change among White Children and Young Adults: Evidence for Significant Increase in Myopia among White UK Children. PLoS One 2016; 11:e0146332. [PMID: 26783753 PMCID: PMC4718680 DOI: 10.1371/journal.pone.0146332] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/14/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To determine six-year spherical refractive error change among white children and young adults in the UK and evaluate differences in refractive profiles between contemporary Australian children and historical UK data. Design Population-based prospective study. Participants The Northern Ireland Childhood Errors of Refraction (NICER) study Phase 1 examined 1068 children in two cohorts aged 6–7 years and 12–13 years. Prospective data for six-year follow-up (Phase 3) are available for 212 12–13 year olds and 226 18–20 year olds in each cohort respectively. Methods Cycloplegic refractive error was determined using binocular open-field autorefraction (Shin-Nippon NVision-K 5001, cyclopentolate 1%). Participants were defined by spherical equivalent refraction (SER) as myopic SER ≤-0.50D, emmetropic -0.50D<SER<+2.00 or hyperopic SER≥+2.00D. Main Outcome Measures Proportion and incidence of myopia. Results The proportion of myopes significantly increased between 6–7 years (1.9%) and 12–13 years (14.6%) (p<0.001) but not between 12–13 and 18–20 years (16.4% to 18.6%, p = 0.51). The estimated annual incidence of myopia was 2.2% and 0.7% for the younger and older cohorts respectively. There were significantly more myopic children in the UK at age 12–13 years in the NICER study (16.4%) than reported in Australia (4.4%) (p<0.001). However by 17 years the proportion of myopia neared equivalence in the two populations (NICER 18.6%, Australia 17.7%, p = 0.75). The proportion of myopic children aged 12–13 years in the present study (2006–2008) was 16.4%, significantly greater than that reported for children aged 10–16 years in the 1960’s (7.2%, p = 0.01). The proportion of hyperopes in the younger NICER cohort decreased significantly over the six year period (from 21.7% to 14.2%, p = 0.04). Hyperopes with SER ≥+3.50D in both NICER age cohorts demonstrated persistent hyperopia. Conclusions The incidence and proportion of myopia are relatively low in this contemporary white UK population in comparison to other worldwide studies. The proportion of myopes in the UK has more than doubled over the last 50 years in children aged between 10–16 years and children are becoming myopic at a younger age. Differences between the proportion of myopes in the UK and in Australia apparent at 12–13 years were eliminated by 17 years of age.
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Affiliation(s)
- Sara J. McCullough
- Biomedical Sciences Research Institute, School of Biomedical Sciences, University of Ulster, Cromore Road, Coleraine, N. Ireland, United Kingdom
- * E-mail:
| | - Lisa O’Donoghue
- Biomedical Sciences Research Institute, School of Biomedical Sciences, University of Ulster, Cromore Road, Coleraine, N. Ireland, United Kingdom
| | - Kathryn J. Saunders
- Biomedical Sciences Research Institute, School of Biomedical Sciences, University of Ulster, Cromore Road, Coleraine, N. Ireland, United Kingdom
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Affiliation(s)
- W Neil Charman
- Faculty of Life Sciences, University of Manchester, Manchester, UK
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Castagno VD, Fassa AG, Vilela MAP, Meucci RD, Resende DPM. Moderate hyperopia prevalence and associated factors among elementary school students. CIENCIA & SAUDE COLETIVA 2015; 20:1449-58. [PMID: 26017947 DOI: 10.1590/1413-81232015205.02252014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 11/16/2014] [Indexed: 11/22/2022] Open
Abstract
Hyperopia is the most common refractive condition in childhood. There are few studies on moderate hyperopia and associated factors. This study aims to investigate the prevalence of moderate hyperopia and associated factors among school children. A cross-sectional study comprising 1,032 students attending 1st to 8th grades at two public schools was conducted in a Southern Brazilian urban area in 2012. Cycloplegia was used to examine both eyes and refractive error was measured through auto-refraction. A socioeconomic and cultural questionnaire was administered. Multivariable analysis was performed through Poisson regression. Moderate hyperopia prevalence was 13.4% (95% CI, 11.2-15.4) and 85% of these did not wear glasses. Age was inversely associated with moderate hyperopia, while female gender RP = 1.39 (95%CI, 1.02 - 1.90) and white skin RP = 1.66 (95%CI, 1.04 - 2.66) were risk factors for this outcome. This study makes progress in estimating mild and moderate hyperopia prevalence both by age range and specific age. It emphasizes how the lack of this condition being corrected in southern Brazil is a serious problem. It highlights the importance of detailing and characterizing the amount of time spent on close-range, long-range and outdoor activities.
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Affiliation(s)
| | | | | | - Rodrigo Dalke Meucci
- Departamento de Medicina Social, Universidade Federal de Pelotas, Pelotas, RS, Brasil,
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Zhang YY, Jiang WJ, Teng ZE, Wu JF, Hu YY, Lu TL, Wu H, Sun W, Wang XR, Bi HS, Jonas JB. Corneal curvature radius and associated factors in Chinese children: the Shandong Children Eye Study. PLoS One 2015; 10:e0117481. [PMID: 25658095 PMCID: PMC4319968 DOI: 10.1371/journal.pone.0117481] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/23/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the distribution of the (CCR) and its associated factors in children. METHODS Using a random cluster sampling method, the school-based, cross-sectional Shandong Children Eye Study included children aged 4 to 18 years from the rural county of Guanxian and the city of Weihai in the province of Shandong in East China. CCR was measured by ocular biometry. RESULTS CCR measurements were available for 5913 (92.9%) out of 6364 eligible children. Mean age was 10.0±3.3 years, and mean CCR was 7.84±0.27 mm (range: 6.98 to 9.35 mm). In multivariate linear regression analysis, longer CCR (i.e. flatter cornea) was significantly associated with the systemic parameters of male sex (P<0001; standardized regression coefficient beta: -0.08; regression coefficient B: -0.04; 95% Confidence Interval (CI): -0.05, -0.03), younger age (P<0.001; beta: -0.37; B: -0.03; 95%CI: -0.04, -0.03), taller body height (P = 0.002; beta: 0.06; B: 0.001; 95%CI: 0.000, 0.001), lower level of education of the father (P = 0.001; beta: -0.04; B: -0.01; 95%CI: -0.02, -0.01) and maternal myopia (P<0.001; beta: -0.07; B: -0.04; 95%CI: -0.06, -0.03), and with the ocular parameters of longer ocular axial length (P<0.001; beta: 0.59; B: 0.13; 95%CI: 0.12, 0.14), larger horizontal corneal diameter (P<0.001; beta: 0.19; B: 0.13; 95%CI: 0.11, 0.14), and smaller amount of cylindrical refractive error (P = 0.001; beta: -0.09; B: -0.05; 95%CI: -0.06, -0.04). CONCLUSIONS Longer CCR (i.e., flatter corneas) (mean:7.84±0.27 mm) was correlated with male sex, younger age, taller body height, lower paternal educational level, maternal myopia, longer axial length, larger corneas (i.e., longer horizontal corneal diameter), and smaller amount of cylindrical refractive error. These findings may be of interest for elucidation of the process of emmetropization and myopization and for corneal refractive surgery.
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Affiliation(s)
- Yue Ying Zhang
- The First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Institute of Basic Medicine, Shandong Academy of medical sciences, Jinan, Shandong, China
| | - Wen Jun Jiang
- Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Zhao E. Teng
- Department of Ophthalmology, Wulian People’s Hospital, Rizhao, Shandong, China
| | - Jian Feng Wu
- Department of Ophthalmology, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yuan Yuan Hu
- Department of Ophthalmology, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong, China
| | - Tai Liang Lu
- Department of Ophthalmology, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong, China
| | - Hui Wu
- Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Wei Sun
- Department of Ophthalmology, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong, China
| | - Xing Rong Wang
- Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Department of Ophthalmology, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong, China
| | - Hong Sheng Bi
- Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Department of Ophthalmology, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong, China
- * E-mail:
| | - Jost B. Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Germany
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Castagno VD, Fassa AG, Carret MLV, Vilela MAP, Meucci RD. Hyperopia: a meta-analysis of prevalence and a review of associated factors among school-aged children. BMC Ophthalmol 2014; 14:163. [PMID: 25539893 PMCID: PMC4391667 DOI: 10.1186/1471-2415-14-163] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/17/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Studies show great variability in the prevalence of hyperopia among children. This study aimed to synthesize the existing knowledge about hyperopia prevalence and its associated factors in school children and to explore the reasons for this variability. METHODS This systematic review followed PRISMA guidelines. Searching several international databases, the review included population- or school-based studies assessing hyperopia through cycloplegic autorefraction or cycloplegic retinoscopy. Meta-analysis of hyperopia prevalence was performed following MOOSE guidelines and using the random effects model. RESULTS The review included 40 cross-sectional studies. The prevalence of hyperopia ranged from 8.4% at age six, 2-3% from 9 to 14 years and approximately 1% at 15 years. With regard to associated factors, age has an inverse association with hyperopia. The frequency of hyperopia is higher among White children and those who live in rural areas. There is no consensus about the association between hyperopia and gender, family income and parental schooling. CONCLUSION Future studies should use standardized methods to classify hyperopia and sufficient sample size when evaluating age-specific prevalence. Furthermore, it is necessary to deepen the understanding about the interactions among hyperopic refractive error and accommodative and binocular functions as a way of identifying groups of hyperopic children at risk of developing visual, academic and even cognitive function sequelae.
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Affiliation(s)
- Victor Delpizzo Castagno
- Department of Specialized Medicine - Ophthalmology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Centro, 96020-220, Pelotas, RS, Brazil.
| | - Anaclaudia Gastal Fassa
- Department of Social Medicine, Rua Marechal Deodoro, 1160, Centro, 96020-220, Pelotas, RS, Brazil.
| | - Maria Laura Vidal Carret
- Department of Social Medicine, Federal University of Pelotas, Avenida Duque de Caxias, 250, Fragata, 96001-970, Pelotas, RS, Brazil.
| | - Manuel Augusto Pereira Vilela
- Department of Specialized Medicine - Ophthalmology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Centro, 96020-220, Pelotas, RS, Brazil.
| | - Rodrigo Dalke Meucci
- Department of Social Medicine, Federal University of Pelotas, Avenida Duque de Caxias, 250, Fragata, 96001-970, Pelotas, RS, Brazil.
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The anterior chamber depth and retinal nerve fiber layer thickness in children. ScientificWorldJournal 2014; 2014:538283. [PMID: 25431789 PMCID: PMC4241318 DOI: 10.1155/2014/538283] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/15/2014] [Accepted: 10/15/2014] [Indexed: 12/14/2022] Open
Abstract
Purpose. To investigate the correlation of anterior chamber depth (ACD) with the peripapillary retinal nerve fiber layer (RNFL) thickness, age, axial length (AL), and spherical equivalent in children. Subjects. Consecutive subjects aged 4 to 18 were recruited. Visually disabling eye conditions were excluded. Only the right eye was included for analysis. The ACD was correlated with RNFL thickness, age, spherical equivalent, and AL for all subjects. Subjects were then divided into 3 groups based on their postcycloplegic spherical equivalent: myopes (<−1.0 D), emmetropes (≥−1.0 to ≤+1.0 D), and hyperopes (>+1.0 D). The ACD was compared among the 3 groups before and after age adjustment. Results. In 200 subjects (mean age 7.6 ± 3.3 years), a deeper ACD was correlated with thinner global RNFL (r = −0.2, r2 = 0.06, P = 0.0007), older age (r = 0.4, r2 = 0.1, P < 0.0001), myopic spherical equivalent (r = −0.3, r2 = 0.09, P < 0.0001), and longer AL (r = 0.5, r2 = 0.2, P < 0.0001). The ACD was deepest in myopes (3.5 ± 0.4 mm, n = 67), followed by emmetropes (3.4 ± 0.3, n = 60) and then hyperopes (3.3 ± 0.2, n = 73) (all P < 0.0001). After age adjustment, myopes had a deeper ACD than the other 2 groups (all P < 0.0001). Conclusions. In children, a deeper ACD was associated with thinner RNFL thickness, older age, more myopic spherical equivalent, and longer AL. Myopes had a deeper ACD than emmetropes and hyperopes.
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Comparison of Refractive Error Measures by the IRX3 Aberrometer and Autorefraction. Optom Vis Sci 2014; 91:1183-90. [PMID: 25192432 DOI: 10.1097/opx.0000000000000379] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Shickle D, Griffin M, Evans R, Brown B, Haseeb A, Knight S, Dorrington E. Why don't younger adults in England go to have their eyes examined? Ophthalmic Physiol Opt 2014; 34:30-7. [PMID: 24325432 DOI: 10.1111/opo.12099] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 10/27/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Most research on attitudes to eye health has focussed on older people, reflecting the higher prevalence of eye diseases in older age groups. Little is known about younger people's attitudes to eye health. This paper explores young adults understanding of eye health and the purpose of eye examinations and the reasons why they do or do not attend for eye examinations. The aim is to provide evidence to inform policy on recommendations relating to eye health for individuals at low risk of visual impairment. METHODS Six focus-group meetings were held in Leeds with 43 people aged 18-35 (mean age 22 years). Focus group participants were recruited using a snowballing approach from an initial group of young adults. Focus groups were transcribed and a thematic analysis approach was used. RESULTS Children who wore spectacles were often bullied. As people grew up it became more socially acceptable to wear spectacles. Practicalities, aesthetics and fashion were important issues. Knowledge about eye disease and the eye examination were generally poor. Many claimed to value vision, but recognised that young people do not have eye examinations as often as they should. Eye examinations were only perceived to be needed for younger people experiencing problems or to update prescriptions. Eye health was seen as issue for older people. Some had no idea or were shocked about how much spectacles cost. Optometrists were seen differently to other healthcare professionals. The retail aspect of optometry was seen as too dominant. More information was wanted from the NHS on eye health. CONCLUSION While young adults are at low risk of sight threatening disease, many do benefit from correction of refractive error. There is an argument for reducing the recommended frequency of eye examinations for low risk individuals from the 2 years currently advised. Nevertheless, young adults need to be made more aware of eye health issues, so that optometrists are seen as more than somewhere that sell spectacles. Increasing awareness of eye health in younger adulthood will also be important to ensure that services are appropriately accessed as they get older.
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Affiliation(s)
- Darren Shickle
- Academic Unit of Public Health, University of Leeds, Leeds, UK
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Landmann A, Bechrakis E. Prävalenz und Dimensionen von Refraktionsfehlern bei österreichischen Gymnasiasten. SPEKTRUM DER AUGENHEILKUNDE 2014. [DOI: 10.1007/s00717-014-0208-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
PURPOSE To assess the relationship between near work, outdoor activity, and refractive error in schoolchildren in Beijing. METHODS The Beijing Myopia Progression Study is a hospital-based myopia study, in which 386 students from primary (aged 6 to 12 years) and secondary (aged 13 to 17 years) schools in the inner city of Beijing were enrolled. Cycloplegic refraction and a detailed questionnaire probing near, intermediate, and distance visual activities were completed. RESULTS Three hundred seventy (95.9%) of 386 students with complete cycloplegic autorefraction and myopia questionnaire data were enrolled in this study. Children with more near work time did not exhibit a significantly more myopic refraction in both the primary and secondary school levels after adjusting for the children's gender, outdoor activity time, and average parental refractive error. A significant association between outdoor activity time (in hours per day) and the children's spherical equivalent (in diopters) was found in the primary school students (β = 0.27, p = 0.03) but not in the secondary school students (β = 0.04, p = 0.70) after adjusting for similar confounders. The time spent on outdoor sports and outdoor leisure in the primary school students was also significantly associated with the children's spherical equivalent (β = 0.46, p = 0.04 and β = 0.31, p = 0.02, respectively). Primary school students with more time outdoors exhibited relatively less myopic refraction than their peers (ptrend = 0.0003), but this relation was not demonstrated in the secondary school children (ptrend = 0.53) after adjusting for similar confounders. CONCLUSIONS Higher levels of outdoor activity were associated with less myopic refraction in primary school students in the inner city of Beijing. Near work activity was not found to be associated with refraction at either school level.
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Abstract
PURPOSE To identify variables associated with myopia progression and to identify any interaction between accommodative function, myopia progression, age, and treatment effect in the Cambridge Anti-Myopia Study. METHODS Contact lenses were used to improve static accommodation by altering ocular spherical aberration, and vision training was performed to improve dynamic accommodation. One hundred forty-two subjects, aged 14-21 years, were recruited who had a minimum of -0.75D of myopia. Subjects were assigned to contact lens treatment only, vision training only, contact lens treatment and vision training, or control group. Spherical aberration, lag of accommodation, accommodative convergence/accommodation (AC/A) ratio, accommodative facility, ocular biometry, and refractive error were measured at regular intervals throughout the 2-year trial. RESULTS Ninety-five subjects completed the 24-month trial period. There was no significant difference in myopia progression between the four treatment groups at 24 months. Age, lag of accommodation, and AC/A ratio were significantly associated with myopia progression. There was a significant treatment effect at 12 months in the contact lens treatment group in younger subjects, based on a median split, aged under 16.9 years (p = 0.005). This treatment effect was not maintained over the second year of the trial. Younger subjects experienced a greater reduction in lag of accommodation with the treatment contact lens at 3 months (p = 0.03), compared to older contact lens treatment and control groups. There was no interaction between AC/A ratio and contact lens treatment effect. CONCLUSIONS Age, lag of accommodation, and AC/A ratio were significantly associated with myopia progression. Although there was no significant treatment effect at 24 months, an interaction between age and contact lens treatment suggests younger subjects may be more amenable, at least in the short term, to alteration of the visual system using optical treatments.
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Gao TY, Zhang P, Li L, Lin Z, Jhanji V, Peng Y, Li ZW, Sun LP, Han W, Wang NL, Liang YB. Rationale, design, and demographic characteristics of the Handan Offspring Myopia Study. Ophthalmic Epidemiol 2014; 21:124-32. [PMID: 24568612 DOI: 10.3109/09286586.2014.887734] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The Handan Offspring Myopia Study (HOMS) aims to investigate the familial associations of myopia between parents and their offspring. METHODS Children aged 6-18 years, residing in 6 villages where all people aged ≥30 years had participated in The Handan Eye Study in 2006-2007, were selected for the current eye study between March and June 2010. A mobile clinic was set up in the 6 villages for comprehensive eye examinations, including visual acuity, ocular biometry, cycloplegic autorefraction and retinal photography. RESULTS Of 1238 eligible individuals, 878 children (70.2%; 52.6% male) from 541 families were recruited. Mean age of the children was 10.5 ± 2.5 years. The prevalence of myopia (spherical equivalent refraction <-0.5 diopter) was 23.5% (males 16.8%, females 30.8%). The prevalence of low vision (presenting visual acuity ≥20/400 but <20/60) in the better eye was 7.1%. A higher number of females had low vision at the time of presentation (9.2%) compared to males (5.2%, p = 0.02). The prevalence of low vision in the worse eye was 10.6% (males 6.7%, females 14.9%, p < 0.001). The majority of visual impairment in the better-seeing (56/62, 90.3%) as well as the worse-seeing (84/93, 90.3%) eye was correctable. CONCLUSIONS The HOMS examined about 70% of eligible Han Chinese offspring of Handan Eye Study participants in a rural region of northern China. Results from the HOMS will provide key information about the prevalence of refractive errors and eye diseases in rural Chinese children.
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Affiliation(s)
- Tie Ying Gao
- Handan Eye Hospital , Handan, Hebei Province , China
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