Quality of life in myopia

Link between parental myopia and early-onset high myopia: Insights from a clinical retrospective analysis

INTRODUCTION

Genetic aetiology is suspected in the development of early-onset high myopia (spherical equivalent refractive error [SER] ≤-6.00 D at ≤6 years of age), considering that the role of environmental factors in inducing high myopia is improbable at an early age. Therefore, we aimed to understand if early-onset high myopia is associated with parental myopia in a clinical setting.

METHODS

A retrospective study was conducted in which information about demographics, age of apparent onset of myopia, refractive error, axial length, number of myopic parents, time spent outdoors and time spent on near-work was obtained from electronic medical records (EMR). It included 195 myopic individuals categorised into (1) Early-onset high myopes (EOHM): SER ≤ -6.00 D with age of presentation ≤6 years, (2) Early-onset low myopes (EOLM): SER > -6.00 D with age of apparent onset ≤6 years, (3) Late-onset high myopes (LOHM): SER ≤ -6.00 D with age of presentation and age of apparent onset >6 years and (4) Late-onset low myopes (LOLM): SER > -6.00 D with age of apparent onset >6 years.

RESULTS

Overall, 63% of individuals were found to have parental myopia. The proportion of individuals with EOHM, EOLM, LOHM and LOLM with parental myopia was 57%, 74%, 53% and 64%, respectively. After adjustment for age, gender and environmental factors, the odds of development of EOHM (Odds ratio: 0.78, 95% confidence interval: 0.25-2.48), EOLM (1.54, 0.65-3.67) or LOHM (0.70, 0.30-1.65) were similar in the presence of myopic parents, when compared with LOLM. The SER and axial length did not differ based on the number of myopic parents in any of these categories.

CONCLUSION

This retrospective analysis reveals that the presence of parental myopia, which was self-reported, did not induce additional risk for early-onset high myopia.

Evaluation and application of a Chinese version symptom questionnaire for visual dysfunctions (CSQVD) in school-age children

Objective

To develop and evaluate a Chinese version of the Symptom Questionnaire for Visual Dysfunctions (CSQVD) to quantify visual dysfunction symptoms in school-age children with various eye diseases, and to explore the relationship between ophthalmological disorders and visual dysfunction symptoms.

Methods

Following standard scale adaptation procedures, the Symptom Questionnaire for Visual Dysfunctions (SQVD) was translated into Chinese (CSQVD). We employed random sampling to survey 198 outpatients aged 7-18 to assess the psychometric properties of the CSQVD. Using the reliable and validated questionnaire, we evaluated the determinants of visual dysfunction symptoms among 406 school-age patients at an eye center. The CSQVD scores were correlated with demographic and clinical variables, including gender, age, eye position, refractive power, and best-corrected visual acuity. Univariate analysis identified potential risk factors, followed by binary logistic regression and multiple linear regression analysis on factors with a P-value <0.05.

Results

The CSQVD scale's critical ratio (CR) values ranged from 6.028 to 10.604. The Cronbach's Alpha coefficient was 0.779, and Spearman-Brown split-half reliability was also 0.779. The I-CVI varied from 0.83 to 1.000, the S-CVI/Ave was 0.857, and the KMO value was 0.821. Multifactorial regression analysis indicated that high myopia (OR ​= ​5.744, 95% CI [1.632, 20.218], P ​= ​0.006) and amblyopia (OR ​= ​9.302, 95% CI [1.878, 46.058], P ​= ​0.006) were significant predictors of CSQVD symptoms. Multiple linear regression analysis showed that BCVA of amblyopic eyes (B ​= ​-5.052, 95% CI [-7.779, 2.325], P ​= ​0.000) and SE power (B ​= ​-0.234, 95% CI [-0.375, 0.205], P ​= ​0.001) significantly affected the CSQVD scale scores.

Conclusions

The Chinese version of the SQVD scale (CSQVD) demonstrates good feasibility, discriminatory power, validity, and reliability in assessing Chinese school-aged children. Furthermore, those who have severe myopia and amblyopia reported more visual dysfunction symptoms.

Surgical options and clinical outcomes for high myopia

PURPOSE OF REVIEW

Higher degrees of myopia are currently being treated with refractive surgery. However, there is limited characterization and outcomes data for this cohort. This article aims to review the literature on highly myopic patients who had refractive surgery and present a retrospective analysis of 149 patients (270 eyes) with high to extreme myopia (≤-5.0D SE) who underwent refractive surgery [laser-assisted subepithelial keratomileusis (LASIK), photorefractive keratectomy (PRK), or implantable collamer lense (ICL)] at a single practice.

RECENT FINDINGS

There is substantial literature on the efficacy of LASIK, PRK, and phakic intraocular lenses for refractive error correction, but a dearth of studies on patients with high to extreme myopia undergoing different types of refractive surgery. Our study reveals that this cohort of patients has excellent outcomes with minimal complications.

SUMMARY

Our study reveals that the average preoperative myopia was highest in ICL patients (-10.03D), followed by PRK (-7.21D), and LASIK (-7.04D) patients. Not surprisingly, eyes with high myopia and thin corneas were offered and elected ICLs for their procedure. Highly myopic patients achieved outcomes consistent with data reported in the literature- average postoperative uncorrected visual acuity was 20/20 for LASIK and ICL eyes and 20/25 for PRK eyes.

Large-scale study in Chengdu, China: The prevalence of myopia full-correction decreased with increasing myopia in adolescents

Myopia is an increasingly serious health issue among children and adolescents worldwide. This study investigated the situation related to myopia among students in Chengdu, a city in western China, and analyzed the prevalence of myopia spectacle wear and myopia full-correction and their influencing factors to understand the current status of myopia prevention. This school-based cross-sectional study investigated 1582 schools in seven districts of Chengdu City, China, enrolling a total of 417,337 students aged 6-18 years (elementary, middle, and high school) from 2020 to 2022. Examination items included uncorrected visual acuity (UCVA), slit lamp examination and non-cycloplegic autorefraction. Myopia was defined as non-cycloplegic SE ≤ -0.50 D + UCVA> 0 log MAR (age ≥6). The prevalence of myopia spectacle wear is defined as the number of people wearing glasses for myopia/the number of people with myopia (%) within the study population, and myopia full-correction is defined as normal vision after wearing glasses for myopia (≤0 log MAR for 6 years and above). With the support of the government, this programme is conducted 1-2 times a year. Statistical analyses are conducted to determine the association between myopia and various parameters. The average age of the entire survey population was 10.96 ± 3.5 years, and the overall prevalence of myopia was 48.7%, myopia spectacle wear was 65.7%, and myopia full-correction was 50.5%. With increasing age and educational levels, the prevalence of moderate to high myopia, the prevalence of myopia spectacle wear, and the prevalence of myopia full-correction all rise. The prevalence of mild myopia full-correction (46.5%) was higher than that for moderate myopia (47.1%) and even higher than that for high myopia (39.6%). The correct utilization rate of myopic spectacles was 33.17%, increasing with age and education levels, with the highest correct utilization rate of 40.7% among those with moderate myopia. The prevalence of myopia among children and adolescents in Chengdu is relatively low, and the prevalence of myopia spectacle wear and myopia full-correction need to be improved, and it was found that with the increase of myopia, the prevalence of myopia full-correction among adolescents decreased instead.

Biometric factors associated with the postoperative visual performance of a multifocal intraocular lens

Purpose

To identify the biometric factors associated with postoperative visual performance after uneventful phacoemulsification with multifocal intraocular lens (MIOL) implantation.

Methods

In this retrospective cohort study, 72 eyes of 72 patients implanted with the HumanOptics Diff-aAY MIOL were included. Preoperative examination data including the white-to-white distance (WTW), anterior chamber depth (ACD), axial length and corneal astigmatism were gathered through the electronic medical records. One month postoperatively, the pupil parameters, corneal aberrations, corneal astigmatism, IOL tilts and IOL decentrations were measured using an OPD-Scan III aberrometer. Postoperative visual performance parameters were recorded as the visual acuity, depth of focus, modulation transfer function (MTF) and point spread function (PSF) values, area under log contrast sensitivity function (AULCSF), retinal straylight and visual function questionnaire scores. Univariate and multivariate linear regression analyses were then performed to evaluate the associations between the potential biometric factors and postoperative visual outcomes.

Results

Younger age predicted greater MTF and PSF values, better AULCSF and better retinal straylight (P < 0.05). A lower corneal trefoil predicted better MTF and PSF values (P < 0.05). Smaller IOL decentration predicted better distance-corrected near visual acuity, greater AULCSF and better retinal straylight (P < 0.05). A less negative spherical equivalent (SE) predicted better MTF values (P = 0.017), while a more negative SE predicted better Visual Function Index-14 (VF-14) questionnaire scores and satisfaction scores (P < 0.05). A higher IOL power predicted better best corrected distance visual acuity (P = 0.005). Lower preoperative corneal astigmatism predicted greater MTF values (P = 0.020). Lower postoperative corneal astigmatism, smaller corneal high-order aberrations (HOAs), smaller photopic pupil size, larger WTW and deeper ACD predicted a better AULCSF (P < 0.05).

Conclusions

IOL decentration, IOL power, age, preoperative and postoperative corneal astigmatism, SE, photopic pupil size, corneal trefoil, WTW, ACD and corneal HOAs were significantly associated with postoperative visual performance. These findings might aid in patient selection prior to MIOL implantation.

[Effect of keratoplasty on the quality of life of keratoconus patients]

Corneal deformations caused by keratoconus produce high levels of optical aberration (OA). Despite appropriate optical correction, these alter the quality of vision and diminish the patient's quality of life, especially since the affected population is predominantly young and of working age. When thinning is too severe or corneal transparency too impaired, a corneal transplant may be considered. In this study, we compare the quality of life of patients with keratoconus in the early (stages 1 and 2) or advanced (stages 3 and 4) stages of the Krumeich classification, as well as patients who have had keratoconus treated by keratoplasty. Quality of life was assessed using the NEI-VFQ 25 questionnaire, the most widely used for keratoconus. An aberrometric examination (OQAS®; HD Analyser, Visiometrics, Terrassa, Spain) was also performed to assess patients' quality of vision. Our results show that keratoplasty provides an improvement in quality of life compared with advanced-stage keratoconus in the areas of distance (p=0.0083) and near vision (p=0.029) activities. This improvement also applies to Best-Corrected Visual Acuity (BCVA) (p=0.032) and transparency (OSI) (p=0.049). Our study shows that keratoplasty improves corneal transparency, and it is interesting to note that it improves patients' quality of life over the long term.

Approaches for delivery of refractive and optical care services in community and primary care settings

BACKGROUND

Uncorrected refractive error is a leading cause of vision impairment which, in most cases, can be managed with the appropriate spectacle correction. In 2021, the World Health Assembly endorsed a global target of a 40-percentage-point increase in effective coverage of refractive error by 2030. To achieve this global target, equitable access to refractive and optical services within community and primary care settings needs to be strengthened. This review will inform the development of technical guidance to support improvements in the testing and correction of refractive error among World Health Organization (WHO) member states.

OBJECTIVES

To determine the range of approaches for delivery of refractive and optical care services in community and primary care settings, and the methods employed for their evaluation.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase and Global Health databases, grey literature, and annual reports and websites of relevant organizations involved in eye-care delivery from January 2002 to November 2022 to identify approaches for refractive and optical service delivery.

SELECTION CRITERIA

We included observational and interventional studies, reviews, and reports from relevant organizations related to delivering refractive services and optical services for preschool and school-aged children and adults in community and primary care settings published between January 2002 and November 2022. We searched for studies and reports published within the last 20 years because vision impairment due to uncorrected refractive error has only recently become a public health and eye health priority, therefore we did not expect to find much relevant literature until after 2002.

DATA COLLECTION AND ANALYSIS

Two review authors screened titles, abstracts and full texts, and extracted data. We resolved any discrepancies through discussion. We synthesized data, and presented results as tables, figures, and case studies. This project was led by the World Health Organization (WHO) Vision and Eye Care Programme.

MAIN RESULTS

We identified 175 studies from searches of databases and grey literature, 146 records from company reports, and 81 records from website searches of relevant organizations that matched our inclusion criteria. Delivery approaches for refractive and optical services in community care included school-based, pharmacy, and outreach models, whereas primary care approaches comprised vision centre, health centre, and a combination of vision or health centre and door-to-door delivery. In community care, school-based and outreach approaches were predominant, while in primary care, a vision-centre approach was mainly used. In the WHO African region, the school-based and outreach approaches were mainly reported while, in the Americas, the outreach approach was mostly used. Very few approaches for service delivery were reported in the WHO Eastern Mediterranean region. Prominent gaps exist in the evaluation of the approaches, and few studies attempted to evaluate the approaches for delivery of refractive and optical care services.

AUTHORS' CONCLUSIONS

We comprehensively describe a range of approaches for delivery of refractive and optical services in community and primary care. Further evaluation of their effectiveness will better inform the application of these service-delivery approaches. The study outcomes will help guide WHO member states in strengthening refractive and optical services at community and primary care levels.

FUNDING

This scoping review was supported by the Vision and Eye care Programme, World Health Organization and ATscale Global Partnership.

REGISTRATION

The protocol of this scoping review was published in the Open Source Framework.

Omnidirectional Virtual Visual Acuity: A User-Centric Visual Clarity Metric for Virtual Reality Head-Mounted Displays and Environments

Users' perceived image quality of virtual reality head-mounted displays (VR HMDs) is determined by multiple factors, including the HMD's structure, optical system, display and render resolution, and users' visual acuity (VA). Existing metrics such as pixels per degree (PPD) have limitations that prevent accurate comparison of different VR HMDs. One of the main limitations is that not all VR HMD manufacturers released the official PPD or details of their HMDs' optical systems. Without these details, developers and users cannot know the precise PPD or calculate it for a given HMD. The other issue is that the visual clarity varies with the VR environment. Our work has identified a gap in having a feasible metric that can measure the visual clarity of VR HMDs. To address this gap, we present an end-to-end and user-centric visual clarity metric, omnidirectional virtual visual acuity (OVVA), for VR HMDs. OVVA extends the physical visual acuity chart into a virtual format to measure the virtual visual acuity of an HMD's central focal area and its degradation in its noncentral area. OVVA provides a new perspective to measure visual clarity and can serve as an intuitive and accurate reference for VR applications sensitive to visual accuracy. Our results show that OVVA is a simple yet effective metric for comparing VR HMDs and environments.

Global prevalence of myopic macular degeneration in general population and patients with high myopia: A systematic review and meta-analysis

The prevalence of myopic macular degeneration (MMD) in the general population and patients with high myopia worldwide has not been fully investigated. Therefore, we screened all population-based studies that reported the prevalence of MMD, and pooled prevalence of MMD using a random-effect model. Subgroup analyses were performed to explore the differences in MMD prevalence in the general population and patients with high myopia according to ethnicity, region of residence (urban/rural), and grading system. Finally, 16 studies were included in this meta-analysis. Results obtained from 2,963 patients from seven countries on four continents indicated that the pooled prevalence of MMD in patients with high myopia was 49.0% (95% CI: 31.5%-66.7%). Results obtained from 71,052 participants from 10 countries on four continents suggested that the pooled prevalence of MMD in the general population was 1.7% (95% CI: 1.1%-2.6%). In the general population, living in urban areas and East Asians were associated with a high prevalence of MMD. Among patients with high myopia, only East Asians were at a higher risk of developing MMD. In conclusion, MMD was particularly prevalent in patients with high myopia. Compared with Europeans, East Asians (Chinese and Japanese) have a higher propensity of developing MMD, both in the general population and in patients with high myopia. It remains unclear whether the higher prevalence of MMD in patients with high myopia in East Asia is caused by differences in given age or given degree of myopia.Systematic review registration number: 202270014 (INPLASY.COM).

Association of sleep timings, duration, consistency, and chronotype with premyopia and myopia among Indian children

BACKGROUND

To explore the association of sleep timings, duration, consistency, and chronotype with premyopia and myopia among Indian children.

METHODS

This hospital-based cross-sectional study included 453 children, aged 6-12 years. Two myopia participants were selected for each individual with the corresponding premyopia or emmetropia. All children underwent cycloplegic autorefraction and ocular biometric tests. The Children's Sleep Habits Questionnaire (CSHQ) and parental information on behavioral habits were used to assess the association of sleep parameters with myopia and premyopia using logistic regression models.

RESULTS

Both myopia and premyopia exhibited significant late bedtime, short sleep duration, early wakeup time on only weekdays, and longer weekend catch-up sleep than emmetropia children (p < 0.05). In multivariate analysis, late bedtime (more than 24:00 a.m.) on weekdays (Odds ratio, OR = 3.63, 95% CI [0.74, 8.68]) as well as on free days (OR = 1.04, 95% CI [0.02, 8.08]); and early wake-up time only on weekdays (5:00-6:00 a.m., OR = 2.16, 95% CI [0.24, 6.76] and 06:00-07:00 a.m., OR = 2.42, 95% CI [0.51, 8.44]) were associated with increased risk of myopia (all p < 0.05) but not premyopia. After adjusting the confounding factors, when each of the eight CSHQ subscale components was analyzed, only bedtime resistance, night waking, and daytime sleepiness scores were significantly associated with a higher risk for premyopia and myopia (p < 0.05).

CONCLUSIONS

The sleep quality components, including bedtime resistance, night waking, and daytime sleepiness, equally involve a higher risk for myopia as well as premyopia.

Quality of life and depression among patients with high myopia in Nigeria: a cross sectional study

AIM

To evaluate the quality of life (QOL) and level of depression among participants with high myopia in Nigeria and the demographic factors associated with these outcomes.

METHODS

This cross-sectional study was conducted on 100 adult participants with high myopia (defined as refractive error ≤-5.00 D or worse, and uncorrected visual acuity worse than 6/18 in the better seeing eye) attending ophthalmology centres in Nigeria from 2 October 2021 to 30 August 2022. The means and standard deviations were calculated for each of the four domains of World Health Organization Quality of life scale (WHOQOL-BREF) using the transformed scores. The Beck Depression Inventory (BDI) scale was used to assess the level of depression.

RESULTS

The highest and the lowest mean scores of WHOQOL-BREF domains were found for the psychological and physical health domains (mean percentage scores were 67.0 [95% confidence intervals (CI) 64.1-68.9] and 55.3 (95%CI 51.8-58.8, P<0.001), respectively. One-way analysis of variance (ANOVA) revealed significant differences in physical health with educational status (higher among those with tertiary education: mean difference 0.9, 95%CI -0.2-2.1; P=0.049), differences in psychological health with working status (higher among those who were working 1.2, 95%CI 0.3-2.1; P=0.012). Also, the result showed a statistically significant association between environmental health and marital status (higher among non-married: 1.7, 95%CI -0.9-2.3; P=0.012) while overall health was associated with place of residence (higher in urban areas: 2.3, 95%CI 1.2-3.5; P=0.024). For depression, one in every nine participants reported major depressive symptom, mostly younger people (aged 16-29 vs 30-49y: 17.0% vs 0, P=0.019), and slightly more women than men (14.3% vs 0, P=0.064). There were significant negative correlations between the depression scores and psychological health (r=-0.48, P<0.001), physical health (r=-0.29, P=0.002), social and relationship (r=-0.49, P<0.001), environmental (r=-0.48, P<0.001) and overall health (r=-0.49, P<0.001).

CONCLUSION

People with high myopia have a relatively moderate QOL, but poor physical health, particularly the younger age group, and women who are more likely to experience clinically relevant depression. Eye care professionals should consider possible referrals for counselling for people with high myopia.

Repeated Low-level Red-light Therapy: The Next Wave in Myopia Management?

SIGNIFICANCE

Exposure to long-wavelength light has been proposed as a potential intervention to slow myopia progression in children. This article provides an evidence-based review of the safety and myopia control efficacy of red light and discusses the potential mechanisms by which red light may work to slow childhood myopia progression.The spectral composition of the ambient light in the visual environment has powerful effects on eye growth and refractive development. Studies in mammalian and primate animal models (macaque monkeys and tree shrews) have shown that daily exposure to long-wavelength (red or amber) light promotes slower eye growth and hyperopia development and inhibits myopia induced by form deprivation or minus lens wear. Consistent with these results, several recent randomized controlled clinical trials in Chinese children have demonstrated that exposure to red light for 3 minutes twice a day significantly reduces myopia progression and axial elongation. These findings have collectively provided strong evidence for the potential of using red light as a myopia control intervention in clinical practice. However, several questions remain unanswered. In this article, we review the current evidence on the safety and efficacy of red light as a myopia control intervention, describe potential mechanisms, and discuss some key unresolved issues that require consideration before red light can be broadly translated into myopia control in children.

Effect of Myopia Severity on the Health-Related Quality of Life in Children and Their Parents

PURPOSE

To investigate the effect of different myopia severity on the health-related quality of life (QOL) in both children and their parents.

METHODS

Cross-sectional study from October to November, 2021. Age and sex-matched children with binocular emmetropia (-0.5D < spherical equivalence [SE] < 0.5D), low myopia (-5.0D < SE ≤ -0.5D), and high myopia (SE ≤ -5.0D), as well as their parents, were enrolled. All children underwent ocular examinations. The Pediatric Quality of Life Inventory (PedsQL) Generic Core Scales, Version 4 (child-report, 23 items) and the PedsQL Family Impact Module, Version 2 (parent-report, 36 items) was used for QOL assessment of the children and their parents, respectively.

RESULTS

Forty-one, 48 and 45 age- and sex-matched children with their accompanying parents were included in the emmetropia, low myopia and high myopia group, respectively. Parents in the three groups also did not differ in age, sex, or education level. The median total QOL scores were comparable for emmetropic and low myopic children (96.74 [IQR: 93.48-97.83] vs. 96.74 [IQR: 94.57-98.37]) but were significantly lower for high myopic children (88.04 [IQR: 82.61-92.39], both p < .001). A decreasing trend was observed in the median total QOL for parents in the emmetropia (96.53, IQR: 86.81-100), low myopia (82.30, IQR: 70.83-97.22), and high myopia group (70.83, IQR: 60.42-84.03) (p for trend <.001). The effect of per myopic diopter change on QOL was larger in parents than children (coefficient: 1.48 (95%CI: 1.19-1.78) vs. 2.58 [95%CI: 1.83-3.32]), and parents with higher educational level appeared to have more reduction in QOL (p = .008).

CONCLUSIONS

More severe myopia resulted in a larger QOL decrease in both children and parents. Significantly reduced QOL were identified in children with high myopia and parents of children with any myopia.

Comparative analysis of the quality of life among different retinal diseases

PURPOSE

To assess the impact on the quality of life (QoL) among different retinal diseases such as diabetic macular edema (DME), retinal vein occlusion (RVO), pathologic myopia (PM), neovascular age-related macular degeneration (nAMD) and central serous chorioretinopathy (CSC).

METHODS

A cross-sectional study was carried out in 241 patients, affected by DME (n=44), RVO (n=41), PM (n=34) and nAMD (n=85) receiving intravitreal injections due to the presence of macular edema or choroidal neovascularization. The CSC patients included (n=37) were candidates for laser treatment. The patients included completed the National Eye Visual Functioning Questioning-25 (NEI VFQ-25). Best eye visual acuity (BEVA) was recorded using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale.

RESULTS

There were significant differences between subgroups for all the domains, except for the general vision in which all scores among diseases ranged from 40.7 to 45.2 out of 100 (P=.436), despite the difference in BEVA (CSC: 86.3±11.9; RVO: 78.5±15.5, DME: 73.3±15.2, nAMD: 72.9±12.6 and PM: 68.5±18.1 letters respectively; P<.001). The lowest VFQ-25 total score was observed in the PM patients (52.1±20.9), followed by nAMD (55.3±20.8), RVO (65.0±22.3), DME (68.6±21.0) and CSC (70.9±16.2). The DME group reported the worst score for general health (38.9±21.4). Mental health and role difficulties were lowest for PM (48.2±28.8 and 48.2±31.9, P<.007).

CONCLUSIONS

This study reveals the differences in the QoL among DME, RVO, nAMD, PM and CSC, describing the different repercussions that they can suffer, observing a higher impact in PM and nAMD.

Parental awareness of the implications of myopia and strategies to control its progression: A survey-based study

PURPOSE

Myopia has emerged as a significant public health concern. Effective methods have now been developed to delay its onset and progression. However, this information may not be reaching parents, and they are key players in terms of implementing the necessary preventive measures. This study investigated parental awareness of myopia, its implications and the strategies available for controlling it.

METHODS

A self-administered online survey was distributed to parents of children 6-16 years of age. To be eligible to respond, their child had to be myopic or at risk of developing myopia due to family history.

RESULTS

A total of 330 parents completed the survey, of which 321 were included for analysis. Sixty-seven percent of respondents had at least one myopic son/daughter, and most were between -1.00 and -1.75 D. Among parents of myopic children, 20.9% thought that their child's myopia progressed moderately. Sixty-seven percent of parents had a significant level of concern about the progression of the myopia and felt that it was caused mainly by the use of electronic devices and genetics. A generalised linear model showed that parental concern was significantly predicted by the perception of evolution (p < 0.001) and the number of known health-related consequences (p < 0.001). Almost 40% of parents were unaware of the existence of myopia control strategies. Relatives and eye care practitioners are the main sources of information. The most well-known myopia control strategy was myopia control soft contact lenses (29.2%), although the option that most parents would opt for was spectacles with peripheral defocus lenses (47.1%). The selection of a contact-lens-based myopia control method correlated significantly with the age of the children (p < 0.001).

CONCLUSIONS

Society in general and parents in particular need more information about myopia, its consequences and the options available for its control. Eye care practitioners play an important role in this issue.

Prevalence of Myopia and Its Associated Risk Factors Among Children Attending a Tertiary Hospital in Saudi Arabia

CLINICAL RELEVANCE

This study serves as a tool for optometrists and ophthalmologists to reinforce adherence to several preventive factors, which may decrease the incidence of myopia, and avoidance of risk factors by multiple means including education during hospital visits. It also provides insight into who should be screened and tailored screening programs for children.

BACKGROUND

While studies assessing the prevalence of myopia in Saudi Arabia have contradicting results, only a few studies have evaluated the risk factors of myopia and the effect of using electronic devices on its occurrence. Thus, this study aimed to determine the prevalence of myopia and associated risk factors, among children attending an ophthalmology clinic in King Abdulaziz Medical City, Jeddah, Saudi Arabia.

METHODS

 A cross-sectional study was conducted. A total of 182 patients aged < 14 years were selected using convenient sampling. Direct assessment of the refraction was performed in the clinic, and a questionnaire was completed by the child's parent.

RESULTS

Of 182 patients who met the inclusion criteria, 40.7% had myopia. Myopia was more common in boys (56.8%) than in girls (43.2%), with a median age of 8.7 years. Using multivariate regression analysis, only age (eight years and above) (OR=2.15, CI=1.12-4.12, P= 0.03), and family history of myopia (OR= 5.83, CI= 2.82-12.05, P= 0.001) were significant predictors of myopia in children. Other variables (e.g., sex, and use of laptops, computers, smartphones/tablets, or TV) were not statistically significant.

CONCLUSIONS

This study did not show a statistically significant association between using electronic devices and the onset and progression of myopia among children. Studies with a larger sample size are required to further investigate this association and assess other potential risk factors.

Health-related quality of life for children using orthokeratology (OK), peripheral lenslet designed (PLD) and single-vision (SV) spectacles: based on Child Health Utility 9 Dimensions (CHU9D)

PURPOSE

This study investigated the health-related quality of life (HRQoL) among children with myopia who used orthokeratology (OK), peripheral lenslet designed (PLD), and single-vision (SV) spectacles.

METHODS

This cross-sectional study was conducted between February of 2021 and August of 2022. It involved 211, 231, and 206 respondents with OK, PLD, and SV spectacle lenses, respectively. The HRQoL was presented as utility values using a general preference-based Child Health Utility-nine Dimensions (CHU9D) questionnaire. Descriptive statistical analysis and nonparametric hypothesis testing were used to compare the HRQoL in the OK, PLD, and SV groups.

RESULTS

Of the 648 respondents, the average utility scores was 0.936 (95 % confidence interval (CI): 0.929-0.943). Children who wore the PLD spectacles had a significantly higher utility scores (0.955, 95 % CI: 0.946-0.963) than those who wore the SV spectacles (0.926, 95 % CI: 0.913-0.939) and the OK lenses (0.925, 95 % CI: 0.913-0.937) (p < 0.01). The PLD spectacle wearers were less likely to be worried, sad, tired, or annoyed than those who wore OK and SV spectacles (P < 0.05). Self-reported improved eyesight and lessened eye pain and discomfort from myopia correction using PLD spectacles had higher utility values (P < 0.05).

CONCLUSIONS

The PLD spectacles had a significantly higher HRQoL than the OK and SV spectacles among children. Having better eyesight and less eye pain/discomfort from myopia correction could improve the HRQoL of children. This data indicates that PLD spectacles may be considered for myopia management in children and adolescents.

Limited bandwidth short-wavelength light produces slowly-developing myopia in tree shrews similar to human juvenile-onset myopia

During postnatal development, an emmetropization feedback mechanism uses visual cues to modulate the axial growth of eyes so that, with maturation, images of distant objects are in focus on the retina. If the visual cues indicate that the eye has become too long, it generates STOP signals that slow eye elongation. Myopia is a failure of this process where the eye becomes too long. The existing animal models of myopia have been essential in understanding the mechanics of emmetropization but use visual cues that lead to rapidly progressing myopia and don't match the stimuli that lead to human myopia. Form deprivation removes esssentially all spatial contrast. Minus lens wear accurately guides axial elongation to restore sharp focus: technically it is not a model of myopia! In contrast, childhood myopia involves a slow drift into myopia, even with the presence of clear images. We hypothesize that, in the modern visual environment, STOP signals are present but often are not quite strong enough to prevent myopic progression. Using tree shrews, small diurnal mammals closely related to primates, we have developed an animal model that we propose better represents this situation. We used limited bandwidth light to provide limited chromatic cues for emmetropization that are not quite enough to produce fully effective STOP signaling, resulting in a slow drift into myopia as seen in children. We hypothesize that this animal model of myopia may prove useful in evaluating anti-myopia therapies where form deprivation and minus lens wear would be too powerful.

Myopia and Near Work: A Systematic Review and Meta-Analysis

BACKGROUND

Myopia is a global public health problem affecting quality of life and work productivity. Data is scarce regarding the effects of near work on myopia. Providing a larger meta-analysis with life-long perspective, including adults and occupational exposure seemed needed.

METHODS

We searched PubMed, Cochrane Library, Embase and Science Direct for studies reporting myopia prevalence in near work. Myopia was defined as a mean spherical equivalent ≤ -0.50 diopter. We performed a meta-analysis using random-effects model on myopia prevalence, myopia progression per year, and odds ratio (OR) of myopia in near work, completed by subgroup analyses and meta-regressions on patients' characteristics, type of work in adults, geographic zones, time and characteristics of near work.

RESULTS

We included 78 studies, representing a total of 254,037 participants, aged from 6 to 39 years. The global prevalence of myopia in near work was 35% (95% CI: 30 to 41%), with a prevalence of 31% (95% CI: 26 to 37%) in children and 46% (95% CI: 30 to 62%) in adults. Myopia progression was -0.39 diopters per year (-0.53 to -0.24 D/year), ranging from -0.44 (-0.57 to -0.31) in children to -0.25 D/year (-0.56 to 0.06) in adults. The odds of myopia in workers exposed vs. non-exposed to near work were increased by 26% (18 to 34%), by 31% (21 to 42%) in children and 21% (6 to 35%) in adults. Prevalence of myopia was higher in adults compared to children (Coefficient 0.15, 95% CI: 0.03 to 0.27).

CONCLUSIONS

Near work conditions, including occupational exposure in adults, could be associated with myopia. Targeted prevention should be implemented in the workplace.

Objective measures of viewing behaviour in children during near tasks

CLINICAL RELEVANCE

Objective assessment of near viewing behaviours performed in a laboratory setting showed that children demonstrate differing viewing distances and angles based on the type of task. Findings will contribute to our understanding of how near work influences myopia.

BACKGROUND

Evidence suggests that near working distance and viewing breaks are associated with myopia. The purpose of this study was to use an objective, continuously measuring range finding device to examine these viewing behaviours in children.

METHODS

Viewing distance, number of breaks, and head and eye angles were assessed in 16 non-myopic and 19 myopic children (ages 13.38 ± 4.14 years) using the Clouclip, an objective rangefinder, during five 15-minute near tasks, including (a) passive reading and (b) active writing on printed material, (c) passive viewing and (d) active engagement on an iPad, and (e) active engagement on a cell phone. Height and Harmon distance were measured. Viewing behaviours were analysed by task, refractive error group, and gender.

RESULTS

Mean viewing distances significantly differed by task (P < 0.001) and were highly correlated with children's Harmon distance and height for all near tasks (P < 0.05), except for the active printed task (P > 0.05). Viewing distances did not differ by gender or refractive error group. During each task, mean number of viewing breaks was 2.6 ± 4.1 and did not vary between task (P = 0.92) or refractive error group (P = 0.65). Head declination and total viewing angle varied by type of near task (P < 0.001 for both).

CONCLUSION

Children demonstrated differing viewing distances and viewing angles based on the type of near task they were performing. Viewing behaviours did not vary between myopic and non-myopic children. Findings will contribute to a better understanding of how near viewing behaviours can be quantified objectively and relationships with myopia.

Validation of the Arabic version of the quality of life impact of refractive correction questionnaire

PURPOSE

To validate the Arabic version of the quality of life impact of refractive correction (QIRC) questionnaire.

METHODS

This was a cross-sectional study included participants with refractive errors (myopia, hypermetropia, or astigmatism) aged between 19 and 40 years who were pre or postrefractive surgeries. Uncorrected distance visual acuity, refraction, and corneal topography were collected. The 20-item QIRC questionnaire was translated to the Arabic language and then back translated to the English language. Participants were asked to answer all items of the Arabic QIRC. The validity and reliability of the translated questionnaire were tested using Rasch analysis.

RESULTS

A total of 145 participants with refractive errors participated in this study. The mean age ± standard deviation of participants was 26.29 ± 5.1 years. Person separation (2.01) and reliability (0.80) indicates good precision and stability of the Arabic QIRC questionnaire. Item infit was ranged between 0.82 and 1.23; and item outfit was range between 0.76 and 1.32. The items were well targeted to the persons with a mean difference of 0.30. Skew and kurtosis values were within the normal limits (-2.00 to + 2.00). Cronbach's α for the scale was 0.79, which indicates good reliability of the Arabic 20-item QIRC.

CONCLUSION

The Arabic 20-item QIRC questionnaire is a valid tool to assess the impact of refractive correction on Arabian participants' quality of life.

Myopia: An Increasing Problem for Medical Students at the University of Gondar

Purpose

The purpose of this study was to assess the prevalence and associated factors of myopia among medical students at the University of Gondar College of Medicine and Health Sciences, Northwest Ethiopia.

Patients and Methods

Institution-based cross-sectional study was conducted at the University of Gondar College of Medicine and Health Sciences from June 20 to August 15, 2021. A simple random sampling technique with proportional allocation was used to select 492 students. Interviewer-administered questionnaire, Snellen acuity chart, pinhole, retinoscope and direct ophthalmoscope were used to collect the data. The data were entered to EpiData version 4.6 and exported to SPSS version 25 for analysis. Descriptive statistics were summarized by measures of central tendency. Variables with p-value ≤0.2 in bivariable regression were entered into a multivariable logistic regression model. Adjusted odds ratio with 95% confidence interval was used and variables with p-values <0.05 were considered as statistically significant.

Results

A total of 492 respondents participated giving a response rate of 98.3%. The prevalence of myopia was found to be 16.7% (95% CI = 12.8–19.4%). Urban residents (AOR = 1.56; 95% CI: 1.28–6.21), family history of myopia (AOR = 2.31; 95% CI: 1.33–4.54), near-work activity of 5–7 hours (AOR = 2.41; 95% CI: 1.31–5.76) and ≥8 hours (AOR = 4.35; 95% CI: 1.96–9.66), outdoor activity for <3 hours (AOR = 1.65 95% CI: (1.14–4.53), were significantly associated with myopia.

Conclusion

The prevalence of myopia among medical students at the University of Gondar College of Medicine and Health Sciences was high. Urban residency, positive family history, longer time spent on near-work activities and less outdoor activity were positively associated with myopia.

Correlation between global prevalence of vision impairment and depressive disorders

PURPOSE

To assess the correlation of the worldwide prevalence of visual impairment and depressive disorders.

METHODS

This is an ecologic study on Global Burden of Disease 2019 data. Global and national prevalence numbers and rates of vision impairment (VI) and depressive disorders were obtained from database. The human development index (HDI) and socio-demographic index (SDI) were derived from international open databases. Main outcome measures were the correlation of the VI and depressive disorders in total and different age, sex, and socioeconomic subgroups.

RESULTS

In 2019, the worldwide prevalence of total VI and total depressive disorders were 9.6% (95% Uncertainty Interval (UI): 8.0-11.3) and 3.8% (95% UI: 3.4-4.2), respectively. The prevalence rates of total VI (r = 0.38, P < 0.001) as well as cataract (r = 0.43, P < 0.001), age-related macular degeneration (AMD) (r = 0.32, P < 0.001), refractive disorders (r = 0.19, P < 0.001) and near vision loss (r = 0.33, P < 0.001) correlated, positively, with dysthymia. In addition, the prevalence rates of glaucoma (r for total depressive disorders = 0.37, P < 0.001 and r for major depressive disorders (MDD) = 0.38, P < 0.001) and AMD (r for total depressive disorders = 0.37, P < 0.001 and r for MDD = 0.28, P < 0.001) had a positive correlation with MDD and total depressive disorders. The correlations remained significant in sociodemographic subgroups.

CONCLUSION

There was a significant correlation between national prevalence rates of VI and ocular disabilities with depressive disorders, worldwide.

Objective Measures of Near Viewing and Light Exposure in Schoolchildren during COVID-19

SIGNIFICANCE

Wearable sensors provide the opportunity for continuous objective measurement of the visual environment with high resolution. Our findings show that absolute and temporal properties of near viewing and time outdoors vary between myopic and nonmyopic schoolchildren, which are important considerations when studying refractive error pathogenesis.

PURPOSE

Numerous behavioral factors, including near work, time outdoors, electronic device use, and sleep, have been linked to myopia. The purpose of this study was to assess behaviors using subjective and objective methods in myopic and nonmyopic schoolchildren in the United States.

METHODS

Forty children (aged 14.6 ± 0.4 years) simultaneously wore two sensors for 1 week, a Clouclip for objective measurement of near viewing and light exposure and an Actiwatch for objective measurement of activity and sleep. Parents completed an activity questionnaire for their child. Near-viewing distance, daily duration, short-duration (>1 minute) and long-duration (>30 minutes) near-viewing episodes, light exposure, time outdoors, electronic device use, and sleep duration were analyzed by refractive error group and day of the week.

RESULTS

Objectively measured daily near-viewing duration was 6.9 ± 0.3 hours. Myopes spent more time in near + intermediate viewing than nonmyopes (P = .008) and had higher diopter hours (P = .03). Short- and long-duration near-viewing episodes were similar between groups (P < .05 for both). Daily light exposure and time outdoors were significantly lower for myopes (P < .05 for both). Electronic device use (12.0 ± 0.7 hours per day) and sleep duration (8.2 ± 0.2 hours per night) were similar between groups (P > .05 for both).

CONCLUSIONS

Objective and subjective measures confirm that myopic and nonmyopic schoolchildren exhibit different behaviors. Combining wearable sensors with questionnaires provides a comprehensive description of children's visual environment to better understand factors that contribute to myopia.

Relationship Between Myopia and Other Risk Factors With Anxiety and Depression Among Chinese University Freshmen During the COVID-19 Pandemic

Purpose: To investigate the association of myopia and other risk factors with anxiety and depression among Chinese university freshmen during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: This cross-sectional study was conducted at the Tianjin Medical University from October 2020 to December 2020. Ophthalmic examination of the eyes was performed by an experienced ophthalmologist. Detailed information on depression, anxiety, and other risk factors was collected via the Self-rating Anxiety Scale and Self-rating Depression Scale.

Results: The overall prevalence of anxiety and depression in our study was 10.34 and 25.13%, respectively. The prevalence of myopia and high myopia as 92.02 and 26.7%, respectively. There were significant associations between anxiety and spectacle power [odds ratios (OR) = 0.89; 95% CI: 0.81–0.98, P = 0.019], sphere equivalent (OR = 0.89; 95% CI: 0.81– 0.98, P = 0.025), sleep time (OR = 0.53; 95% CI: 0.35–0.79, P = 0.002), and body mass index (OR = 0.93; 95% CI: 0.86–0.99, P = 0.047). In the multivariable linear regression models, spectacle power (β = −0.43; 95% CI: −0.68 to −0.19, P = 0.001) and sphere equivalent (β = −0.36; 95% CI: −0.60 to −0.11, P = 0.005) were negatively associated with anxiety scores, whereas axial length (β = 0.54; 95% CI: 0.02–1.07, P = 0.044) was positively correlated with anxiety scores. Every 1 h decrease in sleep time was associated with a 0.12-point increase in depression score.

Conclusion: Myopia was associated with anxiety and anxiety scores. The greater the degree of myopia, the higher the anxiety score. However, myopia was not found to be associated with depression. The results highlight the importance of providing psychological support to students with myopia during the COVID-19 pandemic.

Prevalence of Myopic Macular Features in Dutch Individuals of European Ancestry With High Myopia

Question

What is the prevalence of myopic macular degeneration in Dutch individuals of European ancestry with high myopia?

Findings

In this cross-sectional study of 626 individuals with European ancestry with high myopia, the prevalence of myopic macular degeneration was 25.9% and increased with older age, lower spherical equivalent of refractive error, and higher axial length.

Meaning

Myopic retinal features were frequent in this highly myopic study population, but not different than patients of Asian ancestry with similar risk profiles.

Importance

High myopia incidence and prevalence is increasing worldwide, and the visual burden caused by myopia is expected to rise accordingly. Studies investigating the occurrence of myopic complications in individuals of European ancestry with high myopia are scarce, hampering insights into the frequency of myopic retinal complications in European individuals and their visual burden.

Objective

To assess the frequency of myopic macular features in individuals of European ancestry with high myopia.

Design, Setting, and Participants

This cross-sectional analysis of the Dutch Myopia Study (MYST) and individuals with high myopia from the Rotterdam Study (RS) included 626 patients with high myopia (spherical equivalent of refractive error [SER] ≤−6 diopters [D] or axial length [AL] ≥26 mm) who underwent an extensive ophthalmic examination including multimodal retinal imaging. In addition to this combination of a population-based cohort study and mix-based high myopia study, a systematic literature review was also performed to compare findings with studies of individuals of Asian ancestry.

Exposures

High myopia, age, and AL.

Main Outcomes and Measures

Frequency of myopic macular and optic disc features: tessellated fundus, myopic macular degeneration (MMD), staphyloma, peripapillary intrachoroidal cavitation, peripapillary atrophy (PPA), and “plus” lesions (choroidal neovascularization, Fuchs spot, and lacquer cracks).

Results

The mean (SD) SER of the combined study population (MYST and RS) was −9.9 (3.2) D; the mean (SD) age was 51.4 (15.1) years, and 387 (61.8%) were women. The prevalence of MMD was 25.9% and increased with older age (P for trend <.001), lower SER (odds ratio [OR], 0.70; 95% CI, 0.65-0.76; P < .001), and higher AL (OR, 2.53; 95% CI, 2.13-3.06; P < .001). Choroidal neovascularization or Fuchs spot was present in 2.7% (n = 17), both lesions in 0.3% (n = 2), and lacquer cracks in 1.4% (n = 9). Staphyloma, PPA, and MMD were highly prevalent in visual impaired and blind eyes (frequency was 73.9% [20 of 27], 90.5% [19 of 21], and 63.0% [17 of 27] of unilateral blind eyes for MMD, staphyloma, and PPA, respectively). Seven previous studies in Asian populations reported a variable MMD frequency ranging from 8.3% to 64%, but frequencies were similar for comparable risk profiles based on age and SER.

Conclusions and Relevance

In this cross-sectional study of a highly myopic Dutch population of European ancestry, myopic retinal features were frequent; were associated with age, SER, and AL; and occurred in all visually severely impaired eyes. The absence of treatment options for most of these retinal complications emphasizes the need for effective strategies to prevent high myopia.

The influence of alcohol intake in myopia development or progression: The SUN cohort study

BACKGROUND

Myopia is a highly prevalent disorder, and one of the first causes of blindness. In turn, alcohol consumption has been shown to be a risk factor for many diseases and a main contributor to the global burden of disease. However, no studies have investigated the relationship between alcohol intake and myopia. Our aim was to prospectively assess the association between alcohol intake and the development or progression of myopia.

METHODS

In a Spanish dynamic prospective cohort (the SUN Project) we assessed 15,642 university graduates, recruited between 1999 and 2018 and followed up biennially through mailed questionnaires. Alcohol intake was assessed with a validated 136-item food frequency questionnaire. Development or progression of myopia was collected in subsequent questionnaires during follow-up every two years.

RESULTS

Alcohol intake was linearly and significantly associated with a higher risk of myopia development or progression: the OR for 10-year incidence/progression of myopia was 1.05, 95% CI 1.01-1.09 per each 10-grams increase in alcohol intake.

CONCLUSIONS

Alcohol consumption might lead to the development or progression of myopia, although confirmation is needed for the mechanisms through which this association may occur, thus further research is needed to verify these findings.

Outcomes after Cataract Surgery in High Myopes with Axial Length Differences of ≥2 mm

Purpose: To evaluate the visual outcome after cataract operations in high myopia patients, whose axial length differences are longer than 2 mm.Methods: A retrospective study was conducted on patients who had received phacoemulsification cataract surgery from January 2014 to June 2020. The patients whose axial lengths and inter-eye axial lengths exceeded 26 and 2 mm, respectively, were selected. Demographic data, axial lengths, central subfield macular thickness, retinal nerve fiber layer, and best-corrected visual acuities (BCVAs) before and at 6 months postoperatively were collected. The factors related to visual outcome were analyzed using univariate, multivariate linear regression.Results: Twelve patients had an inter-eye axial length difference longer than 2 mm. The average axial lengths of longer and shorter eyes were 29.17 ± 1.94 and 26.66 ± 2.51 mm, respectively (p = 0.02, Mann-Whitney U-test). The BCVAs (logarithm of minimal angle of resolution, logMAR) of the longer and shorter eyes before the surgery were 1.09 ± 0.62 and 0.19 ± 0.16, respectively (p = 0.03, Mann-Whitney U-test). The BCVAs (logMAR) of the longer and shorter eyes 6 months after surgery were 0.19 ± 0.16 and 0.08 ± 0.10, respectively (p = 0.11, Mann-Whitney U-test). In univariate linear regression analysis, the BCVAs 6 months after the surgery showed better preoperative BCVAs (p < 0.001) and a thinner central subfield macular thickness (p = 0.001). In multivariate linear regression analysis, the BCVA at 6 months after the surgery showed significant improvement compared with preoperative BCVA values (p < 0.001).Conclusions: High myopia patients whose axial length differences exceeded 2 mm showed improved VA after cataract surgery.

Contrast sensitivity and higher-order aberrations in Keratoconus subjects

This study analyzes the relationship between contrast-sensitivity and higher-order aberrations (HOA) in mild and subclinical-keratoconus in subjects with good visual-acuity (VA). Keratoconus group (including subclinical-keratoconus) and controls underwent autokeratometry, corneal-tomography, autorefraction and HOA measurement. Contrast-sensitivity was tested using a psychophysical two-alternative forced-choice Gabor patches in three blocks (6, 9, 12 cycles/deg). Controls were compared to the keratoconus group and to a keratoconus subgroup with VA of 0.00 LogMar group ("keratoconus-0.00VA"). Spearman correlation tested association between HOA and contrast-sensitivity. Twenty-two keratoconus subjects (38 eyes: 28 keratoconus, 10 subclinical-keratoconus, 20 keratoconus-0.00VA) and 35 controls were included. There was a significant difference between control and keratoconus, and between control and keratoconus-0.00VA, for keratometry, cylinder, thinnest and central corneal thickness (p < 0.001). Controls showed lower HOA and higher contrast-sensitivity for all spatial-frequencies (p < 0.001). Most HOA were negatively correlated with contrast-sensitivity for all spatial-frequencies for keratoconus group and for 9 and 12 cycles/deg for keratoconus-0.00VA. Keratoconus subjects with good VA showed reduction in contrast-sensitivity and increased HOAs compared to controls. HOA and contrast-sensitivity are inversely correlated in subjects with mild keratoconus despite good VA. This suggests that the main mechanism underlying the decreased vision quality in keratoconus is the increase of HOA.

Flitcroft's model of refractive development in childhood and the possible identification of children at risk of developing significant myopia

PURPOSE

To better understand juvenile myopia in the context of overall refractive development during childhood and to suggest more informative ways of analysing relevant data, particularly in relation to early identification of those children who are likely to become markedly myopic and would therefore benefit from myopia control.

METHODS

Examples of the frequency distributions of childhood mean spherical refractive errors (MSEs) at different ages, taken from previously-published longitudinal and cross-sectional studies, are analysed in terms of Flitcroft's model of a linear combination of two Gaussian distributions with different means and standard deviations. Flitcroft hypothesises that one, relatively-narrow, Gaussian (Mode 1) represents a "regulated" population which maintains normal emmetropisation and the other, broader, Gaussian (Mode 2) a "dysregulated" population.

RESULTS

Analysis confirms that Flitcroft's model successfully describes the major features of the frequency distribution of MSEs in randomly-selected populations of children of the same age. The narrow "regulated" Gaussian typically changes only slightly between the ages of about 6 and 15, whereas the mean of the broader "dysregulated" Gaussian changes with age more rapidly in the myopic direction and its standard deviation increases. These effects vary with the ethnicity, environment and other characteristics of the population involved. At all ages there is considerable overlap between the two Gaussians. This limits the utility of simple refractive cut-off values to identify those children likely to show marked myopic progression.

CONCLUSIONS

Analysing the frequency distributions for individual MSEs in terms of bi-Gaussian models can provide useful insights into childhood refractive change. A wider exploration of the methodology and its extension to include individual progression rates is warranted, using a range of populations of children exposed to different ethnic, environmental and other factors.

IMI Impact of Myopia

The global burden of myopia is growing. Myopia affected nearly 30% of the world population in 2020 and this number is expected to rise to 50% by 2050. This review aims to analyze the impact of myopia on individuals and society; summarizing the evidence for recent research on the prevalence of myopia and high myopia, lifetime pathological manifestations of myopia, direct health expenditure, and indirect costs such as lost productivity and reduced quality of life (QOL). The principal trends are a rising prevalence of myopia and high myopia, with a disproportionately greater increase in the prevalence of high myopia. This forecasts a future increase in vision loss due to uncorrected myopia as well as high myopia-related complications such as myopic macular degeneration. QOL is affected for those with uncorrected myopia, high myopia, or complications of high myopia. Overall the current global cost estimates related to direct health expenditure and lost productivity are in the billions. Health expenditure is greater in adults, reflecting the added costs due to myopia-related complications. Unless the current trajectory for the rising prevalence of myopia and high myopia change, the costs will continue to grow. The past few decades have seen the emergence of several novel approaches to prevent and slow myopia. Further work is needed to understand the life-long impact of myopia on an individual and the cost-effectiveness of the various novel approaches in reducing the burden.

Quality of Life in Presbyopes with Low and High Myopia Using Single-Vision and Progressive-Lens Correction

This study evaluates the impact of the severity of myopia and the type of visual correction in presbyopia on vision-related quality of life (QOL), using the refractive status and vision profile (RSVP) questionnaire. A total of 149 subjects aged 41-75 years with myopic presbyopia were recruited: 108 had low myopia and 41 had high myopia. The RSVP questionnaire was administered. Rasch analysis was performed on five subscales: perception, expectation, functionality, symptoms, and problems with glasses. Highly myopic subjects had a significantly lower mean QOL score (51.65), compared to low myopes (65.24) (p < 0.001). They also had a significantly lower functionality score with glasses (49.38), compared to low myopes (57.00) (p = 0.018), and they had a worse functionality score without glasses (29.12), compared to low myopes (36.24) (p = 0.045). Those who wore progressive addition lenses (PAL) in the high-myope group (n = 25) scored significantly better, compared to those who wore single-vision distance (SVD) lenses (n = 14), with perception scores of 61.19 and 46.94, respectively (p = 0.029). Highly myopic presbyopes had worse overall QOL and functionality, both with and without glasses, compared to presbyopes with low myopia. High-myopic PAL users had a better perception outcome than SVD lens wearers. Low-myopic PAL wearers had a better QOL than SVD wearers.

Practice of orthokeratology in Algeria: a retrospective study

PURPOSE

To report the practice of orthokeratology (OK) in Algeria and to investigate the visual outcomes, safety and subjective responses with this technique in myopes.

METHODS

A retrospective chart review of 48 participants using OK lenses since January 2010 were included in the study. Lenses were selected and fitted according to the manufacturer's recommendations using their respective software and the number of lenses required for a successful fit was recorded. Visual acuity (VA) in logMAR units and biomicroscopic findings were recorded for each visit. Subjective ratings was determined with analogue rating scale was filled in by the investigator, the participants were divided into Group 1 (> 4.00D) and Group 2 (< 3.75D) myopic groups for analysis.

RESULTS

First lens fitting success rate of 64.58%. There was also a significant difference between the BCVA at baseline and VA at Day 1 (P < 0.05), and no significant difference at Day 7, Day 30 and the final visit (P = 0.51, P = 0.93, P = 0.62, respectively), for Group 2. There was a significant difference between the BCVA at baseline and VA at Day 1, 7, 30 and the final visit (P < 0.05), for Group 1. the patients of the second group were happier but the results from the survey were not statistically significant (P = 0.10), no serious complication was reported.

CONCLUSION

the technique was efficient and safe as we didn't have any serious complication, with a high success rate for first lens fitting.

Study time, glasses utilization and age affect quality of life among senior first-year Chinese myopia students

PURPOSE

To compare the quality of life of senior first-year students with normal vision and myopia, and to explore the risk factors related to quality of life in students with myopia.

METHODS

In this study, 1103 senior first-year students were enrolled in ten high schools. These students were divided according to the diopter degree, with 916 myopia students and 187 normal vision students. Visual function indexes, such as naked eye vision, were measured and recorded, and social demographic indexes and the National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25) was used. The differences in quality of life between the two groups were compared. Multiple linear regression analysis was used to explore the possible risk factors for quality of life in myopia students.

RESULTS

In the NEI VFQ-25, the total quality of life scores of myopia students (77.06 ± 15.66) were lower than those of normal vision students (85.49 ± 12.37). The difference was statistically significant (p = 0.007). In the correlation analysis, the total scores of quality of life in myopia students were positively correlated with wearing glasses (p = 0.049), and were negatively correlated with study time (p = 0.029). Multiple linear regression analysis showed that study time, wearing glasses and age were risk factors affecting quality of life in myopia students.

CONCLUSION

Our results show that senior first-year myopia students have lower quality of life scores than students with normal vision. Study time, wearing glasses and age are risk factors for quality of life in senior first-year myopia students.

Reducing the Global Burden of Myopia by Delaying the Onset of Myopia and Reducing Myopic Progression in Children: The Academy's Task Force on Myopia

In 2019, the American Academy of Ophthalmology (AAO) created the Task Force on Myopia in recognition of the substantial global increases in myopia prevalence and its associated complications. The Task Force, led by Richard L. Abbott, MD, and Donald Tan, MD, comprised recognized experts in myopia prevention and treatment, public health experts from around the world, and organization representatives from the American Academy of Family Physicians, American Academy of Optometry, and American Academy of Pediatrics. The Academy's Board of Trustees believes that myopia is a high-priority cause of visual impairment, warranting a timely evaluation and synthesis of the scientific literature and formulation of an action plan to address the issue from different perspectives. This includes education of physicians and other health care providers, patients and their families, schools, and local and national public health agencies; defining health policies to ameliorate patients' access to appropriate therapy and to promote effective public health interventions; and fostering promising avenues of research.

Myopia

Myopia, also known as short-sightedness or near-sightedness, is a very common condition that typically starts in childhood. Severe forms of myopia (pathologic myopia) are associated with a risk of other associated ophthalmic problems. This disorder affects all populations and is reaching epidemic proportions in East Asia, although there are differences in prevalence between countries. Myopia is caused by both environmental and genetic risk factors. A range of myopia management and control strategies are available that can treat this condition, but it is clear that understanding the factors involved in delaying myopia onset and slowing its progression will be key to reducing the rapid rise in its global prevalence. To achieve this goal, improved data collection using wearable technology, in combination with collection and assessment of data on demographic, genetic and environmental risk factors and with artificial intelligence are needed. Improved public health strategies focusing on early detection or prevention combined with additional effective therapeutic interventions to limit myopia progression are also needed.

Pharmacological Myopia Control Influence on Quality of Life and Psyche among Adolescents

Myopia is a global problem affecting all aspects of patients’ lives. Objectives: The aim of the study was to evaluate the influence of low dose atropine (LDA) myopia control on the quality of life in patients with myopia. Material and Methods: A self-constructed questionnaire, including eight questions, was distributed among 40 patients. The questionnaire was divided into two subsections: (1) influence of LDA on visual functions and (2) influence of LDA on self-esteem. Answers were collected separately for boys (18 patients) and girls (22 patients) and compared considering spherical equivalent (SE) and myopia progression rate. Results: Girls reported more issues with near activities and pupil size. Boys and girls complained similarly, regarding the sun glare. We found a high level of certainty about the efficacy of LDA therapy among both examined groups and a little improvement in self-esteem. Girls recommended LDA therapy more often than boys, especially when the progression rate was low. There was no statistically significant difference in answer scores between groups with different myopia progression rates for boys. Girls with lower progression rates reported more issues with near work and sun glare and less trust in LDA therapy’s effectiveness than girls with a higher progression rate. There was no statistically significant correlation between SE and the total answer score for both genders. Conclusions: Findings concerning childrens’ and adolescents’ psyche are a new aspect of myopia control. We prove that patients during pharmacological myopia control did not report significant problems caused by LDA therapy and they were convinced about its efficacy, had greater self-esteem, and recommended it to peers.

Racial and Ethnic Differences in Myopia Progression in a Large, Diverse Cohort of Pediatric Patients

Purpose

The purpose of this study was to characterize the differences in myopic progression in children by race/ethnicity and age.

Methods

Patients enrolled in Kaiser Permanente Southern California between 2011 and 2016 and between the ages of 4 and 11 years old with a documented refraction between -6 and -1 diopters (Ds) were included in this retrospective cohort study. Patients with a history of amblyopia, strabismus, retinopathy of prematurity, or prior ocular surgery were excluded from analyses. Patients' race/ethnicity and language information were used to create the following groups for analysis: white, Black, Hispanic, South Asian, East/Southeast Asian, Other Asian, and other/unknown. A growth curve analysis using linear mixed-effects modeling was used to trace longitudinal progression of spherical equivalents over time, modeled by race/ethnicity. Analyses adjusted for potential confounders, including body mass index (BMI), screen time, and physical activity.

Results

There were 11,595 patients who met the inclusion criteria. Patients were 53% girls, 55% Latino, 15% white, 9% black, 9% East/Southeast Asian, and 2% South Asian. Mean age (standard deviation [SD]) at the time of initial refraction was 8.9 years (1.6 years). Patients had an average (SD) of 3.4 (1.5) refractions, including the baseline measurement, during the study period. A three-way interaction model that assessed the effects of age at baseline, time since baseline, and race/ethnicity found that children of East/Southeast Asian descent showed significantly faster myopia progression across time (P < 0.001). East/Southeast Asian patients who presented with myopia between 6 to < 8 years progressed similarly to white patients in the same age group and significantly faster compared with white patients in other age groups.

Conclusions

Myopia progression differed significantly between East/Southeast Asian and white patients depending on the patients' age.

The Complications of Myopia: A Review and Meta-Analysis

Purpose

To determine the risk between degree of myopia and myopic macular degeneration (MMD), retinal detachment (RD), cataract, open angle glaucoma (OAG), and blindness.

Methods

A systematic review and meta-analyses of studies published before June 2019 on myopia complications. Odds ratios (OR) per complication and spherical equivalent (SER) degree (low myopia SER < -0.5 to > -3.00 diopter [D]; moderate myopia SER ≤ -3.00 to > -6.00 D; high myopia SER ≤ -6.00 D) were calculated using fixed and random effects models.

Results

Low, moderate, and high myopia were all associated with increased risks of MMD (OR, 13.57, 95% confidence interval [CI], 6.18-29.79; OR, 72.74, 95% CI, 33.18-159.48; OR, 845.08, 95% CI, 230.05-3104.34, respectively); RD (OR, 3.15, 95% CI, 1.92-5.17; OR, 8.74, 95% CI, 7.28-10.50; OR, 12.62, 95% CI, 6.65-23.94, respectively); posterior subcapsular cataract (OR, 1.56, 95% CI, 1.32-1.84; OR, 2.55, 95% CI, 1.98-3.28; OR, 4.55, 95% CI, 2.66-7.75, respectively); nuclear cataract (OR, 1.79, 95% CI, 1.08-2.97; OR, 2.39, 95% CI, 1.03-5.55; OR, 2.87, 95% CI, 1.43-5.73, respectively); and OAG (OR, 1.59, 95% CI, 1.33-1.91; OR, 2.92, 95% CI, 1.89-4.52 for low and moderate/high myopia, respectively). The risk of visual impairment was strongly related to longer axial length, higher myopia degree, and age older than 60 years (OR, 1.71, 95% CI, 1.07-2.74; OR, 5.54, 95% CI, 3.12-9.85; and OR, 87.63, 95% CI, 34.50-222.58 for low, moderate, and high myopia in participants aged >60 years, respectively).

Conclusions

Although high myopia carries the highest risk of complications and visual impairment, low and moderate myopia also have considerable risks. These estimates should alert policy makers and health care professionals to make myopia a priority for prevention and treatment.

Progression and Longitudinal Biometric Changes in Highly Myopic Eyes

Purpose

To examine 2-year progression rate and associated biometric changes in highly myopic eyes.

Methods

This is a longitudinal, observational cohort study that included 657 participants aged 7 to 70 years with bilateral high myopia (≤-6.00 diopters [D]) and followed for 2 years. All participants underwent ocular biometry and cycloplegic refraction examinations. Main outcome measures were changes in spherical equivalent refraction (SE) and ocular biometry in the right eyes.

Results

Mean age of participants was 21.6 ± 12.2 years. At baseline, mean SE was -9.82 ± 3.28 D and ocular biometric measurements were 27.40 ± 1.56 mm for axial length, 3.16 ± 0.27 mm for anterior chamber depth, 3.60 ± 0.35 mm for lens thickness, and 20.09 ± 1.50 mm for vitreous chamber depth. After 2 years of follow-up, there was a trend toward more myopia and greater axial elongation in all age groups. Younger participants (≤20 years) had significantly (P < 0.001) greater rates of myopic shift and axial elongation compared with older participants (>20 years). However, highly myopic adults aged 40 to 70 years continued to demonstrate refractive progression, particularly if they had extremely high myopia (≤-10.00 D). In the multiple regression analysis, each additional diopter of myopia at baseline was associated with a 11% higher risk of a >1.00-D/y myopic shift (odds ratio, 1.11; 95% confidence interval, 1.04-1.18; P = 0.002).

Conclusions

Longitudinal data from this large Chinese cohort suggest that highly myopic eyes continue to progress in SE throughout life, with the greatest rates of progression observed in younger participants. Axial elongation rates appeared to stabilize after 20 years of age and were predominantly due to an increase in the vitreous chamber depth. Other risk factors for a myopic shift included a higher degree of myopic refraction at baseline.

Myopia and its progression in children in London, UK: a retrospective evaluation

PURPOSE

Worldwide, the prevalence of myopia is increasing. Myopia begins at younger ages and progresses faster, leading to more adults with high myopia and risk of sight-threatening complications. No data are available about myopia trends in children in urban areas in the UK. We present a 10-year review of children attending a secondary and tertiary eye care facility in London, focussing on the proportion of glasses prescriptions for myopia and progression rates.

METHODS

We collated refraction and demographic data from children under the age of 17 years seen at Moorfields Eye Hospital, London, UK, between 2008 and 2017.

RESULTS

We included 63,854 datasets from 23,593 children (51.2% boys, median age 5.4 years, interquartile range IQR 3.8-7.1). The proportion of myopic prescriptions increased from 24 to 32%. In n = 3355 with initial mild/moderate myopia, median progression rate was -0.16 (-0.5 to 0.04) D/year. In those with progression (n = 2095), the rate was -0.40 (-0.19 to -0.74) D/year, slightly higher in girls than in boys (-0.42 vs -0.38 D/year; p = 0.02). Progression was faster in initial moderate than initial mild myopia (-0.54 vs -0.37 D/year; p < 0.001), and before than after average age of onset of puberty (-0.41 vs -0.35 D/year; p = 0.013). There was no statistically significant difference between children of different ethnic backgrounds.

CONCLUSIONS

In this cohort, the proportion of glasses prescriptions for myopia and the rate of progression are higher than previously reported for European countries. Living in an urban environment may result in similar progression rates despite different genetic backgrounds.

Endothelin-1 Serum Concentration is Lower in Children and Adolescents with High Myopia, a Preliminary Study

The aim of this study is to evaluate the levels of enothelin-1 (ET-1) in children and adolescents with high myopia and its association with the axial length of the eye and the presence of myopic retinal degeneration. The cross-sectional study was carried out in 57 patients with high myopia and 29 control subjects. Serum concentrations of ET-1 were measured using enzyme-linked immunosorbent assay (ELISA) kit. A significantly lower concentration of ET-1 in highly myopic patients compared to controls was found (1.47 (0.91; 1.87) vs. 1.94 (1.1; 2.69) pg/mL, p = 0.005). In patients with high myopia, a weak negative correlation between ET-1 concentration and the longest axial length out of the two eyes was found (r = −0.255, p = 0.0558). Further analysis revealed statistically significant differences in ET-1 concentration between patients with the axial length of the eye > 26 and ≤ 26 mm (p < 0.041) and patients with the axial length of the eye > 26 mm and controls (p < 0.001). ET-1 expression is disturbed in highly myopic children and adolescents. Lower ET-1 concentration in patients with the axial length of the eye > 26 mm may co-occur with high myopia and should be considered a risk factor in the pathophysiology of high myopia progression.

Puberty could regulate the effects of outdoor time on refractive development in Chinese children and adolescents

Aim

To explore the impact of puberty on refractive development and its interaction with outdoor time in children and adolescents.

Methods

In this 2-year observational study, students aged 7–13 years were selected with cluster sampling. All participants underwent cycloplegic refraction and axial length measurements once every year. Information of related factors was acquired through proper questionnaire or inquiry. The level of testosterone/estradiol was detected from the saliva of the subjects using the ELISA kit. Multiple linear regression and generalised estimating equation (GEE) were used to analyse the relationship among puberty, outdoor activities and refractive indicators.

Results

A total of 776 children and adolescents were included, with an average baseline age of 9.64±1.54 years and 53.6% boys. There were 350 myopes (55.2% of the 634 cyclopleged subjects) at baseline. There was a significant difference in the mean axial length changes and outdoor time among different puberty groups (for axial length: p=0.017, for outdoor time: p=0.015). Myopic parents, less outdoor time and more changes in estradiol were associated with greater changes in axial length and spherical equivalent (SE) (axial length changes: parental myopia β=0.230, outdoor time β=−0.250, changes in estradiol β=0.261; SE changes: parental myopia β=−0.267, outdoor time β=0.256, changes in estradiol β=−0.297). In the GEE model, the interaction between outdoor time and puberty was significantly associated with axial length (p=0.024, β=1.199).

Conclusions

This study implies puberty may play a regulating role on the relationship between outdoor time and refractive development among Chinese children and adolescents, which provides clues for in-depth mechanism interpretation and efficient intervention strategies.

Pathogenesis and Prevention of Worsening Axial Elongation in Pathological Myopia

PURPOSE

This review discusses the etiology and pathogenesis of myopia, prevention of disease progression and worsening axial elongation, and emerging myopia treatment modalities.

INTRODUCTION

Pediatric myopia is a public health concern that impacts young children worldwide and is associated with numerous future ocular diseases such as cataract, glaucoma, retinal detachment and other chorioretinal abnormalities. While the exact mechanism of myopia of the human eye remains obscure, several studies have reported on the role of environmental and genetic factors in the disease development.

METHODS

A review of literature was conducted. PubMed and Medline were searched for combinations and derivatives of the keywords including, but not limited to, "pediatric myopia", "axial elongation", "scleral remodeling" or "atropine." The PubMed and Medline database search were performed for randomized control trials, systematic reviews and meta-analyses using the same keyword combinations.

RESULTS

Studies have reported that detection of genetic correlations and modification of environmental influences may have a significant impact in myopia progression, axial elongation and future myopic ocular complications. The conventional pharmacotherapy of pediatric myopia addresses the improvement in visual acuity and prevention of amblyopia but does not affect axial elongation or myopia progression. Several studies have published varying treatments, including optical, pharmacological and surgical management, which show great promise for a more precise control of myopia and preservation of ocular health.

DISCUSSION

Understanding the role of factors influencing the onset and progression of pediatric myopia will facilitate the development of successful treatments, reduction of disease burden, arrest of progression and improvement in future of the management of myopia.

Mental health status of parents of young patients with high myopia

Objective

The study aim was to investigate the mental health status of parents of patients with high myopia using the Symptom Checklist-90 (SCL-90).

Methods

The parents of 160 young patients with high myopia (high myopia group) and 80 healthy children (control group) participated in the study. The SCL-90 was used to evaluate mental health status. The SCL-90 total score and scores on each factor were calculated and compared between the two groups.

Results

The total SCL-90 score, total mean score, positive score and scores on somatization, interpersonal sensitivity, depression, anxiety, hostility, psychosis, diet and sleep were significantly higher in fathers and mothers of patients with high myopia than in parents of control group children. There were statistically significant between-group differences in the above indices.

Conclusion

Parents of children with high myopia are more likely to develop mental health problems than parents of healthy children. This suggests that mental health interventions for parents should not be ignored in the treatment and control of high myopia patients.

The myopic shift associated with hyperbaric oxygen administration is reduced when using a mask delivery system compared to a hood - a randomised controlled trial

INTRODUCTION

A temporary myopic shift is a well-recognized complication of hyperbaric oxygen treatment (HBOT). Oxidation of proteins in the crystalline lens is the likely cause. Direct exposure of the eye to hyperbaric oxygen may exacerbate the effect. Our aim was to measure the magnitude of the myopic shift over a course of HBOT when using two different methods of oxygen delivery.

METHODS

We conducted a randomised trial of oxygen delivery via hood versus oronasal mask during a course of 20 and 30 HBOT sessions. Subjective refraction was performed at baseline and after 20 and 30 sessions. We repeated these measurements at four and 12 weeks after completion of the course in those available for assessment.

RESULTS

We enrolled 120 patients (mean age 57.6 (SD 11.2) years; 81% male). The myopic shift was significantly greater after both 20 and 30 sessions in those patients using the hood. At 20 treatments: refractory change was -0.92 D with hood versus -0.52 D with mask, difference 0.40 D (95% CI 0.22 to 0.57, P < 0.0001); at 30 treatments: -1.25 D with hood versus -0.63 with mask, difference 0.62 D (95% CI 0.39 to 0.84, P < 0.0001). Recovery was slower and less complete in the hood group at both four and 12 weeks.

CONCLUSIONS

Myopic shift is common following HBOT and more pronounced using a hood system than an oronasal mask. Recovery may be slower and less complete using a hood. Our data support the use of an oronasal mask in an air environment when possible.

Outdoor physical activity bears multiple benefits to health and society

INTRODUCTION

Cutting-edge technologies and the rapid urbanization have led to several advantages for mankind and society. However such benefits have been accompanied with the alarming diffusion of sedentary lifestyle disorders, metabolic diseases, major depression and socialization problems, affecting global economy dramatically. The pandemic expansion of chronic diseases is associated with physical inactivity. During the last decade, numerous cities and organizations worldwide have started to adopt strategies aimed at improving outdoor physical activity levels in city residents.

EVIDENCE ACQUISITION

A systematic review focusing on the effects of regular outdoor sports and physical activities across all ages was conducted through multiple databases, according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) standards.

EVIDENCE SYNTHESIS

Performing outdoor sports and physical activities may bear social, psychological and physiological benefits. Preventive effects are similarly documented in youth and seniors towards several morbid conditions: vitamin D deficiency, multiple sclerosis, osteoporosis and myopia.

CONCLUSIONS

Giving the beneficial effects of outdoor sports and physical activities, promotion strategies should be strongly advocated and developed nationally and globally. Likewise, dedicated research areas should inspire guidelines for the promotion of various outdoor activities - a good practice for the social scenario and the healthcare system.