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Xu Y, Chen Q, Shao Z, Wei J, Zhu X, Rong A, Chen X, Ni Y, Jiang Y. Evaluation of new robust silk fibroin hydrogels for posterior scleral reinforcement in rabbits. Front Bioeng Biotechnol 2023; 11:1211688. [PMID: 37388765 PMCID: PMC10300450 DOI: 10.3389/fbioe.2023.1211688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/01/2023] [Indexed: 07/01/2023] Open
Abstract
Background: Currently, there is no ideal material available for posterior scleral reinforcement (PSR) to prevent the progression of high myopia. In this study, we investigated robust regenerated silk fibroin (RSF) hydrogels as potential grafts for PSR in animal experiments to evaluate their safety and biological reactions. Methods: PSR surgery was performed on the right eye of twenty-eight adult New Zealand white rabbits, with the left eye serving as a self-control. Ten rabbits were observed for 3 months, while 18 rabbits were observed for 6 months. The rabbits were evaluated using intraocular pressure (IOP), anterior segment and fundus photography, A- and B-ultrasound, optical coherence tomography (OCT), histology, and biomechanical tests. Results: No complications such as significant IOP fluctuation, anterior chamber inflammation, vitreous opacity, retinal lesion, infection, or material exposure were observed. Furthermore, no evidence of pathological changes in the optic nerve and retina, or structural abnormalities on OCT, were found. The RSF grafts were appropriately located at the posterior sclera and enclosed in fibrous capsules. The scleral thickness and collagen fiber content of the treated eyes increased after surgery. The ultimate stress of the reinforced sclera increased by 30.7%, and the elastic modulus increased by 33.0% compared to those of the control eyes at 6 months after surgery. Conclusion: Robust RSF hydrogels exhibited good biocompatibility and promoted the formation of fibrous capsules at the posterior sclera in vivo. The biomechanical properties of the reinforced sclera were strengthened. These findings suggest that RSF hydrogel is a potential material for PSR.
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Affiliation(s)
- Yule Xu
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qiaolin Chen
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Laborarory of Advanced Materials, Fudan University, Shanghai, China
| | - Zhengzhong Shao
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Laborarory of Advanced Materials, Fudan University, Shanghai, China
| | - Jiahong Wei
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xuyou Zhu
- Department of Pathology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ao Rong
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Ophthalmology, Shanghai Xin Shi Jie Eye Hospital, Shanghai, China
| | - Xin Chen
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Laborarory of Advanced Materials, Fudan University, Shanghai, China
| | - Yusu Ni
- Otology and Skull Base Surgery Department, Eye and ENT Hospital of Shanghai Medical School, Fudan University, Shanghai, China
- Key Laboratory of Hearing Medicine of National Health and Family Planning Commission, Shanghai, China
- Otorhinolaryngology Department of Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Yi Jiang
- Department of Ophthalmology, Shanghai Xin Shi Jie Eye Hospital, Shanghai, China
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2
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Wang Y, Liu L, Lu Z, Qu Y, Ren X, Wang J, Lu Y, Liang W, Xin Y, Zhang N, Jin L, Wang L, Song J, Yu J, Zhao L, Ma X, Zhang L. Rural-urban differences in prevalence of and risk factors for refractive errors among school children and adolescents aged 6-18 years in Dalian, China. Front Public Health 2022; 10:917781. [PMID: 36106164 PMCID: PMC9465045 DOI: 10.3389/fpubh.2022.917781] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/08/2022] [Indexed: 01/22/2023] Open
Abstract
Purpose To assess the prevalence of refractive errors (REs) in school children aged 6-18 years in urban and rural settings in Dalian, Northeast of China. Methods This is a school-based cross-sectional survey using multi-stage randomization technique. Six- to eighteen-year-old school children from elementary schools, junior and senior high schools from a rural area and an urban area in Dalian were included in December 2018. All subjects underwent a comprehensive questionnaire and eye examination. Results A total of 4,522 school children with 6-18 years of age were investigated. The age, gender-adjusted prevalence of myopia, and anisometropia were 82.71 and 7.27% among the urban students as compared to 71.76% and 5.41% among the rural ones (OR = 1.80, 95 % CI = 1.53 - 2.11, P < 0.001; OR = 1.29, 95 % CI = 1.00-1.67, P = 0.049), respectively. The hyperopia was less common in urban students than in rural ones (5.63 vs. 10.21%; OR = 0.54, 95 % CI: 0.43-0.67, P < 0.001). However, there was no significant difference in prevalence of astigmatism between urban (46.07%) and rural (44.69%) participants (OR = 0.96, 95 % CI: 0.84-1.10, P = 0.559). The differences on prevalence of REs were attributed to different social-demographic and physiologic factors. Conclusions The students from urban settings are more likely to have myopia and anisometropia but less likely to have hyperopia than their rural counterparts. Although considerable attention had been paid to controlling REs, it is necessary to further consider the urban-rural differences in REs.
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Affiliation(s)
- Yachen Wang
- Department of Ophthalmology, The Third People's Hospital of Dalian, Dalian, China,Department of Ophthalmology, Dalian Third People's Hospital Affiliated to Dalian Medical University, Dalian, China
| | - Lei Liu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangzhou, China,Lei Liu
| | - Zhili Lu
- Department of Ophthalmology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | | | - Xianlong Ren
- Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Jiaojiao Wang
- Department of Ophthalmology, The Third People's Hospital of Dalian, Dalian, China,Department of Ophthalmology, Dalian Third People's Hospital Affiliated to Dalian Medical University, Dalian, China
| | - Yan Lu
- Department of Ophthalmology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Wei Liang
- Department of Ophthalmology, The Third People's Hospital of Dalian, Dalian, China,Department of Ophthalmology, Dalian Third People's Hospital Affiliated to Dalian Medical University, Dalian, China
| | - Yue Xin
- Department of Ophthalmology, The Third People's Hospital of Dalian, Dalian, China,Department of Ophthalmology, Dalian Third People's Hospital Affiliated to Dalian Medical University, Dalian, China
| | - Nan Zhang
- Department of Ophthalmology, The Third People's Hospital of Dalian, Dalian, China,Department of Ophthalmology, Dalian Third People's Hospital Affiliated to Dalian Medical University, Dalian, China
| | - Lin Jin
- Department of Ophthalmology, The Third People's Hospital of Dalian, Dalian, China,Department of Ophthalmology, Dalian Third People's Hospital Affiliated to Dalian Medical University, Dalian, China
| | - Lijing Wang
- Department of Ophthalmology, The Third People's Hospital of Dalian, Dalian, China,Department of Ophthalmology, Dalian Third People's Hospital Affiliated to Dalian Medical University, Dalian, China
| | - Jian Song
- Department of Ophthalmology, The Third People's Hospital of Dalian, Dalian, China,Department of Ophthalmology, Dalian Third People's Hospital Affiliated to Dalian Medical University, Dalian, China
| | - Jian Yu
- Department of Ophthalmology, The Third People's Hospital of Dalian, Dalian, China,Department of Ophthalmology, Dalian Third People's Hospital Affiliated to Dalian Medical University, Dalian, China
| | - Lijun Zhao
- Department of Ophthalmology, The Third People's Hospital of Dalian, Dalian, China,Department of Ophthalmology, Dalian Third People's Hospital Affiliated to Dalian Medical University, Dalian, China
| | - Xiang Ma
- Department of Ophthalmology, The First Affiliated Hospital of Dalian Medical University, Dalian, China,Xiang Ma
| | - Lijun Zhang
- Department of Ophthalmology, The Third People's Hospital of Dalian, Dalian, China,Department of Ophthalmology, Dalian Third People's Hospital Affiliated to Dalian Medical University, Dalian, China,*Correspondence: Lijun Zhang
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3
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Singh H, Singh H, Latief U, Tung GK, Shahtaghi NR, Sahajpal NS, Kaur I, Jain SK. Myopia, its prevalence, current therapeutic strategy and recent developments: A Review. Indian J Ophthalmol 2022; 70:2788-2799. [PMID: 35918918 PMCID: PMC9672758 DOI: 10.4103/ijo.ijo_2415_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Myopia is a widespread and complex refractive error in which a person's ability to see distant objects clearly is impaired. Its prevalence rate is increasing worldwide, and as per WHO, it is projected to increase from 22% in 2000 to 52% by 2050. It is more prevalent in developed, industrial areas and affects individuals of all ages. There are a number of treatments available for the control of myopia, such as glasses, contact lenses, laser surgery, and pharmaceuticals agents. However, these treatments are less beneficial and have significant side effects. A novel molecule, 7-methylxanthine (7-MX), has been found to be a highly beneficial alternate in the treatment of myopia and excessive eye elongation. Many preclinical and clinical studies showed that 7-MX is effective for the treatment of myopia and is presently under phase II of clinical investigation. We have also investigated preclinical toxicity studies such as acute, sub-acute, sub-chronic, and chronic on rats. In these studies, 7-MX was found to be non-toxic as compared to other reported anti-myopic agents. Moreover, as an ideal drug, 7-MX is observed to have no or low toxicity, brain permeability, non-allergic, higher oral administration efficacy, and low treatment costs and thus qualifies for the long-term treatment of myopia. This review article on 7-MX as an alternative to myopia treatment will highlight recent findings from well-designed preclinical and clinical trials and propose a potential future therapy.
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Affiliation(s)
- Harjeet Singh
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, India,Department of Pharmacy, Government Polytechnic College, Amritsar, Punjab, India
| | - Harmanpreet Singh
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, India
| | - Uzma Latief
- Center for Basic and Translational Research in Health Science, Guru Nanak Dev University, Amritsar, Punjab, India
| | - Gurleen Kaur Tung
- Center for Basic and Translational Research in Health Science, Guru Nanak Dev University, Amritsar, Punjab, India
| | - Navid Reza Shahtaghi
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, India
| | | | - Inderjit Kaur
- Department of Ophthalmology, Baba Farid University of Health Sciences, Faridkot, Punjab, India
| | - Subheet Kumar Jain
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, India,Center for Basic and Translational Research in Health Science, Guru Nanak Dev University, Amritsar, Punjab, India,Correspondence to: Prof. Subheet Kumar Jain, Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab - 143 005, India. E-mail:
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4
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Sangvatanakul P, Tangthianchaichana J, Tasanarong A, Pabalan N, Tharabenjasin P. An Updated Meta-Analysis of Controlling Myopia with Auricular Acupoint Stimulation. Med Acupunct 2021; 33:335-342. [PMID: 35003501 DOI: 10.1089/acu.2020.1490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Myopia prevalence mostly affects young people, particularly in Asia. Of the several recommendations addressing the myopia epidemic, auricular acupoint stimulation (AAS) has been proposed and investigated. However, reported outcomes have been inconsistent, prompting a meta-analysis to obtain more precise estimates. Materials and Methods: Twelve articles were included in a meta-analysis, wherein each article was evaluated for risk of bias. Summary effects were calculated using odds ratios (ORs) and 95% confidence intervals (CIs). Outlier and sensitivity treatments as well as publication bias assessment were applied. Results: Risk of bias among the articles was low in random sequence but generally unclear judgments for the other bias criteria. AAS outcomes were significant (P a [P-value for association] <0.00001-0.003) when random and fixed effects favored the treated groups (ORs: 2.87-3.42; 95% CIs: 1.44-5.75). Conclusions: This meta-analysis showed evidence of AAS being effective for controlling myopia. Substantial magnitude (up to 3.4-fold), robustness, and lack of bias strengthened this effect.
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Affiliation(s)
- Paradi Sangvatanakul
- Cooperative Learning Center, Chulabhorn International College of Medicine, and Faculty of Medicine, Thammasat University, Klong Luang, Rangsit, Pathumthani, Thailand
| | - Jakkree Tangthianchaichana
- Cooperative Learning Center, Chulabhorn International College of Medicine, and Faculty of Medicine, Thammasat University, Klong Luang, Rangsit, Pathumthani, Thailand
| | - Adis Tasanarong
- Cooperative Learning Center, Chulabhorn International College of Medicine, and Faculty of Medicine, Thammasat University, Klong Luang, Rangsit, Pathumthani, Thailand.,Nephrology Unit, Faculty of Medicine, Thammasat University, Klong Luang, Rangsit, Pathumthani, Thailand
| | - Noel Pabalan
- Cooperative Learning Center, Chulabhorn International College of Medicine, and Faculty of Medicine, Thammasat University, Klong Luang, Rangsit, Pathumthani, Thailand
| | - Phuntila Tharabenjasin
- Cooperative Learning Center, Chulabhorn International College of Medicine, and Faculty of Medicine, Thammasat University, Klong Luang, Rangsit, Pathumthani, Thailand
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Morgan IG. The biological basis of myopic refractive error. Clin Exp Optom 2021; 86:276-88. [PMID: 14558849 DOI: 10.1111/j.1444-0938.2003.tb03123.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2003] [Revised: 08/04/2003] [Accepted: 09/02/2003] [Indexed: 11/28/2022] Open
Abstract
Myopia is among the most common refractive errors and is associated with the greatest risk of pathological outcomes. Most animals, including humans, are born with hyperopic errors. During development, axial elongation of the eye occurs and is regulated through a vision-dependent process, known as emmetropisation The extremely rapid changes in the prevalence of myopia and the dependence of myopia on the level of education indicate that there are very strong environmental impacts on the development of myopia. This conflicts with the common occurrence of familial patterns of inheritance of myopia, which suggests a role for genetic determination. There are more than 150 defined genetic syndromes in which familial high myopia is one of the features, including some that are not associated with other syndromes. The evidence for the roles of both nature and nurture in the aetiology of myopia is discussed. This review also examines the experimentally induced refractive errors associated with form-deprivation, recovery from form deprivation and the effects of both negative and positive lenses. In addition, it looks at the local and optical control of eye growth. Finally, the various control pathways for growth are considered. These include dopamine, ZENK-glucagon, retinoic acid and retinoic acid receptors, crystallin, seratonin and melatonin, vasoactive intestinal peptide and enkephalins, nitric oxide and various growth factors.
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Affiliation(s)
- Ian G Morgan
- Visual Sciences Group, Research School of Biological Science and Centre for VIsual Science, Australian National University, GPO Box 475, Canberra, ACT, 2601, Australia
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6
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Efron N, Morgan PB, Jones LW, Nichols JJ. Bibliometric analysis of the refractive error field. Clin Exp Optom 2021; 104:641-643. [DOI: 10.1080/08164622.2021.1880868] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Nathan Efron
- School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Australia
| | - Philip B Morgan
- Eurolens Research, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
| | - Lyndon W Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
- Centre for Eye and Vision Research (CEVR), Hong Kong Polytechnic University, Hong Kong
| | - Jason J Nichols
- School of Optometry, The University of Alabama at Birmingham, Birmingham, AL, USA
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7
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Yazdani N, Sadeghi R, Ehsaei A, Taghipour A, Hasanzadeh S, Zarifmahmoudi L, Heravian Shandiz J. Under-correction or full correction of myopia? A meta-analysis. JOURNAL OF OPTOMETRY 2021; 14:11-19. [PMID: 32507615 PMCID: PMC7752985 DOI: 10.1016/j.optom.2020.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 03/23/2020] [Accepted: 04/11/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To compare the effect of full-correction versus under-correction on myopia progression. METHODS A literature search was performed in PubMed, Scopus, Science Direct, Ovid, Web of Science and Cochrane library. Methodological quality assessment of the literature was evaluated according to the Critical Appraisal Skills Program. Statistical analysis was performed using Comprehensive Meta-Analysis (version 2, Biostat Inc., USA). RESULTS The present meta-analysis included six studies (two randomized controlled trials [RCTs] and four non-RCTs) with 695 subjects (full-correction group, n=371; under-correction group, n=324) aged 6 to 33 years. Using cycloplegic refraction, the pooled difference in mean of myopia progression was - 0.179 D [lower and higher limits: -0.383, 0.025], which was higher but not in full correction group as compared to under correction group (p=0.085). Regarding studies using non-cycloplegic subjective refraction according to maximum plus for maximum visual acuity, the pooled difference in myopia progression was 0.128 D [lower and higher limits: -0.057, 0.312] higher in under-correction group compared with full-correction group (p=0.175). Although, difference in myopia progression did not reach significant level in either cycloplegic or non-cycloplegic refraction. CONCLUSIONS Our findings suggest that, myopic eyes which are fully corrected with non-cycloplegic refraction with maximum plus sphere, are less prone to myopia progression, in comparison to those which were under corrected. However, regarding cycloplegic refraction, further studies are needed to better understand these trends.
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Affiliation(s)
- Negareh Yazdani
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asieh Ehsaei
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Taghipour
- Health Sciences Research Centre, Department of Biostatistics and Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Hasanzadeh
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leili Zarifmahmoudi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Heravian Shandiz
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran.
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Yu TC, Wu TE, Wang YS, Cheng SF, Liou SW. A STROBE-compliant case-control study: Effects of cumulative doses of topical atropine on intraocular pressure and myopia progression. Medicine (Baltimore) 2020; 99:e22745. [PMID: 33235063 PMCID: PMC7710205 DOI: 10.1097/md.0000000000022745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Topical atropine has become a mainstream treatment of myopia throughout East and Southeast Asia, but it is uncertain whether long-term topical atropine therapy induces intraocular pressure (IOP) elevation and subsequent development of glaucoma. We then prospectively examined the effects of long-term atropine treatment on IOP.Our case series collected 186 myopic children who were younger than 16 years of age. Complete ocular examination data, IOP and refractive status measurements beginning in 2008 were collected for all participants. Participants were divided into two groups: 121 children who received atropine therapy at various concentrations were classified as the treated group, whereas 65 children who did not receive atropine therapy were classified as the untreated (reference) group. In the treated group, clinicians prescribed different concentrations of atropine eye drops according to their discretion with regard to the severity of myopia on each visit of the patient. We then calculated the cumulative dose of atropine therapy from 2008 to the patients' last follow-up in 2009. Furthermore, the treated group was then further divided into low- and high-refractive-error groups of nearly equal size for further analysis.There were no significant differences for the baseline refractive errors and IOPs between the treated and untreated groups. Both the low- and high-cumulative atropine dosage subgroups showed significantly lower myopic progression than the untreated group, but there was no significant difference between the two subgroups in terms of different cumulative dosages. All groups, including the untreated group, showed an increase of mean IOP at the last follow-up, but both low- and high-cumulative atropine dosage subgroups experienced a smaller increase of IOP. The mean IOP of all atropine-treated groups showed no significant increase in either low- or high-refractive-error eyes.This study revealed that topical atropine eye drops do not induce ocular hypertension and are effective for slowing the progression of myopia. The treatment effects are not correlated with the cumulative atropine dosages.
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Affiliation(s)
- Teng-Chieh Yu
- Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei
| | - Tzu-En Wu
- Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei
- School of Medicine, Fu Jen Catholic University, New Taipei City
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei
| | - Yuan-Shen Wang
- Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei
| | - Shen-Fu Cheng
- Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei
| | - Shiow-Wen Liou
- Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei
- Department of Ophthalmology, School of Medicine, National Taiwan University, Taipei, Taiwan
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Singh H, Singh H, Sahajpal NS, Paul S, Kaur I, Jain SK. Sub-chronic and chronic toxicity evaluation of 7-methylxanthine: a new molecule for the treatment of myopia. Drug Chem Toxicol 2020; 45:1383-1394. [PMID: 33076712 DOI: 10.1080/01480545.2020.1833904] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Myopia (nearsightedness) is a vision disorder with a blurring of far objects, affect millions worldwide. 7-methylxanthine (7-MX) is a molecule that is presently under clinical investigation for the treatment of myopia. In the present study, we have investigated sub-chronic and chronic toxicity of 7-MX in comparison to other clinically used methylxanthines i.e., caffeine and theobromine as per OECD guidelines 408 and 452. 7-MX was administered orally for 90 days at three different doses of 250, 500, and 1000 mg/kg for sub-chronic toxicity evaluation, and at a limit dose of 1000 mg/kg in 180 days chronic toxicity evaluation in rats. In sub-chronic treatment, 7-MX showed no mortality and signs for toxicity in any group, whereas 10% and 40% mortality with signs for toxicity were observed in caffeine and theobromine treated groups, respectively. A similar, safety profile was observed with 7-MX in 180 days of chronic toxicity study. Further, to confirm any morphological changes in organs; ultrasound and X-rays analysis were performed and no changes in the size of organs, cyst formation, fluid retention, or crystal formation was observed. Thus, the repeated dose study of 7-MX for 180 days may augment the possibility of using 7-MX clinically for the safe and effective treatment of myopia.
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Affiliation(s)
- Harjeet Singh
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, India
| | - Harmanpreet Singh
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, India
| | | | - Surinder Paul
- Department of Pathology, Government Medical College, Amritsar, India
| | - Inderjit Kaur
- Department of Opthalmology, Baba Farid University of Health Sciences, Faridkot, Punjab
| | - Subheet Kumar Jain
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, India
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10
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Al Messabi SS, Dirani M, Mukhi-Marathe S. Adult onset unilateral high myopia in a female patient: A case report. Am J Ophthalmol Case Rep 2020; 20:100941. [PMID: 33024890 PMCID: PMC7527708 DOI: 10.1016/j.ajoc.2020.100941] [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: 09/05/2019] [Revised: 08/19/2020] [Accepted: 09/20/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose We report a rare case of unilateral progressive adult-onset myopia in a healthy 27 year old female patient. Observations The patient presented to our clinic in 2014 with gradual decrease in vision in the right eye since one and a half years. Her uncorrected visual acuity (UCVA) in the right eye was 0.05, improving to 1.0 with −2.25 Diopter Sphere (DS). The left eye uncorrected visual acuity was 1.0 partial improving to 1.0 with −0.50 Diopter Cylinder (DC) at 10°. The myopia in her right eye continued to increase steadily until her last detailed ophthalmic examination in November 2018, at the age of 31 years, showed a refractive error of −6.75 Diopter Sphere with −0.5 Diopter Cylinder at 170°. Ocular biometry readings showed an axial length (AL) of 25.79mm in the right eye compared to 25.05mm in 2015. The ocular examination of both eyes including clinical examination of anterior and posterior segment, corneal topography, lens densitometry, ultrasound B scan all were within normal limits. Over the last two years she has gradually developed moderate constant esotropia in the right eye, currently +30 Prism Diopters. A short visit to the clinic in December 2019, showed a refraction of −6.75DS with −0.5DC at 170° in the right eye and −0.50DC at 10° in the left eye. Conclusions and importance The abrupt onset of myopia in one eye in a healthy individual in this case, the degree of myopia, the nature and rate of progression, absence of risk factors, and otherwise normal ocular examination except for progressive increase in axial length is unusual. Our case brings us to conjecture the role of powerful local factors in the intrinsic regulation of eyeball growth going askew. We believe more and more reporting of myopia cases deviating from natural history and their study might provide clues in a new direction about myopia pathogenesis and our understanding and tackling of one of the oldest eye disease with an ever increasing prevalence.
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Affiliation(s)
| | - Mohamed Dirani
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Vision Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore.,Plano Pte Ltd, Singapore
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Ezinne NE, Mashige KP, Akano OF, Ilechie AA, Ekemiri KK. Spectacle utilisation rate and reasons for non-compliance with wearing of spectacles amongst primary school children in Onitsha, Anambra state, Nigeria. AFRICAN VISION AND EYE HEALTH 2020. [DOI: 10.4102/aveh.v79i1.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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12
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Pugazhendhi S, Ambati B, Hunter AA. Pathogenesis and Prevention of Worsening Axial Elongation in Pathological Myopia. Clin Ophthalmol 2020; 14:853-873. [PMID: 32256044 PMCID: PMC7092688 DOI: 10.2147/opth.s241435] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/14/2020] [Indexed: 12/15/2022] Open
Abstract
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.
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Walline JJ, Lindsley KB, Vedula SS, Cotter SA, Mutti DO, Ng SM, Twelker JD. Interventions to slow progression of myopia in children. Cochrane Database Syst Rev 2020; 1:CD004916. [PMID: 31930781 PMCID: PMC6984636 DOI: 10.1002/14651858.cd004916.pub4] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Nearsightedness (myopia) causes blurry vision when one is looking at distant objects. Interventions to slow the progression of myopia in children include multifocal spectacles, contact lenses, and pharmaceutical agents. OBJECTIVES To assess the effects of interventions, including spectacles, contact lenses, and pharmaceutical agents in slowing myopia progression in children. SEARCH METHODS We searched CENTRAL; Ovid MEDLINE; Embase.com; PubMed; the LILACS Database; and two trial registrations up to February 2018. A top up search was done in February 2019. SELECTION CRITERIA We included randomized controlled trials (RCTs). We excluded studies when most participants were older than 18 years at baseline. We also excluded studies when participants had less than -0.25 diopters (D) spherical equivalent myopia. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. MAIN RESULTS We included 41 studies (6772 participants). Twenty-one studies contributed data to at least one meta-analysis. Interventions included spectacles, contact lenses, pharmaceutical agents, and combination treatments. Most studies were conducted in Asia or in the United States. Except one, all studies included children 18 years or younger. Many studies were at high risk of performance and attrition bias. Spectacle lenses: undercorrection of myopia increased myopia progression slightly in two studies; children whose vision was undercorrected progressed on average -0.15 D (95% confidence interval [CI] -0.29 to 0.00; n = 142; low-certainty evidence) more than those wearing fully corrected single vision lenses (SVLs). In one study, axial length increased 0.05 mm (95% CI -0.01 to 0.11) more in the undercorrected group than in the fully corrected group (n = 94; low-certainty evidence). Multifocal lenses (bifocal spectacles or progressive addition lenses) yielded small effect in slowing myopia progression; children wearing multifocal lenses progressed on average 0.14 D (95% CI 0.08 to 0.21; n = 1463; moderate-certainty evidence) less than children wearing SVLs. In four studies, axial elongation was less for multifocal lens wearers than for SVL wearers (-0.06 mm, 95% CI -0.09 to -0.04; n = 896; moderate-certainty evidence). Three studies evaluating different peripheral plus spectacle lenses versus SVLs reported inconsistent results for refractive error and axial length outcomes (n = 597; low-certainty evidence). Contact lenses: there may be little or no difference between vision of children wearing bifocal soft contact lenses (SCLs) and children wearing single vision SCLs (mean difference (MD) 0.20D, 95% CI -0.06 to 0.47; n = 300; low-certainty evidence). Axial elongation was less for bifocal SCL wearers than for single vision SCL wearers (MD -0.11 mm, 95% CI -0.14 to -0.08; n = 300; low-certainty evidence). Two studies investigating rigid gas permeable contact lenses (RGPCLs) showed inconsistent results in myopia progression; these two studies also found no evidence of difference in axial elongation (MD 0.02mm, 95% CI -0.05 to 0.10; n = 415; very low-certainty evidence). Orthokeratology contact lenses were more effective than SVLs in slowing axial elongation (MD -0.28 mm, 95% CI -0.38 to -0.19; n = 106; moderate-certainty evidence). Two studies comparing spherical aberration SCLs with single vision SCLs reported no difference in myopia progression nor in axial length (n = 209; low-certainty evidence). Pharmaceutical agents: at one year, children receiving atropine eye drops (3 studies; n = 629), pirenzepine gel (2 studies; n = 326), or cyclopentolate eye drops (1 study; n = 64) showed significantly less myopic progression compared with children receiving placebo: MD 1.00 D (95% CI 0.93 to 1.07), 0.31 D (95% CI 0.17 to 0.44), and 0.34 (95% CI 0.08 to 0.60), respectively (moderate-certainty evidence). Axial elongation was less for children treated with atropine (MD -0.35 mm, 95% CI -0.38 to -0.31; n = 502) and pirenzepine (MD -0.13 mm, 95% CI -0.14 to -0.12; n = 326) than for those treated with placebo (moderate-certainty evidence) in two studies. Another study showed favorable results for three different doses of atropine eye drops compared with tropicamide eye drops (MD 0.78 D, 95% CI 0.49 to 1.07 for 0.1% atropine; MD 0.81 D, 95% CI 0.57 to 1.05 for 0.25% atropine; and MD 1.01 D, 95% CI 0.74 to 1.28 for 0.5% atropine; n = 196; low-certainty evidence) but did not report axial length. Systemic 7-methylxanthine had little to no effect on myopic progression (MD 0.07 D, 95% CI -0.09 to 0.24) nor on axial elongation (MD -0.03 mm, 95% CI -0.10 to 0.03) compared with placebo in one study (n = 77; moderate-certainty evidence). One study did not find slowed myopia progression when comparing timolol eye drops with no drops (MD -0.05 D, 95% CI -0.21 to 0.11; n = 95; low-certainty evidence). Combinations of interventions: two studies found that children treated with atropine plus multifocal spectacles progressed 0.78 D (95% CI 0.54 to 1.02) less than children treated with placebo plus SVLs (n = 191; moderate-certainty evidence). One study reported -0.37 mm (95% CI -0.47 to -0.27) axial elongation for atropine and multifocal spectacles when compared with placebo plus SVLs (n = 127; moderate-certainty evidence). Compared with children treated with cyclopentolate plus SVLs, those treated with atropine plus multifocal spectacles progressed 0.36 D less (95% CI 0.11 to 0.61; n = 64; moderate-certainty evidence). Bifocal spectacles showed small or negligible effect compared with SVLs plus timolol drops in one study (MD 0.19 D, 95% CI 0.06 to 0.32; n = 97; moderate-certainty evidence). One study comparing tropicamide plus bifocal spectacles versus SVLs reported no statistically significant differences between groups without quantitative results. No serious adverse events were reported across all interventions. Participants receiving antimuscarinic topical medications were more likely to experience accommodation difficulties (Risk Ratio [RR] 9.05, 95% CI 4.09 to 20.01) and papillae and follicles (RR 3.22, 95% CI 2.11 to 4.90) than participants receiving placebo (n=387; moderate-certainty evidence). AUTHORS' CONCLUSIONS Antimuscarinic topical medication is effective in slowing myopia progression in children. Multifocal lenses, either spectacles or contact lenses, may also confer a small benefit. Orthokeratology contact lenses, although not intended to modify refractive error, were more effective than SVLs in slowing axial elongation. We found only low or very low-certainty evidence to support RGPCLs and sperical aberration SCLs.
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Affiliation(s)
- Jeffrey J Walline
- The Ohio State University, College of Optometry, 338 West Tenth Avenue, Columbus, Ohio, USA, 43210-1240
| | - Kristina B Lindsley
- IBM Watson Health, Life Sciences, Oncology, & Genomics, Baltimore, Maryland, USA
| | - S Swaroop Vedula
- Johns Hopkins University, 3400 N. Charles Street, Baltimore, Maryland, USA, 21218
| | - Susan A Cotter
- Southern California College of Optometry, 2575 Yorba Linda Boulevard, Fullerton, California, USA, 92831
| | - Donald O Mutti
- The Ohio State University, College of Optometry, 338 West Tenth Avenue, Columbus, Ohio, USA, 43210-1240
| | - Sueko M Ng
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, W5010, c/o Cochrane Eyes and Vision Group, Baltimore, Maryland, USA, 21205
| | - J Daniel Twelker
- University of Arizona, Department of Ophthalmology, 655 North Alvernon Way Suite 108, Tucson, Arizona, USA, 85711
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Sacchi M, Serafino M, Villani E, Tagliabue E, Luccarelli S, Bonsignore F, Nucci P. Efficacy of atropine 0.01% for the treatment of childhood myopia in European patients. Acta Ophthalmol 2019; 97:e1136-e1140. [PMID: 31197953 DOI: 10.1111/aos.14166] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/21/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of atropine 0.01% in slowing myopia progression in European paediatric patients. METHODS Retrospective, medical records review study. Medical charts of paediatric patients with a myopia progression > 0.5 D/year treated with atropine 0.01% for at least 1 year were included. Patients receive a complete ophthalmic examination before and 12 months after initiation of atropine treatment. A group of myopic untreated children serves as a control group. The rate of myopia progression at baseline and 12 months after treatment with atropine was evaluated. The rate of myopia progression in treated and untreated patients was also compared. Adverse events were recorded. RESULTS Medical records of 52 treated and 50 control subjects were analysed. In the atropine group, the mean rate of myopia progression after 12 months of treatment (-0.54 ± 0.61 D) was significantly slower compared with the baseline progression (-1.20 ± 0.64 D; p < 0.0001) and to the progression in the control group (-1.09 ± 0.64; p < 0.0001). The responders patients were 41/52 (79%), whereas 11/52 patients (21%) showed a progression > 0.50 D despite treatment. The only adverse event was temporary photophobia in five patients (9.6%), severe adverse events were not reported, and none of the patients discontinued the treatment. CONCLUSION Low-dose atropine significantly slowed the rate of myopia progression in European paediatric patients with a favourable safety profile.
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Affiliation(s)
- Matteo Sacchi
- University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy
| | | | - Edoardo Villani
- University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy
| | | | - Saverio Luccarelli
- University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy
| | | | - Paolo Nucci
- University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy
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15
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Wolffsohn JS, Kollbaum PS, Berntsen DA, Atchison DA, Benavente A, Bradley A, Buckhurst H, Collins M, Fujikado T, Hiraoka T, Hirota M, Jones D, Logan NS, Lundström L, Torii H, Read SA, Naidoo K. IMI - Clinical Myopia Control Trials and Instrumentation Report. Invest Ophthalmol Vis Sci 2019; 60:M132-M160. [PMID: 30817830 DOI: 10.1167/iovs.18-25955] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The evidence-basis based on existing myopia control trials along with the supporting academic literature were reviewed; this informed recommendations on the outcomes suggested from clinical trials aimed at slowing myopia progression to show the effectiveness of treatments and the impact on patients. These outcomes were classified as primary (refractive error and/or axial length), secondary (patient reported outcomes and treatment compliance), and exploratory (peripheral refraction, accommodative changes, ocular alignment, pupil size, outdoor activity/lighting levels, anterior and posterior segment imaging, and tissue biomechanics). The currently available instrumentation, which the literature has shown to best achieve the primary and secondary outcomes, was reviewed and critiqued. Issues relating to study design and patient selection were also identified. These findings and consensus from the International Myopia Institute members led to final recommendations to inform future instrumentation development and to guide clinical trial protocols.
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Affiliation(s)
- James S Wolffsohn
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
| | - Pete S Kollbaum
- Indiana University, School of Optometry, Bloomington, Indiana, United States
| | - David A Berntsen
- The Ocular Surface Institute, College of Optometry, University of Houston, Houston, Texas, United States
| | - David A Atchison
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
| | | | - Arthur Bradley
- Indiana University, School of Optometry, Bloomington, Indiana, United States
| | - Hetal Buckhurst
- School of Health Professions, Peninsula Allied Health Centre, Plymouth University, Plymouth, United Kingdom
| | - Michael Collins
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
| | - Takashi Fujikado
- Department of Applied Visual Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takahiro Hiraoka
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masakazu Hirota
- Department of Applied Visual Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Debbie Jones
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Nicola S Logan
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
| | | | - Hidemasa Torii
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Scott A Read
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
| | - Kovin Naidoo
- African Vision Research Institute, University of KwaZulu-Natal, Durban, South Africa
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16
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Singh H, Sahajpal NS, Singh H, Vanita V, Roy P, Paul S, Singh SK, Kaur I, Jain SK. Pre-clinical and cellular toxicity evaluation of 7-methylxanthine: an investigational drug for the treatment of myopia. Drug Chem Toxicol 2019; 44:575-584. [DOI: 10.1080/01480545.2019.1635615] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Harjeet Singh
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, India
| | - Nikhil Shri Sahajpal
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, India
| | - Harmanpreet Singh
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, India
| | - Vanita Vanita
- Department of Human Genetics, Guru Nanak Dev University, Amritsar, India
| | - Partha Roy
- Department of Biotechnology, Indian Institute of Technology, Roorkee, India
| | - Surinder Paul
- Department of Pathology, Government Medical College, Amritsar, India
| | - Shashank Kumar Singh
- Cancer Pharmacology Division, Indian Institute of Integrative Medicine, Jammu, India
| | - Inderjit Kaur
- Department of Ophthalmology, Baba Farid University of Health Sciences, Punjab, India
| | - Subheet Kumar Jain
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, India
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17
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Li RQ, Lan WZ, Li XN, Wu HR, Xu QL, Zhong H, Li WT, Yang ZK. Effects of the long wavelength-filtered continuous spectrum on natural refractive development in juvenile guinea pigs. Int J Ophthalmol 2019; 12:883-891. [PMID: 31236341 DOI: 10.18240/ijo.2019.06.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 04/28/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the effects of spectral composition and light intensity on natural refractive development in guinea pigs. METHODS A total of 124 pigmented guinea pigs (2-week-old) were randomly assigned to three groups at high (Hi; 4000 lx), medium (Me; 400 lx) and low (Lo; 50 lx) light intensities under a 12:12 light/dark cycle for 6wk. Each group was subdivided into subgroups with the following spectra: broad spectrum Solux halogen light (BS), 600 nm above-filtered continuous spectrum (600F), 530 nm above-filtered continuous spectrum (530F), and 480 nm above-filtered continuous spectrum (480F; HiBS: n=10, Hi600F: n=10, Hi530F: n=10, Hi480F: n=10, MeBS: n=10, Me600F: n=10, Me530F: n=10, Me480F: n=10, LoBS: n=11, Lo600F: n=12, Lo530F: n=10, Lo480F: n=11). Refractive error, corneal curvature radius, and axial dimensions were determined by cycloplegic retinoscopy, photokeratometry, and A-scan ultrasonography before and after 2, 4, and 6wk of treatment. Average changes from both eyes in the ocular parameters and refractive error were compared among different subgroups. RESULTS After 6wk of exposure, high-intensity lighting enhanced hyperopic shift; medium- and low-intensity lighting enhanced myopic shift (P<0.05). Under the same spectrum, axial increase was larger in the low light intensity group than in the medium and high light intensity groups (HiBS: 0.65±0.02 mm, MeBS: 0.67±0.01 mm, LoBS: 0.82±0.02 mm; Hi600F: 0.64±0.02 mm, Me600F: 0.67±0.01 mm, Lo600F: 0.81±0.01 mm; Hi530F: 0.64±0.02 mm, Me530F: 0.67±0.01 mm, Lo530F: 0.73±0.02 mm; Hi480F: 0.64±0.01 mm, Me480F: 0.66±0.01 mm, Lo480F: 0.72±0.02 mm; P<0.05). Under 400 lx, there was a faster axial increase in the MeBS group than in the Me480F group (P<0.05). Under 50 lx, axial length changes were significantly larger in LoBS and Lo600F than in Lo530F and Lo480F (P<0.01). CONCLUSION Under high-intensity lighting, high light intensity rather than spectrum distributions that inhibits axial increase. Under medium- and low-intensity lighting, filtering out the long wavelength inhibits axial growth in juvenile guinea pigs.
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Affiliation(s)
- Rui-Qin Li
- Aier School of Ophthalmology, Central South University, Changsha 410015, Hunan Province, China.,Aier Institute of Optometry and Vision Science, Changsha 410015, Hunan Province, China
| | - Wei-Zhong Lan
- Aier School of Ophthalmology, Central South University, Changsha 410015, Hunan Province, China.,Aier Institute of Optometry and Vision Science, Changsha 410015, Hunan Province, China
| | - Xiao-Ning Li
- Aier Institute of Optometry and Vision Science, Changsha 410015, Hunan Province, China
| | - Hao-Ran Wu
- Aier School of Ophthalmology, Central South University, Changsha 410015, Hunan Province, China.,Aier Institute of Optometry and Vision Science, Changsha 410015, Hunan Province, China
| | - Qing-Lin Xu
- Aier Institute of Optometry and Vision Science, Changsha 410015, Hunan Province, China
| | - Hong Zhong
- Aier Institute of Optometry and Vision Science, Changsha 410015, Hunan Province, China
| | - Wen-Tao Li
- Huizhou Third People's Hospital, Guangzhou Medical University, Huizhou 516002, Guangdong Province, China
| | - Zhi-Kuan Yang
- Aier School of Ophthalmology, Central South University, Changsha 410015, Hunan Province, China.,Aier Institute of Optometry and Vision Science, Changsha 410015, Hunan Province, China
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18
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Wang LZ, Syn N, Li S, Barathi VA, Tong L, Neo J, Beuerman RW, Zhou L. The penetration and distribution of topical atropine in animal ocular tissues. Acta Ophthalmol 2019; 97:e238-e247. [PMID: 30259687 DOI: 10.1111/aos.13889] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/18/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE To conduct a multi-tissue investigation on the penetration and distribution of topical atropine in myopia treatment, and determine if atropine is detectable in the untreated contralateral eye after uniocular instillation. METHODS Nine mature New Zealand white rabbits were evenly divided into three groups. Each group was killed at 5, 24 and 72 hr, respectively, following uniocular instillation of 0.05 ml of 1% atropine. Tissues were sampled after enucleation: conjunctiva, sclera, cornea, iris, ciliary body, lens, retina, aqueous, and vitreous humors. The assay for atropine was performed using liquid chromatography-mass spectrometry (LC-MS), and molecular tissue distribution was illustrated using matrix-assisted laser desorption ionization-imaging mass spectrometry (MALDI-IMS) via an independent experiment on murine eyes. RESULTS At 5 hr, the highest (mean ± SEM) concentration of atropine was detected in the conjunctiva (19.05 ± 5.57 ng/mg, p < 0.05) with a concentration gradient established anteriorly to posteriorly, as supported by MALDI-IMS. At 24 hr, preferential binding of atropine to posterior ocular tissues occurred, demonstrating a reversal of the initial concentration gradient. Atropine has good ocular bioavailability with concentrations of two magnitudes higher than its binding affinity in most tissues at 3 days. Crossing-over of atropine to the untreated eye occurred within 5 hr post-administration. CONCLUSION Both transcorneal and transconjunctival-scleral routes are key in atropine absorption. Posterior ocular tissues could be important sites of action by atropine in myopic reduction. In uniocular atropine trials, cross-over effects on the placebo eye should be adjusted to enhance results reliability. Combining the use of LC-MS and MALDI-IMS can be a viable approach in the study of the ocular pharmacokinetics of atropine.
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Affiliation(s)
- Louis Zizhao Wang
- Singapore Eye Research Institute The Academia Singapore city Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore city Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine National University of Singapore Singapore city Singapore
| | - Shiya Li
- Dyson School of Design Engineering Imperial College London London UK
| | - Veluchamy Amutha Barathi
- Singapore Eye Research Institute The Academia Singapore city Singapore
- Department of Ophthalmology Yong Loo Lin School of Medicine National University of Singapore Singapore city Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program Duke‐NUS Medical School Singapore city Singapore
| | - Louis Tong
- Singapore Eye Research Institute The Academia Singapore city Singapore
- Department of Ophthalmology Yong Loo Lin School of Medicine National University of Singapore Singapore city Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program Duke‐NUS Medical School Singapore city Singapore
- Singapore National Eye Centre Singapore city Singapore
| | | | - Roger W. Beuerman
- Singapore Eye Research Institute The Academia Singapore city Singapore
- Department of Ophthalmology Yong Loo Lin School of Medicine National University of Singapore Singapore city Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program Duke‐NUS Medical School Singapore city Singapore
| | - Lei Zhou
- Singapore Eye Research Institute The Academia Singapore city Singapore
- Department of Ophthalmology Yong Loo Lin School of Medicine National University of Singapore Singapore city Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program Duke‐NUS Medical School Singapore city Singapore
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Ho MC, Hsieh YT, Shen EP, Hsu WC, Cheng HC. Short-term refractive and ocular parameter changes after topical atropine. Taiwan J Ophthalmol 2019; 10:111-115. [PMID: 32874839 PMCID: PMC7442094 DOI: 10.4103/tjo.tjo_110_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/08/2018] [Indexed: 12/18/2022] Open
Abstract
PURPOSE: The purpose of this study is to explore short-term refractive and ocular parameter changes and their correlations after cycloplegia with atropine. METERIALS AND METHODS: This is a prospective clinical trial that enrolled 96 eyes of 96 participants (mean age, 8.5 ± 2.1 years). Spherical equivalent refractive error (SER), axial length (AL), mean keratometric value (mean-K), anterior chamber depth (ACD), and intraocular pressure (IOP) were measured at baseline and 1 week after topical use of 0.125% atropine. Postcycloplegic changes of refractive error and ocular parameters were evaluated, and their correlations were analyzed with multiple linear regression models. RESULTS: After topical atropine use, the mean AL decreased by 0.016 mm (P = 0.008), and the mean ACD increased by 0.58 mm (P < 0.0001). There was no significant change in the Mean-K or IOP. Eighty-two eyes (85%) had an emmetropic or hyperopic shift, and 14 (15%) had a myopic shift. Those with an emmetropic or hyperopic shift had their mean AL shortened by 0.023 mm, whereas the eyes with myopic shifts had their mean AL lengthened by 0.026 mm (P = 0.003). Change in SER was negatively correlated with change in AL (−2.57 D for an increase of 1 mm in AL, P < 0.001) and positively correlated with change in ACD (+0.96 D for an increase of 1 mm in ACD, P = 0.013). CONCLUSION: Most eyes had emmetropic or hyperopic changes after short-term topical atropine use, and AL shortening and anterior chamber deepening both contributed to the hyperopic changes. Meanwhile, myopic change may be observed in some eyes (15%), which were related to transient AL elongation but not invalid myopic control. This encouraged clinicians to sustain the atropine treatment for a longer period before switching to other modalities for myopic control in clinical practice. The clinical trial registration number NCT03839888 (clinicaltrials.gov).
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Affiliation(s)
- Min-Chieh Ho
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Hualien, Taiwan.,Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Elizabeth P Shen
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wei-Cherng Hsu
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Han-Chih Cheng
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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20
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Yamashita T, Iwase A, Sakai H, Terasaki H, Sakamoto T, Araie M. Differences of body height, axial length, and refractive error at different ages in Kumejima study. Graefes Arch Clin Exp Ophthalmol 2018; 257:371-378. [DOI: 10.1007/s00417-018-4192-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/10/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022] Open
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21
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Ezinne NE, Mashige KP. Refractive error and visual impairment in primary school children in Onitsha, Anambra State, Nigeria. AFRICAN VISION AND EYE HEALTH 2018. [DOI: 10.4102/aveh.v77i1.455] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Vision problems have been shown to adversely affect a child’s achievement in school.Aim: To determine the prevalence of refractive error and visual impairment in primary school children in Onitsha, Anambra State, Nigeria.Setting: The study was conducted in a primary school in Onitsha, Anambra State, Nigeria.Methods: A stratified random cluster sampling method was used to select primary school children aged between 5 and 15 years from grades 1 to 6 in primary schools in Onitsha North and South. A total of 1020 children in 102 clusters were enumerated and 998 (97.8%) were examined. The examination included visual acuity measurements, ocular motilities, retinoscopy and auto-refraction under cycloplegia, and examination of the anterior segment, media and fundae.Results: The prevalence of uncorrected, presenting and best corrected visual acuity of 20/40 or worse in the better eye was 9.7%, 7.7% and 1.3%, respectively. Refractive error accounted for 86.6% of all causes of visual impairment. Myopia was the most prevalent refractive error (46.4%), followed by astigmatism (36.1%) and hyperopia (17.5%). Refractive error and visual impairment were significantly more prevalent in females than in males (p = 0.04). Refractive error was highest among children aged between 11 and 13 years, while visual impairment was greatest among children aged between 5 and 7 years.Conclusion: The prevalence of refractive error and visual impairment among primary school children in Onitsha was relatively high, highlighting the need for services and strategies to address these conditions in that area.
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Raina UK, Gupta SK, Gupta A, Goray A, Saini V. Effect of Cycloplegia on Optical Biometry in Pediatric Eyes. J Pediatr Ophthalmol Strabismus 2018; 55:260-265. [PMID: 29809268 DOI: 10.3928/01913913-20180327-05] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/19/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To study the effect of cycloplegia on optical biometry parameters in pediatric eyes using the Lenstar LS 900 (Haag-Streit, Koeniz, Switzerland). METHODS In this observational and comparative study, 56 normal eyes and 20 cataractous eyes in children between 5 and 15 years of age were included. Measurements were taken before and after cycloplegia using 2% homatropine drops. Parameters studied were axial length, central corneal thickness, keratometry, anterior chamber depth, and lens thickness. The Wilcoxon test was used to compare the effects of cycloplegia on all parameters. RESULTS Cycloplegia resulted in a statistically significant decrease in axial length (P < .05), central corneal thickness (P < .05), and lens thickness (P < .001) and an increase in the anterior chamber depth (P < .001) in normal eyes. In the cataract group, cycloplegia resulted in an increase in anterior chamber depth (P < .001) and decrease in lens thickness (P < .001). CONCLUSIONS Biometry measurements have to be carefully interpreted in pediatric eyes where cycloplegia is an important part of the examination. [J Pediatr Ophthalmol Strabismus. 2018;55(4):260-265.].
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Na M, Yoo A. The effect of orthokeratology on axial length elongation in children with myopia: Contralateral comparison study. Jpn J Ophthalmol 2018. [PMID: 29524061 DOI: 10.1007/s10384-018-0573-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the effectiveness of the orthokeratology (OK) lens slowing myopic progression compared with no intervention in pediatric eyes METHODS: A retrospective review of medical records was performed on 45 monocular myopic subjects 7 to 13 years of age who were treated with monocular ortho-k lens and followed-up for more than 12 months. The monocular myopia in the subjects' eyes was -0.75 to -4.25 D (diopter), and near emmetropia in the contralateral and with-the-rule astigmatism no greater than -1.50 D. Axial elongation OU, reflecting the progression of myopia was measured at baseline using the same AL-Scan Optical Biometer and compared between the two eyes of each individual every six months for one year in all subjects and for two years in 9 subjects. RESULTS After 12 months of lens wear, axial length had increased by 0.36 ± 0.23mm in the control eyes (P < 0.001) but showed far less change (+0.07 ± 0.21 mm) in the OK eyes (P = 0.038). The nine subjects followed-up for 2 years showed no axial length change (+0.16 ± 0.25 mm) in the OK eyes (P = 0.095) after 24 months and significant axial length growth (+0.38 ± 0.26 mm; P = 0.002) in the control eyes. Control eyes showed progressive axial length growth throughout the study compared with the one OK lens eye. CONCLUSIONS Using a contralateral eye study design, which prevented the influence of potential confounding factors, Effectiveness of the OK lens was proved. Myopic progression within a subject was excellent compared with no intervention.
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Affiliation(s)
- Miri Na
- Department of Ophthalmology, Saevit Eye Hospital, 1065, Jungang-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10447, Republic of Korea
| | - Aeri Yoo
- Department of Ophthalmology, Saevit Eye Hospital, 1065, Jungang-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10447, Republic of Korea.
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Liu Y, Wang Y, Lv H, Jiang X, Zhang M, Li X. α-adrenergic agonist brimonidine control of experimentally induced myopia in guinea pigs: A pilot study. Mol Vis 2017; 23:785-798. [PMID: 29204068 PMCID: PMC5693025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/13/2017] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To investigate the efficacy of α-adrenergic agonist brimonidine either alone or combined with pirenzepine for inhibiting progressing myopia in guinea pig lens-myopia-induced models. METHODS Thirty-six guinea pigs were randomly divided into six groups: Group A received 2% pirenzepine, Group B received 0.2% brimonidine, Group C received 0.1% brimonidine, Group D received 2% pirenzepine + 0.2% brimonidine, Group E received 2% pirenzepine + 0.1% brimonidine, and Group F received the medium. Myopia was induced in the right eyes of all guinea pigs using polymethyl methacrylate (PMMA) lenses for 3 weeks. Eye drops were administered accordingly. Intraocular pressure was measured every day. Refractive error and axial length measurements were performed once a week. The enucleated eyeballs were removed for hematoxylin and eosin (H&E) and Van Gieson (VG) staining at the end of the study. RESULTS The lens-induced myopia model was established after 3 weeks. Treatment with 0.1% brimonidine alone and 0.2% brimonidine alone was capable of inhibiting progressing myopia, as shown by the better refractive error (p=0.024; p=0.006) and shorter axial length (p=0.005; p=0.0017). Treatment with 0.1% brimonidine and 0.2% brimonidine combined with 2% pirenzepine was also effective in suppressing progressing refractive error (p=0.016; p=0.0006) and axial length (p=0.017; p=0.0004). The thickness of the sclera was kept stable in all groups except group F; the sclera was much thinner in the lens-induced myopia eyes compared to the control eyes. CONCLUSIONS Treatment with 0.1% brimonidine alone and 0.2% brimonidine alone, as well as combined with 2% pirenzepine, was effective in inhibiting progressing myopia. The result indicates that intraocular pressure elevation is possibly a promising mechanism and potential treatment for progressing myopia.
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Chan LW, Hsieh YT, Hsu WC, Cheng HC, Shen EP. Optic Disc Parameters of Myopic Children with Atropine Treatment. Curr Eye Res 2017; 42:1614-1619. [PMID: 28937823 DOI: 10.1080/02713683.2017.1359846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To characterize optic disc parameters, retinal nerve fiber layer thickness (RNFLT), and the intraocular pressure (IOP) of myopic children under continual topical 0.25% atropine treatment. METHODS From October 1, 2010 to September 31, 2011, 67 eyes of 35 myopic children were recruited. The children were treated with 0.25% atropine nightly for myopia control. Visual acuity, refraction, IOP, axial length (AL, IOL Master), RNFLT, and optic disc parameters (Stratus OCT) were measured at enrollment and every 2 months. All patients had at least 1 year of follow-up. RESULTS Enrolled children had a mean age of 10.3 ± 2.4 years (5-15 years). Of the 67 studied eyes, the mean spherical equivalent (SE) was -2.60 ± 1.58 diopters (D) (-6.75--0.5 D). Under the treatment of 0.25% atropine, myopia increased by 0.53 ± 0.10D per year (P < 0.0001), and AL elongated by 0.245 ± 0.042 mm per year (P < 0.0001). No significant change was noted in the IOP and optic nerve parameters including peripapillary RNFLT, areas of optic disc, cup and rim, or cup/disc ratio over the follow-up period during atropine treatment (P > 0.05). CONCLUSIONS 0.25% Atropine treatment for myopia control did not significantly affect the IOP, optic nerve parameters, and RNFLT in children over a mean of 15.2 ± 2.4 months treatment and follow-up. 0.25% Atropine is a relatively safe option for myopia control.
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Affiliation(s)
- Li-Wei Chan
- a Department of Ophthalmology , Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation , Taipei , Taiwan
| | - Yi-Ting Hsieh
- a Department of Ophthalmology , Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation , Taipei , Taiwan
| | - Wei-Cherng Hsu
- a Department of Ophthalmology , Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation , Taipei , Taiwan
| | - Han-Chih Cheng
- a Department of Ophthalmology , Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation , Taipei , Taiwan
| | - Elizabeth P Shen
- a Department of Ophthalmology , Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation , Taipei , Taiwan
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Kim SJ, Lee JE. Influence of Orthokeratology Lens on Axial length Elongation and Myopic Progression in Childhood Myopia. KOSIN MEDICAL JOURNAL 2017. [DOI: 10.7180/kmj.2017.32.2.204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Su Jin Kim
- Department of Ophthalmology, Maryknoll Hospital, Busan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University Hospital, Yangsan, Korea
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Scleral Cross-Linking Using Riboflavin UVA Irradiation for the Prevention of Myopia Progression in a Guinea Pig Model: Blocked Axial Extension and Altered Scleral Microstructure. PLoS One 2016; 11:e0165792. [PMID: 27829051 PMCID: PMC5102452 DOI: 10.1371/journal.pone.0165792] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 10/18/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To develop methods of collagen cross-linking (CXL) in the sclera for the treatment of progressive myopia and to investigate the biomechanical and histological changes that occur in as a result. METHODS Twenty 14-day-old guinea pigs were divided into 3 groups: the cross-linking group (CL, n = 8), non cross-linking group (NCL, n = 8), and control group (n = 4). The scleras of the right eyes of the guinea pigs in the CL group were surgically exposed and riboflavin was dropped onto the irradiation zone for 20 seconds prior to ultraviolet-A (UVA) irradiation. The same procedure was conducted on the NCL group but without UVA irradiation. No procedure was conducted on the control group. The right eyes of the guinea pigs in the CL and NCL groups were then fitted with -10.00DS optics for six weeks. Retinoscopy and the axial lengths (AXL) were measured at baseline, and at the second, fourth and sixth weeks post-treatment in all three groups. All animal subjects were euthanized after the sixth week and then biomechanical and histopathological examinations of the scleras were conducted. RESULTS The mean AXL of the NCL group was longer than both the control and CL groups at six weeks (P = 0.001). The mean refractive error in the NCL group was statistically significantly more negative than both the control and the CL groups at six weeks (P = 0.001). The scleral collagen fiber arrangements of the CL and control groups were denser and more regularly distributed than the NCL group. Ultimate stress of the sclera was lowest in the NCL group, followed by the CL then the control group (P<0.05). Ultimate strain (%) of the sclera was lowest in the CL group followed by the NCL and then the control group (P<0.05). CONCLUSION Our study demonstrates that scleral CXL using riboflavin UVA irradiation effectively prevents the progression of myopia by increasing scleral biomechanical strength in a guinea pig model.
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Wang D, Chun RKM, Liu M, Lee RPK, Sun Y, Zhang T, Lam C, Liu Q, To CH. Optical Defocus Rapidly Changes Choroidal Thickness in Schoolchildren. PLoS One 2016; 11:e0161535. [PMID: 27537606 PMCID: PMC4990278 DOI: 10.1371/journal.pone.0161535] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 08/08/2016] [Indexed: 12/13/2022] Open
Abstract
The current study aimed to examine the short-term choroidal response to optical defocus in schoolchildren. Myopic schoolchildren aged 8–16 were randomly allocated to control group (CG), myopic defocus group (MDG) and hyperopic defocus group (HDG) (n = 17 per group). Children in MDG and HDG received additional +3D and -3D lenses, respectively, to their full corrections on the right eyes. Full correction was given to their left eyes, and on both eyes in the CG. Axial length (AXL) and subfoveal choroidal thickness (SFChT) were then measured by spectral domain optical coherence tomography. Children wore their group-specific correction for 2 hours after which any existing optical defocus was removed, and subjects wore full corrections for another 2 hours. Both the AXL and SFChT were recorded hourly for 4 hours. The mean refraction of all subjects was -3.41 ± 0.37D (± SEM). SFChT thinned when exposed to hyperopic defocus for 2 hours but less thinning was observed in response to myopic defocus compared to the control group (p < 0.05, two-way ANOVA). Removal of optical defocus significantly decreased SFChT in the MDG and significantly increased SFChT in the HDG after 1 and 2 hours (mean percentage change at 2-hour; control vs. hyperopic defocus vs. myopic defocus; -0.33 ± 0.59% vs. 3.04 ± 0.60% vs. -1.34 ± 0.74%, p < 0.01). Our results showed short-term exposure to myopic defocus induced relative choroidal thickening while hyperopic defocus led to choroidal thinning in children. This rapid and reversible choroidal response may be an important clinical parameter in gauging retinal response to optical defocus in human myopia.
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Affiliation(s)
- Danyang Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, PR China.,Laboratory of Experimental Optometry, Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, PR China.,Hainan Eye Hospital, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Haikou, PR China
| | - Rachel Ka Man Chun
- Laboratory of Experimental Optometry, Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, PR China
| | - Manli Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, PR China
| | - Roger Pak Kin Lee
- Laboratory of Experimental Optometry, Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, PR China
| | - Yuan Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, PR China
| | - Ting Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, PR China
| | - Chuen Lam
- Laboratory of Experimental Optometry, Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, PR China
| | - Quan Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, PR China.,Laboratory of Experimental Optometry, Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, PR China
| | - Chi Ho To
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, PR China.,Laboratory of Experimental Optometry, Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, PR China
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Lee CY, Sun CC, Lin YF, Lin KK. Effects of topical atropine on intraocular pressure and myopia progression: a prospective comparative study. BMC Ophthalmol 2016; 16:114. [PMID: 27435576 PMCID: PMC4950753 DOI: 10.1186/s12886-016-0297-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 07/13/2016] [Indexed: 11/19/2022] Open
Abstract
Background Myopia-related maculopathy is one of the leading causes of blindness in the world. The prevalence of myopia has been reported as high as 90 % in some Asian countries. Therefore, controlling myopia progression is an urgent public issue. The purpose of this study is to evaluate the effects of topical atropine with different concentrations on intraocular pressure measurements and myopia progression in school-aged children in Taiwan. Methods Fifty-six myopic children were divided into three groups: 32 children were treated with 0.125 % atropine eyedrop; 12 of them were treated with 0.25 % atropine eye drop and another 12 served as a control group. IOP, auto-refractor and manifest refraction were measured at baseline and every 3 months following treatment for one year. Results There were no significant differences for the mean age, gender and baseline IOPs among the three groups. During the follow up period, no significant IOP difference was found among three groups. The change between final and baseline mean IOPs also revealed no significant differences: 0.54 mmHg, −1.28 mmHg, −0.33 mmHg for the 0.125 % atropine, 0.25 % atropine and control groups. The baseline mean spherical equivalent similarly did not differ significantly among groups but the control group showed a significant myopic progression compared to the 0.125 % atropine group 6 months after treatment, and persisted for one year. The change between final and baseline mean spherical equivalents were −0.05 D, 0 D, −1.05 D for the 0.125 % atropine, 0.25 % atropine and control groups, with both atropine-treated groups showing significant myopic retardation compared to the control group. Conclusions Topical use of low concentration atropine for one year does not induce ocular hypertension and is effective for retarding myopic progression. However, further large scale studies with longer follow up period is necessary to validate the long term safety and efficacy. Trial registration ISRCTN33002849, 2016/01/19, retrospectively registered.
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Affiliation(s)
- Chia-Yi Lee
- Department of Medicine, Chang Gung University, College of Medicine, 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan
| | - Chi-Chin Sun
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, 222, Maijin Road, Keelung, 20402, Taiwan. .,Department of Chinese Medicine, Chang Gung University, 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan.
| | - Yi-Fang Lin
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, 222, Maijin Road, Keelung, 20402, Taiwan
| | - Ken-Kuo Lin
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan, 33305, Taiwan
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Dotan A, Kremer I, Gal-Or O, Livnat T, Zigler A, Bourla D, Weinberger D. Scleral Cross-linking Using Riboflavin and Ultraviolet-A Radiation for Prevention of Axial Myopia in a Rabbit Model. J Vis Exp 2016:e53201. [PMID: 27077753 DOI: 10.3791/53201] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Myopic individuals, especially those with severe myopia, are at higher-than-normal risk of cataract, glaucoma, retinal detachment and chorioretinal abnormalities. In addition, pathological myopia is a common irreversible cause of visual impairment and blindness. Our study demonstrates the effect of scleral crosslinking using riboflavin and ultraviolet-A radiation on the development of axial myopia in a rabbit model. The axial length of the eyeball was measured by A-scan ultrasound in New Zealand white rabbits aged 13 days (male and female). The eye then underwent 360° conjunctival peritomy with scleral crosslinking, followed by tarsorrhaphy. Axial elongation was induced in 13 day-old New Zealand rabbits by suturing their right eye eyelids (tarsorrhaphy). The eyes were divided into quadrants, and every quadrant had two scleral irradiation zones, each with an area of 0.2 cm² and a radius of 4 mm. Crosslinking was performed by dropping 0.1% dextran-free riboflavin-5-phosphate onto the irradiation zones 20 sec before ultraviolet-A irradiation and every 20 sec during the 200 sec irradiation time. UVA radiation (370 nm) was applied perpendicular to the sclera at 57 mW/cm² (total UVA light dose, 57 J/cm²). Tarsorrhaphies were removed on day 55, followed by repeated axial length measurements. This study demonstrates that scleral crosslinking with riboflavin and ultraviolet-A radiation effectively prevents occlusion-induced axial elongation in a rabbit model.
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Affiliation(s)
- Assaf Dotan
- Department of Ophthalmology, Rabin Medical Center, Beilinson Campus;
| | - Israel Kremer
- Department of Ophthalmology, Rabin Medical Center, Beilinson Campus; Sackler Faculty of Medicine, Tel Aviv University
| | - Orly Gal-Or
- Department of Ophthalmology, Rabin Medical Center, Beilinson Campus
| | - Tami Livnat
- Laboratory of Eye Research, Felsenstein Medical Research Center
| | - Arie Zigler
- Racah Institute of Physics, The Hebrew University
| | - Dan Bourla
- Department of Ophthalmology, Rabin Medical Center, Beilinson Campus
| | - Dov Weinberger
- Department of Ophthalmology, Rabin Medical Center, Beilinson Campus; Sackler Faculty of Medicine, Tel Aviv University; Laboratory of Eye Research, Felsenstein Medical Research Center
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Loh KL, Lu Q, Tan D, Chia A. Risk factors for progressive myopia in the atropine therapy for myopia study. Am J Ophthalmol 2015; 159:945-9. [PMID: 25640408 DOI: 10.1016/j.ajo.2015.01.029] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 01/25/2015] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate variables associated with myopic progression despite treatment in the Atropine in the Treatment of Myopia Study. DESIGN Retrospective cohort study. METHODS Two hundred of 400 children were randomized to receive atropine 1% in 1 eye only in this institutional study. Children were followed up with cycloplegic autorefraction every 4 months over 2 years. Children whose myopia progressed by more than 0.5 diopter (D) in the atropine-treated eye at 1 year were classified as being progressors. RESULTS Among the 182 children still in the study at 1 year, 22 (12.1%) were classified as progressors. Univariate analysis suggested these children tended to be younger (8.5 ± 1.4 years vs 9.3 ± 1.5 years; P = .023), to have higher myopic spherical equivalent (SE) at baseline (-3.6 ± 1.3 D vs -2.8 ± 1.4 D; P = .015), and to have 2 myopic parents (77.3% vs 48.1%; P = .012). In nonprogressors, the myopia progression at 1 year was less in the atropine-treated eyes compared with the untreated fellow eye (+0.16 ± 0.37 D vs -0.73 ± 0.48 D; P < .001), but in progressors, progression was more similar between eyes (-0.92 ± 0.31 D vs -1.06 ± 0.44 D; P = .363). Regression analysis showed that the risk of being a progressor was 40% lower with each year of increased age, 43% lower for every 1.0 D less in myopia at baseline, and 59% lower for every 1.0 D less in myopic change in the untreated eyes over the first year. CONCLUSIONS Doctors and parents need to be aware that there is a small group of children (younger, with higher myopia, and greater tendency of myopic progression) who may still progress while receiving atropine treatment.
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Recko M, Stahl ED. Childhood myopia: epidemiology, risk factors, and prevention. MISSOURI MEDICINE 2015; 112:116-121. [PMID: 25958656 PMCID: PMC6170055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Our understanding of the dynamic interaction between the eye's growth and its ability to adapt to maintain vision has shown that childhood myopia is a significant prediction of progressive myopia and the potentially severe ocular comorbidities associated with it. It is important for us to better understand this process and its risk factors in order to better develop a prevention and treatment strategy. This article will discuss the epidemiology, risk factors and current therapeutic regimens for reducing myopic progression.
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Zhu MJ, Feng HY, He XG, Zou HD, Zhu JF. The control effect of orthokeratology on axial length elongation in Chinese children with myopia. BMC Ophthalmol 2014; 14:141. [PMID: 25417926 PMCID: PMC4280707 DOI: 10.1186/1471-2415-14-141] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 11/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To retrospectively compare axial elongation in children with different degrees of myopia wearing spectacles and undergoing ortho-k treatment. METHODS The medical records of 128 patients who were fitted with spectacles or orthokeratology (ortho-k) lenses in our clinic between 2008 and 2009 were reviewed. Ortho-k group comprised 65 subjects and 63 subjects wearing spectacles were included in the control group. Subjects were also divided into low-myopia, moderate-myopia and high-myopia groups, based on the basic spherical equivalent refractive error. Axial length periodically measured over 2-year of lens wear and changes in axial length were compared between treatment groups and between subgroups with different degrees of myopia. RESULTS The control group exhibited more changes in axial length than the ortho-k group at both 12 months (0.39 ± 0.21 mm vs 0.16 ± 0.17 mm, p <0.001) and 24 months (0.70 ± 0.35 mm vs 0.34 ± 0.29 mm, p <0.001). Axial length elongation was estimated to be slower by about 51% in the ortho-k group. Similar results were found for the subgroups (49%, 59% and 46% reductions, respectively). In the group with low and moderate myopia, the annual increases in axial length were significantly different between the ortho-k and control groups during both the first ( Low myopia: 0.19 ± 0.17 mm vs 0.40 ± 0.18 mm, p = 0.001; Moderate myopia: 0.14 ± 0.18 mm vs 0.45 ± 0.22 mm, p <0.001) and second ( Low myopia: 0.18 ± 0.14 mm vs 0.32 ± 0.19 mm, p = 0.012; Moderate myopia: 0.18 ± 0.16 mm vs 0.34 ± 0.30 mm, p = 0.030) years. In the high myopia groups, significant differences were only found between the ortho-k and control groups during the first year (0.16 ± 0.18 mm vs 0.34 ± 0.22 mm, p = 0.004). The 2-year axial elongation was significantly associated with initial age (p <0.001) and treatment (p <0.001), but not with gender, initial refractive error, initial axial length, initial corneal curvature. CONCLUSIONS This 2-year study indicates that ortho-k contact lens wear is effective for reducing myopia progression in children with low, moderate and high myopia.
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Affiliation(s)
| | | | | | | | - Jian-Feng Zhu
- Shanghai Eye Disease Prevention & Treatment Center, No, 380 Kangding Road, Jingan District, Shanghai 200040, China.
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Barathi VA, Chaurasia SS, Poidinger M, Koh SK, Tian D, Ho C, Iuvone PM, Beuerman RW, Zhou L. Involvement of GABA transporters in atropine-treated myopic retina as revealed by iTRAQ quantitative proteomics. J Proteome Res 2014; 13:4647-58. [PMID: 25211393 PMCID: PMC4227558 DOI: 10.1021/pr500558y] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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Atropine,
a muscarinic antagonist, is known to inhibit myopia progression
in several animal models and humans. However, the mode of action is
not established yet. In this study, we compared quantitative iTRAQ
proteomic analysis in the retinas collected from control and lens-induced
myopic (LIM) mouse eyes treated with atropine. The myopic group received
a (−15D) spectacle lens over the right eye on postnatal day
10 with or without atropine eye drops starting on postnatal day 24.
Axial length was measured by optical low coherence interferometry
(OLCI), AC-Master, and refraction was measured by automated infrared
photorefractor at postnatal 24, 38, and 52 days. Retinal tissue samples
were pooled from six eyes for each group. The experiments were repeated
twice, and technical replicates were also performed for liquid chromatography–tandem
mass spectrometry (LC–MS/MS) analysis. MetaCore was used to
perform protein profiling for pathway analysis. We identified a total
of 3882 unique proteins with <1% FDR by analyzing the samples in
replicates for two independent experiments. This is the largest number
of mouse retina proteome reported to date. Thirty proteins were found
to be up-regulated (ratio for myopia/control > global mean ratio
+
1 standard deviation), and 28 proteins were down-regulated (ratio
for myopia/control < global mean ratio - 1 standard deviation)
in myopic eyes as compared with control retinas. Pathway analysis
using MetaCore revealed regulation of γ-aminobutyric acid (GABA)
levels in the myopic eyes. Detailed analysis of the quantitative proteomics
data showed that the levels of GABA transporter 1 (GAT-1) were elevated
in myopic retina and significantly reduced after atropine treatment.
These results were further validated with immunohistochemistry and
Western blot analysis. In conclusion, this study provides a comprehensive
quantitative proteomic analysis of atropine-treated mouse retina and
suggests the involvement of GABAergic signaling in the antimyopic
effects of atropine in mouse eyes. The GABAergic transmission in the
neural retina plays a pivotal role in the maintenance of axial eye
growth in mammals.
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Affiliation(s)
- Veluchamy A Barathi
- Singapore Eye Research Institute , 11 Third Hospital Avenue, Singapore 168751, Singapore
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Dotan A, Kremer I, Livnat T, Zigler A, Weinberger D, Bourla D. Scleral cross-linking using riboflavin and ultraviolet-a radiation for prevention of progressive myopia in a rabbit model. Exp Eye Res 2014; 127:190-5. [PMID: 25111424 DOI: 10.1016/j.exer.2014.07.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 06/15/2014] [Accepted: 07/22/2014] [Indexed: 11/24/2022]
Abstract
Our study demonstrates the effect of scleral cross-linking using riboflavin and ultraviolet-A radiation on the development of axial myopia in a rabbit model. Axial length of the eyeball was measured by A-scan ultrasound in 22 New Zealand white rabbits aged 13 days. The right eyes then underwent 360-degree conjunctival peritomy with (experimental group, n = 11) or without (control group, n = 11) scleral cross-linking, followed by tarsorrhaphy. The left eyes served as a control eye. In the experimental group, the right eyeballs were divided into quadrants, and every quadrant had either 2 (n = 8) or 6 (n = 3) scleral irradiation zones, each with an area of 0.2 cm² and radius of 4 mm. Cross-linking was performed by dropping 0.1% dextran-free riboflavin-5-phosphate onto the irradiation zones at 20 s before ultraviolet-A irradiation and every 20 s during the 200-s irradiation time. UVA radiation (370 nm) was applied perpendicular to the sclera at 57 mW/cm² (total UVA light dose, 57 J/cm²). Tarsorrhaphies were removed on day 55, followed by repeated axial-length measurement. In the control group, mean axial length in the right eyes increased from 10.50 ± 0.67 mm at baseline to 15.69 ± 0.39 mm 55 days later, for a mean change of 5.19 ± 0.85 mm. In the experimental group, corresponding values were 10.68 ± 0.74 mm and 14.29 ± 0.3 mm, for a mean change of 3.61 ± 0.76 mm. The between-group difference in the change in mean axial length was statistically significant (p < 0.001, Mann-Whitney nonparametric test). The present manuscript demonstrates that scleral cross-linking with riboflavin and ultraviolet-A radiation effectively prevents occlusion-induced axial elongation in a rabbit model.
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Affiliation(s)
- Assaf Dotan
- Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel.
| | - Israel Kremer
- Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Tami Livnat
- Laboratory of Eye Research, Felsenstein Medical Research Center, Petach Tikva, Israel.
| | - Arie Zigler
- Racah Institute of Physics, The Hebrew University, Jerusalem, Israel.
| | - Dov Weinberger
- Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Laboratory of Eye Research, Felsenstein Medical Research Center, Petach Tikva, Israel.
| | - Dan Bourla
- Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel.
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Vasudevan B, Esposito C, Peterson C, Coronado C, Ciuffreda KJ. Under-correction of human myopia--is it myopigenic?: a retrospective analysis of clinical refraction data. JOURNAL OF OPTOMETRY 2014; 7:147-152. [PMID: 25000870 PMCID: PMC4087177 DOI: 10.1016/j.optom.2013.12.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 11/05/2013] [Accepted: 11/05/2013] [Indexed: 06/03/2023]
Abstract
PURPOSE To investigate retrospectively, based on routine clinical records in an optometric office, the effect of refractive under-correction of the myopic spectacle prescription on myopic progression in children and young adults. METHODS Patient records of children and young-adult myopes in a private optometric practice in Glendale, Arizona, USA, were initially reviewed to identify those that met the criteria. Information collected from the patient records included: age, gender, the dates and number of their visits (more than one visit was required for use of the data), final prescription, and non-cycloplegic subjective refraction. For each patient visit, the difference in spherical equivalent (SE) between the subjective refraction for maximum visual acuity and the final prescription was calculated for both the left and right eyes. Myopia progression was defined as the difference in SE between the final subjective refraction of the previous visit and that of the subsequent visit. Based on the study criteria, a total of 275 patient visits were obtained from the data collected in 76 patients. RESULTS A significant positive correlation was found between the magnitude of under-correction of the refractive error and myopic progression (r=0.301, p<0.01); that is, the greater the under-correction, the greater the myopic progression. In addition, there was a significant positive correlation between myopia progression and subjective refraction (r=0.166, p=0.006); that is, the greater the degree of myopia, the greater the effect of under-correction. However, there was no significant correlation between myopia progression and either age (r=-0.11, p=0.86) or gender (r=-0.82, p=0.17). CONCLUSION Under-correction of myopia produced a small but progressively greater degree of myopic progression than did full correction. The present finding is consistent with earlier clinical trials and modeling of human myopia.
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Affiliation(s)
| | | | - Cody Peterson
- College of Optometry, Mid Western University, Glendale, AZ 85308, USA
| | - Cory Coronado
- College of Optometry, Mid Western University, Glendale, AZ 85308, USA
| | - Kenneth J Ciuffreda
- Department of Biological and Vision Sciences, SUNY State College of Optometry, New York, NY 10036, USA
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Aldebasi YH. Prevalence of correctable visual impairment in primary school children in Qassim Province, Saudi Arabia. JOURNAL OF OPTOMETRY 2014; 7:168-176. [PMID: 25000873 PMCID: PMC4087181 DOI: 10.1016/j.optom.2014.02.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 09/28/2013] [Accepted: 09/28/2013] [Indexed: 06/03/2023]
Abstract
PURPOSE The worldwide prevalence of refractive errors (RE), which is a common cause of treatable visual impairment among children, varies widely. We assessed the prevalence of correctable visual impairment (uncorrected RE) in primary school children in Qassim, Saudi Arabia. METHODS A cross-sectional study was conducted in 21 primary schools. A total of 5176 children (mean age 9.5±1.8 years), 2573 boys (49.7%) and 2603 girls (50.3%), underwent a comprehensive eye examination. The examinations consisted of visual acuity, autorefraction, cover test, ocular motility, pupillary evaluation, anterior segment examination, cycloplegic auto-refraction and dilated fundus examination with direct ophthalmoscopy. The children were divided into groups based on their age and gender. RESULTS The overall prevalence of RE in the better eye was 18.6% (n=963), and the prevalence of uncorrected RE 16.3% (n=846), with only 2.3% (n=127) of children wearing spectacles during examination. The prevalence of uncorrected myopia (5.8%) and myopic astigmatism (5.4%) was higher compared to that of hyperopic astigmatism (2.7%), mixed astigmatism (1.7%) and hyperopia (0.7%). The anisometropia prevalence was 3.6%. Risks for astigmatism, myopia and anisometropia were positively associated with age. In addition, myopia and anisometropia risks were also associated with female gender, while risk of astigmatism was correlated with male gender. Few children with vision reducing RE wore spectacles; an additional 16.3% of children could benefit from spectacle prescription. CONCLUSION The prevalence of uncorrected RE in children is relatively high and represents an important public health problem in school-aged children in Qassim province. Performance of routine periodical vision screening throughout childhood may reverse this situation.
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Affiliation(s)
- Yousef H Aldebasi
- Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia.
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Cheng HC, Hsieh YT. The effect of low-concentration atropine combined with auricular acupoint stimulation in myopia control. Complement Ther Med 2014; 22:449-55. [PMID: 24906584 DOI: 10.1016/j.ctim.2014.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 02/09/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To compare the effect of myopia control between patients treated with low-concentration atropine eye drops combined with auricular acupoint stimulation and those treated with atropine alone. DESIGN AND SETTINGS Single-blinded randomized controlled clinical trial in a regional teaching hospital. INTERVENTIONS The patients received either topical 0.125% atropine nightly plus auricular acupoint stimulation (0.125A + ACU group) or topical 0.125% atropine alone nightly (0.125A group). MAIN OUTCOME MEASURES The changes in spherical equivalent (SE), axial length (AL), anterior chamber depth (ACD), and intraocular pressure (IOP) per year were compared between the two groups. RESULTS Seventy-three of 110 total patients (66.4%) completed at least 6 months of follow-up. Patients in the 0.125A + ACU group had less myopic progression and AL elongation (-0.41 diopter and 0.24 mm/year) than those in the 0.125A group (-0.66 diopter and 0.32 mm/year) (mean follow-up 14.7 months, p < 0.0001 and p = 0.02, respectively). The ACD increased more in the 0.125A + ACU group than in the 0.125A group (0.076 mm vs. 0.023 mm/year, p = 0.0004). IOP decreased more in the 0.125A + ACU group than in the 0.125A group (-1.01 mmHg vs. -0.13 mmHg/year, p = 0.007). A decrease of 1 mmHg of IOP correlated with a decrease of myopic progression of 0.021 diopter/year (p = 0.006). CONCLUSIONS Patients treated with 0.125% atropine eye drops plus auricular acupoint stimulation had less myopic progression, less axial length elongation, more anterior chamber deepening, and greater IOP reductions than those treated with 0.125% atropine alone. Auricular acupoint stimulation in combination with low-concentration topical atropine was beneficial for myopia control.
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Affiliation(s)
- Han-Chih Cheng
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan; Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
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Abstract
PURPOSE To compare saccadic eye movements in groups of myopes and emmetropes, as eye movements could have an influence on refractive error development. Individual saccadic eye movement parameters were also compared with subjective refraction and axial length data. METHODS Horizontal eye movements of 28 participants (14 myopes and 14 emmetropes; mean age [SD], 27.0 [4.7] years) were recorded using a head-mounted eye tracker. To reduce the influence of head movements, a chin rest was used. Two fixation stimuli lying symmetrically at ±10 degrees on either side of the median line were presented on a computer monitor and were alternately displayed for durations of 2 seconds each. The participants alternated their fixation between the target positions immediately after they became aware that the target had changed. Only right eye data were considered for analysis. RESULTS Durations, amplitudes, and peak velocities of the main saccades and the numbers of overshoots, undershoots, and exact fixations were analyzed. For all analyzed parameters, no significant differences were found between myopes and emmetropes. When analyzing the whole study population or the emmetropic group alone, none of the saccadic eye movement parameters were correlated with axial length or refractive error. In myopes, only the peak velocity showed a weak correlation with refractive error and axial length, but this failed to reach statistical significance when allowance was made for multiple testing. CONCLUSIONS Because saccadic eye movements seem to be similar in myopes and emmetropes, there is no evidence that saccadic eye movements are involved in myopia development.
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Abstract
PURPOSE To investigate the safety and efficacy of the treatment of myopic anisometropia with 1% atropine. METHODS Twenty-two children with myopic anisometropia were prescribed 1% solution of atropine sulfate to the more myopic eye, one drop before sleep every 3 days. Children were visited every 3 to 4 months until the degree of anisometropia was no more than 0.5 diopters (D) ("Success") or unchanged after 9 months of treatment ("No effect"). The treatment effect was assessed by comparing the interocular imbalance in refraction and axial length before and after the treatment. A detailed questionnaire about subjective symptoms in each visit and an electroretinogram in the end were administered to evaluate the side effects of this treatment. RESULTS The subjects were followed for 7 to 16 months. Six subjects withdrew participation on their own accord, and three were excluded because of inconstant usage of drug. Of the 13 remaining subjects, the refraction of the treated eyes decreased by 0.63 ± 0.59 D (p = 0.007), whereas that of the untreated eyes increased by -0.72 ± 0.65 D (p < 0.001). A corresponding trend was also found in the change of the axial length. Accordingly, the level of anisometropia was reduced from 1.82 ± 0.73 D to 0.47 ± 0.65 D (p < 0.001) and 10 (76.9%) of the 13 subjects were designated a "Success." One percent atropine was well tolerated by the children, and no electroretinogram abnormality was detected. CONCLUSIONS The results from this pilot study indicate that monocular usage of a solution of 1% atropine sulfate is an effective treatment to reduce anisometropia, although with some tolerable side effects. Nevertheless, an attenuated benefit was observed after cessation of atropine treatment. Thus, participants should be informed of a possible rebound effect before the administration of atropine for myopic anisometropia.
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Ide T, Ishikawa M, Tsubota K, Miyao M. The Effect of 3D Visual Simulator on Children's Visual Acuity - A Pilot Study Comparing Two Different Modalities. Open Ophthalmol J 2013; 7:69-48. [PMID: 24222810 PMCID: PMC3821097 DOI: 10.2174/1874364101307010069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/28/2013] [Accepted: 10/02/2013] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the efficacy of two non-surgical interventions of vision improvement in children. METHODS A prospective, randomized, pilot study to compare fogging method and the use of head mounted 3D display. Subjects were children, between 5 to 15 years old, with normal best corrected visual acuity (BCVA) and up to -3D myopia. Subjects played a video game as near point work, and received one of the two methods of treatments. Measurements of uncorrected far visual acuity (UCVA), refraction with autorefractometer, and subjective accommodative amplitude were taken 3 times, at the baseline, after the near work, and after the treatment. RESULTS Both methods applied after near work, improved UCVA. Head mounted 3D display group showed significant improvement in UCVA and resulted in better UCVA than baseline. Fogging group showed improvement in subjective accommodative amplitude. While 3D display group did not show change in the refraction, fogging group's myopic refraction showed significant increase indicating the eyes showed myopic change of eyes after near work and treatment. DISCUSSION Despite our lack of clear knowledge in the mechanisms, both methods improved UCVA after the treatments. The improvement in UCVA was not correlated to measured refraction values. CONCLUSION UCVA after near work can be improved by repeating near and distant accommodation by fogging and 3D image viewing, although at the different degrees. Further investigation on mechanisms of improvements and their clinical significance are warranted.
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Affiliation(s)
- Takeshi Ide
- Minamiaoyama Eye Clinic, Tokyo, Japan ; Department of Ophthalmology, Keio University, Tokyo, Japan
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Myopia onset and progression: can it be prevented? Int Ophthalmol 2013; 34:693-705. [PMID: 24043334 DOI: 10.1007/s10792-013-9844-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/03/2013] [Indexed: 12/28/2022]
Abstract
Myopia is the commonest ocular abnormality and the high and growing prevalence of myopia, especially but not only in Asian populations, as well as its progressive nature in children, has contributed to a recent surge in interest. Such worldwide growing prevalence seems to be associated with increasing educational pressures, combined with life-style changes, which have reduced the time that children spend outdoors. Highly nearsighted people are at greater risk for several vision-threatening problems such as retinal detachments, choroidal neovascularization, cataracts and glaucoma, thus the potential benefits of interventions that can limit or prevent myopia progression would be of remarkable social impact. Our understanding of the regulatory processes that lead an eye to refractive errors is undoubtedly incomplete but has grown enormously in the last decades thanks to the animal studies, observational clinical studies, and randomized clinical trials recently published. In this review we assess the effects of several types of life-style and interventions, including outdoor activities, eye drops, undercorrection of myopia, multifocal spectacles, contact lenses, and refractive surgery on the onset and progression of nearsightedness.
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Barathi VA, Kwan JL, Tan QSW, Weon SR, Seet LF, Goh LK, Vithana EN, Beuerman RW. Muscarinic cholinergic receptor (M2) plays a crucial role in the development of myopia in mice. Dis Model Mech 2013; 6:1146-58. [PMID: 23649821 PMCID: PMC3759334 DOI: 10.1242/dmm.010967] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Myopia is a huge public health problem worldwide, reaching the highest incidence in Asia. Identification of susceptible genes is crucial for understanding the biological basis of myopia. In this paper, we have identified and characterized a functional myopia-associated gene using a specific mouse-knockout model. Mice lacking the muscarinic cholinergic receptor gene (M2; also known as Chrm2) were less susceptible to lens-induced myopia compared with wild-type mice, which showed significantly increased axial length and vitreous chamber depth when undergoing experimental induction of myopia. The key findings of this present study are that the sclera of M2 mutant mice has higher expression of collagen type I and lower expression of collagen type V than do wild-type mice and mice that are mutant for other muscarinic subtypes, and, therefore, M2 mutant mice were resistant to the development of experimental myopia. Pharmacological blockade of M2 muscarinic receptor proteins retarded myopia progression in the mouse. These results suggest for the first time a role of M2 in growth-related changes in extracellular matrix genes during myopia development in a mammalian model. M2 receptor antagonists might thus provide a targeted therapeutic approach to the management of this refractive error.
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Affiliation(s)
- Veluchamy A Barathi
- Singapore Eye Research Institute, 11 Third Hospital Avenue, 168751 Singapore, Singapore
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Prescription of atropine eye drops among children diagnosed with myopia in Taiwan from 2000 to 2007: a nationwide study. Eye (Lond) 2013; 27:418-24. [PMID: 23288141 DOI: 10.1038/eye.2012.279] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE This study was conducted to examine the atropine eye drop prescription trend for children diagnosed with myopia, and to determine the factors associated with the prescription of atropine eye drops. DESIGN This was a population-based cross-sectional study. METHODS This study was conducted using a national representative sample from the National Health Insurance (NHI) claims data. All school children between 4 and 18 years of age who had visited an ophthalmologist and were diagnosed with myopia between 2000 and 2007 were included herein. The main outcome measure was the proportion of subjects who were prescribed atropine eye drops in each year. Logistic regression was used to identify the factors associated with atropine eye drops being prescribed. RESULTS The prescription of atropine eye drops for children diagnosed with myopia increased significantly from the school years 2000 (36.9%) to 2007 (49.5%). There was also a shift from prescribing high concentrations (0.5 and 1%) of atropine eye drops to lower concentration ones (0.3, 0.25, and 0.1%) within this period. Atropine eye drops were more frequently prescribed to 9-12-year-old children (OR=1.26-1.42, compared with those 7-8 years old), and to children from families with a high socioeconomic status (OR=1.19-1.25); however, they were less prescribed to those living in mid to low urbanized areas (OR=0.65-0.84). CONCLUSIONS This study revealed an increasing trend of atropine eye drop prescription for children with myopia in Taiwan. Our study provides eye-care professionals worldwide a reference for the potential integration of atropine eye drops into their clinical practice toward children with myopia.
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An J, Hsi E, Zhou X, Tao Y, Juo SHH, Liang CL. The FGF2 gene in a myopia animal model and human subjects. Mol Vis 2012; 18:471-8. [PMID: 22393273 PMCID: PMC3291517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 02/13/2012] [Indexed: 10/31/2022] Open
Abstract
PURPOSE Fibroblast growth factor-2 (FGF2) has been implied in the development of myopia according to previous studies investigating FGF2 in the sclera and retinal pigment epithelium. This study measured retinal FGF2 gene expression in an animal model and also tested for the association between single nucleotide polymorphisms (SNPs) in FGF2 and high myopia. METHODS The guinea pigs were assigned to 2 groups: form deprivation myopia (FDM) for two weeks and normal control (free of form deprivation). Biometric measurement was performed and FGF2 expression levels were compared among the FDM eyes, the fellow eyes of the FDM group and the normal eyes in retina. We also enrolled 1,064 cases (≤-6.0 D) and 1,001 controls (≥-1.5 D) from a Chinese population residing in Taiwan. Six tagging SNPs were genotyped to test for an association between genotypes and high myopia. RESULTS The FDM eyes had the most prominent changes of refraction and axial length. Compared with the mRNA levels of FGF2 in the normal eyes, the FDM eyes had the highest levels of mRNA (p=0.0004) followed by the fellow eyes (p=0.002). The FDM and normal eyes became more myopic compared with the fellow eyes, but the fellow eyes became more hyperopic (p=0.004) in the end of the experiment which may be due to its relatively short axial length when compared with normal eyes (p=0.05). The SNP genotypes were all in Hardy-Weinberg equilibrium. However, none of the SNPs were significantly associated with high myopia (all p values >0.1). CONCLUSIONS We identified a significant change of FGF2 expression in the FDM eyes but FGF2 genetic variants are unlikely to influence susceptibility to myopia. There may be a systemic effect to influence gene expression and refraction on the fellow eyes, which may perturb emmetropization in the fellow eyes. Our data also suggest using normal eyes rather than the fellow eyes as the control eyes when study the form deprivation myopia.
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Affiliation(s)
- Jianhong An
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical College, Wenzhou, Zhejiang, China,State Key Laboratory Cultivation Base and Key Laboratory of Vision Science, Ministry of Health P.R. China and Zhejiang Provincial Key Laboratory of Ophthalmology and Optometry, Wenzhou, Zhejiang, China
| | - Edward Hsi
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan,Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Xiangtian Zhou
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical College, Wenzhou, Zhejiang, China,State Key Laboratory Cultivation Base and Key Laboratory of Vision Science, Ministry of Health P.R. China and Zhejiang Provincial Key Laboratory of Ophthalmology and Optometry, Wenzhou, Zhejiang, China
| | - Yijin Tao
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical College, Wenzhou, Zhejiang, China,State Key Laboratory Cultivation Base and Key Laboratory of Vision Science, Ministry of Health P.R. China and Zhejiang Provincial Key Laboratory of Ophthalmology and Optometry, Wenzhou, Zhejiang, China
| | - Suh-Hang Hank Juo
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan,Department of Medical Genetics, Kaohsiung Medical University, Kaohsiung, Taiwan
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Chia A, Chua WH, Cheung YB, Wong WL, Lingham A, Fong A, Tan D. Atropine for the Treatment of Childhood Myopia: Safety and Efficacy of 0.5%, 0.1%, and 0.01% Doses (Atropine for the Treatment of Myopia 2). Ophthalmology 2012; 119:347-54. [DOI: 10.1016/j.ophtha.2011.07.031] [Citation(s) in RCA: 372] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 07/20/2011] [Accepted: 07/20/2011] [Indexed: 11/17/2022] Open
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Walline JJ, Lindsley K, Vedula SS, Cotter SA, Mutti DO, Twelker JD. Interventions to slow progression of myopia in children. Cochrane Database Syst Rev 2011:CD004916. [PMID: 22161388 PMCID: PMC4270373 DOI: 10.1002/14651858.cd004916.pub3] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Nearsightedness (myopia) causes blurry vision when looking at distant objects. Highly nearsighted people are at greater risk of several vision-threatening problems such as retinal detachments, choroidal atrophy, cataracts and glaucoma. Interventions that have been explored to slow the progression of myopia include bifocal spectacles, cycloplegic drops, intraocular pressure-lowering drugs, muscarinic receptor antagonists and contact lenses. The purpose of this review was to systematically assess the effectiveness of strategies to control progression of myopia in children. OBJECTIVES To assess the effects of several types of interventions, including eye drops, undercorrection of nearsightedness, multifocal spectacles and contact lenses, on the progression of nearsightedness in myopic children younger than 18 years. We compared the interventions of interest with each other, to single vision lenses (SVLs) (spectacles), placebo or no treatment. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 10), MEDLINE (January 1950 to October 2011), EMBASE (January 1980 to October 2011), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to October 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (http://clinicaltrials.gov). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 11 October 2011. We also searched the reference lists and Science Citation Index for additional, potentially relevant studies. SELECTION CRITERIA We included randomized controlled trials (RCTs) in which participants were treated with spectacles, contact lenses or pharmaceutical agents for the purpose of controlling progression of myopia. We excluded trials where participants were older than 18 years at baseline or participants had less than -0.25 diopters (D) spherical equivalent myopia. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias for each included study. When possible, we analyzed data with the inverse variance method using a fixed-effect or random-effects model, depending on the number of studies and amount of heterogeneity detected. MAIN RESULTS We included 23 studies (4696 total participants) in this review, with 17 of these studies included in quantitative analysis. Since we only included RCTs in the review, the studies were generally at low risk of bias for selection bias. Undercorrection of myopia was found to increase myopia progression slightly in two studies; children who were undercorrected progressed on average 0.15 D (95% confidence interval (CI) -0.29 to 0.00) more than the fully corrected SVLs wearers at one year. Rigid gas permeable contact lenses (RGPCLs) were found to have no evidence of effect on myopic eye growth in two studies (no meta-analysis due to heterogeneity between studies). Progressive addition lenses (PALs), reported in four studies, and bifocal spectacles, reported in four studies, were found to yield a small slowing of myopia progression. For seven studies with quantitative data at one year, children wearing multifocal lenses, either PALs or bifocals, progressed on average 0.16 D (95% CI 0.07 to 0.25) less than children wearing SVLs. The largest positive effects for slowing myopia progression were exhibited by anti-muscarinic medications. At one year, children receiving pirenzepine gel (two studies), cyclopentolate eye drops (one study), or atropine eye drops (two studies) showed significantly less myopic progression compared with children receiving placebo (mean differences (MD) 0.31 (95% CI 0.17 to 0.44), 0.34 (95% CI 0.08 to 0.60), and 0.80 (95% CI 0.70 to 0.90), respectively). AUTHORS' CONCLUSIONS The most likely effective treatment to slow myopia progression thus far is anti-muscarinic topical medication. However, side effects of these medications include light sensitivity and near blur. Also, they are not yet commercially available, so their use is limited and not practical. Further information is required for other methods of myopia control, such as the use of corneal reshaping contact lenses or bifocal soft contact lenses (BSCLs) with a distance center are promising, but currently no published randomized clinical trials exist.
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Affiliation(s)
- Jeffrey J Walline
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | - Kristina Lindsley
- Center for Clinical Trials, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Satyanarayana S Vedula
- Center for Clinical Trials, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Susan A Cotter
- Southern California College of Optometry, Fullerton, California, USA
| | - Donald O Mutti
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | - J. Daniel Twelker
- Department of Ophthalmology, University of Arizona, Tucson, Arizona, USA
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Jung JJ, Lim EH, Baek SH, Kim YR, Gong SM, Kim US. Attempts to reduce the progression of myopia and spectacle prescriptions during childhood: a survey of eye specialists. KOREAN JOURNAL OF OPHTHALMOLOGY 2011; 25:417-20. [PMID: 22131779 PMCID: PMC3223709 DOI: 10.3341/kjo.2011.25.6.417] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 10/14/2010] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine methods tried in clinical trials to reduce the progression of myopia in children, and spectacle prescribing patterns of hospital ophthalmologists. Methods A multi-sectioned survey composed of Likert items relating to the methods of reducing myopia progression (orthokeratology lenses [O-K lenses], undercorrected glasses, and topical atropine) and the patterns of prescribing spectacles for children (including two cases involving a 5-year-old girl and an 8-year-old boy) were distributed to members of the Korean Ophthalmological Society, and the collected data was statistically analyzed. Results A total of 78 out of 130 ophthalmologists returned the survey. On a scale of 1 to 5, the mean rates of whether the ophthalmologists think O-K lenses arrest myopia progression, and whether they recommend their patients to wear O-K lenses if indicative, were 3.06 and 2.75, respectively. Moreover, the mean rates of whether they consider that wearing glasses which are undercorrected would slow down the progression of the myopia, or if they think topical atropine helps in arresting myopia progression in children, were 2.34 and 1.27, respectively. In response to the case studies, the majority of practitioners preferred to prescribe the full amount found in cycloplegic refraction to pediatric patients with myopia. Conclusions Ophthalmologists in clinical practice encouraged children to wear O-K lenses more than undercorrected glasses as a way to retard myopia progression. However, the application of atropine is rarely tried in clinical trials. In managing pediatric patients with myopia (case specific), the majority of the practitioners chose to prescribe glasses with full cycloplegic correction.
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Affiliation(s)
- Jong Jin Jung
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
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Wei ML, Liu JP, Li N, Liu M. Acupuncture for slowing the progression of myopia in children and adolescents. Cochrane Database Syst Rev 2011:CD007842. [PMID: 21901710 DOI: 10.1002/14651858.cd007842.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Myopia (near-sightedness or short-sightedness) is one of the three commonly detected refractive (focusing) errors. Acupuncture is the stimulation of acupuncture points by various methods including needle insertion and acupressure. It is often used by traditional Chinese medicine practitioners to treat myopia in children. OBJECTIVES To assess the effectiveness and safety of acupuncture in slowing the progression of myopia in children and adolescents. SEARCH STRATEGY We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 7), MEDLINE (January 1950 to July 2011), EMBASE (January 1980 to July 2011), the Allied and Complementary Medicine Database (AMED) (January 1985 to July 2011), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to July 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrial.gov), the National Center for Complementary and Alternative Medicine (NCCAM) (The first issue to August 2010), the Chinese Biological Medicine Database (CBM) (1978 to April 2011), China National Knowledge Infrastructure (CNKI) (1994 to April 2011) and VIP (1989 to April 2011). There were no date or language restrictions in the electronic searches for trials. CENTRAL, MEDLINE, EMBASE, AMED, LILACS, mRCT and ClinicalTrials.gov were last searched on 9 July 2011. NCCAM was searched up to August 2010 and CBM, CNKI, and VIP were last searched on 6 April 2011. SELECTION CRITERIA We included randomized controlled trials (RCTs) that included any type of acupuncture treatment for myopia in children and adolescents. DATA COLLECTION AND ANALYSIS Two authors independently evaluated the search results according to the inclusion and exclusion criteria. Two authors extracted and assessed data independently. We contacted the study investigator for missing data. MAIN RESULTS We included two RCTs conducted in Taiwan with a total of 131 participants. We did not perform a meta-analysis as the trials were assessing different outcomes. Neither trial met our pre-defined primary outcome criteria of myopia progression defined as one diopter mean change. Only one trial reported the changes of axial length without non-significant difference among groups and both trials reported that several children experienced mild pain during acupuncture stimulation. AUTHORS' CONCLUSIONS Two trials are included in this review but no conclusions can be drawn for the benefit of co-acupressure for slowing progress of myopia in children. Further evidence in the form of RCTs are needed before any recommendations can be made for the use of acupuncture treatment in clinical use. These trials should compare acupuncture to placebo and have large sample sizes. Other types of acupuncture (such as auricular acupuncture) should be explored further as well as compliance with treatment for at least six months or longer. Axial length elongation of the eye should be investigated for at least one year. The potential to reduce/eliminate pain from acupuncture experienced by children should also be reviewed.
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Affiliation(s)
- Mao Ling Wei
- Chinese Cochrane Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, China, 610041
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