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

Changes in Subfoveal Choroidal Thickness after Orthokeratology in Myopic Children: A Systematic Review and Meta-Analysis

AIMS

This study aimed to synthesize the variations in subfoveal choroidal thickness (SFCT) observed at different follow-up intervals in myopic children undergoing orthokeratology treatment.

MATERIALS AND METHODS

Relevant articles were systematically retrieved from databases such as PubMed, EMBASE, Web of Science, and Cochrane Library. The retrieval period extended from the inception of these databases to November 2023. Means and standard deviations (SD) of baseline and post-treatment SFCT were selected as the results for analysis and calculation.

RESULTS

A total of eight articles involving 478 eyes fulfilled the inclusion criteria. At 1 month, 3 months, and 6 months intervals, the SFCT demonstrated significant increases by 16.74 μm (95% CI: 8.66, 24.82; p < 0.0001), 13.41 μm (95% CI: 4.36, 22.45; p = 0.004), and 17.57 μm (95% CI: 8.41, 26.73; p = 0.0002), respectively. Besides, children treated with orthokeratology exhibited a notably thicker change of SFCT in comparison with children with single-vision spectacles (SVL) (WMD = 13.50, 95% CI: 11.69, 15.13; p < 0.0001).

CONCLUSION

Myopic children undergoing orthokeratology treatment experience a discernible increase in SFCT at 1 month, 3 months, and 6 months. Furthermore, compared to children utilizing SVL, those undergoing orthokeratology manifest a more pronounced thickening of SFCT.

Association between Near Work, Physical Activities and Myopia in Korean Adults During COVID-19 Outbreak

PURPOSE

This study investigated the relationship between near work hours and myopia in Korean adults.

METHODS

We used data from the 2021 Korean National Health and Nutrition Examination Survey. Associations between near work time, physical activity, and myopia were assessed using chi-square tests and multiple logistic regression analyses.

RESULTS

The overall prevalence of myopia was 60.2% in adults aged 19-59 years. The prevalence of myopia was 46.2% for individuals who used smart devices for less than one hour per day, while it was 68.0% for those who used smart devices for more than four hours. In the multiple logistic regression analysis, the odds ratio (OR) for myopia was significantly higher among individuals using smart devices for 3 hours (OR = 1.55, 95% CI = 1.08-2.23) or more than 4 hours (OR = 1.75, 95% CI = 1.27-2.42), compared to users with less than 1 hour of usage. Regarding sitting time, the OR for myopia was significantly higher in individuals who sat for more than 12 hours (OR = 1.66, 95% CI = 1.05-2.61) compared to those who sat less than 4 hours.

CONCLUSION

This study found that near work and sitting times were positively associated with myopia. Given the high prevalence of myopia and its implications for serious eye diseases, it is essential to implement measures to manage myopia. Considering the increased near work hours resulting from the COVID-19 pandemic, it is necessary to adopt supplementary measures, such as ensuring sufficient rest time for the eyes and adjusting the brightness of lights, to improve eye health.

Bi-Gaussian analysis reveals distinct education-related alterations in spherical equivalent and axial length-results from the Gutenberg Health Study

PURPOSE

The aim of this study is to investigate the distribution of spherical equivalent and axial length in the general population and to analyze the influence of education on spherical equivalent with a focus on ocular biometric parameters.

METHODS

The Gutenberg Health Study is a population-based cohort study in Mainz, Germany. Participants underwent comprehensive ophthalmologic examinations as part of the 5-year follow-up examination in 2012-2017 including genotyping. The spherical equivalent and axial length distributions were modeled with gaussian mixture models. Regression analysis (on person-individual level) was performed to analyze associations between biometric parameters and educational factors. Mendelian randomization analysis explored the causal effect between spherical equivalent, axial length, and education. Additionally, effect mediation analysis examined the link between spherical equivalent and education.

RESULTS

A total of 8532 study participants were included (median age: 57 years, 49% female). The distribution of spherical equivalent and axial length follows a bi-Gaussian function, partially explained by the length of education (i.e., < 11 years education vs. 11-20 years). Mendelian randomization indicated an effect of education on refractive error using a genetic risk score of education as an instrument variable (- 0.35 diopters per SD increase in the instrument, 95% CI, - 0.64-0.05, p = 0.02) and an effect of education on axial length (0.63 mm per SD increase in the instrument, 95% CI, 0.22-1.04, p = 0.003). Spherical equivalent, axial length and anterior chamber depth were associated with length of education in regression analyses. Mediation analysis revealed that the association between spherical equivalent and education is mainly driven (70%) by alteration in axial length.

CONCLUSIONS

The distribution of axial length and spherical equivalent is represented by subgroups of the population (bi-Gaussian). This distribution can be partially explained by length of education. The impact of education on spherical equivalent is mainly driven by alteration in axial length.

Myopia Is an Ischemic Eye Condition: A Review from the Perspective of Choroidal Blood Flow

Myopia is a common refractive error that affects a large proportion of the population. Recent studies have revealed that alterations in choroidal thickness (ChT) and choroidal blood flow (ChBF) play important roles in the progression of myopia. Reduced ChBF could affect scleral cellular matrix remodeling, which leads to axial elongation and further myopia progression. As ChT and ChBF could be used as potential biomarkers for the progression of myopia, several recent myopia treatments have targeted alterations in ChT and ChBF. Our review provides a comprehensive overview of the recent literature review on the relationship between ChBF and myopia. We also highlight the importance of ChT and ChBF in the progression of myopia and the potential of ChT as an important biomarker for myopia progression. This summary has significant implications for the development of novel strategies for preventing and treating myopia.

Effects and potential mechanisms of exercise and physical activity on eye health and ocular diseases

In the field of eye health, the profound impact of exercise and physical activity on various ocular diseases has become a focal point of attention. This review summarizes and elucidates the positive effects of exercise and physical activities on common ocular diseases, including dry eye disease (DED), cataracts, myopia, glaucoma, diabetic retinopathy (DR), and age-related macular degeneration (AMD). It also catalogues and offers exercise recommendations based on the varying impacts that different types and intensities of physical activities may have on specific eye conditions. Beyond correlations, this review also compiles potential mechanisms through which exercise and physical activity beneficially affect eye health. From mitigating ocular oxidative stress and inflammatory responses, reducing intraocular pressure, enhancing mitochondrial function, to promoting ocular blood circulation and the release of protective factors, the complex biological effects triggered by exercise and physical activities reveal their substantial potential in preventing and even assisting in the treatment of ocular diseases. This review aims not only to foster awareness and appreciation for how exercise and physical activity can improve eye health but also to serve as a catalyst for further exploration into the specific mechanisms and key targets through which exercise impacts ocular health. Such inquiries are crucial for advancing innovative strategies for the treatment of eye diseases, thereby holding significant implications for the development of new therapeutic approaches.

Lifestyle Factors in Myopic Spanish Children

BACKGROUND

Childhood myopia represents a global concern with increasing prevalence in recent decades. Lifestyle factors significantly impact myopia.

AIM

To evaluate lifestyle factors in myopic children from a metropolitan area in Europe.

METHODS

This was a descriptive study including myopic subjects aged 4-18 years. Patient demographic and clinical data were collected, including cycloplegic refraction in spherical equivalent refraction (SER) and axial length (AL). In addition, a questionnaire on lifestyle factors was conducted between September 2022 and April 2023.

RESULTS

A total of 321 myopic children were included, aged 10.72 ± 3.05 years, of whom 51.4% were boys, with SER -2.25 ± 1.9 D and AL 24.54 ± 0.98 mm. The mean age of myopia onset was 7.69 ± 3.05 years. A total of 59.8% had family history of myopia. Those children who had <2 h/day of screen time (on weekdays) presented SER -2 ± 1.91 D, compared to those who had >2 h/day, SER: -2.50 ±1.88 D (p = 0.009). Children who spent <2 h/day doing near work after school were less myopic compared to those who spent >2 h/day (SER: -1.75 ± 1.83 vs. SER: -2.75 ± 1.82, respectively, p = 0.03). However, no significant association was observed between SER and AL and time spent outdoors nor between SER and AL and academic performance (p > 0.05).

CONCLUSIONS

Screen time and near-work time appear to be lifestyle factors related to myopia.

Associations of Near Work, Time Outdoors, and Sleep Duration With Myopic Regression 5 Years After SMILE and FS-LASIK: A Cross-sectional Study

PURPOSE

To investigate the association of near work, time outdoors, and sleep duration with myopic regression 5 years after small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) .

METHODS

This cross-sectional study included patients who received SMILE or FS-LASIK at Beijing Tongren Hospital 5 years ago. The patients underwent ophthalmic examinations including visual acuity, intraocular pressure, subjective refraction, slit-lamp examination, keratometry, corneal topography, optical coherence tomography, and fundus examination from January 2020 to March 2023. Fluorescein break-up time was measured and the Ocular Surface Disease Index questionnaire was completed to exclude dry eye. A self-administered questionnaire was used to collect data on near work exposure, physical activities, and sleep duration.

RESULTS

A total of 323 eyes were included in the analysis, with a 5-year incidence rate of myopic regression after SMILE or FSLASIK of 16.1%. After adjusted for all confounders, total near work more than 8 hours/day revealed a significant association with myopic regression (odds ratio: 2.461; 95% CI: 1.143 to 5.298, P = .021), particularly in younger adults, women, and patients with high myopia and FS-LASIK treatment. The significant association between sleep duration 8 hours/day or more and myopic regression was restricted to women and patients with FS-LASIK (near significant). However, no significant associations were observed between continuous near work or time outdoors and myopic regression.

CONCLUSIONS

Excessive near work exposure was associated with greater myopic regression 5 years after SMILE or FS-LASIK. It is crucial to maintain good visual behavior and care for preventing regression after SMILE or FS-LASIK, especially for younger patients and eyes with high myopia. [J Refract Surg. 2024;40(1):e10-e19.].

Prevalence of Myopia and Its Related Factors Among University Students in Madinah, Saudi Arabia

BACKGROUND

Myopia, a common refractive error, is a growing global health burden influenced by both genetic and environmental factors. Despite its high prevalence, studies on its prevalence and risk factors among university students are lacking.

OBJECTIVES

The objective of this study is to investigate the prevalence of myopia and its associated factors among college students in Saudi Arabia's Madinah region.

METHODS

A cross-sectional study was conducted in Al-Madinah, Saudi Arabia, from February to June 2023, utilizing a survey that was distributed to college students through a social media application.

RESULTS

A total of 433 university students from Al-Madinah province were enrolled in this study; 66.3% were females and 33.7% were males. Participants' ages ranged from 18 to 33 years with a mean of 21.3 ± 2.0 years. The prevalence of myopia among college students in Al-Madinah and its provinces was 57.3%, and 87.9% of them had myopia in both eyes. Respondents with an electronic screen time of more than three hours and a reading distance of less than 15cm were at significant risk of myopia with p-values of 0.037 and 0.019, respectively.

CONCLUSIONS

A significant prevalence of myopia has been observed among university students in Madinah. Studying in scientific and medical fields, having eye diseases, prolonged use of digital devices, limiting daily outdoor activities to one hour, and having a reading distance of less than 15 cm significantly increased the risk of myopia. Encouraging education and screening programs for myopia prevention and control is crucial.

Safety and efficacy of 0.01% and 0.1% low-dose atropine eye drop regimens for reduction of myopia progression in Danish children: a randomized clinical trial examining one-year effect and safety

BACKGROUND

To investigate the efficacy and safety of 0.1% and 0.01% low-dose atropine eye drops in reducing myopia progression in Danish children.

METHODS

Investigator-initiated, placebo-controlled, double-masked, randomized clinical trial. Ninety-seven six- to twelve-year old myopic participants were randomized to 0.1% loading dose for six months followed by 0.01% for six months (loading dose group, Number (N) = 33), 0.01% for twelve months (0.01% group, N = 32) or vehicle for twelve months (placebo, N = 32). Primary outcomes were axial length and spherical equivalent refraction. Secondary outcomes included adverse events and reactions, choroidal thickness and ocular biometry. Outcomes were measured at baseline and three-month intervals. Data was analyzed with linear-mixed model analysis according to intention-to-treat.

RESULTS

Mean axial elongation was 0.10 mm less (95% confidence interval (CI): 0.17; 0.02, adjusted-p = 0.06) in the 0.1% loading dose and 0.07 mm less (95% CI: 0.15; 0.00, adjusted-p = 0.16) in the 0.01% group at twelve months compared to placebo. Mean spherical equivalent refraction progression was 0.24 D (95% CI: 0.05; 0.42) less in the loading dose and 0.19 D (95% CI: 0.00; 0.38) less in the 0.01% groups at twelve months, compared to placebo (adjusted-p = 0.06 and 0.14, respectively). A total of 108 adverse events were reported during the initial six-month loading dose period, primarily in the loading dose group, and 14 were reported in the six months following dose switching, all deemed mild except two serious adverse events, unrelated to the intervention.

CONCLUSIONS

Low-dose atropine eye drops are safe over twelve months in otherwise healthy children. There may be a modest but clinically relevant reduction in myopia progression in Danish children after twelve months treatment, but the effect was statistically non-significant after multiple comparisons adjustment. After dose-switching at six months the loading dose group approached the 0.01% group, potentially indicating an early "rebound-effect".

TRIAL REGISTRATION

this study was registered in the European Clinical Trials Database (EudraCT, number: 2018-001286-16) 05/11/2018 and first posted at www.

CLINICALTRIALS

gov (NCT03911271) 11/04/2019, prior to initiation.

Book Review: Efron, N. Contact Lens Practice; Elsevier Health Sciences: Amsterdam, The Netherlands, 2024; ISBN: 978-0-7020-8427-0

The book Contact Lens Practice (ISBN 978-0-7020-8427-0), fourth edition [...].

Prevalence of myopia in school-age children in Ethiopia: A systematic review and meta-analysis

Objective

This study aimed to estimate the pooled prevalence of myopia among school-age children in Ethiopia.

Methods

Eligible articles were searched from PubMed, Embase, and Web of Science databases. In addition, Google Scholar and reference lists of the retrieved articles were searched from 30 July 2022 to 02 January 2023. The preferred reporting of items for systematic reviews and meta-analysis was used to report the search results. Microsoft Excel was used to keep the data. The qualities of eligible studies were checked using the Joanna Briggs Institute critical appraisal checklist for prevalence studies. Analysis was held using STATA Version 11. The degree of heterogeneity was checked using I² statistics. The possible sources of heterogeneity were examined using meta-regression and subgroup analyses. The funnel plot and Egger's test were used to assess the potential publication bias. A correction was made for publication bias using Duval and Twee Die's trim-and-fill analysis. The systematic review registration number is PROSPERO (#CRD42022330541).

Results

We identified 21 eligible articles including 20,757 subjects. Of those participants, 10,601 (51.1%) and 10,156 (48.9%) were males and females, respectively. A total of 15,152 (73%) participants were urban residents. The estimated prevalence of myopia among school-age children in Ethiopia was found to be 5.26% (95% confidence interval: 4.09-6.42).

Conclusions

The prevalence of myopia among school-age children in Ethiopia is considerable, affecting one in 20 school-age children. Therefore, the authors recommend the stakeholders take extra steps to speed up the implementation of the school vision screening program and its integration plan into the existing school nutrition program.

Ultrasound Assessment of Gaze-induced Posterior Eyewall Deformation in Highly Myopic Eyes

Purpose

To establish a quantitative metric of posterior eyewall deformability in different directions of gaze in highly myopic eyes with and without posterior staphyloma.

Methods

A prospective study was performed on 53 highly myopic patients (106 eyes). Ultrasound scans were acquired in primary, up, downward, nasal, and temporal gazes. A validated intensity-based segmentation algorithm was used to quantify the posterior eyewall geometry on digitalized B-scan images. Posterior eyewall local curvature (K) and distance (L) to the transducer were calculated. The associations between directions of gaze, axial length (AL), and presence of staphyloma with the K and L parameters were assessed.

Results

A total of 53 participants (106 eyes) were studied. Multivariate regression analysis demonstrated that, after accounting for longer AL, and presence of staphyloma, eccentric gaze was often independently associated with various K and L parameters. Specifically, downward gaze was associated with increased posterior eyewall concavity as reflected in the maximum of K (KMax) (β = 0.050, P < 0.001) and absolute value of KMax (β = 0.041, P = 0.011). Both downward gaze and upgaze were independently associated with increase in the derivative of absolute KMax (which is consistent with more apparent, steeper staphyloma ridges), local KMax (which detects KMax at smaller intervals), and Kstd (which represents likelihood of staphyloma presence) and decrease in maximum of L (which represents movement of the staphyloma apex) with all P < 0.05. The β coefficients for downward gaze were consistently greater in magnitude compared with those in upgaze. After accounting for AL and presence of staphyloma, horizontal gazes were independently associated only with decrease in the standard deviation of L (which also represents likelihood of staphyloma presence) and maximum of L.

Conclusions

Downward gaze results in a significant increase in posterior eyewall concavity in highly myopic eyes after accounting for AL and staphyloma presence. In comparison with downward gaze, upgaze resulted in a lower magnitude, but significant changes in staphyloma ridge steepness and the likelihood of staphyloma presence. Horizontal gazes seemed to be associated with less posterior eyewall geometric parameters. Studies are required to further assess the association between downward gaze during near work on posterior eyewall concavity and possible effects on myopia development and progression.