How to effectively manage myopia

Context of Atropine Adherence in Preschool Children with Early-Onset Myopia: A Qualitative Study

The use of atropine is currently one of the most effective methods used to prevent myopia progression. The purpose of this study was to investigate atropine adherence in preschool children with myopia, to explain the context of treatment through caregivers, and to identify barriers and facilitators of using atropine. We conducted in-depth interviews with 60 caregivers of children (parents, kindergarten teachers and nurses) in four different areas ranging from large cities to rural areas in Taiwan. Based on the social ecological theory model, the recorded text was systematically analyzed, extracted, edited and indexed by NVivo 12 Plus. After interviewing caregivers, we determined the barriers and facilitators at the four levels of influence (children, parents, school, and hospital and society). Barriers included the side effects, parental neglect, lack of understanding of long-term drug use, lack of conducive environment, and lack of friendly medical services. Facilitators included overcoming side effects, parental responsibility, myopia progression on treatment adherence, teacher support, management by nurses, navigation by ophthalmologists, and model learning. Hence, establishing a social support network, discussing the experience of individualized drug use in preschool children, and establishing a friendly medical intervention strategy can raise awareness among parents regarding myopia, and improve atropine adherence in preschool children.

Effect of physical activity combined with extra ciliary-muscle training on visual acuity of children aged 10-11

This study is intended for exploring the effects of the physical activity combined with extra ciliary-muscle training with different frequencies on children's kinetic visual acuity and uncorrected distance visual acuity, and eventually figuring out the optimal frequency of ciliary-muscle training for each physical education class. To do the present research, A total of 160 students aged 10-11 from a school in Suzhou (a major city located in southeastern Jiangsu Province, East China) were randomly selected and divided into control group (n = 33), 15-frequency group (n = 44), 30-frequency group (n = 40) and 60-frequency group (n = 43), and the latter three experimental groups participated in a specially designed physical activity plan based on the training principles of ciliary muscle, while the control group participated in normal physical activity as usual. The experimental intervention period was 16 weeks, and all students' kinetic visual acuity and uncorrected distance visual acuity were measured before and after the experiment. The result showed that the kinetic visual acuity of the students in the 30 and 60-frequency groups got improved significantly after the experiment (p < 0.05), with the highest improvement occurring in the 30-frequency group, while there was no significant change in the 15-frequency group and the control group; The uncorrected distance visual acuity of the students in the 30 and 60-frequency groups was significantly improved after the experiment (p < 0.05), and the improvement range in these two groups was similar. In contrast, there was no significant change in the 15-frequency group, while the control group showed a significant decrease (p < 0.05). Physical activity combined with extra ciliary-muscle training has a positive effect on improving children's vision; at the same time, ciliary-muscle training with different frequencies bring out different outcomes on children's vision improvement, among which ciliary-muscle training with frequency of 30 in each physical education class is the best choice to enhance children's kinetic visual acuity and uncorrected distance visual acuity.

Attending a Sports Club Can Help Prevent Visual Impairment Caused by Cram School in Elementary School Children in Japan

Longer durations for near-work activities, such as studying, worsen eyesight. In contrast, outdoor exercise is effective in reducing the risk of developing myopia. Despite these findings, however, the interaction between studying and exercise in eyesight has not been quantitatively evaluated. Moreover, since there is a culture of attending lessons in Japan, it is important to investigate the relationship between elementary school activities, such as cram schools or sports clubs, and vision. Therefore, in this study, we examined whether attending cram schools and/or sports clubs is associated with the use of glasses among elementary school students. We conducted a survey among 7419 elementary school students in Tokyo, Japan using a food education questionnaire. A logistic regression analysis was used to evaluate the relationship between wearing glasses, an objective variable, and attending sports clubs and cram schools. Sex and school year were considered confounding factors. The results of this study showed that students who attended only sports clubs were more likely to be categorized into the “not wearing glasses” group (p = 0.03, OR = 1.45), whereas those who attended only cram schools were more likely to be categorized into the “wearing glasses” group (p = 0.008, OR = 0.67). In addition, students who attended both cram schools and sports clubs were more likely to be categorized into the “not wearing glasses” group than those who only attended cram schools (p = 0.28, OR = 0.85). Our findings indicate that attending not only cram schools but also sports clubs may prevent deterioration of eyesight. Parents and health care providers need to take these findings into account in order to prevent visual impairment in children.

Comparing the results of manual and automated quantitative corneal neuroanalysing modules for beginners

This study aimed to evaluate the reliability of in vivo confocal microscopic neuroanalysis by beginners using manual and automated modules. Images of sub-basal corneal nerve plexus (SCNP) from 108 images of 18 healthy participants were analyzed by 7 beginner observers using manual (CCMetrics, [CCM]) and automated (ACCMetrics, [ACCM]) module. SCNP parameters analyzed included corneal nerve fiber density (NFD), corneal nerve branch density (NBD), corneal nerve fiber length (NFL), and tortuosity coefficient (TC). The intra-observer repeatability, inter-observer reliability, inter-module agreement, and left–right eye symmetry level of SCNP parameters were examined. All observers showed good intra-observer repeatability using CCM (intraclass correlation coefficient [ICC] > 0.60 for all), except when measuring TC. Two observers demonstrated especially excellent repeatability in analyzing NFD, NBD, and NFL using manual mode, indicating the quality of interpretation may still be observer-dependent. Among all SCNP parameters, NFL had the best inter-observer reliability (Spearman’s rank-sum correlation coefficient [SpCC] and ICC > 0.85 for the 3 original observers) and left–right symmetry level (SpCC and ICC > 0.60). In the additional analysis of inter-observer reliability using results by all 7 observers, only NFL showed good inter-observer reliability (ICC = 0.79). Compared with CCM measurements, values of ACCM measurements were significantly lower, implying a poor inter-module agreement. Our result suggested that performance of quantitative corneal neuroanalysis by beginners maybe acceptable, with NFL being the most reliable parameter, and automated method cannot fully replace manual work.

The Role of Time Exposed to Outdoor Light for Myopia Prevalence and Progression: A Literature Review

Purpose

The development of myopia as a refractive disorder seems to hold multifactorial causes. Among others, increased time exposed to natural light outdoors is regarded as possible effective preventive measure against myopia development. The objective of this review is to analyse and summarize the evidence investigating the association between time outdoors and myopia prevalence and progression.

Methods

A review, restricted to articles published in the last ten years, was conducted. The literature search for the included articles was performed in the following databases: PubMed, the Cochrane Library, Web of Science and Scopus. If predefined inclusion criteria were met, the studies were further categorized and data were summarized and individually evaluated.

Results

Two cross-sectional studies, 7 prospective cohort studies and 3 intervention studies were reported in this review, representing the data of a total of 32,381 participants. The majority of the studies found an inverse association between myopia incidence/prevalence and increased time outdoors. The association between time outdoors and myopia progression on the other hand remains debatable; one recent randomized controlled trial indicating a protective value of increased time outdoors for further progression in myopic children.

Conclusion

In summary, increasing time exposed to outdoor light seems to be a simple and effective preventive measure to decrease myopia prevalence. Also, contrasting previous review work, it may represent a potential strategy for myopia progression control. Future investigation is necessary to better define and quantify outdoor time and its effects on myopia.

Current trends among pediatric ophthalmologists to decrease myopia progression-an international perspective

PURPOSE

To explore what the current worldwide preferred practice patterns of pediatric ophthalmologists are to decrease myopia progression among their patients.

METHODS

A questionnaire was sent to all members of supranational and national pediatric ophthalmology and strabismus societies.

RESULTS

The questionnaire was fully completed by most respondents 90.10% (847 of 940 responses). Fifty-seven percent (457) routinely treat to decrease myopia progression. The most common parameter to initiate treatment was a myopic increase of 1 diopter/year or more (74.8%, 246). Seventy percent (345) prescribed eye drops. Atropine 0.01% was the most popular (63.4%, 277) followed by atropine 1% (10.9%, 48) and atropine 0.5% (8.9%, 39). Eighty-six percent (394) of the respondents advised to spend more time outdoors, to reduce the amount of time viewing screens (60.2%, 277), and cutback the use of smart phones (63.9%, 294).

CONCLUSIONS

Most pediatric ophthalmologists treat to decrease myopia. They employ a wide variety of means to decrease myopia progression. Atropine 0.01% is the most popular and safe modality used similarly to recent reports. However, there is no consensus when treatment should be initiated. Further prospective studies are needed to elucidate the best timing to start treatment and the applicability of recent studies in the Asian population to other ethnic groups. This will improve the ability to update pediatric ophthalmologist with evidenced-based treatment options to counter the myopia epidemic.