The optimal atropine concentration for myopia control in Chinese children: a systematic review and network Metaanalysis

AIM:To figure out whether various atropine dosages may slow the progression of myopia in Chinese kids and teenagers and to determine the optimal atropine concentration for effectively slowing the progression of myopia.METHODS:A systematic search was conducted across the Cochrane Library,PubMed,Web of Science,EMBASE,CNKI,CBM,VIP,and Wanfang database,encompassing literature on slowing progression of myopia with varying atropine concentrations from database inception to January 17,2024.Data extraction and quality assessment were performed,and a network Meta-analysis was executed using Stata version 14.0 Software.Results were visually represented through graphs.RESULTS:Fourteen papers comprising 2475 cases were included;five different concentrations of atropine solution were used.The network Meta-analysis,along with the surface under the cumulative ranking curve(SUCRA),showed that 1%atropine(100%)>0.05%atropine(74.9%)>0.025%atropine(51.6%)>0.02%atropine(47.9%)>0.01%atropine(25.6%)>control in refraction change and 1%atropine(98.7%)>0.05%atropine(70.4%)>0.02%atropine(61.4%)>0.025%atropine(42%)>0.01%atropine(27.4%)>control in axial length(AL)change.CONCLUSION:In Chinese children and teenagers,the five various concentrations of atropine can reduce the progression of myopia.Although the network Meta-analysis showed that 1%atropine is the best one for controlling refraction and AL change,there is a high incidence of adverse effects with the use of 1%atropine.Therefore,we suggest that 0.05%atropine is optimal for Chinese children to slow myopia progression.

Effect of artificial natural light on the development of myopia among primary school-age children in China:a three-year longitudinal study

AIM:To assess the efficacy of artificial natural light in preventing incident myopia in primary school-age children.METHODS:This is a prospective,randomized control,intervention study.A total of 1840 students from 39 classes in 4 primary schools in Foshan participated in this study.The whole randomization method was adopted to include classes as a group according to 1:1 randomized control.Classrooms in the control group were illuminated by usual light,and classrooms in the intervention group were illuminated by artificial natural light.All students received uncorrected visual acuity and best-corrected visual acuity measurement,non-cycloplegic autorefraction,ocular biometric examination,slit lamp and strabismus examination.Three-year follow-up,the students underwent same procedures.Myopia was defined as spherical equivalent refraction≤-0.50 D and uncorrected visual acuity<20/20.RESULTS:There were 894 students in the control group and 946 students in the intervention group with a mean±SD age of 7.50±0.53y.The three-year cumulative incidence rate of myopia was 26.4%(207 incident cases among 784 eligible participants at baseline)in the control group and 21.2%(164 incident cases among 774 eligible participants at baseline)in the intervention group[difference of 5.2%(95%CI,3.7%to 10.1%);P=0.035].There was also a significant difference in the three-year change in spherical equivalent refraction for the control group(-0.81 D)compared with the intervention group[-0.63 D;difference of 0.18 D(95%CI,0.08 to 0.28 D);P<0.001].Elongation of axial length was significantly different between in the control group(0.77 mm)and the intervention group[0.72 mm;difference of 0.05 mm(95%CI,0.01 to 0.09 mm);P=0.003].CONCLUSION:Artificial natural light in the classroom of primary schools can result in reducing incidence rate of myopia during a period of three years.

Associations between near work, outdoor activity, parental myopia and myopia among school children in Aba, Nigeria

●AIM:To assess the influence of near work,time outdoor and parental myopia on the prevalence of myopia in school children in Aba,Nigeria.●METHODS:Primary and secondary school children aged between 8 and 15 y were randomly recruited from 12 schools in Aba.Information on family history,near work and outdoor activity was obtained using myopia risk factor questionnaire.Cycloplegic refraction was performed using autorefraction technique.Myopia was defined as spherical equivalent refraction(SER)≤-0.50 D in the poorer eye.Data were analysed for 1197(male:538 and female:659)children with full relevant data.●RESULTS:Risk of developing myopia was positively associated with parental myopia[odds ratio(OR):6.80;95%CI,2.76-16.74;P<0.01)for one myopic parent and(OR:9.47;95%CI,3.88-23.13;P<0.01)for two myopic parents,longer daily reading hour(OR:1.21;95%CI,1.03-1.42;P=0.02)and less time outdoors(OR:0.8;95%CI,0.74-0.87;P<0.01).●CONCLUSION:Parental history of myopia is the most important risk factor associated with myopia.In addition,children with both parents being myopic has increased odds of developing myopia than those with one myopic parent.It is recommended therefore,that children spend more time outdoors as this could reduce the prevalence and progression of myopia.

The diluted atropine for inhibition of myopia progression in Korean children

AIM：To evaluate the efficacy and safety of three different concentrations of diluted atropine for the control of myopia in Korean children,and to assess the risk factors associated with rapid myopia progression.METHODS：A total of 285 children,with refractive errors within the range of-6 diopters（D）between 5 and 14 years of age were included.After using 0.01%,or 0.025%,or 0.05% atropine,for about 1y,changes in refraction,axial lengths and frequency of adverse events were analyzed.Logistic regression analyses were performed to evaluate the risk factors associated with rapid myopia progression.RESULTS：The changes in the mean spherical equivalent values were -0.134 D/mo in the before atropine group,-0.070 D/mo in the 0.01% atropine group,-0.047 D/mo in the 0.025% atropine group,and -0.019 D/mo in the 0.05% atropine group,with significant differences between the groups（P〈0.001）.The axial elongation was 0.046 mm/mo,0.037 mm/mo,0.025 mm/mo,and 0.019 mm/mo respectively,with significant differences between the groups（P=0.003）.The incidence of photophobia and near vision difficulty was not different among the three atropine groups（P=0.425and P=0.356,respectively）.Multivariate logistic regression analyses showed that only highly myopic parents were a significant predictive factor of rapid myopia progression in Korean children（odds ratio,8.155;95% confidence interval,3.626-18.342;P〈0.001）.CONCLUSION：Treatment with 0.01%,0.025% and 0.05% atropine solution inhibits myopia progression in Korean children in a dose-dependent manner.Children with highly myopic parents preferentially shows a rapid myopia progression rate.

Relationship between higher-order aberrations and myopia progression in schoolchildren: a retrospective study

AIM: To investigate the relationship between higher- order aberration (HOA) and myopic progression in schoolchildren. ·METHODS: Between April 23 2011 and August 29, 2011 in the children’s myopia outpatient clinic of the West China Hospital of Sichuan University, 148 eyes of 74 schoolchildren were reviewed. HOAs for a 6 -mm pupil were measured with an aberrometer. Myopic progression rate was defined according to the change in spherical equivalent refraction (SER) divided by the time span (years). Subjects with myopic progression rate of ≥0.50 diopters (D) were classified as the ’fast’group and the subjects with myopic progression rate of 【0.50D were classified as the’slow’group. A retrospective study was conducted to compare HOA between the two groups, using root mean square (RMS) values and Zernike coefficients. ·RESULTS: The RMS values of HOA (t =2.316, P =0.02), HOA without Z 4 0 (t =2.224, P =0.03),third-order aberrations (t’ =2.62, P =0.01), and coma (t’ =2.49, P =0.01) were significantly higher in the fast group than those in the slow group. The individual Zernike coefficients of Z 3 -1 (t = -2.072, P =0.04) and Z 5 1 (Z =-2.627, P =0.01) displayed statistically significant differences between the two groups. Significant correlations were found between the RMS values of HOA (r =0.193, P =0.019), RMS values of HOA without Z 4 0 (r =0.23, P =0.005), RMS values of coma(r =0.235,P =0.004),RMS values of third-order aberrations (r =0.243, P =0.003), and the progression rate. · CONCLUSION: Our results provide evidence of a relationship between HOA and myopic progression. In a future prospective longitudinal study, we aim to verify whether HOA is a risk factor for myopic progression.

Efficacy of long-term orthokeratology treatment in children with anisometropic myopia

AIM:To explore the efficacy of the orthokeratology lens for anisometropic myopia progression.METHODS:A retrospective study was performed.Cycloplegic refraction and axial length(AL)were collected from 50 children(10.52±1.72 y)who visited Peking University Third Hospital from July 2015 to August 2020.These children’s one eyes(Group A)received monocular orthokeratology lenses at first,after different durations(12.20±6.94 mo),their contralateral eyes(Group B)developed myopia and receive orthokeratology as well.The data in 1-year of binocular period were recorded.AL growth rate(difference of follow-up and baseline per month)were compared between two groups by paired t test.Interocular differences of AL were compared by Wilcoxon test.RESULTS:During monocular period,the AL growth rate of the Group A(0.008±0.022 mm/mo)was significantly slower than that of the Group B(0.038±0.018 mm/mo;P<0.0001).However,during binocular period,the AL growth rate of the Group A(0.026±0.014 mm/mo)was significantly faster than that of the Group B(0.016±0.015 mm/mo;P<0.0001).The AL difference between both eyes was 0.6(0.46)mm,then significantly decreased to 0.22(0.39)mm when started binocular treatment(P<0.0001).However,it was significantly increased to 0.30(0.32)mm after a year(P<0.0001),but still significantly lower than baseline(P<0.0001).CONCLUSION:The orthokeratology lens is efficient for control the AL elongation of monocular myopia eyes and reduce anisometropia.For the condition that the contralateral eyes develop myopia and receive orthokeratology lens later,there is no efficiency observed on control interocular difference of AL during binocular treatment.

Prevalence of refractive errors in school-aged and preadolescent children in Colombia

AIM:To describe the distribution of refractive errors by age and sex among schoolchildren in Soacha,Colombia.METHODS:This was an observational cross-sectional study conducted in five urban public schools in the municipality of Soacha.A total of 1161 school-aged and pre-adolescent children,aged 5-12y were examined during the school year 2021-2022.Examinations included visual acuity and static refraction.Spherical equivalent(SE)was analysed as follows:myopia SE≤-0.50 D and uncorrected visual acuity of 20/25 or worse;high myopia SE≤-6.00 D;hyperopia SE≥+1.00 D(≥7y)or SE≥+2.00 D(5-6y);significant hyperopia SE≥+3.00 D.Astigmatism was defined as a cylinder in at least one eye≥1.00 D(≥7y)or≥1.75 D(5-6y).If at least one eye was ametropic,children were classified according to the refractive error found.RESULTS:Of the 1139 schoolchildren included,50.6%were male,58.8%were aged between 5 and 9y,and 12.1%were already using optical correction.The most common refractive error was astigmatism(31.1%),followed by myopia(20.8%)and hyperopia(13.1%).There was no significant relationship between refractive error and sex.There was a significant increase in astigmatism(P<0.001)and myopia(P<0.0001)with age.CONCLUSION:Astigmatism is the most common refractive error in children in an urban area of Colombia.Emmetropia decreased and myopia increased with age.

Choroidal thickness,myopia,and myopia control interventions in children:a Meta-analysis and systemic review

AIM:To investigate changes of choroidal thickness(ChT) in children with myopia and the effect of current myopia control interventions on ChT.METHODS:Major literature databases were searched for studies relevant to myopia in children.All studies used swept-source optical coherence tomography(SS-OCT) or enhanced depth imaging optical coherence tomography(EDI-OCT) to measure the ChT value.The weighted mean difference(WMD) and 95% confidence interval(CI) were pooled to evaluate ChT in myopia children.RESULTS:A total of 11 eligible articles,including 1693 myopic and 1132 non-myopic eyes,were included in the first Meta-analysis.The sub-foveal choroidal thickness(SFCT;WMD=-40.06,95%CI,-59.36 to-20.75,P<0.001) and ChT at other sectors were significantly thinner in myopic eyes compared with the non-myopic eyes.The Meta-analysis revealed that the ChT decreased horizontally from the temporal sector toward the nasal sector in the pediatric myopia population.Another 11 studies reporting the effect of myopia control interventions were included in the second Meta-analysis for the relationship between myopia control treatments and ChT.SFCT significantly increased after orthokeratology(OK) treatment and OK combined with 0.01% atropine(OKA) treatment(WMD=19.47,95%CI,15.96 to 22.98,P<0.001;WMD=21.81,95%CI,12.92 to 29.70,P<0.001,respectively).The forest plots showed that SFCT changed little in myopic children receiving 0.01% atropine(P=0.30).Furthermore,the Meta-analysis showed that OK treatment had a stronger effect on the value of SFCT in myopic children as compared with 0.01% atropine(WMD=9.86;95%CI,-0.21 to 19.93,P=0.05).There is no difference between the treatment with OK and OKA treatment in ChT in myopic children(P=0.37).CONCLUSION:The ChT in myopic eyes is thinner than that in non-myopic eyes in pediatric population.Myopia control interventions including OK and OKA lead to ChT thickening,but other treatments such as 0.01% atropine did not show an increase in ChT.

Efficacy and safety of atropine at different concentrations in prevention of myopia progression in Asian children: a systematic review and Meta-analysis of randomized clinical trials

AIM:To assess the efficacy versus the adverse effects of various concentrations of atropine in the prevention of myopia in Asian children.METHODS:Databases(PubMed,EMBASE,the Cochrane Library and Web of science)were comprehensively searched from inception to April 2022.Types of studies included were randomized clinical trials(RCTs).The published languages were limited to English.Two researchers assessed the quality of included studies independently using Cochrane risk of bias tool based on the Cochrane Handbook for Systematic Reviews of Interventions.Funnel plots and Egger’s test were used for detection of publication bias.Meta-analyses were conducted using STATA(version 15.0;StataCorp).RESULTS:A total of 15 RCTs involving 2268 patients were included in the study.In the atropine group,spherical equivalent progressed at a significantly lower rate[weighted mean difference(WMD)=0.39,95%confidence interval(CI):0.23,0.54]than in the control group.A WMD of 0.15 mm was associated with less axial elongation(95%CI-0.19,-0.10).Different doses showed statistically significant differences(P<0.05)and an improved effect could result from a higher concentration.Changes in photopic pupil size and mesopic pupil size in atropine group is 0.70 mm(95%CI:0.33,1.06)and 0.38 mm(95%CI:0.22,0.54)more than the control group.In the present Meta-analysis,no changes in accommodative amplitude(AA)were associated with atropine administration.Atropine administration increased the risk of adverse effects by 1.37 times.CONCLUSION:Concentrations of less than 1%atropine are able to effectively retard diopter and axis growth of myopia in Asian children in a dose-dependent manner.Meanwhile,it caused pupil enlargement,but induced no change in the AA within this range.Further study is required to determine the dosage needed to achieve maximum efficacy and minimal side effects.

Distribution and correlation of refractive parameters in children with different corneal curvatures in southeast China

AIM:To analyze the distribution of refractive status in school-age children with different corneal curvatures(CC)and the correlation between CC and refractive status.METHODS:A total of 2214 school-aged children of grade 4 in Hangzhou who were screened for school myopia were included.Uncorrected distance visual acuity(UCDVA),non-cycloplegic refraction,axial length(AL),horizontal and vertical corneal curvature(K1,K2)were measured and spherical equivalent(SE),corneal curvature radius(CCR)and axial length/corneal radius of curvature ratio(AL/CR)were calculated.UCDVA<5.0 and SE≤-0.50 D were classified as school-screening myopia.According to the different CCRs,the patients were divided into the lower corneal curvature(LCC)group(CCR≥7.92)and the higher corneal curvature(HCC)group(CCR<7.92).Each group was further divided into the normal AL subgroup and the long AL subgroup.The refractive parameters were compared to identify any differences between the two groups.RESULTS:Both SE and AL were greater in the LCC group(P=0.013,P<0.001).The prevalence of myopia was 38% in the LCC group and 44% in the HCC group(P<0.001).The proportion of children without screening myopia was higher in the LCC group(62%)than in the HCC group(56%).Among these children without screening myopia,the proportion of long AL in the LCC group(24%)was significantly higher than that in the HCC group(0.012%;P<0.001).The change of SE in the LCC group was less affected by the increase of AL than that in the HCC group.CONCLUSION:School-aged children in the LCC group have a lower incidence of screening myopia and longer AL.Low CC can mask SE reduction and AL growth to some extent,and the change of AL growth change more in children with low CC than high CC.Before the onset of myopia,its growth rate is even faster than that after the onset of myopia.

Investigation of children’s habits of smartphone usage and parental awareness of myopia control in underdeveloped areas of China

AIM: To investigate the behaviors of smartphone usage and parental knowledge of vision health among primary students in the rural areas of China. METHODS: In this school-based, cross-sectional study, a total of 52 606 parents of students from 30 primary schools in the Xingguo County were investigated through an online questionnaire from July 2020 to August 2020. The self-designed questionnaire contained three parts: the demographic factors of both children and parents, parental knowledge and attitude toward myopia, and the preventive treatment of myopia.RESULTS: A total of 52 485 appropriately answered questionnaires were received, showing an effective response rate of 95.1%. The average age of the primary students was 10.1±0.98 y and the prevalence of myopia among the primary students was 40.3%. The age of myopia occurrence in elementary students was significantly correlated with the parents’ educational level(95%CI: 0.82-0.98, P=0.013), children’s gender(95%CI: 1.08-1.20, P<0.001), school location(county or countryside)(95%CI: 0.59-0.66, P<0.001), children’s smartphone ownership(95%CI: 1.09-1.26, P<0.001), and the average time spent on smartphone per day(95%CI: 0.78-0.88, P<0.001). School location in the county town, high family income, and high parents’educational level significantly affected both parents’ myopia awareness and children’s vision-threatening behaviors(P<0.01). Left-behind children showed a higher incidence of vision-threatening habits than those who lived with their parents(P<0.01).CONCLUSION: The results reveal the current situation of myopia development among rural primary school students and their parents. This survey will serve as a guidance for designing myopic prevention policies in the rural areas of China.

Relative peripheral refraction in school children with different refractive errors using a novel multispectral refraction topographer

AIM:To compare relative peripheral refraction(RPR)in Chinese school children with different refractive errors using multispectral refraction topography(MRT).METHODS:A total of 713 eyes of primary school children[172 emmetropia(E),429 low myopia(LM),80 moderate myopia(MM),and 32 low hypermetropia(LH)]aged 10 to 13y were analyzed.RPRs were measured using MRT without mydriasis.MRT results showed RPR at 0-15°(RPR 0-15),15°-30°(RPR 15-30),and 30°-45°(RPR 30-45)annular in the inferior(RPR-I),superior(RPR-S),nasal(RPR-N),and temporal(RPR-T)quadrants.Spherical equivalent(SE)was detected and calculated using an autorefractor.RESULTS:There were significant differences of RPR 15-30 between groups MM[0.02(-0.12;0.18)]and LH[-0.13(-0.36;0.12)](P<0.05),MM and E[-0.06(-0.20;0.10)](P<0.05),and LM[-0.02(-0.15;0.15)]and E(P<0.05).There were also significant differences of RPR 30-45 between groups MM[0.45(0.18;0.74)]and E[0.29(-0.09;0.67)](P<0.05),and LM[0.44(0.14;0.76)]and E(P<0.001).RPR values increased from the hyperopic to medium myopic group in each annular.There were significant differences of RPR-S between groups MM[-0.02(-0.60;0.30)]and E[-0.44(-0.89;-0.04)](P<0.001),and LM[-0.28(-0.71;0.12)]and E(P<0.05).There were also significant differences of RPR-T between groups MM[0.37(0.21;0.78)]and LH[0.14(-0.52;0.50)](P<0.05),LM[0.41(0.06;0.84)]and LH(P<0.05),and LM and E[0.29(-0.10;0.68),P<0.05].A Spearman’s correlation analysis showed a negative correlation between RPR and SE in the 15°-30°(P=0.005),30°-45°(P<0.05)annular(P=0.002),superior(P<0.001),and temporal(P=0.001)quadrants.CONCLUSION:Without pupil dilation,values for RPR 15-30,30-45,RPR-S,and T shows significant differences between myopic eyes and emmetropia,and the differences are negatively correlated with SE.

Two different autorefractors for vision screening in children and adolescents

AIM:To compare the consistency of two autorefractors(Tianle RM-9000 and Topcon KR-800)for school-age myopia children,and to provide a basis for largescale data analysis and comparison.METHODS:The refractive error in 909 subjects(age 4–18y)were measured using both autorefractors without cycloplegia.The data were analyzed using Fourier decomposition and the correlation coefficients,intraclass correlation coefficients(ICC),and Bland-Altman limits of agreement(LoA)for each parameter were calculated.RESULTS:There was a strong correlation between the spherical equivalent(SE),sphere diopter(DS),and cylinder diopter(DC)readings of the Tianle RM-9000 and those of the Topcon KR-800,with correlation coefficient values of 0.98,0.98 and 0.83 and ICC values of 0.99,0.99 and 0.93,respectively.However,the correlation coefficients and ICC values of J0 and J45 were unreliable(R=-0.004,-0.034;both ICC<0.10).Bland-Altman analysis revealed that SE,DS,and DC measured by the Tianle RM-9000 were significantly biased toward myopia compared with the Topcon KR-800,and the mean differences were-0.072,-0.026,-0.091 D,respectively(all P<0.01).The minimum absolute value of the difference within the 95%LoA for SE,DS,and DC was 0.63 D,0.50 D,0.62 D,respectively;all these values were in the clinically acceptable range.For J0 and J45,the mean differences were close to zero(P=0.43,0.84);however,the 95%LoA were relatively wide(J0 SD:0.53;95%CI:-1.00,1.10;J45 SD:0.52;95%CI:-1.00,1.00).CONCLUSION:The two autorefractors are consistent with each other,as the differences in SE,DS,and DC were within the clinically acceptable range.Readers can compare the data measured by either device in different studies and use the two devices in the same study to generate a dataset that can be analyzed together.However,the J0 and J45 vectors are unreliable and should not be used to assess astigmatism.

Refraction difference value variations in children and adolescents with different refractive errors

AIM:To evaluate the refraction difference value(RDV)variations in children and adolescents with different refractive errors and analyze its correlation with refractive development.METHODS:Participants aged 4-16y with different refractive statuses(hyperopia,emmetropia,myopia)underwent comprehensive eye examinations,including spherical equivalent(SE)refraction,axial length(AL),total RDV(TRDV),and RDVs at various eccentricities(0°-15°,15°-30°,30°-45°)and quadrants(inferior,superior,nasal,temporal).Statistical analysis involved one-way ANOVA for group comparisons and Pearson correlation for examining relationships between SE/AL and RDVs.Paired t-tests compared quadrant-specific RDVs within groups.RESULTS:Significant difference was found in TRDV(P<0.001),RDV15°-30°(P=0.033),RDV30°-45°(P<0.001),RDV-inferior(RDV-I,P<0.001)and RDV-temporal(RDV-T,P<0.001)among hyperopia,emmetropia and myopia group.Pearson correlation analysis revealed a negative correlation of SE with TRDV(P=0.001),RDV30°-45°(P=0.004),RDV-I(P=0.047),and RDV-T(P<0.001).The differences between RDV-superior(RDV-S)and RDV-I were statistically significant in all groups(P<0.001 for all)and between RDV-T and RDV-nasal(RDV-N)were statistically significant in hyperopia group(P<0.001).Within the premyopic group,the analysis revealed a negative correlation of SE with RDV-I(P=0.009).Pearson correlation analysis revealed a positive correlation of AL with TRDV(P=0.036),RDV15°-30°(P=0.004),RDV30°-45°(P<0.001),RDV-S(P=0.003),RDV-I(P<0.001),RDV-T(P<0.001),RDV-N(P=0.022),while revealed a negative correlation of AL with RDV0-15°(P=0.018).CONCLUSION:Our study indicates TRDV,RDV30°-45°,RDV-I,RDV-T may relate to refractive development,and a negative correlation between SE and RDV-I in pre-myopic children.

0.05% atropine on control of myopia progression in Chinese school children: a randomized 3-year clinical trial

·AIM:To evaluate the effect of 0.05%atropine on the control of myopia for 2y(phase I)and on spherical equivalent refraction(SER)progression for 1y(phase II)after its withdrawal in Chinese myopic children.·METHODS:Totally 142 children with myopia were randomly assigned to the 0.05%atropine group or to the placebo group.In phase I,children received 1 treatment for each eye daily.In phase II,the patients received no treatment.Axial length(AL),SER,intraocular pressure(IOP)and atropine-related side effects were assessed at 6 months’intervals.·RESULTS:During phase I,the mean change of SER was-0.46±0.30 D in the atropine group,compared to-1.72±1.12 D in the placebo group(P<0.001).The mean change of AL in the atropine group(0.26±0.30 mm)was significantly shorter than that in the placebo group(0.76±0.62 mm,P=0.002).In addition,in phase II(12mo after the withdrawal of atropine),there was no significant difference in AL change from the atropine group,when compared with that from the placebo group(0.31±0.25 mm vs 0.28±0.26 mm,P>0.05).Furthermore,the change in SER from the atropine group was 0.50±0.41 D,which was significantly lower than 0.72±0.60 D from placebo group,(P<0.05).Finally,there were no statistically significant differences in IOP between the treatment and control groups at any stages(all P>0.05).·CONCLUSION:The use of 0.05%atropine for two consecutive years may effectively control elongation of AL and thus progression of myopia,without significant SER progression 1y after atropine withdrawal.Therefore,treatment with 0.05%atropine daily for 2y is effective and safe.

Prevalence of Myopia in Preschool and School Children in the Municipality of Prishtina in Kosovo

Introduction: Myopia is the refractive anomaly of the eye in which the conjugate focus of the retina is at some finite point in front of the eye, when the eye is not accommodating. Myopia is else known as short-sightedness and is considered as one of the most frequent causes of reduced vision especially in adolescents. Adolescence is one of the life periods when most cases are diagnosed with myopia. Purpose: The aim of this study was to identify myopia in pre-school and school children (3 - 9 years old in Prishtina), to determine the prevalence of myopia among other refractive anomalies in cases included in the study;compare the prevalence of myopia in this population in Prishtina to other countries in the world;determine the effect of hereditary and socio-economic factors on the prevalence of myopia;and determine the degrees of myopia in our cases included in our study. Materials and Methods: This was a cross-sectional study involving 1027 pre-school children and pupils from 4 schools in Prishtina, aged 3 - 9 years old, who were screened for refractive anomalies, with a special focus on the incidence of myopia in this age group. The data were collected by screening children in the institutions of pre-school and primary school education, including 2 primary schools and two kindergarten during a two-year period 2010-2012 in Prishtina. Results: On the screening of pre-school and school children for refractive anomalies, were included 1027 subjects of ages 3 - 9 years old. Of the 1027 children screened 536 (52.2%) were male and 491 (47.8%) were female. Statistically, the prevalence of refractive anomalies in the total population studied is significant based on the resulting value (P Conclusions: The Prishtina study is a report of prevalence of myopia among pre-school and school-age children in the municipality. The study reveals that refractive error and myopia were significantly common finding among the study group, and the prevalence was found to be even higher in children within the school age-group. The number of newly diagnosed myopia was significant, suggesting the need for a robust school eye health programme, regular assessment of school children for refractive error and provision of timely refractive corrections.

Correlation of myopia onset and progression with corneal biomechanical parameters in children

BACKGROUND Recent epidemiological studies have shown that general eye measurement parameters and corneal biomechanical properties can predict the speed of myopic progression in children.AIM To investigate the correlation between the onset and progression of myopia and corneal biomechanical parameters in children.METHODS The study included 102 cases in the emmetropia group,207 cases in the myopic group,and 109 cases in the hyperopic group.The correlation between the change in corneal biomechanical indexes and the change in general ocular measurement parameters was analyzed.A one-way ANOVA test compared general ocular measurement and corneal biomechanical parameters.Pearson’s correlation coefficient was analyzed to correlate corneal biomechanical and general ocular measurement parameters.RESULTS The general ophthalmometric parameters:Spherical equivalent(SE),intraocular pressure(IOP),and axial length(AL),differed significantly among subjects in myopia,emmetropia,and hyperopic groups.Children’s SE positively correlated with corneal biomechanical parameters:Second velocity of applanation(A2V),peak distance(PD),and deformation amplitude(DA)(P<0.05),and second applanation length(A2L)(P<0.05).But it was negatively correlated with PD,DA and integral radius(IR)(P<0.05).Also,IOP was negatively correlated with A2L and IR(P<0.05).AL positively correlated with A2V and negatively correlated with second applanation time(A2T),highest concavity,and PD.Central corneal thickness positively correlated with first applanation length,first applanation time,first applanation deformation amplitude,A2V,A2L,A2T,second applanation deformation amplitude,central curvature radius at highest concavity(HCR),PD,DA,IR,ambrosia relational thickness-horizontal,first applanation stiffness parameter,corvis biomechanical index,topographic and biomechanics index and the first velocity of applanation.The general ocular Km in children positively correlated with corneal biomechanical parameters DA and IR and negatively correlated with A2L,HCR,and PD.There was a positive correlation between the general ocular measurement parametersΔSE and corneal biomechanical parametersΔA2V andΔA2L,and a negative correlation withΔIR.The increase in general ocular measurement parameterΔKm positively correlated with changes in corneal biomechanical parameters,ΔDA andΔIR,and negatively correlated withΔHCR andΔPD.CONCLUSION Myopia development in children was associated with multiple corneal biomechanical parameters.

Appendicitis combined with Meckel’s diverticulum obstruction, perforation, and inflammation in children: Three case reports

BACKGROUND Meckel’s diverticulum is a common congenital malformation of the small intestine,with the three most common complications being obstruction,per-foration,and inflammation.To date,only a few cases have been reported world-wide.In children,the clinical symptoms are similar to appendicitis.As most of the imaging features are nonspecific,the preoperative diagnosis is not precise.In addition,the clinical characteristics are highly similar to pediatric acute appendicitis,thus special attention is necessary to distinguish Meckel’s diver-ticulum from pediatric appendicitis.Patients with poor disease control should undergo laparoscopic exploration to avoid serious complications,including intestinal necrosis,intestinal perforation and gastrointestinal bleeding.CASE SUMMARY This report presents three cases of appendicitis in children combined with intestinal obstruction,which was caused by fibrous bands(ligaments)arising from the top part of Meckel's diverticulum,diverticular perforation,and diver-ticular inflammation.All three patients,aged 11-12 years,had acute appendicitis as their initial clinical presentation.All were treated by laparoscopic surgery with a favorable outcome.A complete dataset including clinical presentation,dia-gnostic imaging,surgical information,and histopathologic findings was also provided.CONCLUSION Preoperative diagnosis of Meckel’s diverticulum and its complications is challenging because its clinical signs and complications are similar to those of appendicitis in children.Laparoscopy combined with laparotomy is useful for diagnosis and treatment.

Tendency for Evolution of High Myopia in 308 Chinese School Children from Xi'an City

Purpose: To observe the refractive status, especially the tendency for evolution of high myopia, in eyes of Chinese school children from Xi’an city.Methods: The study was conducted in 11514 eyes of the 5757students aged between 7~18 years in Xi’an city primary and high schools. The inclusion criterion was >-6D of the spherical equivalent refraction. The object ophthalmic examinations were done, included non-cycloplegic objective refraction, visual acuity, intraocular pressure, fundus evaluation by ophthalmologists and nurses with professional training. Specially designed questionnaires were filled in and the data were statistically analyzed with SPSS10.0.Results: Of 11514 eyes, the detection rate was 81.4%(9376eyes) for myopia and 5.3%(615 eyes) for high myopia. High myopia was found in 2.6%.(300 eyes).of right eyes, 2.7%(315 eyes) in left eyes, and 2.4%(275 eyes) were in boys and 2.9%(340 eyes) in girls. Among 12 school grades, the detection rates of high myopia increased significantly with student age, with 0.9% in the 1stgrade of primary school and12.5% in the 3rd year of senior middle school. The average refractive error of spherical equivalent refraction was(-7.43±1.29) D with 95% confidence interval(-7.54,-7.33). No significant differences were found between the right and left eyes or both genders. The distribution of myopic severity was lowest(-6D).in primary school students younger than 12 years,was higher(-8D) in junior middle school students older than13 years, and highest(-13D) in senior middle school students.Conclusion: A continuous growth was evident in the severity of high myopia throughout 12 years of primary and middle school except for the first year of primary school, with growth occurring in two transitional stages between the senior primary and junior middle school years, and between the junior and senior middle school years. The distribution of high myopia was lowest, at-6D, in primary school, increased to-8D in junior middle school, and progressed to-10D in senior middle school, indicating a high risk of development of pathologic myopia during the students’ later lifespan. The adolescent period of 13 to 18 years of age in middle school is a critical period for the development of pathological myopia over-8D.

Relationship between Authoritative Parenting Style and Preschool Children’s Emotion Regulation:A Moderated Mediation Model

An authoritative parenting style has been shown to promote children’s emotion regulation in European-American family studies.However,little is known about how sleep problems and the child’s sibling status in Chinese families affect this relationship.Based on family system theory,this study attempts to better understand the relationship between authoritative parenting style and emotion regulation.Mothers of preschool children in Chinese kindergartens completed questionnaires about their children’s sleep habits,their authoritative parenting styles,and children’s emotion regulation.A total of 531 children participated in this study.Results showed that authoritative parenting was positively associated with emotional regulation.Sleep problems mediated the effects of authoritative parenting style on emotion regulation.The child’s sibling status moderated the mediating effects of sleep problems in authoritative parenting and emotion regulation relationships.Specifically,the relationship between the authoritative parenting style and sleep problems was significant for only children,while birth order had no significant influence on the authoritative parenting style and sleep problems in two-child families.These findings suggest that a lowauthoritative parenting style predicts low emotion regulation through sleep problems,and this depends on the child’s sibling status,indicating that children without siblings may impair emotion regulation due to increased sleep problems.