One-year results for myopia control of orthokeratology with different back optic zone diameters: a randomized trial using a novel multispectral-based topographer

AIM:To present the 1-year results of a prospective cohort study investigating the efficacy,potential mechanism,and safety of orthokeratology(ortho-k)with different back optic zone diameters(BOZD)for myopia control in children.METHODS:This randomized clinical study was performed between Dec.2020 and Dec.2021.Participants were randomly assigned to three groups wearing ortho-k:5 mm BOZD(5-MM group),5.5 mm BOZD(5.5-MM group),and 6 mm BOZD(6-MM group).The 1-year data were recorded,including axial length,relative peripheral refraction(RPR,measured by multispectral refractive topography,MRT),and visual quality.The contrast sensitivity(CS)was evaluated by CSV-1000 instrument with spatial frequencies of 3,6,12,and 18 cycles/degree(c/d);the corneal higher-order aberrations(HOAs)were measured by iTrace aberration analyzer.The one-way ANOVA was performed to assess the differences between the three groups.The correlation between the change in AL and RPR was calculated by Pearson’s correlation coefficient.RESULTS:The 1-year results of 20,21,and 21 subjects in the 5-MM,5.5-MM,and 6-MM groups,respectively,were presented.There were no statistical differences in baseline age,sex,or ocular parameters between the three groups(all P>0.05).At the 1-year visit,the 5-MM group had lower axial elongation than the 6-MM group(0.07±0.09 vs 0.18±0.11 mm,P=0.001).The 5-MM group had more myopic total RPR(TRPR,P=0.014),with RPR in the 15°–30°(RPR 15–30,P=0.015),30°–45°(RPR 30–45,P=0.011),temporal(RPR-T,P=0.008),and nasal area(RPR-N,P<0.001)than the 6-MM group.RPR 15–30 in the 5.5-MM group was more myopic than that in the 6-MM group(P=0.002),and RPR-N in the 5-MM group was more myopic than that in the 5.5-MM group(P<0.001).There were positive correlations between the axial elongation and the change in TRPR(r=0.756,P<0.001),RPR 15–30(r=0.364,P=0.004),RPR 30–45(r=0.306,P=0.016),and RPR-N(r=0.253,P=0.047).The CS decreased at 3 c/d(P<0.001),and the corneal HOAs increased in the 5-MM group(P=0.030).CONCLUSION:Ortho-k with 5 mm BOZD can control myopia progression more effectively.The mechanism may be associated with greater myopic shifts in RPR.

Effectivity and safety of trifocal intraocular lenses and capsular tension rings implantation for cataract patients with axial high myopia

●AIM:To assess effectivity and safety of trifocal intraocular lenses(IOLs)and capsular tension rings in treating cataract patients with axial high myopia.●METHODS:A prospective nonrandomized controlled clinical trial was conducted.Totally 98 eyes(74 patients)who underwent femtosecond laser-assisted cataract surgery(FLACS)with trifocal IOLs were enrolled in the study and followed up for 2y after surgery:46 eyes(33 patients)with capsular tension ring implantation in the long axial lengths(AL)group(26<AL<29 mm)and 52 eyes(41 patients)in the normal AL group(22<AL<24.5 mm).Postoperative outcomes about effectivity and safety,including the subjective and objective visual quality,and postoperative complications were assessed.●RESULTS:Uncorrected distance visual acuity at 5 m and uncorrected intermediate visual acuity at 60 and 80 cm in the long AL group were significantly worse than those in the normal AL group at 3mo postoperatively(P<0.05).The differences in reading speed,spectacle independence and potential visual complaints between the two groups were not statistically significant(P>0.05).The dysfunctional lens index and total modulation transfer function(MTF)average height were similar between the two groups.The postoperative internal coma aberrations in the axial high myopia eyes were significantly higher than that in the normal AL group(P<0.05).The total satisfaction score in the long AL group(91.32±2.76)was slightly higher than that in the normal AL group(90.36±3.47),but there was no difference(P=0.136).A statistically negative correlation was found between corrected distance visual acuity(CDVA)and dysfunctional lens index(r=-0.382,P=0.009),and between CDVA and the total MTF average height(r=-0.374,P=0.01).But there was no significant correlation between CDVA and total satisfaction score(r=0.059,P=0.696).Postoperative complications mainly presented as posterior capsular opacity(PCO),retinal detachment and cystoid macular edema.There was no difference in the incidence of fundus disease(6.5%vs 3.8%,P=0.663)or PCO(17.4%vs 7.7%,P=0.217)between the two groups at two years.●CONCLUSION:The utilization of trifocal IOL and capsular tension ring implantation is beneficial for cataract patients with axial high myopia undergoing FLACS.This approach not only ensures excellent subjective feelings and objective visual quality,but also does not increase the incidence of postoperative complications.

The Research on the Paths of Popular Science Education about Myopia Prevention and Control among College Students in the Context of Shifting the Focus Forward

Currently, the number of myopic people in China has reached as high as 600 million, and it shows a trend of “early onset, high incidence, and a high degree of severity”. The issue of myopia among children and adolescents has attracted widespread attention from all sectors of society. Comprehensive myopia prevention and control efforts have been launched nationwide. Popular science education, vision screening, and improving visual environments are effective measures for preventing myopia. However, among the target audience for comprehensive myopia prevention and control, the preschool children group has been neglected, and the work of myopia prevention and control for this group has been significantly weakened and marginalized. Due to insufficient awareness of prevention and control, the hyperopia reserve in the preschool children group is being continuously depleted, leading to the early onset of myopia. In light of this situation, the focus of myopia prevention and control needs to shift forward, and it is worth exploring and pondering how college students with a background in optometry can develop entertaining and engaging popular science education materials and methods.

Retrospective Case Series on The Enduring Rotational Stability of The AcrySof IQ Toric Intraocular Lens in Cataract Patients Suffering from Myopia

Objective:To analyze the enduring rotational steadiness of AcrySof IQ Toric intraocular lens(IOL)in cataract patients suffering from myopia in a long-term study.Methods:A retrospective study was conducted on a case series involving 78 patients.A total of 120 eyes with an axial length(AL)ranging from 24-30 mm and corneal astigmatism≥1.50 D underwent implantation of AcrySof IQ Toric IOL guided by the version navigation system.The eyes were divided into two groups based on AL.Group A included 60 eyes with high myopia(AL≥26 mm),while Group B consisted of eyes with low to moderate myopia(24 mm≤AL<26 mm).Data on the preoperative AL were collected.Measurements were taken for residual astigmatism,the best corrected visual acuity(BCDVA),corneal astigmatism,and IOL rotation occurring between 24-and 48-months post-surgery.The percentage of eyes with an IOL rotation of under 5°and 10°was analyzed.Results:The mean length of follow-up times was recorded as 34.27±4.98,and the average rotation was 2.73±1.29°.Group A exhibited a slightly higher average rotation of 2.87±1.31°,compared to the rotation of 2.59±1.27°observed in Group B.At both the 24-36 month and 26-48 month post-operation marks,the degree of IOL rotation did not show a statistically significant difference between the two groups,with none of the patients experiencing a rotation exceeding 10°(P>0.05).The percentage of rotation degrees under 5°was recorded as 98.22%.After the procedure,the BCDVA was 0.1322±0.03 LogMAR.There was a substantial increase in theχvalue after the operation as compared to the pre-operativeχ^(2) value(χ^(2)=76.79).The standard deviation of preoperative corneal astigmatism was statistically significant(P<0.05)at 2.17±1.08 D.Following the surgical procedure,the remaining astigmatism was measured at 0.41±0.26 D.The data showed a notable gap in statistical significance(t=4.281,P<0.05).Conclusion:The AcrySof Toric IOL was a reliable solution for managing corneal astigmatism in cataract patients with myopia,demonstrating excellent long-term rotational stability.

Evaluation of the Clinical Efficacy of Full Femtosecond Laser Surgery in the Treatment of Myopia

Objective:To evaluate the clinical effect of full femtosecond laser surgery in the treatment of myopia patients.Methods:120 myopia patients admitted to our hospital from January 2022 to June 2023 were selected.According to the random number table method,60 patients in the observation group underwent full femtosecond laser surgery,and 60 patients in the control group underwent femtosecond laser-assisted in situ keratomileusis(FS-LASIK)surgery.The clinical effects of the two groups were compared.Results:10 days postoperatively and 6 months after operation,the visual acuity level of the observation group was higher than that of the control group,the postoperative corneal asphericity coefficient and corneal full-thickness were lower than those of the control group,and the total effective rate 6 months after operation was higher than that of the control group(P<0.05).Conclusion:Full femtosecond laser surgical treatment can improve the postoperative visual acuity of patients with myopia,enhance the corneal asphericity coefficient(Q)and corneal full-thickness,and exert significant clinical effects.

Improving myopia awareness via school-based myopia prevention health education among Chinese students

AIM:To investigate the myopia awareness level,knowledge,attitude,and skills at baseline and to implement and evaluate the efficacy of myopia prevention health education among Chinese students.METHODS:A total of 1000 middle school students from 2 middle schools were invited to participate in the study,and myopia prevention health education was conducted.The students were assessed at baseline,followed by a survey.The efficacy of health education was evaluated using the self-comparison method pre-and post-health education.RESULTS:The study included 957 and 850 pre-and post-health education par ticipants,respectively.The baseline knowledge of all respondents on myopic symptoms(87.5%),myopia is a risk of eyes(72.9%),myopia prevention(91.3%),myopia increases with age(86.7%),performing periodic eye examinations(92.8%),and one first,one foot,and one inch(84.8%)significantly increased after health education(P<0.001 for all).However,the percentage of students who still did not think it necessary to take breaks after 30-40min of continuous near work was 27.0%.The opinion that“myopia can be cured”was still present in 38.3%.CONCLUSION:Implementing school-based myopia prevention health education improves knowledge,attitudes,and skills regarding myopia among Chinese middle school students.

Time trends in myopia and high myopia prevalence in young university adults in China

AIM:To investigate time trends in myopia and high myopia prevalence over 6y among young university adults in China.METHODS:This is a 6-year series cross-sectional study from 2016 to 2021.Totally 4910 freshmen were enrolled and completed a questionnaire concerning age,gender,and disease history.Students with eye diseases were excluded after a detailed eye examination.The refractive status was measured by non-cycloplegic objective refraction and ocular parameters were measured by Lenstar 900.The examination followed the same protocol each year.Trends over time in myopia and high myopia prevalence,as well as ocular biometry parameters,were analyzed.RESULTS:From 2016 to 2021,the axial length(AL)and corneal radius(CR)increased significantly(P=0.002 for AL;P=0.04 for CR).However,the spherical equivalent(SE)and the ratio of axial length to the corneal radius(AL/CR)did not change significantly(P=0.59 for SE;P=0.24 for AL/CR).The frequency of AL≥26.0 mm increased from 26.6%in 2016 to 29.3%in 2021(P=0.05 for trend).The prevalence of myopia and high myopia did not change significantly in our study(P≥0.18).Compared to a similar cross-sectional study conducted 10 years ago,the prevalence of myopia decreased significantly(94.9%vs 91.8%,P<0.001).Whereas the prevalence of high myopia increased largely(18.12%vs 27.6%,P<0.001).CONCLUSION:The prevalence of high myopia increases in young university adults during 10y period.Myopia control should begin earlier in childhood.However,these interventions are still needed for high myopia even in young adulthood.

Perspectives and clinical practices of optometrists in Saudi Arabia concerning myopia in children

AIM:To investigate the practice patterns of optometrists in Saudi Arabia regarding myopia management.METHODS:An internet-based survey was distributed to all practicing optometrists in Saudi Arabia(n=1886).The survey contained questions related to 1)demographics,2)knowledge about myopia and its associated complications,3)current clinical care,4)type and frequency of myopia treatment prescribed,and 5)potential barriers limiting treatment adoption.RESULTS:The completed surveys were collected from 171 optometrists(9.06%response rate,60%male).Knowledge regarding myopia-associated complications was prevalent but somewhat inaccurate among the respondents.Cycloplegic refraction at initial visit was used by 59%of the respondents.The cover test was the most reported binocular vision test(83%),and 38%of optometrists did not perform any ocular biometrics.Twothirds prescribed single-vision spectacles for children with myopia.Increased time spent outdoors was selected by 80%of the practitioners who prescribed myopia control treatment as the primary approach.Insufficient support and lack of clinical experience in providing myopia treatment were reported as the most important factors limiting the adoption of myopia management strategies.CONCLUSION:The current optometric practices in Saudi Arabia require further investigation.Optometrists appear to be somewhat aware of myopia and the associated risks.However,most evidence-based myopia treatments are not being locally adopted,primarily because of lack of support,lack of experience,and limited availability.

Progression of myopia among undergraduate students in central China

AIM:To investigate the progression of myopia and risk factors among university students in central China.METHODS:A total of 7359 first-year undergraduate students at Huazhong University of Science and Technology in central China were recruited to the study and invited to a centralized clinic for medical examination,including optometry,and re-examined after one year.Correlation analyses were performed to assess the associations between one-year myopia progression and various parameters.RESULTS:The spherical equivalent refraction for the overall population was-3.14±2.28 D at baseline.The rate of myopia progression over 0.50 D after one year was 41.9%,and the 1-year progression of myopia was-0.47±0.58 D.There was no difference of mean 1-year myopia progression between male and female or difference among age group.The myopia progression of original myopia was severer than progression of new-onset myopia.There was also difference of mean myopia progression among different degrees of myopia at baseline.The under corrected eyes had a higher percentage of myopia progression than well corrected eyes(χ^(2)=7.90,P<0.01).There was no correlation between myopia progression and height,weight,body mass index,hemoglobin(Spearman correlation,ρ=-0.078,-0.152,-0.170,-0.096,respectively,all P>0.05).CONCLUSION:Myopes still progress in undergraduate students,especially in high myopes.

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.

Long-term observation on safety and visual quality of implantable collamer lens V4c implantation for myopia correction:a 5-year follow-up

AIM:To elucidate the safety and visual quality of implantable collamer lens with central hole(ICL V4c)implantation for correcting moderate and high myopia for at least 5y.METHODS:This retrospective study was conducted on 58 patients(114 eyes)who were followed up for at least 5y after ICL V4c implantation.The observation was done before and on 1d,1mo,1 and 5y or more after the surgical procedure.The visual acuity,subjective refraction,intraocular pressure,vault,axial length,central hole position,pupil diameter,visual quality,and adverse events were analyzed.The visual quality includes aberration,the modulation transfer function cutoff frequency(MTF cutoff),objective scattering index(OSI),Stroller's ratio(SR),and visual quality questionnaire.RESULTS:The average follow-up period was 69.25±3.80mo(range 60–82mo)and the preoperative spherical equivalent(SE)was-8.66±1.97 D.At 5y after operation,the safety index was 1.01±0.02 and the efficacy index was 0.99±0.42 and SE was-0.65±0.63 D.The 59.6%of the eyes achieved an uncorrected distance visual acuity of 20/20,76.3%of the eyes had SE within±1.0 D at the last visit.The axial length increased by 0.29±0.71 mm 5y after the surgery(t=-3.843,P<0.001).The mean vault at the last follow-up was 510.59±245.61μm.The central hole was on the temporal side in 80 eyes(84.2%).The visual quality questionnaire showed that 98.2%patients were satisfied with the surgical procedure.Adverse events occurred in 4 eyes(3.5%),including the posttraumatic toric ICL rotation(2 eyes),iris incarceration(1 eye),and posttraumatic ICL displacement(1 eye)at the last follow-up.CONCLUSION:Long-term ICL V4c implantation is safe,effective,and stable for correcting moderate and to high myopia,and the visual quality with patients is excellent and satisfactory,but the progression of axial length still needs attention after surgery.

Effects of endogenous dopamine induced by low concentration atropine eye drops on choroidal neovascularization in high myopia mice

AIM:To evaluate effects of endogenous dopamine induced by low concentration atropine eye drops on choroidal neovascularization(CNV)in high myopia mice.METHODS:The C57BL/6J mice were deprived of the right eye for 4wk,and the high myopia was diagnosed by optometry,the diopter was less than-6.00 D,and CNV was induced by 532 nm laser.The changes of dopamine D1 receptor(DRD1),dopamine D2 receptor(DRD2),and vascular endothelial growth factor A(VEGFA)were detected by Western blot technology at 0.5,1,2h,and 7d after 0.01%,0.05%,and 0.1%atropine eye drops,respectively,the area of CNV was measured.RESULTS:Significant increases were observed on the expression of DRD2 in mouse high myopia model at 0.5,1,2h,7d with 0.05%and 0.1%atropine eye drops(P<0.05).Significant decreases were observed on the expression of DRD1 and VEGFA in mouse high myopia model at 0.5,1,2h,7d with 0.05%and 0.1%atropine eye drops(P<0.05).The area of CNV induced by laser in the drug-treated group was significantly smaller than that in the control group,and the higher the concentration,the more significant the inhibitory effect(P<0.05).CONCLUSION:The 0.01%,0.05%,0.1%atropine eye drops can decrease the level of VEGFA and inhibit high myopia CNV indirectly by up-regulating the level of DRD2 and down-regulating the level of DRD1,and the effect of 0.05%and 0.1%atropine eye drops is more significant.

Orthokeratology with increased compression factor in adolescent myopia control:a 2-year prospective randomized clinical trial

AIM:To explore the long-term efficacy,safety,and optical mechanism of orthokeratology with increased compression factor in adolescent myopia control.METHODS:A prospective,double-masked,and randomized clinical trial was performed from May 2016 to June 2020.Subjects aged between 8 and 16y,with myopia(-5.00 to-1.00 D),low astigmatism(≥-1.50 D)and anisometropia(≤1.00 D),were stratified into low(-2.75 to-1.00 D)and moderate(-5.00 to-3.00 D)myopia groups.Then they were randomly assigned to wear either increased compression factor(ICF;1.75 D)orthokeratology or conventional compression factor(CCF;0.75 D)orthokeratology.The data were recorded including axial length(AL),spherical equivalent(SE),best corrected visual acuity(BCVA),near visual acuity(NVA),corneal staining(using Efron grading scales),corneal hysteresis(CH),corneal resistance factor(CRF),higher-order aberrations(HOAs,expressed as root mean square,RMS_(h)),and subfoveal choroidal thickness(SFCh T)in the 2-year followup period.Pearson's correlation coefficient was conducted to analyze the association between the changes in AL and RMS_(h),SFCh T.RESULTS:At the 2-year visit,there were no statistical differences in all the parameters between the ICF group and the CCF group in low myopia subjects(P>0.05).For the moderate myopia subjects,the ICF group had shorter AL elongation(0.23±0.08 vs 0.30±0.11 mm,P=0.015),higher RMS_(h)(1.94±0.50 vs 1.65±0.51μm,P=0.041),and higher SFCh T(279.04±35.72 vs 254.08±29.60μm,P=0.008)than those in CCF group.The change in AL was negatively correlated with RMS_(h)(r=-0.687,P<0.001)and SFCh T(r=-0.464,P=0.013).CONCLUSION:ICF orthokeratology can control the progression of moderate myopia more effectively,which might be related to greater RMS_(h) and SFCh T.

A 3-month comparison study of subjective and objective visual quality of small incision lenticule extraction and transepithelial photorefractive keratectomy in patients with low and moderate myopia

AIM:To compare the subjective and objective visual quality between small incision lenticule extraction(SMILE)and transepithelial photorefractive keratectomy(t PRK)in patients with low and moderate myopia.METHODS:Patients undertaking SMILE or t PRK for the correction of low and moderate myopia were consecutively recruited in this prospective cohort study with a 3-month follow-up period.Objective evaluation[visual acuity test,manifest refraction,wavefront aberrations,the total cut-off value of the total modulation transfer function(MTFcut-off),and Strehl ratio(SR)]and subjective evaluation of visual quality(quality-of-life questionnaire)were conducted before surgery and at days 1,7,30,and 90 after surgery.RESULTS:A total of 47 patients(94 eyes)with SMILE and 22 patients(22 eyes)with t PRK were enrolled.The uncorrected visual acuity(UCVA)was better in SMILE patients on day 7 after surgery(1.13±0.13 vs 0.99±0.17,t=4.85,P<0.001)but was comparable at days 30 and 90.At day 90,the SMILE group had a lower spherical equivalent(SE)than the t PRK group(0.04±0.31 vs 0.19±0.43,t=2.08,P=0.042).Total higher order aberrations(HOAs)were induced in both surgical types,which were more evident in the t PRK group with 3-mm pupil diameter(0.16±0.07 vs0.11±0.05,t=4.27,P<0.001)and 5-mm pupil diameter(0.39±0.17 vs 0.36±0.11,t=2.33,P=0.022).The MTFcut-offand SR showed a trend of improvement in both SMILE and t PRK patients but were statistically better in the SMILE group with both pupil diameters.There was a significant improvement of contrast sensitivity(CS)over baseline levels at the spatial frequency of 18 cycles/degree(c/d)in the SMILE group(F=2.72,P=0.033)and at 3 c/d(F=3.03,P=0.031),12 c/d(F=3.72,P=0.013),and 18 c/d(F=4.62,P=0.004)in the t PRK group.The subjective quality of life questionnaire showed a steady improvement in the SMILE group(F=8.31,P<0.001)but not the t PRK group.CONCLUSION:SMILE and t PRK are both safe and effective ways to correct low and moderate myopia.A generally better and quicker recovery of visual quality favors the application of SMILE in qualified patients.

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.

Evaluation of a novel deep learning based screening system for pathologic myopia

AIM:To evaluate the clinical application value of the artificial intelligence assisted pathologic myopia(PM-AI)diagnosis model based on deep learning.METHODS:A total of 1156 readable color fundus photographs were collected and annotated based on the diagnostic criteria of Meta-pathologic myopia(PM)(2015).The PM-AI system and four eye doctors(retinal specialists 1 and 2,and ophthalmologists 1 and 2)independently evaluated the color fundus photographs to determine whether they were indicative of PM or not and the presence of myopic choroidal neovascularization(mCNV).The performance of identification for PM and mCNV by the PMAI system and the eye doctors was compared and evaluated via the relevant statistical analysis.RESULTS:For PM identification,the sensitivity of the PM-AI system was 98.17%,which was comparable to specialist 1(P=0.307),but was higher than specialist 2 and ophthalmologists 1 and 2(P<0.001).The specificity of the PM-AI system was 93.06%,which was lower than specialists 1 and 2,but was higher than ophthalmologists 1 and 2.The PM-AI system showed the Kappa value of 0.904,while the Kappa values of specialists 1,2 and ophthalmologists 1,2 were 0.968,0.916,0.772 and 0.730,respectively.For mCNV identification,the AI system showed the sensitivity of 84.06%,which was comparable to specialists 1,2 and ophthalmologist 2(P>0.05),and was higher than ophthalmologist 1.The specificity of the PM-AI system was 95.31%,which was lower than specialists 1 and 2,but higher than ophthalmologists 1 and 2.The PM-AI system gave the Kappa value of 0.624,while the Kappa values of specialists 1,2 and ophthalmologists 1 and 2 were 0.864,0.732,0.304 and 0.238,respectively.CONCLUSION:In comparison to the senior ophthalmologists,the PM-AI system based on deep learning exhibits excellent performance in PM and mCNV identification.The effectiveness of PM-AI system is an auxiliary diagnosis tool for clinical screening of PM and mCNV.

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.

Role of 7-methylxanthine in myopia prevention and control: a mini-review

·Myopia is becoming increasingly common. By 2050 around 10% of the world’s population is expected to be highly myopic(<-5 diopters) and therefore particularly at risk of suffering from sight-threatening complications. Currently used myopia control treatments, such as multifocal soft contact lenses or spectacle lenses, orthokeratology, and atropine eyedrops, either do not completely arrest myopia progression or are associated with significant ocular and possibly systemic side effects. A new candidate for pharmaceutical control of myopia progression and excessive eye elongation, the non-selective adenosine antagonist 7-methylxanthine(7-MX), appears to be nontoxic and effective in reducing myopia progression and axial eye growth in experimental and clinical studies. The latest findings regarding 7-MX for myopia control and evaluate its potential as a supplement to existing treatment options were reviewed.

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

AIM:To evaluate the quality of life(QOL)and level of depression among participants with high myopia in Nigeria and the demographic factors associated with these outcomes.METHODS:This cross-sectional study was conducted on 100 adult participants with high myopia(defined as refractive error≤-5.00 D or worse,and uncorrected visual acuity worse than 6/18 in the better seeing eye)attending ophthalmology centres in Nigeria from 2 October 2021 to 30 August 2022.The means and standard deviations were calculated for each of the four domains of World Health Organization Quality of life scale(WHOQOL-BREF)using the transformed scores.The Beck Depression Inventory(BDI)scale was used to assess the level of depression.RESULTS:The highest and the lowest mean scores of WHOQOL-BREF domains were found for the psychological and physical health domains(mean percentage scores were 67.0[95% confidence intervals(CI)64.1-68.9]and 55.3(95%CI 51.8-58.8,P<0.001),respectively.One-way analysis of variance(ANOVA)revealed significant differences in physical health with educational status(higher among those with tertiary education:mean difference 0.9,95%CI-0.2-2.1;P=0.049),differences in psychological health with working status(higher among those who were working 1.2,95%CI 0.3-2.1;P=0.012).Also,the result showed a statistically significant association between environmental health and marital status(higher among non-married:1.7,95%CI-0.9-2.3;P=0.012)while overall health was associated with place of residence(higher in urban areas:2.3,95%CI 1.2-3.5;P=0.024).For depression,one in every nine participants reported major depressive symptom,mostly younger people(aged 16-29 vs 30-49y:17.0%vs 0,P=0.019),and slightly more women than men(14.3%vs 0,P=0.064).There were significant negative correlations between the depression scores and psychological health(r=-0.48,P<0.001),physical health(r=-0.29,P=0.002),social and relationship(r=-0.49,P<0.001),environmental(r=-0.48,P<0.001)and overall health(r=-0.49,P<0.001)CONCLUSION:People with high myopia have a relatively moderate QOL,but poor physical health,particularly the younger age group,and women who are more likely to experience clinically relevant depression.Eye care professionals should consider possible referrals for counselling for people with high myopia.

Changes of optic nerve head microcirculation in high myopia

AIM:To analyze the correlation of age,spherical equivalent(SE),and axial length(AL)with the microcirculation of optic nerve head(ONH)in high myopia(HM).METHODS:In this cross-sectional clinical study,164 right eyes were included.Optical coherence tomography angiography(OCTA)was used to detect ONH vessel density.Eyes were classified based on age,SE,and AL.Groups of Age1,Age2,and Age3 were denoted for age classification(Age1<20y,20y≤Age2<30y,Age3≥30y);Groups SE1,SE2,and SE3 for the SE classification(-9≤SE1<-6 D,-12≤SE2<-9 D,SE3<-12 D);Groups AL1,AL2,AL3,and AL4 for the AL classification(AL1<26 mm,26≤AL2<27 mm,27≤AL3<28 mm,AL4≥28 mm).RESULTS:No significant difference was observed in vessel density among the Age1,Age2,and Age3 groups(all P>0.05)and the SE1,SE2,and SE3 groups(all P>0.05).No significant difference was observed in the intrapapillary vascular density(IVD)among AL1,AL2,AL3,and AL4 groups(P>0.05).However,a significant decrease was found in the peripapillary vascular density(PVD)in the AL1,AL2,AL3,and AL4 groups(F=3.605,P=0.015),especially in the inferotemporal(IT;F=6.25,P<0.001),temporoinferior(TI;F=2.865,P=0.038),and temporosuperior(TS;F=6.812,P<0.001)sectors.The IVD was correlated with age(r=-0.190,P<0.05)but not with SE or AL(P>0.05).The PVD was correlated with AL(r=-0.236,P<0.01)but not with age or SE(P>0.05).CONCLUSION:With the increase of AL,the IVD remains stable while the PVD decreases,especially in the three directions of temporal(IT,TI,and TS).The main cause of microcirculation reduction may be related to AL elongation rather than an increase in age or SE.