Medicine › Epidemiology

Ophthalmology and Visual Impairment Studies

Works Count: 42953

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This cluster of papers focuses on the global epidemiology of myopia and visual impairment, including the prevalence, risk factors, progression, and treatment of myopia, refractive errors, and related conditions. It also explores the impact of environmental factors, genetic influences, and interventions such as orthokeratology and atropine therapy.

Keywords

Myopia; Visual Impairment; Epidemiology; Refractive Error; Global Prevalence; Childhood Myopia; Uncorrected Refractive Errors; Amblyopia; Ocular Aberrations; Orthokeratology

Parental myopia, near work, school achievement, and children's refractive error.

2002-12-01

Donald O. Mutti , G. Lynn Mitchell , Melvin L. Moeschberger +2 more

To quantify the degree of association between juvenile myopia and parental myopia, near work, and school achievement.Refractive error, parental refractive status, current level of near activities (assumed working distance-weighted hours … To quantify the degree of association between juvenile myopia and parental myopia, near work, and school achievement.Refractive error, parental refractive status, current level of near activities (assumed working distance-weighted hours per week spent studying, reading for pleasure, watching television, playing video games or working on the computer), hours per week spent playing sports, and level of school achievement (scores on the Iowa Tests of Basic Skills [ITBS]) were assessed in 366 eighth grade children who participated in the Orinda Longitudinal Study of Myopia in 1991 to 1996.Children with myopia were more likely to have parents with myopia; to spend significantly more time studying, more time reading, and less time playing sports; and to score higher on the ITBS Reading and Total Language subtests than emmetropic children (chi(2) and Wilcoxon rank-sum tests; P < 0.024). Multivariate logistic regression models showed no substantial confounding effects between parental myopia, near work, sports activity, and school achievement, suggesting that each factor has an independent association with myopia. The multivariate odds ratio (95% confidence interval) for two compared with no parents with myopia was 6.40 (2.17-18.87) and was 1.020 (1.008-1.032) for each diopter-hour per week of near work. Interactions between parental myopia and near work were not significant (P = 0.67), indicating no increase in the risk associated with near work with an increasing number of parents with myopia.Heredity was the most important factor associated with juvenile myopia, with smaller independent contributions from more near work, higher school achievement, and less time in sports activity. There was no evidence that children inherit a myopigenic environment or a susceptibility to the effects of near work from their parents.

Proper Method for Calculating Average Visual Acuity

1997-07-01

Jack T. Holladay

Worldwide prevalence and risk factors for myopia

2011-12-12

Chen‐Wei Pan , Dharani Ramamurthy , Seang‐Mei Saw

Citation information: Pan C‐W, Ramamurthy D & Saw S‐M. Worldwide prevalence and risk factors for myopia. Ophthalmic Physiol Opt 2012, 32, 3‐16. doi: 10.1111/j.1475‐1313.2011.00884.x Abstract Background: Myopia, the most common … Citation information: Pan C‐W, Ramamurthy D & Saw S‐M. Worldwide prevalence and risk factors for myopia. Ophthalmic Physiol Opt 2012, 32, 3‐16. doi: 10.1111/j.1475‐1313.2011.00884.x Abstract Background: Myopia, the most common type of refractive error, is a complex trait including both genetic and environmental factors. Numerous studies have tried to elucidate the aetiology of myopia. However, the exact aetiology of myopia is still unclear. Purpose: To summarize the worldwide patterns and trends for the prevalence of myopia and to evaluate the risk factors for myopia in population‐based studies. Recent findings: The prevalences of myopia vary across populations of different regions and ethnicities. In population‐based studies on children, the prevalence of myopia has been reported to be higher in urban areas and Chinese ethnicity. The regional and racial difference is not so obvious in adult populations aged over 40 years. More time spent on near work, less time outdoors, higher educational level and parental history of myopia have been reported to increase the risk of myopia. Conclusions: Environmental factors play a crucial role in myopia development. The effect of gene‐environment interaction on the aetiology of myopia is still controversial with inconsistent findings in different studies. A relatively hyperopic periphery can stimulate compensating eye growth in the centre. Longitudinal cohort studies or randomized clinical trials of community‐based health behaviour interventions should be conducted to further clarify the aetiology of myopia.

The arrangement of the three cone classes in the living human eye

1999-02-01

Austin Roorda , David R. Williams

Visual Acuity and the Causes of Visual Loss in Australia

1996-03-01

Karin Attebo , Paul Mitchell , Wayne Smith

Effect of Time Spent Outdoors at School on the Development of Myopia Among Children in China

2015-09-15

Mingguang He , Fan Xiang , Yangfa Zeng +6 more

IMPORTANCE Myopia has reached epidemic levels in parts of East and Southeast Asia.However, there is no effective intervention to prevent the development of myopia.OBJECTIVE To assess the efficacy of increasing … IMPORTANCE Myopia has reached epidemic levels in parts of East and Southeast Asia.However, there is no effective intervention to prevent the development of myopia.OBJECTIVE To assess the efficacy of increasing time spent outdoors at school in preventing incident myopia.

Visual acuity measurements

2004-02-01

Jack T. Holladay

Modern visual acuity charts are designed so the letter sizes on each line follow a geometric progression (ie, change in a uniform step on a logarithmic scale).1–3 The accepted step … Modern visual acuity charts are designed so the letter sizes on each line follow a geometric progression (ie, change in a uniform step on a logarithmic scale).1–3 The accepted step size has been chosen to be 0.1 log unit, which is equivalent to letter sizes changing by a factor of 1.2589 between lines. This standard gave rise to the logMAR (logarithm of the minimum angle of resolution) notation as shown in Table 1, column 3. The bold values correspond to the accepted logMAR steps. Values that are not in logMAR steps such as 20/30, 20/60, 20/70, 20/150, and 20/300 are included because of their common appearance in older visual acuity charts. A geometric progression of lines on the visual acuity chart was chosen because it parallels the way our visual system functions. If patient 1 has a visual acuity of 20/20 and patient 2 has a visual acuity of 20/40, we conclude that patient 1 has two times better visual acuity than patient 2 because he/she can recognize a letter twice as small. Once we have chosen to compare vision as a ratio using a reference visual angle (20/20), a geometric progression results and a geometric mean must be calculated for a meaningful result.Table 1: Visual acuity conversion chart.Notice that in Table 1, the only values that increase linearly are the line numbers and the logMar notation. Snellen acuity, decimal acuity, and visual angle increase by the geometric factor of 1.2589. Once we have decided that equal steps in visual acuity measurement are geometric and not arithmetic, we must use the appropriate geometric mean to compute the correct average. In Table 1, we see that line 0 is the 20/20 Snellen acuity that corresponds to the logMAR value zero, since 20/20 is the standard. We also see that line 10 is 20/200 Snellen visual acuity, which corresponds to a logMAR value of 1.0 (10 times or 1 log unit worse than 20/20). Intuitively, it would appear that halfway between line 0 and line 10 would be line 5 or 20/63. This is the correct average, because geometrically it is halfway between 20/200 and 20/20. Calculating the average visual acuity and standard deviation in a series of patients is not difficult, but has been done incorrectly in most studies.4 The basic problem relates to the difference between the arithmetic and geometric mean for a set of numbers. For the correct average visual acuity, the geometric mean must be used, which gives significantly different values than the arithmetic mean. The simplest method for computing the proper average visual acuity from any notation is to convert the value to the logMAR equivalent and then take the average of the logMAR values. The easiest way to compute the logMAR value is to convert to the decimal notation and then take the negative of the logarithm. For example, 20/20 = 1 and the log of 1 is 0, and 20/200 = 0.10 and the negative of the log is +1.0; the average of 0 and +1.0 is 0.5 logMAR units. Converting back from the logMAR value of 0.5, the corresponding visual acuity is 20/63, the correct geometric average. The formulas for going from decimal to logMAR and then back are as follows: Two other considerations occur when sets of visual acuity measurements are evaluated: (1) what to do with values of counting fingers, hand motion, light perception, etc., and (2) how to compute the correct value if the patient did not read all the letters on the line completely. Counting Fingers, Hand Motion, Light Perception, No Light Perception Counting fingers at a given distance can be converted to a Snellen equivalent by assuming that the fingers are approximately the size of the elements of a 200 letter. Therefore, a person who can count fingers at 20 feet would have approximately 20/200 vision.5 A person able to count fingers at 2 feet would have 2/200 vision or the equivalent of 20/2000. This value is somewhat conservative because a hand against a white coat is much lower contrast than a black letter on a white background. Also, the examiner usually uses 4 or fewer fingers, making the number of forced choices less than the number of Snellen optotypes (10). From studies we have performed in our low-vision clinic, hand motion at a given distance is 10 times worse than counting fingers; ie, a person who can detect hand motion at 20 feet has approximately 20/2000 Snellen visual acuity equivalent. A person who has hand motion at 2 feet would have an equivalent Snellen acuity of 20/20000. Light perception with and without projection and no light perception are not actually visual acuity measurements, but simply the detection of a stimulus. These cases should be excluded and described in the materials and methods section of the manuscript. Patient Cannot Read Entire Line It is very common for visual acuity sets to include values in which the patient did not read all of the letters on a single line correctly. Although recording the last line that was read completely or the majority of letters (3 out of 5) is an acceptable method, it reduces the precision of the measurement, similar to rounding off laboratory measurements. A more accurate method is to interpolate between the values of the logMAR acuity using the fraction of the number of letters correctly read on a visual acuity line. For example, suppose our acuity chart had 5 letters on each visual acuity line and the patient read all the letters on the 20/50 (logMAR = +0.4) line but only 3 of the 5 letters on the 20/40 (logMAR = +0.3) line. Three fifths (3/5 = 0.6) of the way from logMAR +0.4 to +0.3 is logMAR +0.34. The logMAR value of +0.34 is the correct value for this patient's visual acuity. For studies that involve large data bases, in which converting the values manually is tedious, we have published the formulas that allow direct conversion from the Snellen acuity value to the interpolated logMAR value.6 These formulas work only if there are an equal number of letters on a line, such as the Bailey-Lovie visual acuity chart3 and other standardized charts.6 Unfortunately, if the number of letters on the acuity chart are not equal on each line (as occurs on many projector and wall charts), a table must be created that shows the conversion interpolation for each line and a single formula is not possible. Sample Calculations Once the logMAR value for the visual acuity of each patient has been obtained, statistical analyses on the data set can be performed. All statistical calculations (means, standard deviations, standard errors of the mean, correlation coefficients, etc.) must be calculated using logMAR values for visual acuity. Performing these analyses using any other value for visual acuity will lead to erroneous results.7,8 Table 2 gives a 7-patient sample data set to illustrate the correct calculations and serves as a guide for an investigator to use to validate his/her calculation method. The average value and standard deviation are calculated using the logMAR values. The average logMAR acuity was 0.85 and the standard deviation was 1.24, normally expressed as 0.85 ± 1.24. To determine the equivalent decimal acuity for the average, we must use equation 2 above:Table 2: Visual acuity data set for 7 theoretical eyes. The only meaningful conversion of the standard deviation in logMAR units is to lines of visual acuity. Since each line of the standardized visual acuity chart increases by 0.1 log units, a standard deviation of ±1.24 log units is equivalent to ±12.4 lines (1.24/0.1). In this data set of 7 patients, the mean visual acuity and standard deviation are 0.85 ± 1.24 logMAR units, 0.141 ± 12.4 lines in decimal units, and 20/142 ± 12.4 lines in Snellen units. Other statistical calculations such as correlation coefficients, Student t test, analysis of variance should be performed using the logMAR values, as shown above for the mean and standard deviation. Using these techniques will provide meaningful analyses of data sets and allow valid comparisons of different data sets. Near-vision measurements must conform to the same visual angle as distance measurements and the most common near distance is 14 inches (35 centimeters). In Table 1, line 0 with a visual angle of 1 minute of arc is 14/14 and 35/35. The “M” notation in the last column used in low-vision patients uses the 20/50 angular size to be equivalent to 1 M and all the remaining values are proportional. For example, 2 M print is 20/100 and 0.5 M print is equivalent to 20/25 angular size.5 Jaeger values have undergone a number of revisions over the years, but the “revised Jaeger standard” was adopted in the late 50s and is shown in the 3rd to the last column in Table 1.9–12 The approximate American point type used by printers is shown in the next to last column in Table 1. Finally, percentage central visual efficiency was standardized in 1993 by the American Medical Association.13 The percentage central visual disability is 100% minus the central visual efficiency (eg, if the central visual efficiency is 30%, the central visual disability is 70%). It should be noted that the distance visual efficiency decreases almost linearly with logMAR steps. However, near central visual efficiency decreases abruptly after the 20/40 distance equivalent. This abrupt drop is because most newspaper and other periodical print are near the 20/40 distance equivalent level.

How genetic is school myopia?

2004-10-12

Ian G. Morgan , Kathryn Rose

Visual Acuities “Hand Motion” and “Counting Fingers” Can Be Quantified with the Freiburg Visual Acuity Test

2006-02-27

Kilian Schulze-Bonsel , Nicolas Feltgen , H Burau +2 more

The visual acuity (VA) of patients with very low vision is classified using the semiquantitative scale "counting fingers" (CF), "hand motion" (HM), "light perception" (LP), and "no light perception." More … The visual acuity (VA) of patients with very low vision is classified using the semiquantitative scale "counting fingers" (CF), "hand motion" (HM), "light perception" (LP), and "no light perception." More quantitative measures would be desirable, especially for clinical studies. The results of clinical VA measurements, Early Treatment Diabetic Retinopathy Study (ETDRS) charts, and the Freiburg Visual Acuity Test (FrACT) were compared. The FrACT is a computerized visual acuity test that can present very large Landolt C optotypes when necessary.Examined were 100 eyes of 100 patients with various eye diseases (e.g., diabetic retinopathy, ARMD), covering a range of VAs from LP to decimal 0.32. The FrACT optotypes were presented on a 17-inch LCD monitor with random orientation. After extensive training, two ETDRS and FrACT measurements were obtained. The testing distance was 50 or 100 cm.ETDRS and FrACT coincided closely for VA > or = 0.02 (n = 80). ETDRS measures were successfully obtainable down to CF (at 30 cm; test-retest averaged over all patients, coefficient of variation [CV](ETDRS) = 9% +/- 8%), and FrACT provided reproducible measurements down to HM (test-retest CV(FrACT) =12% +/- 11%). For CF (n = 6), both ETDRS and FrACT resulted in a mean VA of 0.014 +/- 0.003 (range, 0.01-0.02). The VA results of FrACT for HM (n = 12) were 0.005 +/- 0.002 (range, 0.003-0.009); the individual values were highly reproducible. No results were obtainable for LP (n = 2).The three acuity procedures concur above a VA of 0.02. The results suggest that the category CF at 30 cm can be replaced by 0.014, using ETDRS or FrACT. Using FrACT, one can even reproducibly quantify VA in the HM-range, yielding a mean VA of 0.005.

Adaptive optics scanning laser ophthalmoscopy

2002-05-06

Austin Roorda , Fernando Romero‐Borja , William J. Donnelly +3 more

We present the first scanning laser ophthalmoscope that uses adaptive optics to measure and correct the high order aberrations of the human eye. Adaptive optics increases both lateral and axial … We present the first scanning laser ophthalmoscope that uses adaptive optics to measure and correct the high order aberrations of the human eye. Adaptive optics increases both lateral and axial resolution, permitting axial sectioning of retinal tissue in vivo. The instrument is used to visualize photoreceptors, nerve fibers and flow of white blood cells in retinal capillaries.

New Visual Acuity Charts for Clinical Research

1982-07-01

Frederick L. Ferris , Aaron Kassoff , George H. Bresnick +1 more

Outdoor Activity Reduces the Prevalence of Myopia in Children

2008-02-22

Kathryn Rose , Ian G. Morgan , Jenny M. Ip +4 more

Statistical variation of aberration structure and image quality in a normal population of healthy eyes

2002-12-01

Larry N. Thibos , Xin Hong , Arthur Bradley +1 more

A Shack–Hartmann aberrometer was used to measure the monochromatic aberration structure along the primary line of sight of 200 cyclopleged, normal, healthy eyes from 100 individuals. Sphero-cylindrical refractive errors were … A Shack–Hartmann aberrometer was used to measure the monochromatic aberration structure along the primary line of sight of 200 cyclopleged, normal, healthy eyes from 100 individuals. Sphero-cylindrical refractive errors were corrected with ophthalmic spectacle lenses based on the results of a subjective refraction performed immediately prior to experimentation. Zernike expansions of the experimental wave-front aberration functions were used to determine aberration coefficients for a series of pupil diameters. The residual Zernike coefficients for defocus were not zero but varied systematically with pupil diameter and with the Zernike coefficient for spherical aberration in a way that maximizes visual acuity. We infer from these results that subjective best focus occurs when the area of the central, aberration-free region of the pupil is maximized. We found that the population averages of Zernike coefficients were nearly zero for all of the higher-order modes except spherical aberration. This result indicates that a hypothetical average eye representing the central tendency of the population is nearly free of aberrations, suggesting the possible influence of an emmetropization process or evolutionary pressure. However, for any individual eye the aberration coefficients were rarely zero for any Zernike mode. To first approximation, wave-front error fell exponentially with Zernike order and increased linearly with pupil area. On average, the total wave-front variance produced by higher-order aberrations was less than the wave-front variance of residual defocus and astigmatism. For example, the average amount of higher-order aberrations present for a 7.5-mm pupil was equivalent to the wave-front error produced by less than 1/4 diopter (D) of defocus. The largest pupil for which an eye may be considered diffraction-limited was 1.22 mm on average. Correlation of aberrations from the left and right eyes indicated the presence of significant bilateral symmetry. No evidence was found of a universal anatomical feature responsible for third-order optical aberrations. Using the Marechal criterion, we conclude that correction of the 12 largest principal components, or 14 largest Zernike modes, would be required to achieve diffraction-limited performance on average for a 6-mm pupil. Different methods of computing population averages provided upper and lower limits to the mean optical transfer function and mean point-spread function for our population of eyes.

Visual Impairment and Falls in Older Adults: The Blue Mountains Eye Study

1998-01-01

Rebecca Ivers , Robert G. Cumming , Paul Mitchell +1 more

OBJECTIVES: To examine the association between visual impairment and falls in older people. DESIGN: Cross‐sectional survey of eye disease with retrospective collection of falls data. SETTING: Two postcode areas in … OBJECTIVES: To examine the association between visual impairment and falls in older people. DESIGN: Cross‐sectional survey of eye disease with retrospective collection of falls data. SETTING: Two postcode areas in the Blue Mountains west of Sydney, Australia. PARTICIPANTS: All people 49 years of age and older were invited to participate, 3654 (82.4%) of 4433 eligible residents took part, and 3299 answered questions about falls. MEASUREMENTS: Subjects had a detailed eye examination and answered questions about health and vision status, use of medication, and number of falls in the previous 12 months. RESULTS: Tests of visual function that had a statistically significant association with two or more falls after adjustment for confounders were visual acuity (prevalence ratio (PR) 1.9 for visual acuity worse than 20/30), contrast sensitivity (PR 1.2 for a 1‐unit decrease at 6 cycles per degree), and suprathreshold visual field screening (PR 1.5 for 5 or more points missing). However, only visual acuity and contrast sensitivity were significantly associated with two or more falls per 1 standard deviation decrease. The presence of posterior subcapsular cataract (PR 2.1) and use of nonmiotic glaucoma medication (PR 2.0) had a statistically significant association with two or more falls; presence of age‐related macular degeneration, diabetic retinopathy, and cortical or nuclear cataract did not. CONCLUSION: Visual impairment is strongly associated with two or more falls in older adults. In addition to poor visual acuity, visual factors such as reduced visual field, impaired contrast sensitivity, and the presence of cataract may explain this association.

Retardation of Myopia in Orthokeratology (ROMIO) Study: A 2-Year Randomized Clinical Trial

2012-09-13

Pauline Cho , Sin-Wan Cheung

This single-masked randomized clinical trial aimed to evaluate the effectiveness of orthokeratology (ortho-k) for myopic control.A total of 102 eligible subjects, ranging in age from 6 to 10 years, with … This single-masked randomized clinical trial aimed to evaluate the effectiveness of orthokeratology (ortho-k) for myopic control.A total of 102 eligible subjects, ranging in age from 6 to 10 years, with myopia between 0.50 and 4.00 diopters (D) and astigmatism not more than 1.25D, were randomly assigned to wear ortho-k lenses or single-vision glasses for a period of 2 years. Axial length was measured by intraocular lens calculation by a masked examiner and was performed at the baseline and every 6 months. This study was registered at ClinicalTrials.gov, number NCT00962208.In all, 78 subjects (37 in ortho-k group and 41 in control group) completed the study. The average axial elongation, at the end of 2 years, were 0.36 ± 0.24 and 0.63 ± 0.26 mm in the ortho-k and control groups, respectively, and were significantly slower in the ortho-k group (P < 0.01). Axial elongation was not correlated with the initial myopia (P > 0.54) but was correlated with the initial age of the subjects (P < 0.001). The percentages of subjects with fast myopic progression (>1.00D per year) were 65% and 13% in younger (age range: 7-8 years) and older (age range: 9-10 years) children, respectively, in the control group and were 20% and 9%, respectively, in the ortho-k group. Five subjects discontinued ortho-k treatment due to adverse events.On average, subjects wearing ortho-k lenses had a slower increase in axial elongation by 43% compared with that of subjects wearing single-vision glasses. Younger children tended to have faster axial elongation and may benefit from early ortho-k treatment. (ClinicalTrials.gov number, NCT00962208.).

Sources of error in intraocular lens power calculation

2008-02-26

Sverker Norrby

To identify and quantify sources of error in the refractive outcome of cataract surgery.AMO Groningen BV, Groningen, The Netherlands.Means and standard deviations (SDs) of parameters that influence refractive outcomes were … To identify and quantify sources of error in the refractive outcome of cataract surgery.AMO Groningen BV, Groningen, The Netherlands.Means and standard deviations (SDs) of parameters that influence refractive outcomes were taken or derived from the published literature to the extent available. To evaluate their influence on refraction, thick-lens ray tracing that allowed for asphericity was used. The numerical partial derivative of each parameter with respect to spectacle refraction was calculated. The product of the partial derivative and the SD for a parameter equates to its SD, expressed as spectacle diopters, which squared is the variance. The error contribution of a parameter is its variance relative to the sum of the variances of all parameters.Preoperative estimation of postoperative intraocular lens (IOL) position, postoperative refraction determination, and preoperative axial length (AL) measurement were the largest contributors of error (35%, 27%, and 17%, respectively), with a mean absolute error (MAE) of 0.6 diopter (D) for an eye of average dimensions. Pupil size variation in the population accounted for 8% of the error, and variability in IOL power, 1%.Improvement in refractive outcome requires better methods for predicting the postoperative IOL position. Measuring AL by partial coherence interferometry may be of benefit. Autorefraction increases precision in outcome measurement. Reducing these 3 major error sources with means available today reduces the MAE to 0.4 D. Using IOLs that compensate for the spherical aberration of the cornea would eliminate the influence of pupil size. Further improvement would require measuring the asphericity of the anterior surface and radius of the posterior surface of the cornea.

Refractive Error and Visual Impairment in Urban Children in Southern China

2004-02-25

Mingguang He , Junwen Zeng , Yizhi Liu +3 more

purpose. To assess the prevalence of refractive error and visual impairment in school-age children in a metropolitan area of southern China. methods. Random selection of geographically defined clusters was used … purpose. To assess the prevalence of refractive error and visual impairment in school-age children in a metropolitan area of southern China. methods. Random selection of geographically defined clusters was used to identify children 5 to 15 years of age in Guangzhou. Children in 22 clusters were enumerated through a door-to-door survey and examined in 71 schools and 19 community facilities from October 2002 to January 2003. The examination included visual acuity measurements, ocular motility evaluation, retinoscopy, and autorefraction under cycloplegia and examination of the external eye, anterior segment, media, and fundus. results. A total of 5053 children living in 4814 households were enumerated, and 4364 (86.4%) were examined. The prevalence of uncorrected, presenting, and best-corrected visual acuity 20/40 or worse in the better eye was 22.3%, 10.3%, and 0.62%, respectively. Refractive error was the cause in 94.9% of the 2335 eyes with reduced vision, amblyopia in 1.9%, other causes in 0.4%, and unexplained causes in the remaining 2.8%. External and anterior segment abnormalities were seen in 1496 (34.3%) children, mainly minor conjunctival abnormalities. Media and fundus abnormalities were observed in 32 (0.73%) children. Myopia (spherical equivalent of at least −0.50 D in either eye) measured with retinoscopy affected 73.1% of children 15 years of age, 78.4% with autorefraction. The prevalence of myopia was 3.3% in 5-year-olds with retinoscopy and 5.7% with autorefraction. Females had a significantly higher risk of myopia. Hyperopia (+2.00 D or more) measured with retinoscopy was present in 16.7% of 5-year-olds, 17.0% with autorefraction. The prevalence of hyperopia was below 1% in 15-year-olds, with both methods. Astigmatism (cylinder of ≥0.75 D) was present in 33.6% of children with retinoscopy and in 42.7% with autorefraction. conclusions. The prevalence of reduced vision because of myopia is high in school-age children living in metropolitan Guangzhou, representing an important public health problem. One third of these children do not have the necessary corrective spectacles. Effective strategies are needed to eliminate this easily treated cause of significant visual impairment.

Atropine for the Treatment of Childhood Myopia: Safety and Efficacy of 0.5%, 0.1%, and 0.01% Doses (Atropine for the Treatment of Myopia 2)

2011-10-03

Audrey Chia , Wei‐Han Chua , Yin‐Bun Cheung +4 more

The Hoffer Q formula: A comparison of theoretic and regression formulas

1993-11-01

Kenneth J. Hoffer

A new formula, the Hoffer Q, was developed to predict the pseudophakic anterior chamber depth (ACD) for theoretic intraocular lens (IOL) power formulas. It relies on a personalized ACD, axial … A new formula, the Hoffer Q, was developed to predict the pseudophakic anterior chamber depth (ACD) for theoretic intraocular lens (IOL) power formulas. It relies on a personalized ACD, axial length, and corneal curvature. In 180 eyes, the Q formula proved more accurate than those using a constant ACD (P < .0001) and equal (P = .63) to those using the actual postoperative measured ACD (which is not possible clinically). In 450 eyes of one style IOL implanted by one surgeon, the Hoffer Q formula was equal to the Holladay (P =.65) and SRK/T (P =.63) and more accurate than the SRK (P <.0001) and SRK II (P =.004) regression formulas using optimized personalization constants. The Hoffer Q formula may be clinically more accurate than the Holladay and SRK/T formulas in eyes shorter than 22.0 mm. Even the original nonpersonalized constant ACD Hoffer formula compared with SRK I (using the most valid possible optimized personal A-constant) has a better mean absolute error (0.56 versus 0.59) and a significantly better range of IOL prediction error (3.44 diopters [D] versus 7.31 D). The range of error of the Hoffer Q formula (3.59 D) was half that of SRK 1(7.31 D). The highest IOL power errors in the 450 eyes were in the SRK II (3.14 D) and SRK I (6.14 D); the power error was 2.08 D using the Hoffer Q formula. The series using overall personalized ACD was more accurate than using an axial length subgroup personalized ACD in each axial length subgroup. The results strongly support replacing regression formulas with third-generation personalized theoretic formulas and carefully evaluating the Holladay, SRK/T, and Hoffer Q formulas.

Increased Prevalence of Myopia in the United States Between 1971-1972 and 1999-2004

2009-12-14

Susan Vitale , Robert D. Sperduto , Frederick L. Ferris

<h3>Objective</h3> To compare US population prevalence estimates for myopia in 1971-1972 and 1999-2004. <h3>Methods</h3> The 1971-1972 National Health and Nutrition Examination Survey provided the earliest nationally representative estimates for US … <h3>Objective</h3> To compare US population prevalence estimates for myopia in 1971-1972 and 1999-2004. <h3>Methods</h3> The 1971-1972 National Health and Nutrition Examination Survey provided the earliest nationally representative estimates for US myopia prevalence; myopia was diagnosed by an algorithm using either lensometry, pinhole visual acuity, and presenting visual acuity (for presenting visual acuity ≥20/40) or retinoscopy (for presenting visual acuity ≤20/50). Using a similar method for diagnosing myopia, we examined data from the 1999-2004 National Health and Nutrition Examination Survey to determine whether myopia prevalence had changed during the 30 years between the 2 surveys. <h3>Results</h3> Using the 1971-1972 method, the estimated prevalence of myopia in persons aged 12 to 54 years was significantly higher in 1999-2004 than in 1971-1972 (41.6% vs 25.0%, respectively;<i>P</i> < .001). Prevalence estimates were higher in 1999-2004 than in 1971-1972 for black individuals (33.5% vs 13.0%, respectively;<i>P</i> < .001) and white individuals (43.0% vs 26.3%, respectively;<i>P</i> < .001) and for all levels of myopia severity (>−2.0 diopters [D]: 17.5% vs 13.4%, respectively [<i>P</i> < .001]; ≤−2.0 to >−7.9 D: 22.4% vs 11.4%, respectively [<i>P</i> < .001]; ≤−7.9 D: 1.6% vs 0.2%, respectively [<i>P</i> < .001]). <h3>Conclusions</h3> When using similar methods for each period, the prevalence of myopia in the United States appears to be substantially higher in 1999-2004 than 30 years earlier. Identifying modifiable risk factors for myopia could lead to the development of cost-effective interventional strategies.

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The complex interactions of retinal, optical and environmental factors in myopia aetiology

2012-07-05

D.I. Flitcroft

The myopia boom

2015-03-01

Elie Dolgin

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Development of the 25-list-item National Eye Institute Visual Function Questionnaire

2001-07-01

Carol M. Mangione

To develop and test the psychometric properties of a 25-item version of the National Eye Institute Visual Function Questionnaire (NEI VFQ-25).Prospective observational cohort study of persons with 1 of 5 … To develop and test the psychometric properties of a 25-item version of the National Eye Institute Visual Function Questionnaire (NEI VFQ-25).Prospective observational cohort study of persons with 1 of 5 chronic eye diseases or low vision who were scheduled for nonurgent visits in ophthalmology practices and a reference sample of persons without eye disease.Eleven university-based ophthalmology practices and the NEI Clinical Center.Eligible participants had to have 1 of the following eye conditions: age-related cataracts, age-related macular degeneration, diabetic retinopathy, primary open-angle glaucoma, cytomegalovirus retinitis, or low vision from any cause. Seven of the 12 sites also enrolled persons in a reference sample. Reference sample participants had no evidence of underlying eye disease but were scheduled for either screening eye examinations or correction of refractive error. All eligible persons had to be 21 years or older, English speaking, and cognitively able to give informed consent and participate in a health status interview.To provide the data needed to create the NEI VFQ-25, all subjects completed an interview that included the 51-item NEI VFQ. Estimates of internal consistency indicate that the subscales of the NEI VFQ-25 are reliable. The validity of the NEI VFQ-25 is supported by high correlations between the short- and long-form versions of the measure, observed between-group differences in scores for persons with different eye diseases of varying severity, and the moderate-to-high correlations between the NEI VFQ-25 subscales that have the most to do with central vision and measured visual acuity.The reliability and validity of the NEI VFQ-25 are comparable to those of the 51-item NEI VFQ field test version of the survey. This shorter version will be more feasible in settings such as clinical trials where interview length is a critical consideration. In addition, preliminary analyses indicate that the psychometric properties of the NEI VFQ-25 are robust for the eye conditions studied; this suggests that the measure will provide reproducible and valid data when used across multiple conditions of varying severity.

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The Lens Opacities Classification System III

1993-06-01

L.T. Chylack

To develop the Lens Opacities Classification System III (LOCS III) to overcome the limitations inherent in lens classification using LOCS II. These limitations include unequal intervals between standards, only one … To develop the Lens Opacities Classification System III (LOCS III) to overcome the limitations inherent in lens classification using LOCS II. These limitations include unequal intervals between standards, only one standard for color grading, use of integer grading, and wide 95% tolerance limits.The LOCS III contains an expanded set of standards that were selected from the Longitudinal Study of Cataract slide library at the Center for Clinical Cataract Research, Boston, Mass. It consists of six slit-lamp images for grading nuclear color (NC) and nuclear opalescence (NO), five retroillumination images for grading cortical cataract (C), and five retroillumination images for grading posterior subcapsular (P) cataract. Cataract severity is graded on a decimal scale, and the standards have regularly spaced intervals on a decimal scale. The 95% tolerance limits are reduced from 2.0 for each class with LOCS II to 0.7 for nuclear opalescence, 0.7 for nuclear color, 0.5 for cortical cataract, and 1.0 for posterior subcapsular cataract with the LOCS III, with excellent interobserver agreement.The LOCS III is an improved LOCS system for grading slit-lamp and retroillumination images of age-related cataract.

Prevalence of Myopia in Taiwanese Schoolchildren: 1983 to 2000

2004-01-15

LLK Lin , Y-F Shih , Chuhsing Kate Hsiao +1 more

Introduction: To determine time trends in myopia over a 20-year period in Taiwan, we conducted 5 nationwide surveys pertaining to the ocular refraction of schoolchildren in 1983, 1986, 1990, 1995 … Introduction: To determine time trends in myopia over a 20-year period in Taiwan, we conducted 5 nationwide surveys pertaining to the ocular refraction of schoolchildren in 1983, 1986, 1990, 1995 and 2000. Materials and Methods: The sampling technique used herein involved the assessment of stratified systematic clusters, with the unweighted myopic rate being represented using data derived from different sectors of the population, such as metropolitan, city, town, and aboriginal. The mean values for the spherical equivalent of the cycloplegic refractive status and the dimension of corneal radii as determined by the autorefractometer were used for the calculation. Results: In our review of 5 nationwide myopia surveys, we found that the mean prevalence of myopia among 7 year olds increased from 5.8% in 1983 to 21% in 2000. At the age of 12, the prevalence of myopia was 36.7% in 1983 increasing to 61% in 2000, corresponding figures for 15-year-olds being 64.2% and 81%, respectively. The prevalence of myopia increased from 74% in 1983 to 84% in 2000 for children aged between 16 and 18 years, and, in addition, the prevalence of high myopia (over –6.0 D) increased from 10.9% in 1983 to 21% of 18-year-old students of Taiwan in 2000. The mean refractive status at the age of 12 deteriorated from –0.48 D in 1983 to –1.45 D in 2000, and from –1.49 D to –2.89 D for children aged 15, whilst for individuals aged 18, it deteriorated from –2.55 D in 1983 to –3.64 D in 2000. The mean ocular refraction began to progress to a myopic condition at the age of 11 in 1983, this becoming an age of 8 years in 2000. There appeared to be significant difference in both the prevalence and the degree of myopia between study participants residing in cities and villages. Conclusions: We conclude that the cause of the relative increasing severity of myopia among the schoolchildren was due to the onset of myopia at a very young, and progressively-decreasing, age over the study period. Thus, to reduce the prevalence and severity of myopia, we should pay more attention to the eye care of pre-schoolchildren.

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Supernormal vision and high-resolution retinal imaging through adaptive optics

1997-11-01

Junzhong Liang , David R. Williams , Donald T. Miller

Even when corrected with the best spectacles or contact lenses, normal human eyes still suffer from monochromatic aberrations that blur vision when the pupil is large. We have successfully corrected … Even when corrected with the best spectacles or contact lenses, normal human eyes still suffer from monochromatic aberrations that blur vision when the pupil is large. We have successfully corrected these aberrations using adaptive optics, providing normal eyes with supernormal optical quality. Contrast sensitivity to fine spatial patterns was increased when observers viewed stimuli through adaptive optics. The eye's aberrations also limit the resolution of images of the retina, a limit that has existed since the invention of the ophthalmoscope. We have constructed a fundus camera equipped with adaptive optics that provides unprecedented resolution, allowing the imaging of microscopic structures the size of single cells in the living human retina.

Global data on visual impairment in the year 2002.

2004-11-01

Serge Resnikoff , Donatella Pascolini , Daniel Etya’ale +4 more

This paper presents estimates of the prevalence of visual impairment and its causes in 2002, based on the best available evidence derived from recent studies. Estimates were determined from data … This paper presents estimates of the prevalence of visual impairment and its causes in 2002, based on the best available evidence derived from recent studies. Estimates were determined from data on low vision and blindness as defined in the International statistical classification of diseases, injuries and causes of death, 10th revision. The number of people with visual impairment worldwide in 2002 was in excess of 161 million, of whom about 37 million were blind. The burden of visual impairment is not distributed uniformly throughout the world: the least developed regions carry the largest share. Visual impairment is also unequally distributed across age groups, being largely confined to adults 50 years of age and older. A distribution imbalance is also found with regard to gender throughout the world: females have a significantly higher risk of having visual impairment than males. Notwithstanding the progress in surgical intervention that has been made in many countries over the last few decades, cataract remains the leading cause of visual impairment in all regions of the world, except in the most developed countries. Other major causes of visual impairment are, in order of importance, glaucoma, age-related macular degeneration, diabetic retinopathy and trachoma.

Parental History of Myopia, Sports and Outdoor Activities, and Future Myopia

2007-07-25

Lisa Jones , Loraine T. Sinnott , Donald O. Mutti +3 more

To identify whether parental history of myopia and/or parent-reported children's visual activity levels can predict juvenile-onset myopia.Survey-based data from Orinda Longitudinal Study of Myopia subjects from 1989 to 2001 were … To identify whether parental history of myopia and/or parent-reported children's visual activity levels can predict juvenile-onset myopia.Survey-based data from Orinda Longitudinal Study of Myopia subjects from 1989 to 2001 were used to predict future myopia. Univariate and multiple logistic regression analyses were performed, and receiver operator characteristic (ROC) curves were generated. Differences among the areas under the ROC curves were compared using the method of multiple comparison with the best.Of the 514 children eligible for this analysis, 111 (21.6%) became myopic. Differences in the third grade between eventual myopes and nonmyopes were seen for the number of myopic parents (P < 0.001) and for the number of sports and outdoor activity hours per week (11.65 +/- 6.97 hours for nonmyopes vs. 7.98 +/- 6.54 hours for future myopes, P < 0.001). Analysis of the areas under the ROC curves showed three variables with a predictive value better than chance: the number of myopic parents, the number of sports and outdoor activity hours per week, and the number of reading hours per week. After controlling for sports and outdoor hours per week and parental myopia history, reading hours per week was no longer a statistically significant factor. The area under the curve for the parental myopia history and sports and outdoor activities model was 0.73. A significant interaction in the logistic model showed a differential effect of sport and outdoor activity hours per week based on a child's number of myopic parents.Parental history of myopia was an important predictor in univariate and multivariate models, with a differential effect of sports and outdoor activity hours per week based on the number of myopic parents. Lower amounts of sports and outdoor activity increased the odds of becoming myopic in those children with two myopic parents more than in those children with either zero or one myopic parent. The chance of becoming myopic for children with no myopic parents appears lowest in the children with the highest amount of sports and outdoor activity, compared with those with two myopic parents.

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Vision assessment using the NIH Toolbox

2013-03-11

Rohit Varma , Roberta McKean‐Cowdin , Susan Vitale +2 more

One of the goals of the NIH Toolbox for Assessment of Neurological and Behavioral Function was to identify or develop brief measures of emotion for use in prospective epidemiologic and … One of the goals of the NIH Toolbox for Assessment of Neurological and Behavioral Function was to identify or develop brief measures of emotion for use in prospective epidemiologic and clinical research. Emotional health has significant links to physical health and exerts a powerful effect on perceptions of life quality. Based on an extensive literature review and expert input, the Emotion team identified 4 central subdomains: Negative Affect, Psychological Well-Being, Stress and Self-Efficacy, and Social Relationships. A subsequent psychometric review identified several existing self-report and proxy measures of these subdomains with measurement characteristics that met the NIH Toolbox criteria. In cases where adequate measures did not exist, robust item banks were developed to assess concepts of interest. A population-weighted sample was recruited by an online survey panel to provide initial item calibration and measure validation data. Participants aged 8 to 85 years completed self-report measures whereas parents/guardians responded for children aged 3 to 12 years. Data were analyzed using a combination of classic test theory and item response theory methods, yielding efficient measures of emotional health concepts. An overview of the development of the NIH Toolbox Emotion battery is presented along with preliminary results. Norming activities led to further refinement of the battery, thus enhancing the robustness of emotional health measurement for researchers using the NIH Toolbox.

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Global magnitude of visual impairment caused by uncorrected refractive errors in 2004

2008-01-01

Serge Resnikoff

Estimates of the prevalence of visual impairment caused by uncorrected refractive errors in 2004 have been determined at regional and global levels for people aged 5 years and over from … Estimates of the prevalence of visual impairment caused by uncorrected refractive errors in 2004 have been determined at regional and global levels for people aged 5 years and over from recent published and unpublished surveys.The estimates were based on the prevalence of visual acuity of less than 6/18 in the better eye with the currently available refractive correction that could be improved to equal to or better than 6/18 by refraction or pinhole.A total of 153 million people (range of uncertainty: 123 million to 184 million) are estimated to be visually impaired from uncorrected refractive errors, of whom eight million are blind.This cause of visual impairment has been overlooked in previous estimates that were based on best-corrected vision.Combined with the 161 million people visually impaired estimated in 2002 according to best-corrected vision, 314 million people are visually impaired from all causes: uncorrected refractive errors become the main cause of low vision and the second cause of blindness.Uncorrected refractive errors can hamper performance at school, reduce employability and productivity, and generally impair quality of life.Yet the correction of refractive errors with appropriate spectacles is among the most cost-effective interventions in eye health care.The results presented in this paper help to unearth a formerly hidden problem of public health dimensions and promote policy development and implementation, programmatic decision-making and corrective interventions, as well as stimulate research.

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Aberrations and retinal image quality of the normal human eye

1997-11-01

Junzhong Liang , David R. Williams

We have constructed a wave-front sensor to measure the irregular as well as the classical aberrations of the eye, providing a more complete description of the eye's aberrations than has … We have constructed a wave-front sensor to measure the irregular as well as the classical aberrations of the eye, providing a more complete description of the eye's aberrations than has previously been possible. We show that the wave-front sensor provides repeatable and accurate measurements of the eye's wave aberration. The modulation transfer function of the eye computed from the wave-front sensor is in fair, though not complete, agreement with that obtained under similar conditions on the same observers by use of the double-pass and the interferometric techniques. Irregular aberrations, i.e., those beyond defocus, astigmatism, coma, and spherical aberration, do not have a large effect on retinal image quality in normal eyes when the pupil is small (3 mm). However, they play a substantial role when the pupil is large (7.3-mm), reducing visual performance and the resolution of images of the living retina. Although the pattern of aberrations varies from subject to subject, aberrations, including irregular ones, are correlated in left and right eyes of the same subject, indicating that they are not random defects.

Blindness and Visual Impairment in an American Urban Population

1990-02-01

James M. Tielsch

• Data on the prevalence of blindness and visual impairment in multiracial urban populations of the United States are not readily available. The Baltimore Eye Survey was designed to address … • Data on the prevalence of blindness and visual impairment in multiracial urban populations of the United States are not readily available. The Baltimore Eye Survey was designed to address this lack of information and provide estimates of prevalence in age-race subgroups that had not been well studied in the past. A population-based sample of 5300 blacks and whites from east Baltimore, Md, received an ophthalmologic screening examination that included detailed visual acuity measurements. Blacks had, on average, a twofold excess prevalence of blindness and visual impairment than whites, irrespective of definition. Rates rose dramatically with age for all definitions of vision loss, but there was no difference in prevalence by sex. More than 50% of subjects improved their presenting vision after refractive correction, with 7.5% improving three or more lines. Rates in Baltimore are as high or higher than those reported from previous studies. National projections indicate that greater than 3 million persons are visually impaired, 890 000 of whom are bilaterally blind by US definitions.

Development of the SRK/T intraocular lens implant power calculation formula

1990-05-01

John Retzlaff , Donald R. Sanders , Manus C. Kraff

A new implant power calculation formula (SRK/T) was developed using the nonlinear terms of the theoretical formulas as its foundation but empirical regression methodology for optimization. Postoperative anterior chamber depth … A new implant power calculation formula (SRK/T) was developed using the nonlinear terms of the theoretical formulas as its foundation but empirical regression methodology for optimization. Postoperative anterior chamber depth prediction, retinal thickness axial length correction, and corneal refractive index were systematically and interactively optimized using an iterative process on five data sets consisting of 1,677 posterior chamber lens cases. The new SRK/T formula performed slightly better than the Holladay, SRK II, Binkhorst, and Hoffer formulas, which was the expected result as any formula performs superiorly with the data from which it was derived. Comparative accuracy of this formula upon independent data sets is addressed in a follow-up report. The formula derived provides a primarily theoretical approach under the SRK umbrella of formulas and has the added advantage of being calculable using either SRK A-constants that have been empirically derived over the last nine years or using anterior chamber depth estimates.

Psychometric Properties of the National Eye Institute Visual Function Questionnaire (NEI-VFQ)

1998-11-01

Carol M. Mangione , Paul P. Lee , J Pitts +3 more

<h3>Objective</h3> To test the reliability and validity of the 51-item Field Test Version of the National Eye Institute Visual Function Questionnaire (NEI-VFQ) across 5 common chronic eye conditions. <h3>Design</h3> Prospective … <h3>Objective</h3> To test the reliability and validity of the 51-item Field Test Version of the National Eye Institute Visual Function Questionnaire (NEI-VFQ) across 5 common chronic eye conditions. <h3>Design</h3> Prospective observational cohort study of persons with 1 of 5 chronic eye diseases who were scheduled for nonurgent visits in ophthalmology practices or had low vision from any cause, and a reference sample of persons without eye disease. <h3>Setting</h3> Six university-based ophthalmology practices and the National Eye Institute Clinical Center, Bethesda, Md. <h3>Patients</h3> Eligible participants had to have 1 of the following eye conditions: age-related cataracts, age-related macular degeneration, diabetic retinopathy, primary open-angle glaucoma, cytomegalovirus retinitis, or low vision from any cause. Each of the 7 sites also enrolled persons in a reference sample. Reference sample participants had no evidence of underlying eye disease but were scheduled for either screening eye examinations or correction of refractive error. All eligible persons had to be aged 21 years or older, English speaking, and cognitively able to give informed consent and participate in a health status interview. <h3>Measurements and Main Results</h3> To provide the data needed to assess the reliability and validity of the 51-item NEI-VFQ, all subjects completed an interview that consisted of the 51-item NEI-VFQ, the Medical Outcomes Study 36-Item Short-Form Health Survey, and at least 1 measure of vision-targeted functional status. Estimates of internal consistency and test-retest reproducibility indicate that the 51-item NEI-VFQ is reliable. Tests of association with other scales and clinical variables support the construct validity of the survey. <h3>Conclusions</h3> In this cross-sectional study, the 51-item NEI-VFQ seems to be reliable and valid and should be a useful tool for group-level comparisons of vision-targeted, health-related quality of life in clinical research. Additionally, the psychometric properties of the NEI-VFQ were not influenced by the type or severity of the underlying eye disease, suggesting that the measure will provide reproducible and valid data when used across multiple eye conditions.

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Outdoor Activity during Class Recess Reduces Myopia Onset and Progression in School Children

2013-02-23

Pei‐Chang Wu , Chia‐Ling Tsai , Hsiang-Lin Wu +2 more

Racial Variations in Causes of Vision Loss in Nursing Homes

2004-07-01

David S. Friedman , Sheila K. West , Beatriz Muñoz +7 more

<h3>Objective</h3> To determine the prevalence and causes of low vision in a large sampleof nursing home residents. <h3>Methods</h3> Twenty-eight nursing homes on the Eastern Shore of Maryland and Delawarewere enrolled … <h3>Objective</h3> To determine the prevalence and causes of low vision in a large sampleof nursing home residents. <h3>Methods</h3> Twenty-eight nursing homes on the Eastern Shore of Maryland and Delawarewere enrolled in a clinical trial to assess the impact of vision restoration/rehabilitationon nursing home residents. Visual acuity was measured using both recognitioncharts and preferential looking techniques. An ophthalmologist examined allresidents with visual acuity worse than 20/40 in the better-seeing eye anddetermined the primary cause for decreased vision. Results are reported forthe better-seeing eye. <h3>Results</h3> Of 2544 eligible residents, 1591 (63%) participated, but 286 residentswere unable to respond to visual acuity testing. Of the remaining 1307 residents,496 (37%) had best-corrected visual acuity worse than 20/40 in the better-seeingeye. Causes were ascribed for 412 subjects. Rates of low vision were similarbetween African American subjects and white subjects (39% and 38%, respectively;age-adjusted<i>P</i>= .18). Cataract was the leading causeof low vision, responsible for 37% of low vision among white subjects and54% of low vision among African American subjects. Macular degeneration wasresponsible for 29% of low vision among white subjects but only 7% among AfricanAmerican subjects. Glaucoma caused low vision in 4% of white subjects and10% of African American subjects. Refractive error was not a frequent causeof low vision in nursing home residents. <h3>Conclusions</h3> Low vision is highly prevalent among nursing home residents, with 37%having visual acuity worse than 20/40 in the better-seeing eye. Differencesin causes of low vision between African American subjects and white subjectswere noted, with African American subjects more likely to have vision losson the basis of cataract, a readily treated condition. Appropriate interventionsfor nursing home residents, who face significant obstacles in accessing eyecare services, have the potential to improve the quality of life of this at-riskolder population.

Causes of vision loss worldwide, 1990–2010: a systematic analysis

2013-11-11

Rupert Bourne , Gretchen A Stevens , Richard White +7 more

BackgroundData on causes of vision impairment and blindness are important for development of public health policies, but comprehensive analysis of change in prevalence over time is lacking.MethodsWe did a systematic … BackgroundData on causes of vision impairment and blindness are important for development of public health policies, but comprehensive analysis of change in prevalence over time is lacking.MethodsWe did a systematic analysis of published and unpublished data on the causes of blindness (visual acuity in the better eye less than 3/60) and moderate and severe vision impairment ([MSVI] visual acuity in the better eye less than 6/18 but at least 3/60) from 1980 to 2012. We estimated the proportions of overall vision impairment attributable to cataract, glaucoma, macular degeneration, diabetic retinopathy, trachoma, and uncorrected refractive error in 1990–2010 by age, geographical region, and year.FindingsIn 2010, 65% (95% uncertainty interval [UI] 61–68) of 32·4 million blind people and 76% (73–79) of 191 million people with MSVI worldwide had a preventable or treatable cause, compared with 68% (95% UI 65–70) of 31·8 million and 80% (78–83) of 172 million in 1990. Leading causes worldwide in 1990 and 2010 for blindness were cataract (39% and 33%, respectively), uncorrected refractive error (20% and 21%), and macular degeneration (5% and 7%), and for MSVI were uncorrected refractive error (51% and 53%), cataract (26% and 18%), and macular degeneration (2% and 3%). Causes of blindness varied substantially by region. Worldwide and in all regions more women than men were blind or had MSVI due to cataract and macular degeneration.InterpretationThe differences and temporal changes we found in causes of blindness and MSVI have implications for planning and resource allocation in eye care.FundingBill & Melinda Gates Foundation, Fight for Sight, Fred Hollows Foundation, and Brien Holden Vision Institute.

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Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050

2016-02-11

Brien A. Holden , Tim Fricke , David A. Wilson +6 more

PurposeMyopia is a common cause of vision loss, with uncorrected myopia the leading cause of distance vision impairment globally. Individual studies show variations in the prevalence of myopia and high … PurposeMyopia is a common cause of vision loss, with uncorrected myopia the leading cause of distance vision impairment globally. Individual studies show variations in the prevalence of myopia and high myopia between regions and ethnic groups, and there continues to be uncertainty regarding increasing prevalence of myopia.DesignSystematic review and meta-analysis.MethodsWe performed a systematic review and meta-analysis of the prevalence of myopia and high myopia and estimated temporal trends from 2000 to 2050 using data published since 1995. The primary data were gathered into 5-year age groups from 0 to ≥100, in urban or rural populations in each country, standardized to definitions of myopia of −0.50 diopter (D) or less and of high myopia of −5.00 D or less, projected to the year 2010, then meta-analyzed within Global Burden of Disease (GBD) regions. Any urban or rural age group that lacked data in a GBD region took data from the most similar region. The prevalence data were combined with urbanization data and population data from United Nations Population Department (UNPD) to estimate the prevalence of myopia and high myopia in each country of the world. These estimates were combined with myopia change estimates over time derived from regression analysis of published evidence to project to each decade from 2000 through 2050.ResultsWe included data from 145 studies covering 2.1 million participants. We estimated 1406 million people with myopia (22.9% of the world population; 95% confidence interval [CI], 932–1932 million [15.2%–31.5%]) and 163 million people with high myopia (2.7% of the world population; 95% CI, 86–387 million [1.4%–6.3%]) in 2000. We predict by 2050 there will be 4758 million people with myopia (49.8% of the world population; 3620–6056 million [95% CI, 43.4%–55.7%]) and 938 million people with high myopia (9.8% of the world population; 479–2104 million [95% CI, 5.7%–19.4%]).ConclusionsMyopia and high myopia estimates from 2000 to 2050 suggest significant increases in prevalences globally, with implications for planning services, including managing and preventing myopia-related ocular complications and vision loss among almost 1 billion people with high myopia.

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Efficacy Comparison of 16 Interventions for Myopia Control in Children

2016-01-27

Jinhai Huang , Daizong Wen , Qinmei Wang +7 more

PurposeTo determine the effectiveness of different interventions to slow down the progression of myopia in children.MethodsWe searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical … PurposeTo determine the effectiveness of different interventions to slow down the progression of myopia in children.MethodsWe searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov from inception to August 2014. We selected randomized controlled trials (RCTs) involving interventions for controlling the progression of myopia in children with a treatment duration of at least 1 year for analysis.Main Outcome MeasuresThe primary outcomes were mean annual change in refraction (diopters/year) and mean annual change in axial length (millimeters/year).ResultsThirty RCTs (involving 5422 eyes) were identified. Network meta-analysis showed that in comparison with placebo or single vision spectacle lenses, high-dose atropine (refraction change: 0.68 [0.52–0.84]; axial length change: −0.21 [−0.28 to −0.16]), moderate-dose atropine (refraction change: 0.53 [0.28–0.77]; axial length change: −0.21 [−0.32 to −0.12]), and low-dose atropine (refraction change: 0.53 [0.21–0.85]; axial length change: −0.15 [−0.25 to −0.05]) markedly slowed myopia progression. Pirenzepine (refraction change: 0.29 [0.05–0.52]; axial length change: −0.09 [−0.17 to −0.01]), orthokeratology (axial length change: −0.15 [−0.22 to −0.08]), and peripheral defocus modifying contact lenses (axial length change: −0.11 [−0.20 to −0.03]) showed moderate effects. Progressive addition spectacle lenses (refraction change: 0.14 [0.02–0.26]; axial length change: −0.04 [−0.09 to −0.01]) showed slight effects.ConclusionsThis network analysis indicates that a range of interventions can significantly reduce myopia progression when compared with single vision spectacle lenses or placebo. In terms of refraction, atropine, pirenzepine, and progressive addition spectacle lenses were effective. In terms of axial length, atropine, orthokeratology, peripheral defocus modifying contact lenses, pirenzepine, and progressive addition spectacle lenses were effective. The most effective interventions were pharmacologic, that is, muscarinic antagonists such as atropine and pirenzepine. Certain specially designed contact lenses, including orthokeratology and peripheral defocus modifying contact lenses, had moderate effects, whereas specially designed spectacle lenses showed minimal effect.

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The VF-14

1994-05-01

Earl P. Steinberg , James M. Tielsch , O. D. Schein +7 more

To describe the development and the performance of a brief questionnaire designed to measure functional impairment caused by cataract (the VF-14).Observational cross-sectional study. Patients were recruited between July 15 and … To describe the development and the performance of a brief questionnaire designed to measure functional impairment caused by cataract (the VF-14).Observational cross-sectional study. Patients were recruited between July 15 and December 15, 1991.Patients were recruited from the practices of 70 ophthalmologists, located in Columbus, Ohio (N = 21), St Louis, Mo (N = 26), and Houston, Tex (N = 23).Seven hundred sixty-six patients undergoing cataract surgery for the first time.Preoperative best corrected visual acuity in each eye; scores on the VF-14, a new index of functional impairment in patients with cataract; patient reports of overall trouble and satisfaction with their vision; and scores on the Sickness Impact Profile, a measure of general health status.The VF-14 has high internal consistency (Cronbach's alpha = .85) and correlates more strongly with the overall self-rating of the amount of trouble and satisfaction patients have with their vision than do several measures of visual acuity or the Sickness Impact Profile score. The VF-14 score is moderately correlated with visual acuity in the better eye.The VF-14 is a reliable and valid measure of functional impairment caused by cataract and provides information not conveyed by visual acuity or a general measure of health status.

The Prevalence of Refractive Errors Among Adults in the United States,Western Europe, and Australia

2004-04-01

John H. Kempen , Paul Mitchell , Kristine E. Lee +6 more

<h3>Objective</h3> To estimate the prevalence of refractive errors in persons 40 yearsand older. <h3>Methods</h3> Counts of persons with phakic eyes with and without spherical equivalentrefractive error in the worse eye … <h3>Objective</h3> To estimate the prevalence of refractive errors in persons 40 yearsand older. <h3>Methods</h3> Counts of persons with phakic eyes with and without spherical equivalentrefractive error in the worse eye of +3 diopters (D) or greater, −1D or less, and −5 D or less were obtained from population-based eyesurveys in strata of gender, race/ethnicity, and 5-year age intervals. Pooledage-, gender-, and race/ethnicity–specific rates for each refractiveerror were applied to the corresponding stratum-specific US, Western European,and Australian populations (years 2000 and projected 2020). <h3>Results</h3> Six studies provided data from 29 281 persons. In the US, WesternEuropean, and Australian year 2000 populations 40 years or older, the estimatedcrude prevalence for hyperopia of +3 D or greater was 9.9%, 11.6%, and 5.8%,respectively (11.8 million, 21.6 million, and 0.47 million persons). For myopiaof −1 D or less, the estimated crude prevalence was 25.4%, 26.6%, and16.4% (30.4 million, 49.6 million, and 1.3 million persons), respectively,of whom 4.5%, 4.6%, and 2.8% (5.3 million, 8.5 million, and 0.23 million persons),respectively, had myopia of −5 D or less. Projected prevalence ratesin 2020 were similar. <h3>Conclusions</h3> Refractive errors affect approximately one third of persons 40 yearsor older in the United States and Western Europe, and one fifth of Australiansin this age group.

Use of NeuroEyeCoach™ to Improve Eye Movement Efficacy in Patients with Homonymous Visual Field Loss

2016-01-01

Arash Sahraie , Nicola Smania , Josef Zihl

Visual field deficits are common in patients with damaged retinogeniculostriate pathways. The patient’s eye movements are often affected leading to inefficient visual search. Systematic eye movement training also called compensatory … Visual field deficits are common in patients with damaged retinogeniculostriate pathways. The patient’s eye movements are often affected leading to inefficient visual search. Systematic eye movement training also called compensatory therapy is needed to allow patients to develop effective coping strategies. There is a lack of evidence-based, clinical gold-standard registered medical device accessible to patients at home or in clinical settings and NeuroEyeCoach (NEC) is developed to address this need. In three experiments, we report on performance of patients on NEC compared to the data obtained previously on the earlier versions of the search task (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mi>n</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">32</mml:mn></mml:math>); we assessed whether the self-administered computerised tasks can be used to monitor the progress (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mi>n</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">24</mml:mn></mml:math>) and compared the findings in a subgroup of patients to a healthy control group. Performance on cancellation tasks, simple visual search, and self-reported responses on activities of daily living was compared, before and after training. Patients performed similarly well on NEC as on previous versions of the therapy; the inbuilt functionality for pre- and postevaluation functions was sensitive to allowing assessment of improvements; and improvements in patients were significantly greater than those in a group of healthy adults. In conclusion, NeuroEyeCoach can be used as an effective rehabilitation tool to develop compensatory strategies in patients with visual field deficits after brain injury.

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Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis

2017-08-03

Rupert Bourne , Seth Flaxman , Tasanee Braithwaite +7 more

Global and regional prevalence estimates for blindness and vision impairment are important for the development of public health policies. We aimed to provide global estimates, trends, and projections of global … Global and regional prevalence estimates for blindness and vision impairment are important for the development of public health policies. We aimed to provide global estimates, trends, and projections of global blindness and vision impairment.We did a systematic review and meta-analysis of population-based datasets relevant to global vision impairment and blindness that were published between 1980 and 2015. We fitted hierarchical models to estimate the prevalence (by age, country, and sex), in 2015, of mild visual impairment (presenting visual acuity worse than 6/12 to 6/18 inclusive), moderate to severe visual impairment (presenting visual acuity worse than 6/18 to 3/60 inclusive), blindness (presenting visual acuity worse than 3/60), and functional presbyopia (defined as presenting near vision worse than N6 or N8 at 40 cm when best-corrected distance visual acuity was better than 6/12).Globally, of the 7·33 billion people alive in 2015, an estimated 36·0 million (80% uncertainty interval [UI] 12·9-65·4) were blind (crude prevalence 0·48%; 80% UI 0·17-0·87; 56% female), 216·6 million (80% UI 98·5-359·1) people had moderate to severe visual impairment (2·95%, 80% UI 1·34-4·89; 55% female), and 188·5 million (80% UI 64·5-350·2) had mild visual impairment (2·57%, 80% UI 0·88-4·77; 54% female). Functional presbyopia affected an estimated 1094·7 million (80% UI 581·1-1686·5) people aged 35 years and older, with 666·7 million (80% UI 364·9-997·6) being aged 50 years or older. The estimated number of blind people increased by 17·6%, from 30·6 million (80% UI 9·9-57·3) in 1990 to 36·0 million (80% UI 12·9-65·4) in 2015. This change was attributable to three factors, namely an increase because of population growth (38·4%), population ageing after accounting for population growth (34·6%), and reduction in age-specific prevalence (-36·7%). The number of people with moderate and severe visual impairment also increased, from 159·9 million (80% UI 68·3-270·0) in 1990 to 216·6 million (80% UI 98·5-359·1) in 2015.There is an ongoing reduction in the age-standardised prevalence of blindness and visual impairment, yet the growth and ageing of the world's population is causing a substantial increase in number of people affected. These observations, plus a very large contribution from uncorrected presbyopia, highlight the need to scale up vision impairment alleviation efforts at all levels.Brien Holden Vision Institute.

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The epidemics of myopia: Aetiology and prevention

2017-09-23

Ian G. Morgan , Amanda French , Regan Ashby +4 more

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IMI – Defining and Classifying Myopia: A Proposed Set of Standards for Clinical and Epidemiologic Studies

2019-02-01

Daniel Ian Flitcroft , Mingguang He , Jost B. Jonas +7 more

We provide a standardized set of terminology, definitions, and thresholds of myopia and its main ocular complications. We provide a standardized set of terminology, definitions, and thresholds of myopia and its main ocular complications.

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Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study

2020-12-01

Rupert Bourne , Jaimie D Steinmetz , Seth Flaxman +7 more

BackgroundTo contribute to the WHO initiative, VISION 2020: The Right to Sight, an assessment of global vision impairment in 2020 and temporal change is needed. We aimed to extensively update … BackgroundTo contribute to the WHO initiative, VISION 2020: The Right to Sight, an assessment of global vision impairment in 2020 and temporal change is needed. We aimed to extensively update estimates of global vision loss burden, presenting estimates for 2020, temporal change over three decades between 1990–2020, and forecasts for 2050.MethodsWe did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. Only studies with samples representative of the population and with clearly defined visual acuity testing protocols were included. We fitted hierarchical models to estimate 2020 prevalence (with 95% uncertainty intervals [UIs]) of mild vision impairment (presenting visual acuity ≥6/18 and <6/12), moderate and severe vision impairment (<6/18 to 3/60), and blindness (<3/60 or less than 10° visual field around central fixation); and vision impairment from uncorrected presbyopia (presenting near vision <N6 or <N8 at 40 cm where best-corrected distance visual acuity is ≥6/12). We forecast estimates of vision loss up to 2050.FindingsIn 2020, an estimated 43·3 million (95% UI 37·6–48·4) people were blind, of whom 23·9 million (55%; 20·8–26·8) were estimated to be female. We estimated 295 million (267–325) people to have moderate and severe vision impairment, of whom 163 million (55%; 147–179) were female; 258 million (233–285) to have mild vision impairment, of whom 142 million (55%; 128–157) were female; and 510 million (371–667) to have visual impairment from uncorrected presbyopia, of whom 280 million (55%; 205–365) were female. Globally, between 1990 and 2020, among adults aged 50 years or older, age-standardised prevalence of blindness decreased by 28·5% (–29·4 to −27·7) and prevalence of mild vision impairment decreased slightly (–0·3%, −0·8 to −0·2), whereas prevalence of moderate and severe vision impairment increased slightly (2·5%, 1·9 to 3·2; insufficient data were available to calculate this statistic for vision impairment from uncorrected presbyopia). In this period, the number of people who were blind increased by 50·6% (47·8 to 53·4) and the number with moderate and severe vision impairment increased by 91·7% (87·6 to 95·8). By 2050, we predict 61·0 million (52·9 to 69·3) people will be blind, 474 million (428 to 518) will have moderate and severe vision impairment, 360 million (322 to 400) will have mild vision impairment, and 866 million (629 to 1150) will have uncorrected presbyopia.InterpretationAge-adjusted prevalence of blindness has reduced over the past three decades, yet due to population growth, progress is not keeping pace with needs. We face enormous challenges in avoiding vision impairment as the global population grows and ages.FundingBrien Holden Vision Institute, Fondation Thea, Fred Hollows Foundation, Bill & Melinda Gates Foundation, Lions Clubs International Foundation, Sightsavers International, and University of Heidelberg.

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Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study

2020-12-01

Jaimie D Steinmetz , Rupert Bourne , Paul Svitil Briant +7 more

Background Many causes of vision impairment can be prevented or treated.With an ageing global population, the demands for eye health services are increasing.We estimated the prevalence and relative contribution of … Background Many causes of vision impairment can be prevented or treated.With an ageing global population, the demands for eye health services are increasing.We estimated the prevalence and relative contribution of avoidable causes of blindness and vision impairment globally from 1990 to 2020.We aimed to compare the results with the World Health Assembly Global Action Plan (WHA GAP) target of a 25% global reduction from 2010 to 2019 in avoidable vision impairment, defined as cataract and undercorrected refractive error. MethodsWe did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018.We fitted hierarchical models to estimate prevalence (with 95% uncertainty intervals [UIs]) of moderate and severe vision impairment (MSVI; presenting visual acuity from <6/18 to 3/60) and blindness (<3/60 or less than 10° visual field around central fixation) by cause, age, region, and year.Because of data sparsity at younger ages, our analysis focused on adults aged 50 years and older.Findings Global crude prevalence of avoidable vision impairment and blindness in adults aged 50 years and older did not change between 2010 and 2019 (percentage change -0•2% [95% UI -1•5 to 1•0]; 2019 prevalence 9•58 cases per 1000 people [95% IU 8•51 to 10•8], 2010 prevalence 96•0 cases per 1000 people [86•0 to 107•0]).Age-standardised prevalence of avoidable blindness decreased by -15•4% [-16•8 to -14•3], while avoidable MSVI showed no change (0•5% [-0•8 to 1•6]).However, the number of cases increased for both avoidable blindness (10•8% [8•9 to 12•4]) and MSVI (31•5% [30•0 to 33•1]).The leading global causes of blindness in those aged 50 years and older in 2020 were cataract (15•2 million cases [9% IU 12•7-18•0]), followed by glaucoma (3•6 million cases [2•8-4•4]), undercorrected refractive error (2•3 million cases [1•8-2•8]), age-related macular degeneration (1•8 million cases [1•3-2•4]), and diabetic retinopathy (0•86 million cases [0•59-1•23]).Leading causes of MSVI were undercorrected refractive error (86•1 million cases [74•2-101•0]) and cataract (78•8 million cases [67•2-91•4]).Interpretation Results suggest eye care services contributed to the observed reduction of age-standardised rates of avoidable blindness but not of MSVI, and that the target in an ageing global population was not reached.

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Myopia

2012-05-01

Ian G. Morgan , Kyoko Ohno‐Matsui , Seang‐Mei Saw

Prevalence and risk factors for refractive errors in adult Chinese in Singapore.

2000-08-01

Tien Yin Wong , Paul J. Foster , J Hee +5 more

To determine the epidemiology of refractive errors in an adult Chinese population in Singapore.A disproportionate, stratified, clustered, random-sampling procedure was used to select names of 2000 Chinese people aged 40 … To determine the epidemiology of refractive errors in an adult Chinese population in Singapore.A disproportionate, stratified, clustered, random-sampling procedure was used to select names of 2000 Chinese people aged 40 to 79 years from the 1996 Singapore electoral register in the Tanjong Pagar district in Singapore. These people were invited to a centralized clinic for a comprehensive eye examination, including refraction. Refraction was also performed on nonrespondents in their homes. Myopia, high myopia, and hyperopia were defined as a spherical equivalent (SE) in the right eye of less than -0.5 D, less than -5.0 D, and more than +0.5 D, respectively. Astigmatism was defined as less than -0.5 D of cylinder. Anisometropia was defined as a difference in SE of more than 1.0 D between the two eyes. Only phakic eyes were analyzed.From 1717 eligible people, 1232 (71.8%) were examined. Adjusted to the 1997 Singapore population, the overall prevalence of myopia, hyperopia, astigmatism, and anisometropia was 38.7% (95% confidence interval [CI]: 35.5, 42.1), 28.4% (95% CI: 25.3, 31.3), 37.8% (95% CI: 34.6, 41.1), and 15.9% (95% CI: 13.5, 18.4), respectively. The prevalence of high myopia was 9.1% (95% CI: 7.2, 11.2), with women having significantly higher rates than men. The age pattern of myopia was bimodal, with higher prevalence in the 40 to 49 and 70 to 81 age groups and lower prevalence between those age ranges. Prevalence was reversed in hyperopia, with a higher prevalence in subjects aged 50 to 69. There was a monotonic increase in prevalence with age for both astigmatism and anisometropia. Increasing educational levels, higher individual income, professional or office-related occupations, better housing, and greater severity of nuclear opacity were all significantly associated with higher rates of myopia, after adjustment for age and sex.The results indicate that whereas myopia is 1.5 to 2.5 times more prevalent in adult Chinese residing in Singapore than in similarly aged European-derived populations in the United States and Australia, the sociodemographic associations are similar.

Factors affecting light-adapted pupil size in normal human subjects.

1994-03-01

Barry Winn , David Whitaker , David B. Elliott +1 more

To investigate the effect of age, gender, refractive error, and iris color on light-adapted pupil size in humans.Pupil diameters of 91 subjects (age range, 17 to 83 years) with normal, … To investigate the effect of age, gender, refractive error, and iris color on light-adapted pupil size in humans.Pupil diameters of 91 subjects (age range, 17 to 83 years) with normal, healthy eyes were measured using an objective infrared-based continuous recording technique. Five photopic ocular illuminance levels were used (2.15 to 1050 lumens m-2), and the accommodative status of each subject was precisely controlled at a constant level.Pupil size decreased linearly as a function of age at all illuminance levels. Even at the highest illuminance level, there was still a significant effect of age upon pupil size. The rate of change of pupil diameter with age decreased from 0.043 mm per year at the lowest illuminance level to 0.015 mm per year at the highest. In addition, the variability between pupil sizes of subjects of the same age decreased by a factor of approximately two as luminance was increased over the range investigated. Pupil size was found to be independent of gender, refractive error, or iris color (P > 0.1).Of the factors investigated, only chronologic age had a significant effect on the size of the pupil. The phenomenon of senile miosis is present over a wide range of ocular illuminance levels.

Antibiotics-Induced Gut Microbiome Dysbiosis Affects Susceptibility to Minus Lens-Induced Myopia in Mice

2025-06-25

S. Ikeda , Deokho Lee , Junhan Chen +4 more | Investigative Ophthalmology & Visual Science

The prevalence of myopia has increased worldwide in recent decades, shifting the focus in research from genetic to environmental factors. The roles of diet in the development of myopia may … The prevalence of myopia has increased worldwide in recent decades, shifting the focus in research from genetic to environmental factors. The roles of diet in the development of myopia may be directly associated with gut microbiota composition. Therefore this study evaluated the effects of antibiotic-induced gut dysbiosis on the development of negative lens-induced myopia. We administered several antibiotics (ampicillin, vancomycin, neomycin, or a mixture) to induce gut dysbiosis in male C57BL/6J mice with negative lens-induced myopia. Gut microbiome profiles were analyzed by 16 S rRNA gene sequencing. Mice administered vancomycin, neomycin, and a mixture of three antibiotics exhibited resistance to lens-induced myopia, unlike control or ampicillin-administered mice. Further analyses revealed no specific trend in the gut microbiota composition and diversity related to myopia resistance, except for an increase in the abundance of Clostridiaceae. These findings demonstrate the potential role of the gut microbiome, particularly Clostridiaceae family, in myopia susceptibility. This study offers new insights into the preventive strategies and therapeutic interventions to mitigate myopia development.

Unilateral Myopia With Posterior Staphyloma

2025-06-25

Malik Muhammad Hamza Khan , Muhammad Nauman Malik , Muhammad Bilal Malik +2 more | Cureus

Closing in on a Consensus in Identifying, Assessing and Diagnosing Children With Cerebral Visual Impairment

2025-06-25

B Lindquist , Carl-Einar Westerberg | Acta Paediatrica

ABSTRACT Aim Lack of global consensus regarding CVI makes assessment and research more difficult. Our aim is to describe current consensus and evident methods for how to identify, assess and … ABSTRACT Aim Lack of global consensus regarding CVI makes assessment and research more difficult. Our aim is to describe current consensus and evident methods for how to identify, assess and diagnose CVI in children. Method Data‐based search on reviews and papers published 2014–2023. Result The seven reviews and 23 papers reviewed here jointly convey a broad knowledge on CVI including its definition, assessment tools, and evidence‐based methods to diagnose this condition. The definition of CVI as a verifiable visual dysfunction that cannot be attributed to disorders of the anterior visual pathways, or any potentially co‐occurring ocular impairment was confirmed. Assessment tools based on Dutton's CVI questionnaire were identified as being most relevant. A diagnosis of CVI should be assessed and established by a multidisciplinary team, following a cognitive assessment. A magnetic resonance imaging scan in addition to the ophthalmological examination can be valuable but is optional and is not on its own sufficient for diagnosis. The neuropsychological assessment must further include tests of visual and visuospatial perception. All assessments should be in co‐operation with caregivers and teachers. Conclusion This scoping review demonstrates satisfactory evidence and consensus needed in order to proceed with general recommendations for assessment and diagnosis of CVI.

<i>In vivo</i> structured illumination ophthalmoscopy demonstration on the human retina using adaptive optics

2025-06-24

Yann Lai-Tim , Laurent M. Mugnier , Léa Krafft +6 more | Biomedical Optics Express

Structured illumination microscopy (SIM) is one of the most versatile super-resolution techniques. Yet, its application to high-resolution live imaging has been mainly limited to fluorescent and stationary specimens. Here, we … Structured illumination microscopy (SIM) is one of the most versatile super-resolution techniques. Yet, its application to high-resolution live imaging has been mainly limited to fluorescent and stationary specimens. Here, we present advancements in SIM to jointly tackle all the challenges of imaging living samples, i.e. , obtaining super-resolution over an undistorted wide-field while dealing with sample motion, multiple scattering, sample-induced optical aberrations, and low signal-to-noise ratio. By using adaptive optics to compensate for optical aberrations and a reconstruction algorithm tailored for moving and thick tissue, we successfully apply SIM to in vivo retinal imaging and demonstrate structured illumination ophthalmoscopy with optical sectioning and resolution improvement for in vivo imaging of the human retina.

The optics of simultaneous vision intraocular lenses

2025-06-24

Miguel Faria‐Ribeiro | Journal of Cataract & Refractive Surgery

This review examines the optical principles underlying presbyopia-correcting simultaneous vision intraocular lenses (IOLs), providing a fundamental, physics-based perspective on their function. Rather than focusing on commercial models or clinical outcomes, … This review examines the optical principles underlying presbyopia-correcting simultaneous vision intraocular lenses (IOLs), providing a fundamental, physics-based perspective on their function. Rather than focusing on commercial models or clinical outcomes, this work aims to enhance the understanding of the optical mechanisms governing simultaneous vision. The discussion covers key design variations in both refractive and diffractive IOLs, explaining how wavefront modulation can affect light distribution and visual performance. The analysis is presented from the dual perspectives of a former eyecare practitioner and a vision scientist experienced in the research and development of presbyopia-correcting IOLs. The review uses accessible language aimed at nonphysicists and uses accurate optical simulations and general design representations to illustrate the optical principles of contemporary presbyopia-correcting IOLs. Although variations in lens geometry and material properties influence optical performance, the core concept remains consistent. By elucidating the fundamental physical principles behind modern IOL designs, this review aims to enhance professional knowledge and provide a robust foundation for evaluating emerging technologies and developing innovative solutions for presbyopia correction.

LRP2 is a potential molecular target for nonsyndromic pathological myopia

2025-06-24

Kimberley Delaunay , Émilie Picard , Patricia Lassiaz +7 more | JCI Insight

High myopia (HM) and posterior staphyloma (PS) are major causes of vision loss worldwide. Genetic and environmental factors, especially light exposure, influence myopia. This study shows that LRP2 (Low-density lipoprotein-related … High myopia (HM) and posterior staphyloma (PS) are major causes of vision loss worldwide. Genetic and environmental factors, especially light exposure, influence myopia. This study shows that LRP2 (Low-density lipoprotein-related receptor type 2) levels are decreased in the vitreous of patients with HM and PS, and that in human donor eyes affected by PS, LRP2 expression was reduced in the neural retina and retinal pigment epithelium (RPE), with morphologic changes similar to those observed in the Foxg1-Cre-Lrp2lox/lox mouse that also develops PS. In human iPSc-derived RPE cells (iRPE), LRP2 silencing regulated genes involved in eye and neuronal development, visual perception, tissue remodeling, hormone metabolism and RPE structure. Its expression increased under light exposure, particularly red light, but was downregulated by cortisol. These findings establish a link between LRP2, myopization, and environmental factors, highlighting its crucial role in nonsyndromic HM and PS. LRP2 appears to be a promising therapeutic target for high myopia treatment.

Comparative evaluation of different (peripheral defocus based) spectacle designs in preventing myopia progression: A double‐blinded randomised clinical trial

2025-06-24

Vinay Gupta , Rohit Saxena , Rebika Dhiman +2 more | Ophthalmic and Physiological Optics

This study aimed to evaluate and compare the efficacy of different peripheral defocus-based spectacle designs [Defocus Induced Multiple Segment (DIMS), Highly Aspherical Lenslets (HALT) and Cylindrical Annular Refractive Elements (CARE)] … This study aimed to evaluate and compare the efficacy of different peripheral defocus-based spectacle designs [Defocus Induced Multiple Segment (DIMS), Highly Aspherical Lenslets (HALT) and Cylindrical Annular Refractive Elements (CARE)] in controlling myopia progression. This was a prospective, interventional, double-blinded, randomised clinical trial. Children aged 5 to 15 years, with myopia ranging from -1 D to -8 D and documented myopia progression of ≥0.5 D/year, were randomly assigned (1:1:1) to wear either DIMS, HALT or CARE spectacles full-time. Cycloplegic refraction and axial length measurements were taken at baseline and after 1 year. The primary outcome was the change in the rate of myopia progression. All analyses were performed based on the intention-to-treat principle. A total of 120 participants (40 in each group: DIMS, HALT and CARE) with a mean age of 10.1 ± 3.3 years (57% male) were enrolled. At the 1-year follow-up, the rate of myopia progression reduced by 0.38 ± 0.13 D/year (56.7%), 0.36 ± 0.12 D/year (58.1%) and 0.31 ± 0.15 D/year (47%) for the DIMS, HALT and CARE groups, respectively. The respective change in axial length was 0.2 ± 0.11 mm, 0.19 ± 0.12 mm and 0.23 ± 0.14 mm. Inter-group comparisons showed a significant difference in spherical equivalent refractive error changes between HALT and CARE (p = 0.04) and in the rate of myopia progression between DIMS and CARE (p = 0.04). No significant differences were found between HALT and DIMS for any parameter. Spectacle lenses incorporating peripheral defocus (DIMS, HALT and CARE) were all effective in reducing the rate of myopia progression significantly, with no adverse effects being observed. Among the three designs, DIMS and HALT exhibited comparable and significantly better efficacy than CARE spectacles at 1 year follow-up. However, further long-term studies are required to validate these findings.

The role of correlated colour temperature in myopia development and prevention

2025-06-23

Dan‐Lin Li , Jianhua Liu , Shan Gong +5 more | Acta Ophthalmologica

Identifying a balanced light environment that supports healthy ocular development is important. Correlated colour temperature (CCT, measured in Kelvin, K) of light sources, based on human visual perception, is believed … Identifying a balanced light environment that supports healthy ocular development is important. Correlated colour temperature (CCT, measured in Kelvin, K) of light sources, based on human visual perception, is believed to be associated with myopia, but its impact and underlying mechanisms remain unclear. This study aimed to review the literature and elucidate the potential relationship and biological mechanisms linking CCT and myopia. A systematic search was conducted across PubMed, Scopus, Web of Science and Embase, Wiley and Cochrane databases. Studies published from January 2000 to December 2024 that have explored the connection between CCT and myopia were included. PRISMA was used for data validity. A total of 10 articles were included in this review, comprising seven experimental studies and three population-based studies. The impact of CCT on myopia was inconsistent in different animal models. Human studies suggest high CCT artificial lighting environments may be associated with a higher progression of myopia. However, the effects of confounding factors may influence the results, and the number of relevant publications is limited. Although relatively lower CCT may have a protective effect against myopia, its influence is often confounded by spectral composition, making it difficult to isolate the specific role of CCT. Lower CCT light may have a protective effect against myopia, though this is not universal and further depends on wavelength, illuminance and exposure duration. Further research is needed to determine whether changes in CCT can help prevent and control myopia in humans, especially in combination with other myopia control treatments.

The role of general practice in the identification of age-related vision impairment and chronic eye diseases: a systematic review

2025-06-23

Marie Honoré Jacobsen , Olivia Hjulsager Mathiesen , Emma Katrine Frøhlke Steinbo +3 more | BJGP Open

Age-related vision impairment (ARVI) is associated with an increased risk of dementia and depression and can affect older patients' overall health and ability to manage everyday tasks. ARVI is often … Age-related vision impairment (ARVI) is associated with an increased risk of dementia and depression and can affect older patients' overall health and ability to manage everyday tasks. ARVI is often asymptomatic making it difficult to detect. The WHO recommends primary care settings for identification of ARVI, underscoring the importance of general practice. This study aims to synthesize recent knowledge on identifying ARVI in general practice within countries with well-established primary healthcare systems. A systematic literature review searching for published research focused on identification of ARVI and chronic eye diseases in general practice. The search was conducted in June 2024 across PubMed, Web of Science, and Scopus. Inclusion criteria included empirical, peer-reviewed studies focused on ARVI or eye diseases in adults in general practice, conducted in countries with well-established primary healthcare systems, and published in English or Scandinavian languages. Acute eye-diseases were excluded. Twenty articles were included. A thematic qualitative synthesis of included articles was conducted. Three themes were identified: (1) General practice screenings and referrals, highlighting a limited knowledge of eye health, but a high focus on diabetic retinopathy (DR) (2), collaboration between GP practices and other health professions implied the importance of cross-sectorial collaboration, and (3) General practice potentials in detecting ARVI, through initiatives such as continued professional development, systematic DR screening and more focus on other eye diseases than DR. This review highlights the need for more research in detection of ARVI and prevalent chronic eye diseases in general practice.

Effectiveness of a split-dose, twice-daily low-dose atropine monocular treatment in children with anisometropia: a retrospective study

2025-06-23

Hae Ri Yum , Shin Hae Park , Sun Young Shin | International Ophthalmology

A Comparative Study of Heterophoria in Young Adults with Emmetropic and Myopic Refractive Errors

2025-06-23

Priyanka Roy | International Journal of Science and Research (IJSR)

Visual Quality and Symptomatology Following Implantation of a Non-Diffractive Extended Depth-of-Focus Intraocular Lens

2025-06-23

Antonio Cano-Ortiz , Álvaro Sánchez-Ventosa , Timoteo González-Cruces +6 more | Journal of Clinical Medicine

Background/Objectives: This study aimed to evaluate the visual quality and symptomatology of a non-diffractive extended depth-of-focus (EDoF) intraocular lens (IOL), the Elon 877PEY (Medicontur, Zsámbék, Hungary), three months after implantation. … Background/Objectives: This study aimed to evaluate the visual quality and symptomatology of a non-diffractive extended depth-of-focus (EDoF) intraocular lens (IOL), the Elon 877PEY (Medicontur, Zsámbék, Hungary), three months after implantation. Methods: A cross-sectional case series study was conducted, with measurements taken three months post-implantation of the Elon IOL. A total of 56 implanted eyes from 28 patients (mean age: 64.5 ± 9.5 years) were included in the statistical analysis. The variables analyzed to assess the effectiveness of the Elon IOL included high-contrast visual acuity, contrast sensitivity, the defocus curve, and visual symptoms. Results: Three months after implantation, the mean residual sphere was 0.00 ± 0.33 D, while the mean residual cylinder was −0.25 ± 0.41 D. Without correction, patients achieved monocular decimal visual acuity values of 0.94 ± 0.26 for distance, 0.79 ± 0.17 for intermediate, and 0.58 ± 0.15 for near vision. The mean uncorrected contrast sensitivity was 1.61 ± 0.15 log. The defocus curve showed visual acuity exceeding 0.80 decimal (0.10 logMAR) over a 2.00 D range and above 0.63 decimal (0.20 logMAR) over a 2.50 D range. The most frequently reported symptoms, with mild severity and bothersomeness, were glare, starbursts, halos, and focusing difficulties. Conclusions: Patients implanted with the Elon IOL achieved satisfactory visual quality at all distances, comparable to outcomes reported for other EDoF IOLs in the scientific literature.

Cross-sectional study of myopia prevalence and associated risk factors among children and adolescents in Shaanxi Province, China, in 2021

2025-06-22

Yiming Guo , Guanchen Liu , Junhan Wei +5 more | Annals of Medicine

Myopia is a growing global health issue, particularly among Chinese children and adolescents. This study aimed to investigate the prevalence and risk factors of myopia among children and adolescents in … Myopia is a growing global health issue, particularly among Chinese children and adolescents. This study aimed to investigate the prevalence and risk factors of myopia among children and adolescents in Shaanxi Province, China. A cross-sectional study conducted in 2021 included 261,504 participants from Guanzhong, Southern Shaanxi, and Northern Shaanxi. Ophthalmological examinations were performed, and refractive error was assessed using non-cycloplegic refraction to determine the spherical equivalent (SE). Myopia was defined as SE ≤-0.5 D and categorized into low (SE >-3.0 D), moderate (SE >-6.0 D), and high myopia (SE ≤-6.0 D). Data on age, gender, education level, and ethnicity were collected using structured questionnaires administered through face-to-face interviews. The overall prevalence of myopia was 67.4% (95% CI: 67.20%-67.50%), with high myopia at 4.63% (95% CI: 4.55%-4.71%). Myopia was more common in females and increased with educational level, reaching 92.48% in senior high school students. Northern Shaanxi exhibited the highest prevalence of both myopia and high myopia. Regression analysis identified gender, education level, and region as significant risk factors. Myopia is highly prevalent among children and adolescents in Shaanxi Province, with notable gender, educational, and regional disparities. The findings underscore the urgent need for region-specific and education-level-targeted myopia prevention strategies.

A psychometric evaluation of the Chinese Impact of Vision Impairment (C-IVI) questionnaire in an adult cohort with high myopia using Rasch Analysis

2025-06-22

Wei Pan , Ryan Eyn Kidd Man , Eva Fenwick +7 more | medRxiv (Cold Spring Harbor Laboratory)

Abstract Purpose: A psychometric evaluation of the Chinese Impact of Vision Impairment (C-IVI) questionnaire in an adult cohort with high myopia using Rasch Analysis and determination of the relationship between … Abstract Purpose: A psychometric evaluation of the Chinese Impact of Vision Impairment (C-IVI) questionnaire in an adult cohort with high myopia using Rasch Analysis and determination of the relationship between vision-related quality-of-life (VRQoL) and myopia macular degeneration (MMD). Methods: We used the baseline visit data of the AIER-Singapore Eye Research Institute (SERI) High Myopia Adult Cohort Study. VRQoL was assessed using the 28-item C-IVI. Rasch analysis was conducted to evaluate the overall C-IVI and domain scores (‘Mobility and independence’—MB, ‘Reading and accessing information’—RD, and ‘Emotional well-being’—EWB), including response category functioning, precision, unidimensionality, targeting, and differential item functioning (DIF). The criterion validity, C-IVI’s ability to distinguish participants based on severity of vision impairment (VI), spherical equivalent, and the presence of MMD were analyzed using ANOVA and pairwise t-tests. Results: There were 431 participants, with mean (SD) age of 42.2 (7.1) years, spherical equivalent of -8.3 (3.8) D, and visual acuity of 0.1 (0.2) LogMAR. Of these, 15.8% presented MMD, 79.4%, 13.5%, 7.0%, and 0.2% had no, mild, moderate, and severe VI, respectively. Response thresholds were ordered for the overall and three domains. The overall range-based precision was 0.94, and 0.80 for each domain. The three domains demonstrated unidimensionality. DIF was uniform in overall and EWB, but not the MB and RD domains. Person estimates decreased with increasing VI severity, worsening SER, and presenting MMD (all p<0.05) for the overall and domain scores. Conclusions: The C-IVI questionnaire is a valid and reliable tool for assessing VRQoL in adults with high myopia in China.

Childhood amblyopia in a tertiary eye care center in western India

2025-06-20

Jai Kelkar , Aditya Kelkar , Shreekant Kelkar | International Journal of Ophthalmology

AIM: To describe the demographics, clinical characteristics and treatment outcomes of childhood amblyopia in a tertiary eye center in western India. METHODS: This was a retrospective longitudinal hospital-based study of … AIM: To describe the demographics, clinical characteristics and treatment outcomes of childhood amblyopia in a tertiary eye center in western India. METHODS: This was a retrospective longitudinal hospital-based study of 1382 children aged ≤12y included in the National Institute of OphthalMology AmBlyopia StUdy in Indian Paediatric EyeS (NIMBUS) Study. Data on patient demographics, treatment approach, and best-corrected visual acuity (BCVA) changes were reviewed. RESULTS: The mean age of the study cohort was 4.54±2.46y, with males constituting the majority (55.4%). The cause of amblyopia was refractive error in 73.2%, strabismus in 7.3%, and anisometropia in 6.8% of eyes. The majority of therapies comprised glasses (74.4%), followed by occlusion+glasses (10.3%), occlusion alone (7.3%), and surgery+patching+glasses (5.1%). The mean occlusion time was 2.46±1.14h. After a median follow-up of 10.00 (6–85)mo, the mean BCVA significantly improved from 0.85±0.41 to 0.55±0.42 logMAR. Subgroup analysis revealed BCVA gain for all etiologies, including refractive errors (P&#x003C;0.001), strabismus (P&#x003C;0.001), cataract (P&#x003C;0.001), and ptosis (P&#x003C;0.001). Additionally, eyes with refractive errors showed significantly better BCVA than eyes with cataracts (P&#x003C;0.001), strabismus (P&#x003C;0.001) and marginally better BCVA than eyes with ptosis (P&#x003C;0.05), both at the baseline and final visit. CONCLUSION: Refractive errors are the commonest cause of amblyopia, followed by strabismus and anisometropia. Timely detection, optimal therapy, and periodic follow-up are crucial in bettering visual acuity regardless of the cause.

Optical interventions for presbyopia

2025-06-20

Dawn Y. Lam , Manbir Nagra , Langis Michaud +7 more | Cochrane library

Axial length normative data and percentile curves for schoolchildren in Taiwan: A tool for myopia monitoring

2025-06-20

Yao‐Lin Liu , Tze Lai , Shih‐Wen Wang +2 more | Ophthalmic and Physiological Optics

Abstract Purpose The prevention and control of myopia are crucial public health issues. Therefore, this study aimed to construct reference percentile curves of age‐specific axial length based on population‐based sampling … Abstract Purpose The prevention and control of myopia are crucial public health issues. Therefore, this study aimed to construct reference percentile curves of age‐specific axial length based on population‐based sampling data of Taiwanese children and assess their role in the progression of myopia using a cohort of children undergoing orthokeratology. Methods Data from 2997 representative samples of schoolchildren aged 6–18 years from a recent myopia survey in Taiwan between 2016 and 2017 were analysed for axial length distribution. Additionally, data from a cohort of 35 children with myopia treated with orthokeratology (mean follow‐up period: 36.1 ± 14.6 months) were retrospectively collected. The ability to estimate myopia progression based on percentile change rate was compared with that of axial elongation rate through model comparisons involving linear and linear mixed‐effect models. Results Percentile curves of the children's age‐specific axial length were modelled and served as a population‐based reference in Taiwan. The percentile change rate in the cohort of orthokeratology users showed a higher correlation (ρ = 0.64) with the myopia progression rate compared to the axial length elongation rate (ρ = 0.57). The baseline spherical equivalent and percentile change rate demonstrated the most effective performance in estimating myopia progression among all parameters. Conclusions Population‐based reference percentile curves were established for age‐specific axial length in Taiwanese schoolchildren, which can serve as valuable indicators for assessing individual health and monitoring vision trends within the population.

Comparison of a novel gamified binocular therapy and standard monocular patching therapy in treating unilateral amblyopia in young children: a prospective, multicenter, randomized controlled trial

2025-06-20

Wenqing Zhu , Jiawei Zhang , Heying Zhang +4 more | Trials

Amblyopia is a leading cause of visual impairment in children, and conventional treatments often encounter challenges related to poor compliance and adverse psychosocial effects. Recent advancements in treatment approaches have … Amblyopia is a leading cause of visual impairment in children, and conventional treatments often encounter challenges related to poor compliance and adverse psychosocial effects. Recent advancements in treatment approaches have evolved beyond merely suppressing the dominant eye, now focusing on improving binocular visual function. Binocular therapy has emerged as a promising and innovative approach. The study evaluates the efficacy of a novel gamified binocular therapy for treating unilateral amblyopia on comprehensive visual functions. This prospective, multicenter, randomized, blinded, controlled trial is designed as a non-inferiority study. A total of 144 patients, aged 4 to 7 years, diagnosed with amblyopia, will be randomly assigned to either the intervention group (72 patients) or the control group (72 patients). Participants in the intervention group will engage in daily 1-h sessions of gamified binocular therapy, 5 days per week, for a total duration of 8 weeks (40 h). The treatment employs a roguelike shooting game, presented through binocular presentation via two distinct channels, powered by a real-time artificial intelligence-driven visual engine. The control group will receive traditional patching therapy for 2 h per day, 7 days per week for 8 weeks (112 h). The primary outcome measure of this study is distance visual acuity, while secondary outcome measures include stereoacuity and developmental visual perception assessed using the Developmental Test of Visual Perception (DTVP). These measures will be assessed at baseline and follow-up visits to determine the effectiveness of the intervention. This study is a multicenter randomized trial to evaluate the efficacy and safety of the Vision Planet Training System for the treatment of unilateral amblyopia in young children compared with standard monocular patching therapy. The results are anticipated to offer valuable insights into the efficacy of binocular treatment for unilateral amblyopia. Chinese Clinical Trial Registry ChiCTR2300079090. Registered on 25 December 2023. https://www.chictr.org.cn/showproj.html?proj=215374 .

Visual impairment in any eye adversely affects quality of life: Psychometric validation of the Malay NEI VFQ-25

2025-06-20

Jee Yao Loke , Sanjay Rampal , Jemaima Che Hamzah +2 more | PLoS ONE

Purpose To cross-culturally translate and adapt the National Eye Institute Visual Functioning Questionnaire (NEIVFQ-25) into Malay or Bahasa Malaysia, and to analyze its psychometric properties in a cohort of Malaysian … Purpose To cross-culturally translate and adapt the National Eye Institute Visual Functioning Questionnaire (NEIVFQ-25) into Malay or Bahasa Malaysia, and to analyze its psychometric properties in a cohort of Malaysian patients with visual impairment from various causes. Design Cross-sectional validation study Methods The NEI-VFQ 25 was translated and cross-culturally adapted into the Malay version. Total of 324 visually impaired patients caused by cataracts, glaucoma, age-related macular degeneration (ARMD) or diabetic macular edema (DME), and a control group were included. Psychometric analysis was performed including test-retest and internal consistency reliability, convergent validity, discriminant validity, and factor analysis. Clinical validity was measured by correlation of clinical measurements with subdomain scores and known-groups comparison. Results Participants’ average age was 60.4 years (SD 15.4) and 47.2% were male. The internal consistency was high in most subdomains, with Cronbach alpha ranging from 0.66–0.89. The test-retest reliability was high (intraclass correlation coefficient 0.92). Even when just one eye had impaired vision, participants scored much lower on the Malay NEIVFQ 25, highlighting how well the questionnaire reflects the real impact of visual impairment. Moderate correlations were detected between visual acuity and the ‘General vision’, ‘Near Activities’, ‘Distance Activities’, ‘Social Functioning’, ‘Mental Health’, ‘Role Difficulties’, ‘Dependency’ and ‘Driving’ subdomains suggesting that these subdomains were associated with central vision. Factor analysis demonstrated that 4 factors can be extracted from 12 subdomains. Conclusions This study revealed that the Malay version of the NEIVFQ-25 is a valid, reliable, and reproducible instrument to measure the vision-related quality of life in patients with visual impairment. Quality of life was adversely affected even with only one eye having poor vision.

Obesity Increases the Prevalence of Astigmatism in Children and Adolescents

2025-06-20

Min Wang , Yue Zhou , Xiaojuan Chen +7 more | The Open Ophthalmology Journal

Introduction Obesity is currently the most common form of malnutrition in most regions of the world. Refractive error is a major public health concern worldwide, with astigmatism being the most … Introduction Obesity is currently the most common form of malnutrition in most regions of the world. Refractive error is a major public health concern worldwide, with astigmatism being the most common type of refractive error. However, it is still unclear whether nutritional status is related to astigmatism in children and adolescents. Methods A cross-sectional study was performed in 2023, and a stratified cluster sampling technique was employed among school-aged students in Nantong City, China. A total of 9,458 participants were enrolled in the study. Univariate and multivariate logistic regression analyses were carried out to investigate specific correlations between astigmatism and related parameters. Various types of nutritional status were also considered in the study. Results The prevalence of astigmatism among Chinese school-aged children and adolescents was 28.5%, and the overall prevalence of obesity was 11.8%. Multiple logistic regression analyses showed that nutritional status, refractive state, axis position, and age were significantly associated with astigmatism (all, p < 0.001). Among them, participants with obesity were 2.01 times more likely to suffer from astigmatism (aOR: 2.01, 95% CI: 1.74–2.31, p < 0.001). However, nutritional status was not significantly associated with myopia ( p > 0.05). Conclusion The findings of this study have identified the relationship between nutritional status and astigmatism in children and adolescents. It is necessary to strive to maintain a normal nutritional status in children and adolescents in order to reduce the risk of astigmatism.

The hidden impact of myopia severity on interocular suppression in myopia: a cross-sectional study

2025-06-19

Yan Luo , Xiyang Yang , Enwei Lin +7 more | Frontiers in Medicine

Objective This study aimed to investigate the association between spherical equivalent (SE) and interocular suppression in myopic adults, addressing the knowledge gap in functional visual impairments beyond structural changes. Methods … Objective This study aimed to investigate the association between spherical equivalent (SE) and interocular suppression in myopic adults, addressing the knowledge gap in functional visual impairments beyond structural changes. Methods This hospital-based cross-sectional study included 988 myopic patients (aged 18.0–48.7 years, SE ≥ 0.50D). Grating stereopsis (GS), fine stereopsis at 1.5 m (FS1.5), fine stereopsis at 0.8 m (FS0.8), division, fusion, and interocular suppression were examined via computer-based tasks. Multivariate logistic regression analysis and restricted cubic splines (RCSs) were used to analyze the dose–response relationships between SE and the prevalence of suppression disorders (permanent suppression or binocular rivalry suppression). Sensitivity analysis and subgroup analysis were used. Results The prevalence of suppression disorders was 30.6%. Multivariate logistic regression analysis revealed a dose–response relationship between SE and the prevalence of suppression disorder (odds ratio [OR]: 1.08, 95% CI: 1.00–1.17, p = 0.044) after adjusting for age, sex, anisometropia, cylindrical anisometropia, division, fusion, best corrected visual acuity (BCVA), FS0.8, FS1.5, and GS. Restricted cubic splines analysis revealed that the odds ratio of suppression disorder increased approximately linearly with the increase in spherical equivalent ( P for non-linearity = 0.7633 &gt; 0.05). Subgroup analyses showed that this association persisted in those aged &lt;25 years (OR: 1.15; 95% CI: 1.04 ~ 1.27, p = 0.006), those with normal GS (OR: 1.17, 95% CI, 1.03–1.34, p = 0.020), and those with normal FS0.8 (1.09, 95% CI: 1.01–1.18, p = 0.026). In a sensitivity analysis that categorized myopia into three groups, a statistically significant positive association between high myopia (OR: 1.87, 95% CI: 1.10–3.29, p = 0.025), moderate myopia (OR: 1.75, 95% CI: 1.04–3.03, p = 0.039), and suppression disorder was found after adjustment for covariates. Conclusion Myopia severity independently correlates with suppression disorders, suggesting the need for functional vision screening and personalized myopia correction strategies in high-risk populations.

Atropine restores retinal glutamate / γ-aminobutyric acid levels in vitro in an experimental chick model of myopia

2025-06-19

Jordan T. Lloyd , Andrew Collins , John R. Phillips +1 more | Vision Research

Atropine is widely used to slow childhood myopia progression, but its mechanisms of action remain poorly understood. This study investigated atropine's effects on retinal neurochemistry in a chick model of … Atropine is widely used to slow childhood myopia progression, but its mechanisms of action remain poorly understood. This study investigated atropine's effects on retinal neurochemistry in a chick model of form-deprivation myopia (FDM). Myopia was induced in chicks via monocular FDM. Retinas from FDM and contralateral normal eyes were enucleated, bisected and six retinal samples per group were incubated for 60 min in vitro in either 1.8 mM atropine or normal physiological buffer. Samples were fixed in glutaraldehyde for neurotransmitter detection using silver-intensified immunogold labelling. In a separate experiment, the incubation procedure of FDM and normal eyes was repeated and tissues were fixed in formaldehyde to examine dopaminergic neurons using tyrosine hydroxylase (TH) immunofluorescence. No significant changes in TH immunolabelling were observed between groups. However, myopia reduced glutamate levels by 43% compared to controls, with altered glutamate distribution in the inner retina. Bipolar cells in myopic eyes also showed a 57% decrease in glutamine levels. Within 60 min, atropine treatment restored both glutamate and glutamine levels toward normal levels. The most noteworthy changes to gamma aminobutyric acid (GABA) was a 62% reduction observed in the outer plexiform layer (OPL) between normal and myopic retinas. Following atropine treatment, there was a further decrease in (GABA) levels in OPL and horizontal cells. These findings suggest that one immediate effect of atropine treatment is to restore the balance of neurotransmitters that are disrupted in myopia, elevating glutamate while reducing GABA. This neurotransmitter modulation may contribute to atropine's therapeutic effects in myopia control.

Comparative Study of Visual Acuity, Colour Vision and Refractive Status in School Going Children of 6-12 Years of Age in Urban And Rural Areas of Pune District

2025-06-18

Susmita Banerjee , Renu Magdum , Veshal Madan +1 more | Advances in Human Biology

Abstract Introduction: Visual acuity (VA) and colour vision are crucial aspects of vision, impacting individuals’ ability to perceive details and discern colours accurately. Understanding the prevalence of impairments in these … Abstract Introduction: Visual acuity (VA) and colour vision are crucial aspects of vision, impacting individuals’ ability to perceive details and discern colours accurately. Understanding the prevalence of impairments in these areas amongst urban and rural school-going children is vital for addressing potential academic and social development implications. This study aims to assess the prevalence of VA, colour vision and refractive index impairments amongst urban and rural school children in Pune District, Maharashtra. Materials and Methods: A cross-sectional study was conducted in three urban and four rural areas of Pune District, selecting a total of 900 school children, with 450 from each area. VA was assessed using Snellen’s chart, and colour vision was evaluated using the Ishihara colour vision test. Data analysis utilised logMAR values. Results: Demographic analysis revealed a majority of 16.6% of school children aged 9 years, with a male-to-female ratio of 1:1.16. Myopia was observed in 215 participants, with a statistically significant difference between urban (94.8%) and rural (70.7%) areas. Hypermetropia was present in 50 participants, with a significantly higher prevalence in rural areas (29.3%) compared to urban areas (5.2%). Conclusion: Early detection of visual impairments is crucial for timely intervention to prevent deterioration of visual function. Schools and parents should prioritise regular eye checkups to ensure optimal vision health in children. The high prevalence of visual impairments and colour vision deficiencies amongst school-age children underscores the importance of addressing these issues to mitigate potential impacts on academic success and self-esteem.

Comparative effectiveness of dual-focus contact lenses and DIMS spectacle lenses for myopia control in patients with low astigmatism: a retrospective study

2025-06-18

Chia‐Yi Lee , Shun‐Fa Yang , Yu‐Ling Chang +3 more | Frontiers in Medicine

Purpose This study aimed to evaluate and compare the effectiveness of dual-focus contact lenses (DFCL) and defocus incorporated multiple segment (DIMS) spectacle lenses in controlling myopia progression in patients with … Purpose This study aimed to evaluate and compare the effectiveness of dual-focus contact lenses (DFCL) and defocus incorporated multiple segment (DIMS) spectacle lenses in controlling myopia progression in patients with low astigmatism. Methods A retrospective cohort study was conducted involving myopic patients with astigmatism of less than −1.25 diopters (D) who used either DFCL or DIMS spectacle lenses. The study included 95 eyes in the DFCL group and 88 eyes in the DIMS group, and the spherical equivalent refraction (SER) of the study population ranged from −0.50 D to −6.00 D. The primary outcomes were the progression of SER and the elongation of axial length (AXL) over 1 year. A generalized linear mixed model was used to calculate adjusted odds ratios (aORs) and the associated 95% confidence intervals (CIs), adjusting for age, sex, initial AXL, and initial SER. Results The mean SER progression was −0.28 ± 0.15 D in the DFCL group and −0.25 ± 0.12 D in the DIMS group ( p = 0.139). The mean AXL elongation was 0.12 ± 0.07 mm for DFCL users and 0.10 ± 0.05 mm for DIMS users ( p = 0.029). Trend analysis revealed no significant differences in SER progression (aOR: 0.988; 95% CI: 0.945–1.033; p = 0.513) or AXL elongation (aOR: 0.982; 95% CI: 0.945–1.018; p = 0.307) between the groups after adjusting for confounders. Subgroup analyses indicated no significant differences in SER progression or AXL elongation between DIMS and DFCL users across different baseline characteristics (all p &gt; 0.05). Conclusion The use of DIMS spectacle lenses showed SER and AXL control similar to that of DFCL.

Associations Between Myopia and Brain Volumes: An Observational and Genetic Analysis

2025-06-18

Selena Wei Zhang , Jie Guo , Yanxian Chen +4 more | Investigative Ophthalmology & Visual Science

To examine phenotypic and genetic associations between myopia and various brain volumes using the UK Biobank database. After 1:1 propensity score matching (PSM) between participants with myopia and healthy controls, … To examine phenotypic and genetic associations between myopia and various brain volumes using the UK Biobank database. After 1:1 propensity score matching (PSM) between participants with myopia and healthy controls, the relationship between myopia and brain volumes was examined using general linear regression, with adjustments for covariates including age, sex, ethnicity, Townsend Deprivation Index, lifestyle factors, and disease status. Bonferroni correction was applied for multiple comparisons. Bidirectional Mendelian randomization (MR) and genetic risk score (GRS) were used to assess genetic associations. After Bonferroni correction, general linear regression revealed that myopia was significantly associated with reduced total brain volume (β, -0.07 mL; 95% confidence interval [CI], -0.11 to -0.03) and white matter volume (β, -0.08 mL; 95% CI, -0.13 to -0.03) in the fully adjusted model. Education significantly modified the myopia-gray matter association, with a stronger negative correlation in individuals without a college education (β, -0.09 mL; 95% CI, -0.15 to -0.04). MR analysis indicated no obvious causal effect of myopia on brain volumes, and GRS analysis revealed only a slight decreasing trend in total brain volume with increasing genetic risk for myopia (P value for trend < 0.05). Although myopia shows phenotypic associations with brain volumes, including total brain and white matter, and particularly with gray matter in individuals with lower education, genetic analysis (MR and GRS) did not support a causal or genetic link with brain volumes. These findings suggest that residual confounding factors beyond education level may underlie the observed associations between myopia and brain volumes, underscoring the need for further research to elucidate these relationships.

Relationship of Visual Impairment and Poor Mobility With Mortality

2025-06-18

Atalie C. Thompson , Joseph Rigdon , Michael E. Miller +1 more | Journal of the American Geriatrics Society

ABSTRACT Background Older adults with visual impairment (VI) have a greater risk of mortality, but the reasons are poorly understood. We have shown that older adults with VI are more … ABSTRACT Background Older adults with visual impairment (VI) have a greater risk of mortality, but the reasons are poorly understood. We have shown that older adults with VI are more likely to have poor mobility performance on the short physical performance battery (SPPB). In this analysis, we examined whether VI predicted mortality over 10 years and if this was related to poor baseline mobility (SPPB < 9). Methods We analyzed 2457 older adults (mean age 75.6 (±2.8) years, 38.5% black, 51.9% female) who completed vision testing at the year 3 visit in the Health, Aging and Body Composition study. Cox proportional hazards models for mortality were right‐censored at 10 years and adjusted for demographic and clinical comorbidities. VI (visual acuity < 20/40 or log contrast sensitivity < 1.55 or stereoacuity > 85) and SPPB < 9 were tested as main predictors and their interaction was tested. Results In separate multivariable models, VI (HR 1.511, 95% CI [1.335–1.709], p < 0.0001) and SPPB < 9 (HR 1.442, 95% CI [1.210–1.717], p < 0.0001) each predicted mortality. When including both poor mobility and vision variables as main effects, both poor mobility and impaired vision remained significant predictors of mortality in all models (all p < 0.001). When adding poor mobility (as a main effect and interaction with VI) and using unimpaired vision and mobility as the reference, those with only VI (HR 1.467, 95% CI [1.287–1.672], p < 0.0001) or only poor mobility (HR 1.380, 95% CI [0.963–1.979], p = 0.0792) had similar HRs, while those with both VI and poor mobility had an increased mortality risk (HR 2.035, 95% CI [1.643–2.522], p < 0.0001), but the interaction was not significant ( p = 0.981). Conclusions Older adults with both VI and poor mobility are at an additive increased risk of mortality. Future interventions may want to target older adults with both VI and poor mobility to improve survival.

Photoreceptor cone loss is associated with decreased deep retinal vessel density and impaired retinal sensitivity in high myopia

2025-06-18

Jia Liang , Dong Fang , Y.H. Diao +7 more | British Journal of Ophthalmology

Purpose To assess alterations in cone morphology, retinal sublayer thicknesses and vessel densities (VDs) in eyes with non-pathological high myopia (HM) and their correlation with retinal sensitivity (RS). Methods This … Purpose To assess alterations in cone morphology, retinal sublayer thicknesses and vessel densities (VDs) in eyes with non-pathological high myopia (HM) and their correlation with retinal sensitivity (RS). Methods This prospective study included 43 patients with non-pathological HM and 38 age-matched healthy volunteers. Participants underwent detailed ophthalmic evaluations. Cone morphology was assessed using adaptive optics scanning laser ophthalmoscopy. The thicknesses of the myoid and ellipsoid zone (MEZ), photoreceptors outer segment (OS), central macula and choroid were measured by optical coherence tomography (OCT). Retinal VDs of the superficial and deep capillary plexus (DCP) were evaluated by OCT angiography, and RS was assessed through microperimetry. Group comparisons were conducted, and correlations among these parameters were explored. Results The HM group showed significantly reduced cone density and regularity, increased cone dispersion and spacing at 3° eccentricity across four quadrants (all p<0.001) and decreased VDs (all p<0.01), except for foveal VDs in both capillary plexuses and parafoveal VD in DCP (all p>0.05). Additionally, MEZ, OS, central macula and choroid were thinner in HM (all p<0.001). Multivariate regression indicated that higher cone density correlated with shorter axial length (p= 0.013 ) and higher DCP whole VD (p=0.009). Better RS was related to higher cone density (p=0.026), thicker MEZ (p<0.001), thicker choroid (p=0.044) and higher DCP whole VD (p=0.009). Conclusions Our findings demonstrate that impaired DCP perfusion independently predicts cone loss in non-pathological HM, independent of axial elongation. RS impairment is associated with cone loss, MEZ thinning and DCP hypoperfusion, indicating synergistic microvascular and structural damage in HM-related vision impairment.

Bidirectional Causal Relationship Between Myopia and Neurodegenerative Diseases: Two-Sample Mendelian Randomization Analyses

2025-06-18

Yuanyuan Fan , Zhijie Wang , Mengai Wu +3 more | British Journal of Hospital Medicine

Aims/Background Myopia is highly prevalent in certain neurodegenerative diseases (NDDs), and both conditions demonstrate genetic susceptibility. This study investigated the potential bidirectional causal relationships between myopia and four NDDs, Parkinson’s … Aims/Background Myopia is highly prevalent in certain neurodegenerative diseases (NDDs), and both conditions demonstrate genetic susceptibility. This study investigated the potential bidirectional causal relationships between myopia and four NDDs, Parkinson’s disease (PD), Alzheimer’s disease (AD), multiple sclerosis (MS), and amyotrophic lateral sclerosis (ALS), using Mendelian randomization (MR). We aimed to determine whether myopia contributes to the risk of NDDs and vice versa. Methods We analyzed data from two independent, large-scale genome-wide association study (GWAS) cohorts on myopia, comprising 212,571 participants in the first cohort (finn-b-H7_MYOPIA) and 95,619 in the second (GCST009521). GWAS summary statistics for the four NDDs, encompassing 589,439 samples, were also incorporated. Bidirectional MR was employed to investigate causal relationships between myopia and each of the four NDDs. The inverse variance-weighted (IVW) method served as the primary analytical approach. Sensitivity analyses, including MR-Egger regression, weighted median, weighted mode, and simple mode, were conducted to assess the robustness of the findings. Horizontal pleiotropy was evaluated using the MR-Egger regression intercept test and the Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) global test, while heterogeneity was assessed via Cochran’s Q test. Leave-one-out analyses were conducted to evaluate the influence of individual single nucleotide polymorphisms (SNPs). Odds ratios (ORs) with 95% confidence intervals (CIs) were reported, and statistical significance was set at p < 0.05. Results MR analyses identified no evidence of a causal relationship between myopia and refractive error and increased risk of any of the four NDDs (all p > 0.05). Similarly, none of the NDDs were associated with an increased risk of myopia or refractive error (all p > 0.05). Sensitivity analyses revealed no SNPs with significant influence on the causal associations (all p > 0.05), supporting the robustness of the findings. Conclusion This study provides no evidence of a bidirectional causal relationship between myopia and the four NDDs among individuals of European ancestry. Future research should extend beyond direct causal inference to investigate potential mediating biological mechanisms.

Safety Evaluation in Healthy Adults of Motion-Based Virtual Reality Dichoptic Training for Pediatric Patients With Amblyopia: Prospective Intervention Study

2025-06-17

Masakazu Hirota , Yuichi Okumura , Ken Nagino +5 more | JMIR Formative Research

Abstract Background Amblyopia, a unilateral or bilateral visual disorder, affects up to 5% of the general population and is a leading cause of childhood visual impairment. Current treatments, such as … Abstract Background Amblyopia, a unilateral or bilateral visual disorder, affects up to 5% of the general population and is a leading cause of childhood visual impairment. Current treatments, such as patching therapy, aim to improve amblyopia by temporarily occluding the unaffected eye, thereby promoting the use of the amblyopic eye. However, adherence to patch therapy can be challenging, as the forced use of the amblyopic eye can be stressful for children. Moreover, despite improvements in visual acuity by patch therapy, children with amblyopia often face difficulties with hand-eye coordination; therefore, a treatment that reduces stress for them while simultaneously improving hand-eye coordination could address the limitations of existing amblyopia therapies. Objective This study investigated the safety of our motion-based virtual reality (VR) dichoptic training app using Japanese Kendama in healthy adult participants, which was designed to improve hand-eye coordination in pediatric patients with amblyopia. Methods This prospective intervention study involved 20 healthy young adults (median age 21, IQR 21‐28.3 y), including 16 women. The participants played the motion-based VR dichoptic training app for 30 minutes and then completed a subjective symptom questionnaire, which comprised 9 questions (Q1-Q9) with each item scored on a 4-point scale, except Q9, which was assessed on a binary scale. Q1-Q3 focused on subjective eye symptoms, Q4-Q7 evaluated physical and mental discomfort, Q8 assessed the degree of VR session–induced arm fatigue, and Q9 assessed the severity of visually induced motion sickness. Results No significant differences were observed in the reported ocular symptoms before and after the VR session, including eye fatigue (mean before vs after: 1.25, SD 0.94 points vs 1.35, SD 0.85 points), blurred vision (0.55, SD 0.50 points vs 0.80, SD 0.40 points), eye dryness (0.95, SD 0.74 points vs 1.25, SD 0.83 points), and visually induced motion sickness (0.00, SD 0.00 points vs 0.05, SD 0.22 points). These results suggested that the motion-based VR dichoptic training did not induce significant adverse ocular effects. Conclusions The motion-based VR dichoptic training app demonstrated minimal adverse ocular effects in healthy adult participants, suggesting that it is safe for use in this population. These findings demonstrate the feasibility and good tolerability of this VR-based intervention in healthy adults. Further studies, including clinical studies in adult and pediatric patients with amblyopia, are warranted to evaluate its applicability and therapeutic effects.

A longitudinal study of development in language, cognition, social adaptation, and exploratory behaviour of toddlers with vision impairment

2025-06-17

Carlijn Veldhorst , S. Kef , Mathijs P. J. Vervloed +1 more | British Journal of Visual Impairment

Research on children with vision impairment (VI) has primarily focused on comparing their development to that of sighted peers, offering limited insights into their individual developmental trajectories. To enhance early … Research on children with vision impairment (VI) has primarily focused on comparing their development to that of sighted peers, offering limited insights into their individual developmental trajectories. To enhance early intervention, understanding these individual pathways is crucial. This study examined the developmental trajectories of 24 toddlers aged 8 and 38 months ( M = 19.96, SD = 8.06) with VI in four key domains: language, cognition, social adaptation, and exploratory behaviour. Over 2 years, participants were assessed during home visits using the Reynell Zinkin Scales. Individual plots and linear mixed effect models revealed individual developmental trajectories, with most children showing progress in social adaptation and exploratory behaviour before language and cognition. No significant differences in developmental growth were found between children with moderate VI or severe VI. This longitudinal investigation emphasizes diversity within the population of children with VI suggesting that factors beyond VI itself should be considered when addressing developmental differences.

Effect of Repeated Intense Foveal Red-Light Therapy in Children with Pre-Myopia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2025-06-17

Markus Leber , Tanize Louize Milbradt , Alexandre Yamada Fujimura +4 more | Current Eye Research

Myopia is a significant public health concern with increased risk of ocular complications. Intense Foveal Red Light (IFRL) therapy has been explored in myopia control, but its efficacy at the … Myopia is a significant public health concern with increased risk of ocular complications. Intense Foveal Red Light (IFRL) therapy has been explored in myopia control, but its efficacy at the pre-myopic stage remains underexplored. The use of this therapy in a population without a myopia diagnosis may offer a new window for the prophylactic application of IFRL therapy. The purpose of this meta-analysis is to determine the effectiveness of IFRL therapy in children with pre-myopia. PubMed, Embase, and the Cochrane Library were systematically searched for studies investigating the effects of IFRL therapy on myopia incidence, changes in axial length (AL), choroidal thickness (CT), and cycloplegic spherical equivalent refraction (SER). Two independent reviewers screened studies, extracted data, and assessed the risk of bias. Meta-analyses were conducted using random-effects models to estimate the pooled effect sizes. Of 365 studies identified, 4 met the criteria, totaling 619 participants (mean age 8.48 years, 51.8% female). At 6 months, IFRL significantly reduced myopia incidence (Risk Difference [RD] - 0.1; 95% CI -0.15 to -0.05; p < 0.01), with benefits persisting at 12 months (RD -0.17; 95% CI -0.26 to 0.09; p < 0.01). IFRL also reduced AL at 6 months (Mean Difference [MD] - 0.12 mm; 95% CI -0.16 to -0.09; p < 0.01) and 12 months (MD -0.18 mm; 95% CI -0.23 to -0.14; p < 0.01), increased CT (MD 22.34 µm; 95% CI 5.45-39.24; p < 0.01), and improved SER at 6 (MD 0.27 D; 95% CI 0.23 to 0.32; p < 0.01) and 12 months (MD 0.36 D; 95% CI 0.27-0.46; p < 0.01). IFRL effectively reduced myopia incidence, AL, and improved SER and CT. These findings support further research on its long-term efficacy and safety, particularly regarding potential adverse effects and durability of outcomes. Overall, IFRL may offer a preventive strategy for pre-myopic children.

ASSESSMENT OF THE ROLE OF HEREDITARY PREDISPOSITION AND HYPEROPIA RESERVE IN THE DEVELOPMENT OF MYOPIA IN PRESCHOOL AND EARLY SCHOOL-AGE CHILDREN. MYOPIA AS THE "PLAGUE" OF THE 21ST CENTURY

2025-06-17

J.Kh. Samadova , Navid Valizadeh , A.Y. Amirova | Azerbaijan Journal of Ophthalmology

Purpose – to evaluate the impact of hereditary predisposition and hyperopic reserve on the risk of myopia development in preschool and early school-age children. Material and methods The study included … Purpose – to evaluate the impact of hereditary predisposition and hyperopic reserve on the risk of myopia development in preschool and early school-age children. Material and methods The study included 200 children with emmetropic refraction, with a mean age of 6.0±0.8 years. Observation period at least 2 years. The groups were stratified according to the level of hyperopia reserve:(+) 0.75 D (low risk) and (+) 0.75 D (high risk). Additionally, the presence of myopia in one or both parents was recorded. Descriptive statistics, the following methods were used: descriptive statistics, Pearson correlation coefficient, logistic regression, OR (odds ratio), RR (relative risk), RERI (Relative Excess Risk due to Interaction) calculations. Results Myopia developed in 62% of children during follow-up. Hereditary predisposition (r= 0.394) and low hyperopia reserve (r = –0.371) were significantly correlated with myopia onset (p < 0.001). Both factors proved to be independent predictors: adjusted OR=4.71 for heredity and OR=4.29 for hyperopia reserve. In cases where both risk factors were present, the combined OR reached 20.0. However, the variable interactions in the logistic model were not statistically significant (B=– 0.07; p=0.916), and the RERI value (-0,41) was negative, indicating an additive rather than synergistic effect. Conclusion This study focused on two easily and objectively measurable parameters — hereditary predisposition and hyperopia reserve. Both factors demonstrated statistical independence and high predictive value, complementing each other in the assessment of cumulative risk. The obtained data are planned to be used in future research to develop a scoring-based model for assessing the risk of myopia, designed for use in practical pediatric ophthalmology. Key words: myopia in children, predictors of myopia development, hereditary predisposition to myopia, hyperopia reserves in children, logistic regression

Clinical Data Registry Comparing Outcomes of Two Light Adjustable Lenses

2025-06-17

John F. Doane , T. Hunter Newsom , Stephen Slade +3 more | Journal of Cataract & Refractive Surgery

Purpose: To compare the clinical performance of the light adjustable lenses (LAL) to the LAL+ with an increased central power to have broader depth of focus. Setting: Private practice clinics. … Purpose: To compare the clinical performance of the light adjustable lenses (LAL) to the LAL+ with an increased central power to have broader depth of focus. Setting: Private practice clinics. Design: Prospective, non-randomized, non-masked, multi-center. Methods: Clinical data collection registry of patients bilaterally implanted with the LAL or LAL+ (RxSight, Inc.). Outcome measures included subjective manifest refraction; monocular best corrected distance, intermediate and near visual acuity; binocular uncorrected distance, intermediate, and near visual acuity; and binocular uncorrected best focus visual acuity at differing contrast levels. Results: 91.1% and 93.5% of LAL and LAL+ eyes had an MRSE within 0.50 D of target, respectively. 92.0% and 89.0% of LAL and LAL+ patients had a binocular uncorrected distance visual acuity (UCDVA) of 20/20 or better after adjustment, respectively. 86.0% and 93.0% of LAL and LAL+ patients had binocular uncorrected best focus visual acuity of J1 or better at 100% contrast, respectively. Distance corrected intermediate and near visual acuity was better with the LAL+ compared to the LAL, consistent with its further broadened depth of focus. Best corrected distance vision was only slightly reduced for LAL+ (1 letter), with both lenses achieving high levels. Conclusions: Both the LAL and LAL+ achieved excellent refractive and binocular visual outcomes at distance, intermediate and near. The broadened depth of focus of the LAL+ was clinically evident and led to less anisometropia. The ability of patients to binocularly select and adjust their refraction according to their visual goal is a unique therapeutic approach to cataract refractive patients.

Comparative Evaluation of Traditional and AI-Based Intraocular Lens Power Calculation Formulas in Highly Myopic Eyes

2025-06-17

Xiaopeng Jiang , Jiangjie Wang , Qingmin Jiang +3 more | Research Square (Research Square)

<title>Abstract</title> <bold>Purpose: </bold>To assess the accuracy of artificial intelligence (AI)-based intraocular lens (IOL) power calculation formulas compared with traditional methods in highly myopic eyes, and to evaluate their performance across … <title>Abstract</title> <bold>Purpose: </bold>To assess the accuracy of artificial intelligence (AI)-based intraocular lens (IOL) power calculation formulas compared with traditional methods in highly myopic eyes, and to evaluate their performance across varying axial lengths and corneal curvatures. <bold>Methods:</bold> This retrospective case series included 115 highly myopic eyes that underwent phacoemulsification with IOL implantation. IOL power was calculated using four conventional formulas (SRK/T, Haigis, Holladay 2, Barrett Universal II) and seven AI-based formulas (Hill-RBF 3.0, Karmona, Hoffer QST, PEARL-DGS, Ladas Super Formula, Kane, HM-ZL). The outcomes were evaluated using mean error (ME), mean absolute error (MAE), median absolute error (MedAE), and the percentage of eyes within ±0.25 D to ±1.00 D of the prediction error. Subgroup analyses were conducted based on axial length (AL) and corneal curvature (Kmean). <bold>Results: </bold>AI-based formulas—especially Hill-RBF 3.0, Hoffer QST, and PEARL-DGS—demonstrated significantly higher accuracy than traditional formulas. Hill-RBF 3.0 achieved the lowest MAE (0.50 D) and MedAE (0.33 D) and the highest percentage of eyes within ±0.50 D (67.83%）and ±1.00 D (89.57%). Subgroup analyses showed that AI formulas maintained consistent performance across various AL and Kmean categories. Significant differences were noted between AI-based and traditional formulas, particularly in eyes with extreme biometric values. <bold>Conclusion: </bold>AI-based formulas provide superior refractive prediction in highly myopic eyes compared with traditional methods, particularly in cases of long axial length or steep corneal curvature. Tailored formula selection based on biometric profiles may enhance refractive outcomes in cataract surgery.

Myopia Development During Transition From Kindergarten to Early Grades in Elementary School: Population-Based Evidence From an Epidemic Area in Taiwan

2025-06-16

Yu‐Chieh Yang , Der-Chong Tsai , Shao-You Fang +7 more | Investigative Ophthalmology & Visual Science

The purpose of this study was to investigate the incidence of myopia, its association, and refractive progression among kindergarten non-myopic children after entering elementary schools in Yilan, Taiwan. A cohort … The purpose of this study was to investigate the incidence of myopia, its association, and refractive progression among kindergarten non-myopic children after entering elementary schools in Yilan, Taiwan. A cohort study was conducted on first- and second-grade elementary school students. Ocular examinations and caregiver-administered questionnaires were performed between December 2023 and March 2024, with data linked to kindergarten records from Yilan Myopia Vision Improvement Program (YMVIP). Myopia was defined as spherical equivalent (SE) ≤ -0.5 diopters (D), and premyopia as -0.5 D < SE ≤ 0.75 D. Of 1754 enrolled students, 1680 (95.73%) underwent ocular examinations, and 1554 (88.55%) were linked to kindergarten data. Among 1428 non-myopic preschoolers, the incidence density of myopia was 8.70% per person-year (95% confidence interval [CI] = 7.60%-9.80%). Children with incident myopia had a more negative baseline SE (0.33 ± 0.50 D vs. 1.02 ± 0.80 D, P < 0.001) and greater annual myopic progression (-0.60 ± 0.42 D/year vs. -0.20 ± 0.34 D/year). A multiple logistic regression model identified risk factors for incident myopia as premyopia in preschool (odds ratio [OR] = 9.641, 95% CI = 5.936-15.660, P < 0.001), having two myopic parents (OR = 1.819, 95% CI = 1.003-3.297, P = 0.049), and older age at the time of the elementary school examination (OR = 1.635, 95% CI = 1.224-2.183, P = 0.001). Spending more than 30 minutes/day outdoors on weekdays in preschool was protective against myopia (OR = 0.528, 95% CI = 0.366-0.762, P = 0.001). The incidence density of myopia in Yilan County was 8.70% per person-year. Risk factors included premyopia, having myopic parents, and less outdoor time in kindergarten.

Patient satisfaction and quality of vision after bilateral implantation of enhanced monofocal IOL and mini-monovision: a prospective study

2025-06-16

A. Llovet-Rausell , Jorge Navalón-Tortosa , Vasyl Druchkiv +3 more | Eye and Vision

Abstract Background Patient expectations for post-cataract surgery outcomes have risen. This study aims to evaluate patient satisfaction after bilateral implantation of enhanced monofocal IOL (RayOne EMV RAO200E) designed with positive … Abstract Background Patient expectations for post-cataract surgery outcomes have risen. This study aims to evaluate patient satisfaction after bilateral implantation of enhanced monofocal IOL (RayOne EMV RAO200E) designed with positive spherical aberration, used for monovision with a 1.00 D offset. Methods Prospective, non-comparative, interventional case series. Patients underwent bilateral cataract surgery and implantation of an enhanced monofocal IOL (RayOne EMV IOL RAO200E, Rayner, Worthing, UK) with target refraction of −1.00 D in the non-dominant eye and emmetropia in the dominant eye. Patient-reported outcome measures (PROMs) were assessed 3 months postoperatively using the Spanish version of the Catquest-9SF and a self-administered questionnaire. Other outcome measures included subjective refraction, visual acuity at various distances, and contrast sensitivity. Results Both eyes of 51 patients were included (102 eyes). Three months postoperatively, all patients reported being satisfied or very satisfied with the overall surgical outcomes. The majority of patients reported that their vision during night driving was as good or better than before the surgery (95%); further, there was no difficulty in recognizing faces (93%), navigating uneven terrain (95%), and viewing prices while shopping (81%). The mean subjective spherical equivalent for dominant and non-dominant eyes were −0.24 ± 0.34 D and −0.86 ± 0.33 D, respectively. Binocular UDVA (4 m), UIVA (66 cm), and UNVA (40 cm) were 0.06 ± 0.09, 0.25 ± 0.12, and 0.30 ± 0.11 logMAR, respectively. Contrast sensitivity was within the population norms (CSV-1000). Conclusion Monovision with the RayOne EMV IOL provided high patient satisfaction, with preserved contrast sensitivity, good distance vision, and functional intermediate and near vision. Trial registration : Clinicaltrials.gov, NCT06528678. Registered 22 July 2024—Retrospectively registered, https://clinicaltrials.gov/study/NCT06528678 .

Comparing Myopia Control Effects of Three Different Orthokeratology Lenses and Spectacle Lenses With Highly Aspherical Lenslets in Low Myopia Children

2025-06-16

Na Li , Luodian Luobu , Bei Du +2 more | Translational Vision Science & Technology

To compare the effectiveness of three different orthokeratology (OK) lenses and highly aspherical-lenslet spectacle lenses (HAL) for myopia control in young children with low myopia, and to compare the relative … To compare the effectiveness of three different orthokeratology (OK) lenses and highly aspherical-lenslet spectacle lenses (HAL) for myopia control in young children with low myopia, and to compare the relative corneal refractive power (RCRP) distributions among the three OK lenses with different designs. This retrospective study involved 166 children aged eight to 11 years with myopia of -0.50 to -3.00 D treated with ProTong OK lenses with aspheric base curve (APOK), ProTong OK lenses with spherical base curve (SPOK), Euclid OK lenses (EOK), HAL, or single-vision spectacle lenses (SVL). Axial length (AL) was measured at baseline and the 12-month visit. Corneal topography was measured for OK wearers to determine the distance from the apex RCRP profile to its three-quarter-peak. The axial elongation for the APOK, SPOK, HAL, EOK, and SVL groups were 0.17 ± 0.14 mm, 0.25 ± 0.17 mm, 0.11 ± 0.15 mm, 0.37 ± 0.12 mm, and 0.45 ± 0.16 mm after 12 months, respectively. Axial elongation was significantly slower for the APOK, SPOK, and HAL groups than for the EOK or SVL groups (all P < 0.05); and it was significantly slower in HAL than in SPOK wearers (P < 0.05). 59.5% and 42.9% of HAL and APOK wearers experienced axial elongation of ≤0.15 mm, respectively. The HAL and APOK, SPOK and APOK, or EOK and SVL groups showed no significant differences in axial elongation. Both SPOK and APOK groups had lower 3/4X values than the EOK group. HAL and APOK wear, relative to EOK or SVL wear, by eight- to 11-year-old children with low myopia led to comparable yet slower axial elongation. APOK and SPOK led to a steeper distribution of the RCRP profile within the pupillary range and yielded better myopia control than EOK. HAL and APOK are recommended for effective myopia control in children aged eight to 11 years with mild myopia.

Review of Mix-and-Match Approach and Binocular Intraocular Lens Systems

2025-06-16

Tadas Naujokaitis , Grzegorz Łabuz , Ramin Khoramnia +1 more | Journal of Clinical Medicine

In the mix-and-match approach and in binocular intraocular lens (IOL) systems, two different IOL models are implanted in each eye to achieve the desired binocular outcome. In the mix-and-match approach, … In the mix-and-match approach and in binocular intraocular lens (IOL) systems, two different IOL models are implanted in each eye to achieve the desired binocular outcome. In the mix-and-match approach, the surgeon selects the IOL models to be combined according to the clinical situation, the patient's needs, and personal preference. Combinations described in the literature include, among others, two bifocal IOLs, an extended-depth-of-focus (EDoF) IOL with a bifocal lens, a trifocal lens with an EDoF IOL or an enhanced monofocal IOL, and two EDoF models utilizing different optical principles. The outcomes depend on the selected combination of IOL models. Binocular IOL systems consist of a fixed combination of two lenses, developed to be complementary in binocular vision. Initial data indicate that they can achieve a depth of focus similar to that with a bilateral implantation of a trifocal IOL. However, comparative studies are needed to evaluate if the postoperative binocular outcome differs from that achieved with the conventional approach. The mix-and-match implantation and binocular IOL systems expand the options available to tailor the IOL selection to the patient's needs.

Hyperopic Eyes Are Structurally More Dynamic Than Myopic Eyes During Accommodation: An In Vivo Investigation

2025-06-16

Tuyishime Didier Fidele Uwacu , Saugat Bhattacharyya , Kathryn J. Saunders +1 more | Investigative Ophthalmology & Visual Science

The impact of different refractive errors on accommodative structural changes remains unclear. Novel swept-source imaging technology in anterior segment optical coherence tomography (AS-OCT) has enabled in vivo investigation of the … The impact of different refractive errors on accommodative structural changes remains unclear. Novel swept-source imaging technology in anterior segment optical coherence tomography (AS-OCT) has enabled in vivo investigation of the accommodating eye. This study investigated ocular structural change and corresponding functional responses during accommodation in individuals with emmetropia, myopia, and hyperopia. Adults (n = 46; mean age, 22.15 ± 3.00 years) with normal accommodation and a wide range of refractive errors (spherical equivalent refraction [SER]: -7.50 D to +7.88 D) were recruited. CASIA2 AS-OCT measured anterior segment changes during accommodation stimulated by the use of inbuilt accommodative targets and bespoke external stimuli at five different accommodative demands (0 D, 2 D, 3 D, 4 D, and 6 D) and under cycloplegia. Simultaneously, changes in refractive state were measured using the PowerRefractor3 photorefraction system. Lens thickness (LT), anterior chamber depth (ACD), lens diameter (LD), anterior segment length (ASL), anterior lens radius of curvature (ALRC), and posterior lens radius of curvature (PLRC) changed significantly during accommodation (all P < 0.001). Accommodative changes in LT, ACD, and ASL were significantly associated with the level of SER (all P < 0.05), as more hyperopic eyes showed significantly greater per-diopter change than myopic eyes in LT (P = 0.014) and ACD (P = 0.039) for comparatively similar accommodative response (P > 0.9). The analysis of lens position showed that cycloplegia induced posterior displacement of the lens. The CASIA2 internal accommodative target and the external proximal target induced similar structural and functional accommodative responses. There are significant differences between structural changes seen in accommodating eyes with different types and magnitudes of refractive error, with hyperopic eyes showing greater changes in LT and ACD than myopic eyes during accommodation.

Binocularity-stimulating Treatment Using a Stereoscopic 3D Game in Patients with Amblyopia

2025-06-15

Jin Wook Jung , Haeng-Jin Lee | Journal of the Korean Ophthalmological Society

Purpose: We investigated the effect of binocularity-stimulating treatment using stereoscopic 3D games in patients with amblyopia.Methods: We retrospectively analyzed amblyopia patients who had at least 12 months of patch therapy … Purpose: We investigated the effect of binocularity-stimulating treatment using stereoscopic 3D games in patients with amblyopia.Methods: We retrospectively analyzed amblyopia patients who had at least 12 months of patch therapy from 2020 to 2023 without further improvement who then underwent binocularity-stimulating treatment using stereoscopic 3D games displayed on a 3D TV. The level of blur and focal length of the screen viewed by the fellow eye were adjusted according to the visual acuity of the amblyopic eye. Each session lasted 30 min and patients participated in 16 sessions. We compared visual acuity, stereopsis, and contrast sensitivity before and after treatment.Results: The study included 24 patients with a mean age of 11.5 years at the time of treatment. The visual acuity of the amblyopic eye improved from 0.29 ± 0.27 logarithm of the minimal angle of resolution (logMAR) to 0.19 ± 0.24 logMAR (<i>p</i>=0.001), with that of 7 (29%) patients improving by two or more lines. Stereopsis improved from 2.89 ± 0.41 to 2.63 ± 0.35 log arcsec (<i>p</i> < 0.001), while contrast sensitivity improved from 1.69 ± 0.11 to 1.73 ± 0.08 log 1/c after treatment (<i>p</i> = 0.059).Conclusions: Additional visual function improvement was achieved through binocularity-stimulating treatment using stereoscopic 3D games in amblyopia patients whose vision did not improve despite patching for a sufficient period of time and in adult amblyopia patients who missed the timing of vision development. Individualized treatment was possible by adjusting the intensity of the stimulus presented to the fellow eye based on the visual acuity of the amblyopic eye, using separate 3D screens.

Visual impairment and blindness among children: A literature review

2025-06-14

Soukaina Loulidi , Mohamed Loukid , Samia Boussaa | Clinical Epidemiology and Global Health

The impact of different optical treatment strategies on the dynamics of refraction after minimally invasive sclero-strengthening treatment of progressive myopia in children

2025-06-14

G. A. Markosyan , Е. П. Тарутта , Е. Н. Иомдина +5 more | Russian Ophthalmological Journal

Purpose : a comparative study of the effect of various optical correction methods on the dynamics of refraction in children with progressive myopia after minimally invasive scleroplasty (MIS). Material and … Purpose : a comparative study of the effect of various optical correction methods on the dynamics of refraction in children with progressive myopia after minimally invasive scleroplasty (MIS). Material and methods . A total of 58 patients (58 eyes) aged 8 to 14 years (mean 12.0 ± 0.2 years) with moderate and high progressive myopia — from 4 to 11.5 D (mean 7.7 ± 0.3 D) with the year progression gradient (YPG) from 0.5 to 1.75 D (mean 1.25 ± 0.06 D) were operated on. In all patients, visual acuity, clinical refraction, axial length of the eye and the state of the fundus were determined. For MIS, the biologically active transplant (BAT) Hitex-HG was used. Patients were divided into groups depending on the optical correction prescribed after the operation. In group 1 (17 patients), monofocal (MF) glasses used before the operation were replaced with perifocal (Perifocal-MS, PMS) or progressive glasses. In group 2 (18 patients), children used PMS or progressive glasses before and after MSP. In group 3 (16 patients), MF or soft contact lenses were used before and after the operation. In group 4 (7 patients), MF, PMS or progressive glasses used before the operation were replaced with orthokeratology lenses. The follow-up period was 1 year. Results . Comparative analysis of YPG in groups with different optical correction showed different decrease of this parameter in the postoperative period: in group 1 — 4.7 times; in group 2 — 4 times; in group 3 — 2.3 times; in group 4 — 5 times. Conclusion . The most effective treatment is a combination of MIS and optical correction with accommodation support and/or impact on peripheral retinal defocus. This approach to managing pediatric patients with progressive myopia should be a priority.

Impact of bifocal soft contact lenses and Midrimax on peripheral refraction and eye aberrations in children with myopia

2025-06-14

Е. П. Тарутта , Н. А. Тарасова , С. В. Милаш +2 more | Russian Ophthalmological Journal

Purpose of the work: to evaluate the effect of combined use of bifocal soft contact lenses (BSCL) and the combined drug Midrimax (Phenylephrine 5.0%; Tropicamide 0.8%) on peripheral refraction and … Purpose of the work: to evaluate the effect of combined use of bifocal soft contact lenses (BSCL) and the combined drug Midrimax (Phenylephrine 5.0%; Tropicamide 0.8%) on peripheral refraction and wavefront aberrations of the eye. Material and methods . Prima BIO Bi-focal BSCL was prescribed to 43 children aged 10.42 ± 0.26 years with myopia of 3.43 ± 0.19 D. After 1 month, 23 children (group 1) were additionally prescribed Midrimax instillations. Results . The wavefront of the eye in BSCL undergoes significant changes: RMS HOAs increases by 4 times, tilt, vertical coma, horizontal trefoil by 1.5–2 times; positive spherical aberration (SA) increases on average by 20 times. In the BMCL, myopic defocus is formed in all zones of the near periphery of the retina, except for the N5° zone (instead of the hypermetropic defocus that existed without correction); in the N5° zone, hyperopic defocus is formed, which was absent without correction. The formation of myopic defocus is completely consistent with the multiple increase in positive SA and is explained by the design of the lens with a paracentral add zone. Continuous wearing of the BMCL for 6–12 months is accompanied by a decrease in hyperopic defocus of uncorrected eyes, and when combined with instillations of Midrimax — the formation of weakly myopic defocus in the N5° zone. After a month of continuous wearing of the BMCL, a decrease in the level of positive SA by 1.7–1.8 times was noted, which is consistent with an increase in manifest refraction and an increase in the tone of accommodation. Further instillations of the Midrimax resulted in a 3-fold increase in positive SA, indicating the elimination of excess tone. Conclusion . The identified changes in the wave front and peripheral defocus in the BMCL obviously explain the stabilizing effect of this optical and optical-pharmacological method of myopia control.

Longitudinal development of ocular biometric components and refractive error in children with hyperopic anisometropia

2025-06-13

Jingyun Wang , Reed M. Jost , Brooke A. Koritala +1 more | Ophthalmic and Physiological Optics

Abstract Purpose To compare the longitudinal development of spherical equivalent refraction (SER) and ocular biometric components in the more hyperopic (MoreH) and less hyperopic (LessH) eyes of children with hyperopic … Abstract Purpose To compare the longitudinal development of spherical equivalent refraction (SER) and ocular biometric components in the more hyperopic (MoreH) and less hyperopic (LessH) eyes of children with hyperopic anisometropia. Methods This prospective longitudinal study included 36 children aged 4 to <13 years with hyperopic anisometropia without strabismus. Based on a best‐corrected interocular visual acuity difference ≥0.20 logMAR, participants were classified as amblyopic ( N = 31) or non‐amblyopic ( N = 5). SER was derived from cycloplegic refraction and anisometropia was defined as an interocular SER difference ≥1 D. Axial length (AL), anterior chamber depth (ACD), lens thickness (LT), and keratometry (K1, K2) were obtained. Corneal curvature (CR) was calculated and the AL/CR ratio determined. Mean follow‐up was 3.7 ± 1.4 years, with 5.8 ± 2.4 visits per child. A linear mixed‐effects model estimated the rate of change for SER and the ocular components, comparing the MoreH and LessH eyes. Results Baseline anisometropia was 2.66 ± 1.22 D. There were significant differences between the MoreH and LessH eyes for baseline AL, ACD and AL/CR (all p < 0.05). SER change with age was slower for the MoreH than the LessH eyes (−0.11 vs. −0.31 D/year, p < 0.001). The rates of change for AL (0.11 vs. 0.19 mm/year, p < 0.05) and AL/CR (0.01 vs. 0.02, p < 0.001) also were slower for the MoreH eyes. Anisometropia increased with age in the amblyopic subgroup (0.08 D/year) and decreased in the non‐amblyopic subgroup (−0.17/D/year; p < 0.001). Conclusions In children with hyperopic anisometropia, axial elongation was slower in the MoreH than in the LessH eyes, particularly in those with amblyopia.