Optometry and Vision Science最新文献

Significance: Atropine is effective at slowing myopia progression in children, but the mechanism of action by which it controls myopia remains unclear. This article is an evidenced-based review of potential receptor-based mechanisms by which atropine may act to slow the progression of myopia.The rising number of individuals with myopia worldwide and the association between myopia and vision-threatening ocular pathologies have made myopia control treatments one of the fastest growing areas of ophthalmic research. High-concentration atropine (1%) is the most effective treatment for slowing myopia progression to date; low concentrations of atropine (≤0.05%) appear partially effective and are currently being used to slow myopia progression in children. While significant progress has been made in the past few decades in understanding fundamental mechanisms by which atropine may control myopia, the precise characterization of how atropine works for myopia control remains incomplete. It is plausible that atropine slows myopia via its affinity to muscarinic receptors and influence on accommodation, but animal studies suggest that this is likely not the case. Other studies have shown that, in addition to muscarinic receptors, atropine can also bind, or affect the action of, dopamine, alpha-2-adrenergic, gamma-aminobutyric acid, and cytokine receptors in slowing myopia progression. This review summarizes atropine's effects on different receptor pathways of ocular tissues and discusses how these effects may or may not contribute to slowing myopia progression. Given the relatively broad array of receptor-based mechanisms implicated in atropine control of myopia, a single mode of action of atropine is unlikely; rather atropine may be exerting its myopia control effects directly or indirectly via several mechanisms at multiple levels of ocular tissues, all of which likely trigger the response in the same direction to inhibit eye growth and myopia progression.

Significance: This 7-year clinical study assessed the impact of age and number of years of myopia control treatment with MiSight 1 day (omafilcon A; CooperVision, Inc., Pleasanton, CA) dual-focus contact lenses on post-treatment eye growth and myopia progression. Growth and progression after treatment were ceased and returned to age-normal levels retaining prior accrued treatment gains.

Purpose: This study aimed to assess eye growth and refractive changes after cessation of prolonged myopia control treatment with a dual-focus contact lens.

Methods: Eighty-three subjects completing a 6-year clinical trial of a dual-focus myopia control contact lens (MiSight 1 day) continued into a follow-on 1-year "wash-out" phase in which all subjects were fit with a single-vision contact lens (Proclear 1 day, omafilcon A; CooperVision, Inc.). Right and left eye data were analyzed from 38 subjects with 6 years of prior treatment (T6) and 40 receiving treatment during study years 4 to 6 (T3). Axial length and cyclopleged spherical equivalent refractive errors were monitored annually for 7 years. Expected axial growth and myopia progression during years 4 to 7 if treatment had not been started were estimated by extrapolating growth of untreated myopic control eyes collected during years 1 to 3 using population-based estimates of age effects on growth rates.

Results: During the untreated year 7, annualized axial growth and refractive changes were 0.09 ± 0.09 (T3) and 0.10 ± 0.10 mm/y (T6), and -0.23 ± 0.36 (T3) and -0.21 ± 0.40 D/y (T6), respectively, each slightly greater than observed during the previous year of treatment (0.07 ± 0.12 [T3] and 0.08 ± 0.07 mm [T6], and -0.04 ± 0.34 [T3] and -0.13 ± 0.42 D [T6]). Year 7 progression was less for the older (11 to 12 at baseline, -0.17 ± 0.40 D/0.05 ± 0.07 mm) than the younger (8 to 10 at baseline, -0.26 ± 0.36 D/0.13 ± 0.10 mm) subgroup. Years in treatment (3 vs. 6) did not influence post-treatment growth or progression.

Conclusions: A cessation study following 3 or 6 years of myopia control treatment with the dual-focus myopia control contact lens found axial growth and myopia progression rates similar to those expected of untreated myopic eyes at these ages. This finding reveals that accrued treatment gains were retained and neither amplified nor diminished after cessation of treatment.

Significance: With the global rise in myopia among school-aged children, effective management strategies, such as contact lenses (CLs), are essential. In Kenya, where myopia prevalence is increasing, understanding parental influence on CL uptake is critical because of parents' key role in healthcare decisions involving their children. This study addresses this significant gap by exploring the parental factors that either promote or hinder CL uptake among school-aged children in Kenya.

Purpose: This study investigated the parental factors influencing CL uptake among school-aged children with myopia in selected Kenyan eye clinics. This study specifically examined the factors that promote or hinder parents' choice of CLs as a myopia correction method for their children.

Methods: This cross-sectional study involved 85 parents or caregivers of children and teenagers aged 8 to 18 years with significant myopia, defined as a spherical equivalent refraction value of ≤-0.50 D in one or both eyes. Data were gathered using a pre-validated questionnaire distributed at selected eye clinics. The questionnaire assessed parental knowledge, attitudes, and the factors affecting CL uptake. Descriptive statistics were used to summarize the key variables, and multivariate logistic regression was used to assess the influence of parental factors on CL uptake.

Results: The study found that 35% of parents approved CL use for their children, with academic performance (odds ratio [OR], 106; p = 0.01) and discomfort with spectacles (OR, 41; p = 0.02) being significant positive influencers. The major barriers identified were concerns about the child being too young (OR, 62; p = 0.03) and not careful enough (OR, 84; p = 0.02) to handle CLs. Other barriers include the perceived high cost of CLs and a lack of professional advice.

Conclusions: Parental CL uptake decisions are significantly influenced by perceived academic benefits and concerns regarding the child's ability to manage CLs. These findings highlight the need for targeted educational interventions and professional guidance to address parental concerns, improve CL uptake, and enhance myopia management in school-aged Kenyan children.

Significance: Slowing myopia progression is quickly becoming the clinical standard of care, but little is known about how changing treatment alters treatment effect. This case series provides insight on how changing treatment modality may affect treatment outcomes in myopia management.

Purpose: Aiming to control myopia progression in children is becoming the clinical standard of care. Little is known about the effect of changing treatment on myopic progression. We present a case series of real-world myopia management patients who underwent a change in treatment method and report the observed effect on axial length.

Methods: Clinical records from the University of Houston Myopia Management Service were reviewed to identify children who underwent a change in treatment. The analyzed dataset consisted of 44 clinic assessments from seven children including two who were switched from peripheral defocus soft contact lenses to orthokeratology, two who were switched from orthokeratology to peripheral defocus soft contact lenses, and three who received combination therapy following an initial period of treatment with either orthokeratology, peripheral defocus soft contact lenses, or atropine alone. Axial length measurements were adjusted by subtracting central corneal thickness from the raw axial length value and then converted to an annualized rate (mm/y) by subtracting the previous corneal thickness-adjusted from the current corneal thickness-adjusted axial length and dividing by elapsed time between the successive clinic visits.

Results: Age at initial assessment ranged from 6.6 to 12.6 years (M = 9.3 ± 2.4) with follow-up times ranging between 26 and 78 months (M = 43 ± 18.5). Each individual had a minimum of two clinical visits per treatment type. The mean (SD) for central corneal thickness-annualized adjusted axial length growth in both the eyes and chronological age at the beginning of each treatment type was calculated. Estimated progression rates are summarized separately for each individual and treatment. Data are grouped by patients who switched treatments for either lack of efficacy or other clinical issues.

Conclusions: In a real-world setting, there are various reasons that necessitate a change in treatment. In this sample, change in treatment continued to show slowing of myopia progression, regardless of reason for change.

Significance: Digital devices are ubiquitous in modern daily life. Although a high prevalence of digital eyestrain has been reported, the mechanisms underlying digital eyestrain have not been fully elucidated, and there is currently no proven treatment.

Purpose: This study aimed to evaluate the relationship between the cognitive demand of a near task, mode of presentation (digital or paper), working distance, and symptoms of digital eyestrain.

Methods: Thirty young participants completed four 30-minute reading tasks. The four conditions (performed in randomized order) entailed (1) a cognitively demanding task performed on a tablet computer and (2) a less cognitively demanding task performed on the same device. Trials (3) and (4) were identical to (1) and (2) except that the tasks were performed on paper. Subjects could hold the reading task at any distance they felt comfortable. Before and immediately following each task, subjects completed a digital eyestrain symptom survey. For all four conditions, a spectacle-mounted device (Clouclip) was used to measure the working distance objectively.

Results: Although all four tasks induced significant symptoms, there was a significant difference between the four conditions, with the increase being greatest for the cognitively demanding task on the tablet computer. There was no significant difference in working distance for the four conditions, and all tasks showed a similar reduction in working distance (p=0.001), on average, from 31.6 to 28.9 cm, over the first 10 minutes, with the working distance remaining stable after this initial period.

Conclusions: Task-induced symptoms varied with both cognitive demand and mode of presentation. However, working distance did not vary significantly with these factors. The wording distance decreased during the first 10 minutes of each trial and was markedly closer than 40 cm for all conditions. The closer working distances being adopted should be considered during routine clinical testing.

Significance: India has a population of more than 1.40 billion with a humongous need for community eye health services. Understanding challenges faced by female optometrists in community eye care will help us address the needs and eventually improve eye and vision care services. The study also aims to give recommendations to policymakers and to leadership in hospitals that provide community eye health services and employ female optometrists.

Purpose: The study aimed to understand the challenges faced by women in optometry while delivering community eye care services.

Methods: Optometrists working in community eye health were invited to participate in this study. In-depth interviews were conducted using a semistructured questionnaire. The interviews were recorded, and the audio files were transcribed to text and analyzed using the MAXQDA-10 software. Data analysis was performed based on thematic codes and responses received from the participants.

Results: Eighteen optometrists completed the interviews, and the average age of the female optometrists who participated in the study was 36.439 ± 6.5 years. The average experiences in overall optometry work and community eye health were 14.3 ± 5.9 and 9.5 ± 5.3 years, respectively. The qualitative analysis revealed that women faced several challenges from basic logistics to gender bias, from the communities they served, and from within the organization's peers. Their work-life balance also faced challenges including their social lives. The enablers and motivating factors were job satisfaction, learning experience, and career growth.

Conclusions: The study describes several challenges faced by female optometrists in community eye health, from the lack of basic facilities to gender bias among peers and challenging work-life balance. Despite this, women are happy to contribute to community work, as they find the experience rewarding, both emotionally and professionally.

Significance: The study first investigated the prevalence and internal relationship of astigmatism components under cycloplegia in Tibetan children on plateau areas of China. We found a higher prevalence of refractive (RA) and corneal astigmatism (CA) in Lhasa children and certified the compensation of internal astigmatism (IA), which might be associated with myopic progression.

Purpose: This study aimed to investigate the prevalence and related risk factors of RA, CA, and IA and evaluate compensation and associated influence factors of IA in Lhasa Tibetan children.

Methods: This was a school-based cross-sectional study. Stratified random clustering was used to recruit 1751 Tibetan children with a mean age of 7.90 ± 0.48 years from schools in Lhasa, China. Cycloplegic autorefraction was conducted, and ocular biometrics were examined.

Results: The prevalence rates of RA, CA, and IA were 18.73, 72.53, and 40.72%, respectively, with the diagnosis criteria ≥1.00 D. With-the-rule was the main type of RA (70.05%) and CA (91.93%), whereas the against-the-rule was predominant in IA (79.67%). Compared with the reference group (spherical equivalent range, 0.51 to 1.00 D), mean RA and CA increased with more hyperopic and myopic refractions, and mean IA was significantly lower only in myopia and emmetropia groups. Girls had a higher incidence of CA and IA than boys. Internal astigmatism was negatively correlated with CA in the vertical/horizontal vector ( J0 ) and oblique vector ( J45 ). The majority of IA compensated for RA in different degrees (95.25% in J0 and 66.43% in J45 ) and no compensation accounted for a higher proportion in myopic children (10.47% in J0 and 5.76% in J45 ).

Conclusions: The prevalence of RA and CA in Tibetan children from Lhasa was higher than reported in most previous studies. The compensation of IA in reducing CA was prominent, and the function could decrease with the myopic progression.

Purpose: This study aimed to assess intrasession repeatability, diurnal intravisit and day-to-day intervisit reproducibility of qualitative tear film lipid layer interferometry grading obtained from the Keratograph 5M (Oculus Optikgeräte GmbH, Wetzlar, Germany), and automated quantitative layer thickness measurements obtained from the TearScience LipiView II Ocular Surface Interferometer (Johnson & Johnson Vision, Milpitas, CA), in community residents, not stratified by dry eye or blepharitis status.

Methods: Forty community residents (24 women, 16 men; age mean ± standard deviation, 36 ± 14 years) were recruited in an investigator-masked, randomized, crossover study. Participants attended two sessions 6 hours apart on the same day and a third session on a separate day. During each session, tear film lipid layer grading and thickness measurements were performed in triplicate, in a masked manner, with 10-minute intervals between each measurement.

Results: There were no significant differences in lipid layer grading and thickness measurements in all pairwise intrasession, diurnal intravisit, and day-to-day intervisit comparisons (all p≥0.19), and positive correlations were observed in all cases (all p<0.001). The weighted Cohen κ coefficients for intrasession repeatability and diurnal intravisit and day-to-day intervisit reproducibility of qualitative lipid layer grading ranged from 0.670 to 0.867. The test-retest repeatability of quantitative lipid layer thickness measurements ranged from 4.5 to 11.7 nm, and the Bland-Altman biases were within the order of 3 nm in all pairwise comparisons. The intraclass correlation coefficients for lipid layer thickness measurements exceeded 0.80 for all intrasession comparisons and were between 0.60 and 0.80 for all diurnal intravisit and day-to-day intervisit comparisons.

Conclusions: Both qualitative grading and automated quantitative thickness measurements of tear film lipid layer interferometry demonstrated relatively favorable levels of intrasession repeatability and diurnal intravisit and day-to-day intervisit reproducibility. The study findings would support the use of either qualitative or quantitative measurement in clinical and research settings, as a reliable tool for assessing lipid layer interferometry.

Significance: Machine learning random forest algorithms were used to predict objective refractive outcomes after cycloplegic refraction using noncycloplegic clinical data. A classification model predicted post-cycloplegic myopia and could be useful in screening, and a second regression model predicted post-cycloplegic refractive and could provide a useful objective starting point in noncycloplegic subjective refractions.

Purpose: A classification model sought to predict post-cycloplegic myopia using noncycloplegic clinical data to enhance myopia screening accuracy, whereas the regression model looked to predict objective refraction outcomes after cycloplegia for use as a starting point for noncycloplegic subjective refraction.

Methods: A cross-sectional study included data from 2483 eyes. Pre-refraction measurements, such as uncorrected visual acuity, axial length, and corneal curvature radius, were recorded. After cycloplegia, the spherical equivalent was measured. Random forest-based classification and regression models were established with input variables including age, gender, axial length, corneal curvature radius, axial length-to-corneal curvature radius ratio, spherical equivalent, and uncorrected visual acuity. Model performance was assessed using various metrics.

Results: The random forest classification model achieved high out-of-bag validation accuracy (92%), cross-validation accuracy (93%), external validation accuracy (94%), and precision (95%). The external validation sensitivity was 93%, and specificity was 95%. The regression model internal validation showed an out-of-bag validation R2 of 0.86, root mean square error (RMSE) of 0.66, and mean absolute error of 0.49. The 10-fold cross-validation R2 was 0.87, the RMSE was 0.64, and the mean absolute error was 0.48. In the external validation, R2 was 0.88, the RMSE was 0.63, and the mean absolute error was 0.48.

Conclusions: By analyzing noncycloplegic clinical data, the classification model enables earlier detection of myopia, supporting timely intervention and management. The regression model aims to accurately predict post-cycloplegia myopic corrections, providing reliable initial data for subjective refraction. This could help optometrists perform noncycloplegic subjective refraction more efficiently and is particularly relevant in China, where retinoscopy is not yet fully popularized and many school students decline cycloplegic refraction due to academic pressures and limited free time, primarily because it requires a follow-up the next day.