Optometry and Vision Science最新文献

Significance: Highly hyperopic infants are at greater risk for not undergoing emmetropization and later developing conditions such as strabismus, amblyopia, and early literacy and reading problems. An early intervention consisting of partial hyperopic correction and encouragement of accommodation may influence the rate of emmetropization in these high-risk infants.

Purpose: This study aimed to determine if moderate spectacle partial correction (3.00 D cut from cycloplegic) and visual exercises to promote accommodation enhance emmetropization (reaching ≤+3.00 D) in highly hyperopic (≥+5.00 D to ≤+7.00 D) 3-month-old infants compared with no treatment (observation).

Methods: Thirty-five highly hyperopic 3-month-old infants (57% female) were randomized to observation or treatment ( clinicaltrials.gov ; NCT03669146). Primary analysis compared the mean hyperopia at 18 months of age in treated versus untreated participants. Data were also modeled using proportional hazards survival analysis (time to reach ≤+3.00 D).

Results: There was no significant difference in refractive error at 18 months of age between infants in the treated (+1.6 ± 0.6 D) and observation groups (+1.2 ± 0.7 D; p = 0.23) but treatment affected the rate of emmetropization depending on baseline hyperopia (p = 0.01). At 12 months of age, treated infants had similar refractive errors regardless of baseline hyperopia but untreated infants at 12 months underwent faster emmetropization if their baseline hyperopia was <+5.50 D and slower emmetropization if it was >+5.50 D.

Conclusions: Partial hyperopic refractive correction with accommodative exercises in highly hyperopic infants did not affect average refractive error at 18 months. However, treatment affected the rate of emmetropization and how long it took to reach ≤+3.00 D. Treatment slowed the rate of emmetropization at lower levels of initial hyperopia but may enhance emmetropization at higher levels.

The journey from myopia being an intriguing scientific puzzle to part of clinical practice has been a long and varied path. Chew Sek Jin was one of the pioneers on this journey and, as director of the Singapore Eye Research Institute, initiated an ambitious research program that has helped us get to where we are today. His work was data-driven, embracing the power of epidemiological and longitudinal studies. He emphasized both the public health aspects and clinical management of myopia, pioneering the use of atropine in Singapore. With his work with Josh Wallman, he recognized the importance of research into the biological mechanisms of myopia.

Significance: Pediatric growth charts are widely used to track height and weight. Recently, axial length growth charts have been developed. Unfortunately, they underestimate the rate of normal myopic eye growth, making it challenging to evaluate the benefits of myopia control interventions, due to the conflation of myopes and nonmyopes.

Purpose: The aim is to assess the value of axial length centile curves in the management of childhood myopia.

Methods: Papers reporting centile curves were identified by searching PubMed. For comparison, axial length values for a representative selection of baseline values (21 to 24 mm at 6 years) were calculated as a function of age and ethnicity using published meta-analyses of myopic and emmetropic eye growth data.

Results: Six published centile curves, largely based on cross-sectional data, were identified: three from European populations, two from China, and one from India. The trajectory of the emmetropic eye growth model generally tracks the European and Indian centile curves at lower centiles. This is not the case for the Chinese centile curves, likely due to the significant numbers of myopic children even at lower centiles. In contrast, the trajectory of the myopic eye growth model is steeper than that of the centile curves, even at higher centiles. This suggests that the higher centiles contain substantial numbers of nonmyopic children. Only in the centile curves for Chinese children, who have a higher prevalence of myopia, do they approach myopic eye growth, and then only for older children and at higher centiles.

Conclusions: Centile curves do not accurately represent myopic eye growth, are not the best tool to monitor myopia progression and treatment, do not accurately represent growth in incident myopes, and are not the best way to predict myopia onset. Separate centile curves for myopic eyes do not alleviate the problem because of incident myopia. Annualized growth models may provide a better approach to assessing axial elongation relative to population norms.

Significance: This study reveals that preschool children with insufficient physiological hyperopia experience accelerated myopic drift and axial length elongation. Regular monitoring can serve as an early warning for impending myopia during early childhood, highlighting its critical role in future myopia prevention strategies.

Purpose: This study examines the patterns of spherical equivalent and biometric parameters if physiological hyperopia has shown an accelerated tendency to regress by preschool age and whether the early onset of physiological hyperopia regression accelerates myopia onset.

Methods: This kindergarten-based longitudinal observational study included 1308 children between 3 and 6 years old from kindergartens in Haidian District, Beijing, China. Comprehensive eye examinations were performed on all participants.

Results: Two grouping methods were used for all children. The first was based on their baseline age and divided into four groups of 3 to 6 years. The second was based on spherical equivalent, with spherical equivalent >0.75 D designated as the physiological hyperopia group and spherical equivalent ≤+0.75 D designated as the pre-myopia or myopia group. Physiological hyperopia and the proportion of children with physiological hyperopia displayed a declining trend over time in all age groups (p<0.001), with the older the baseline age, the more pronounced the decline (p<0.001), and the rate increased year by year (p<0.001). In contrast, axial length, anterior chamber depth, and axial length/corneal curvature radius displayed an increasing trend (p<0.001), and the rate of increase of axial length and anterior chamber depth accelerated over time (p<0.001). Female children have more physiological hyperopia and a higher proportion of children with physiological hyperopia compared with males (p<0.001) but displayed a more rapid decline (p<0.001). The axial length, anterior chamber depth, and the axial length/curvature radius were found to be elevated in the pre-myopia or myopia group in comparison to the physiological hyperopia group (p<0.001). Furthermore, the magnitude of the rate increase in myopic drift and axial length was found to be greater in the aforementioned group.

Conclusions: The regression of physiological hyperopia accelerates in preschool-age children, with older children showing faster regression and lower levels of physiological hyperopia. This premature decline correlates with an increased rate of myopic drift and accelerated biometric growth. Therefore, regular monitoring of physiological hyperopia should begin at preschool age, as the rate of regression serves as a more reliable predictor of future myopia than refraction alone.

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: Contact lenses (CLs) utilizing opaque, nonrefractive features may purposefully modulate retinal ganglion cell activity away from the baseline activity. This is a nonrefractive mechanism that may reduce myopia progression. However, the visual performance of CLs with opaque features is unknown.

Purpose: This study aimed to compare the visual performance and binocular/accommodative function of CLs with opaque features (test) against MiSight (control-1) and single-vision (control-2) CLs.

Methods: This was a prospective, randomized, unmasked, cross-over study where 35 myopic CL wearers (18 to 39 years) wore each design for at least 5 days. Visual performance was subjectively assessed using 1 to 10 numeric ratings comprising clarity of vision, lack of ghosting, vision when driving, overall vision satisfaction, and willingness to purchase (yes/no: based on vision and myopia efficacy). Visual acuity measurements comprised monocular and binocular high and low contrast visual acuity at 6 m, and binocular high contrast visual acuity at 70 and 40 cm. Binocular function was assessed using heterophorias at 3 m and 40 cm. Accommodative function was assessed using monocular accommodative facility (MAF) at 40 cm and dynamic monocular accommodative response (AR: 6 m, 70 cm, and 40 cm).

Results: Test was rated higher than control-1 (p<0.001) and control-2 was rated higher than test (p≤0.0052) for all subjective ratings. More participants were willing to purchase test compared with control-1 for vision and myopia efficacy (p<0.001), while there was no difference between test and control-2 for either question (p>0.7). Both controls were better than test for all acuity-based measurements (p≤0.0013). MAF at 40 cm was better with test compared with control-1 (p=0.010) and not different to control-2 (p>0.99). AR was higher with test than both controls at 70 cm (p<0.0001), higher than control-1 at 40 cm (p<0.0001), and not different to control-2 at 40 cm (p=0.12). There were no differences between CLs for AR at 6 m or heterophorias at 3 m or 40 cm (p>0.1).

Conclusions: Compared with control-1, the test offered better visual performance, a higher proportion of participants willing to purchase, and better MAF. Compared with control-2, the test offered worse visual performance, but the proportion of participants willing to purchase was not different, and accommodative function was comparable.

Significance: The myopia control effect of orthokeratology accrues over time, with 11 years of lens wear providing a cumulative absolute reduction in axial elongation of -0.69 mm in comparison with spectacle lens wear. Steeper corneas are likely to benefit from enhanced myopia control efficacy.

Purpose: To compare axial length growth between a group of orthokeratology contact lens wearers and a control group of distance single-vision lens wearers over an 11-year period.

Methods: White European subjects 6 to 12 years old with myopia -0.75 to -4.00DS and astigmatism ≤1.00DC were prospectively allocated orthokeratology or distance single-vision spectacle correction for 2 years. Axial length measurements (Zeiss, IOLMaster) were taken at 6-month intervals during the initial 2 years of the study. Subjects were contacted approximately 5 and 9 years later (i.e., 7 and 11 years after the beginning of the study, respectively) and axial length measurements were repeated.

Results: Thirty-one orthokeratology and 30 control subjects were initially recruited, but only 10 orthokeratology and 15 control subjects attended the 11-year visit. In comparison with the control group, the change in axial length for the orthokeratology group was reduced by 0.04, 0.10, 0.14, 0.22, 0.45, and 0.69 mm after 0.5, 1, 1.5, 2, 7, and 11 years of lens wear, respectively. Significant differences between groups were found in mean unadjusted changes in axial length at the 1-, 1.5-, and 2-year time points (unpaired t -test, p < 0.05), whereas standard contrasts revealed statistical differences between groups in the estimated marginal means of the change in axial length at the 7- and 11-year time points (p < 0.05).

Conclusions: Eleven years of orthokeratology lens wear provided a substantial slowing in the axial elongation of the eye, with a treatment effect of up to 0.69 mm after 11 years of lens wear in comparison with single-vision lens wear.

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: 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: Significant associations in the epidemiologic and clinical features between migraine and dry eye syndrome suggest that both conditions are comorbid. A potentially overlapping pathophysiological mechanism further indicates a connection between the two conditions. This study highlights the clinical implications of treating dry eye disease on migraine.

Purpose: This study aimed to investigate the impact on migraine severity of treating dry eye disease in migraine patients using ocular lubricants.

Methods: A randomized, double-masked, crossover trial was conducted on 24 participants with both migraine and dry eye disease. They received either Systane Hydration UD (Alcon, Fort Worth, TX) or saline eye drops (NeilMed, Santa Rosa, CA) four times per day for 4 weeks each, with a 2-week washout period between treatments. Migraine severity was assessed using the Headache Impact Test 6 (HIT-6) and Migraine Disability Assessment questionnaires. Dry eye disease was evaluated using the Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire 5 (DEQ-5), tear breakup time, tear osmolarity, and corneal surface integrity. Outcomes were assessed at baseline and after using the first and then second drops.

Results: Ocular lubrication was significantly associated with reduced migraine severity and dry eye disease. The HIT-6 score was reduced from baseline when using Systane Hydration UD (mean change, ∆ = -3.0, p=0.01) and saline (∆ = -3.9, p=0.002). Dry eye disease symptoms and corneal staining were reduced when using Systane Hydration UD (OSDI ∆ = -8.3, p=0.004; DEQ-5 ∆ = -2.1, p=0.004; corneal staining ∆ = -2.2, p=0.001) and saline (OSDI ∆ = -6.4, p=0.03; DEQ-5 ∆ = -1.5, p=0.03; corneal staining ∆ = -1.5, p=0.005).

Conclusions: When migraine and dry eye disease coexist, successfully treating dry eye disease reduces the severity of migraine, as measured by HIT-6.