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Background: The purpose of this study was to evaluate the repeatability and agreement of multispectral refraction topography (MRT) in measuring retinal refraction before and after cycloplegia in children. The results of this study will provide valuable insights into the accuracy and reliability of MRT as a tool for assessing retinal refraction in pediatric patients. Methods: Children aged 7 to 18 years old were recruited for this prospective research. The central and peripheral retinal refraction was measured three times using multispectral refraction topography (MRT) before and after cycloplegia. The retinal deviation value (RDV) was used to describe the average peripheral refractive error of the retina. In addition, objective refraction (OR) and subjective refraction (SR) measurements were also performed. Results: A total of 60 children with a mean age of 10.50 ± 1.81 years were enrolled. Before cycloplegia, all the central and peripheral retinal refraction parameters showed good repeatability with the lowest intraclass correlation coefficient (ICC) being 0.78 in the retinal deviation value from 45° eccentricity to 53° of the retina (RDV 45–53). After cycloplegia, the repeatability of MRT was significantly enhanced (lowest ICC = 0.91 in RDV-I). The 95% limits of agreement (LoA) of the central refraction and OR ranged from − 2.1 to 1.8 D before cycloplegia, and from − 1.69 to 0.27 D after cycloplegia. The 95% LoA of the central refraction and SR ranged from − 1.57 to 0.36 D after cycloplegia. All the 95% LoA demonstrated high agreement. Conclusions: The MRT shows high agreement with autorefractometry and experienced optometrist in measuring central refraction. Additionally, the MRT provides good repeatable measurements of retinal peripheral refraction before and after cycloplegia in schoolchildren. [ABSTRACT FROM AUTHOR]

This retrospective study compared postoperative prediction errors of recent formulas using standard- or total keratometry (K or TK) for intraocular lens (IOL) power calculation in post-myopic LASIK patients. It included 56 eyes of 56 patients who underwent uncomplicated cataract surgery, with at least 1-month follow-up at Keio University Hospital in Tokyo or Hayashi Eye Hospital in Yokohama, Japan. Prediction errors, absolute errors, and percentage of eyes with prediction errors within ± 0.25 D, ± 0.50 D, and ± 1.00 D were calculated using nine formulas: Barrett True-K, Barrett True-K TK, Haigis-L, Haigis TK, Pearl-DGS, Hoffer QST, Hoffer QST PK, EVO K, and EVO PK. Statistical comparisons utilized Friedman test, Conover's all-pairs post-hoc, Cochran's Q, and McNemar post-hoc testing. Root-Mean-Square Error (RMSE) was compared with heteroscedastic testing. Barrett True-K TK had the lowest median predicted refractive error (-0.01). EVO PK had the smallest median absolute error (0.20). EVO PK had the highest percentage of eyes within ± 0.25 D of the predicted value (58.9%), significantly better than Haigis-L (p = 0.047). EVO PK had the lowest mean RMSE value (0.499). The EVO PK formula yielded the most accurate IOL power calculation in post-myopic LASIK eyes, with TK/PK values enhancing accuracy. [ABSTRACT FROM AUTHOR]

Water content in the coatings of aged black carbon (BC) aerosol can be reflected through the complex refractive index. In this study, the retrieval of the refractive index and water content for non-absorbing coatings of BC aerosol during hygroscopic growth (RH = 0 %–95 %) based on scattering and absorption properties is theoretically investigated. Optical properties of morphologically realistic fractal BC aerosols are simulated using the multiple-sphere T-matrix method (MSTM), the optical equivalent refractive index of coating material is retrieved based on the Mie theory, and the water content in coatings is further retrieved using effective medium theory. Results show that the scattering property performs best in retrieving the refractive index and water content. The retrieval errors of the refractive index of heavily aged BC aerosols are less than 10 % at high relative humidities (RHs), while partially coated BC and thinly coated BC have larger errors. The regularity of retrieved water content is similar to that of the refractive index retrieved, and the retrieved water content errors range from 2 % to 63 % for heavily coated BC. This study provides a helpful optical method to obtain the water content of BC coatings. [ABSTRACT FROM AUTHOR]

Purpose: To present the outcomes and detail the surgical procedure employed in the initial 102 eyes treated with keratorefractive lenticule extraction (KLEx) using the FEMTO LDV Z8 platform (Ziemer Ophthalmic Systems). Methods: This was a retrospective analysis of 102 eyes of 53 patients treated with KLEx at the American University of Beirut Medical Center. Visual, refractive, topographic, and aberrometric parameters were evaluated 1 week and 1, 3, 6, and 12 months postoperatively. Results: Mean preoperative spherical equivalent refraction (SEQ) was −4.11 ± 1.82 diopters (D) (range: −10.00 to −1.625 D) and mean preoperative cylinder was −0.75 ± 0.65 D (range: −3.00 to 0.00 D). Postoperatively, the mean SEQ was 0.06 ± 0.54 D (range: −2.88 to +1.00 D) at 1 week and −0.04 ± 0.26 D at 12 months and was within ±0.50 D in 95.6% and ±1.00 D in 100% of eyes. A total of 96.7% of eyes had an uncorrected distance visual acuity (UDVA) of 20/20 at 12 months postoperatively. Fifty percent gained one or more lines of corrected distance visual acuity (CDVA), 5 eyes (5.4%) lost one line, and none lost two or more lines. No suction losses were encountered and all extracted lenticules were intact without tears. Conclusions: The application of KLEx using the FEMTO LDV Z8 platform yields safe and effective outcomes, aligning comparably with established modes of lenticule extraction and femtosecond laser–assisted laser in situ keratomileusis procedures previously employed and accepted within the field of refractive surgery. [J Refract Surg. 2024;40(11):e898–e905.] [ABSTRACT FROM AUTHOR]

Purpose: To assess the incidence and causes for re-treatment following monovision laser refractive surgery in a large data study spanning a decade. Methods: The setting for this retrospective comparative study was Care Vision Laser Center, Tel Aviv, Israel. This study included patients aged 36 to 60 years who underwent monovision laser vision correction at the Care Vision Laser Centers, Israel, from January 2012 to December 2022. Demographic, preoperative, and postoperative data were retrieved for analysis. Results: Overall, 3,674 eyes of 1,847 patients were included. Re-treatment was performed in 1.28% (n = 47) of eyes, 0.84% (n = 31) distance-targeted and 0.44% (n = 16) near-targeted. Monovision reversal in near-targeted eyes occurred due to overcorrection (37.5%, n = 6 of 16), despite being on target (25%, n = 4 of 16), insufficient myopia (18.8%, n = 3 of 16), and de novo astigmatism (12.5%, n = 2 of 16). One eye was targeted for near vision due to de novo astigmatism. Re-treatment in distance-targeted eyes was due to myopic undercorrection (45.2%, n = 14 of 31), myopic regression (19.4%, n = 6 of 31), myopic overcorrection (12.9%, n = 4 of 31), hyperopic regression (6.5%, n = 2 of 31), astigmatism undercorrection (6.5%, n = 2 of 31), de novo astigmatism (6.5%, n = 2 of 31), and astigmatism regression (3.2%, n = 1 of 31). Re-treatment was more likely in distance targeted eyes of patients with monovision compared to near-targeted eyes (P =.025) and patients without monovision (P <.001). Conclusions: In monovision laser vision correction, retreatment in the near-targeted eye is rare when the ideal near target (−1.50 to −1.25 diopters) is achieved. However, the distance-targeted eye is more likely to require re-treatment. Surgeons can plan monovision surgery and advise patients accordingly. [J Refract Surg. 2024;40(11):e892–e897.] [ABSTRACT FROM AUTHOR]

Purpose: To compare the subjective refraction and Innov-Eyes (Alcon Laboratories, Inc) wavefront-measured refraction in patients with myopia and astigmatism before refractive surgery. Methods: Consecutive myopic patients planning to receive refractive surgery with ages between 18 and 50 years old were retrospectively enrolled. The subjective and wavefront-measured refraction (InnovEyes platform) were compared, and the influential factors for the measurement difference were analyzed. Results: Of the 500 eyes enrolled, the mean age was 29.3 ± 6.8 years. Mean wavefront-measured refraction was 0.58 ± 0.62 diopters (D) more myopic and 0.10 ± 0.27 D more astigmatic than subjective refraction (P <.001). Wavefront-measured refraction exhibited excellent consistency and significant correlation with subjective refraction. Linear regression demonstrated that age (P =.008) and wavefront-measured sphere standard deviation (P <.001) were positively correlated with spherical measurement difference, and total quality score (P <.001) and accommodative response (binocular cross-cylinder) (P =.011) demonstrated a negative correlation with spherical and cylindrical measurement difference. The patients with low wavefront measurement quality had significantly greater spherical differences than those with high-quality measurement (P <.001). The patients with accommodative lead had greater spherical equivalent differences than other participants (P =.047). Conclusions: Wavefront-measured refraction had excellent consistency with subjective refraction, although it measured more myopia and astigmatism than subjective refraction. The spherical measurement difference was greater in older patients and those with accommodative lead. More stable and higher quality repeated measurements will yield closer results between wavefront-measured and subjective refraction. [J Refract Surg. 2024;40(11):e836–e844.] [ABSTRACT FROM AUTHOR]

Purpose: To describe Light Adjustable Lens (RxSight, Inc) (LAL) visual and refractive outcomes in a Japanese patient population with and without prior refractive surgery. Methods: In this retrospective chart review of patients with cataract in a private eye clinic, 34 eyes from 21 patients underwent cataract surgery with LAL implantation. Eyes underwent light treatment to adjust the patients' refraction after implantation to meet individual visual goals. Standard visual and refractive outcomes were collected. Contrast sensitivity (to assess quality of vision), clinical defocus and vergence curves (to assess range of vision), and patient satisfaction were also collected. Results: The mean prediction error of the light adjustment was −0.04 ± −0.48. Thirty-one eyes (91%) and 33 eyes (97%) were within ±0.25 and ±0.50 diopters (D) of manifest spherical equivalent target, respectively. Thirty-two eyes (94%) had residual refractive cylinder of 0.50 D or less. The full depth of focus was 3.68 D. Monocular contrast sensitivity shows frequencies equivalent to a normal population aged 50 to 60 years. The mean satisfaction score was 8.8 (scale: 1 to 10). There were no adverse events and no eyes lost corrected distance visual acuity from the light treatment. Conclusions: LALs in cataract refractive surgery hold great promise, including for the Japanese population, which have unique ocular biometrics. By providing a safe procedure and the ability for postoperative adjustments, the LAL provided a tailored approach to vision correction, ultimately improving patient outcomes and satisfaction. [J Refract Surg. 2024;40(11):e854–e862.] [ABSTRACT FROM AUTHOR]

Purpose: To compare and assess the visual, refractive, and tomographic results of patients with corneal ectasia treated with either corneal allogenic intrastromal ring segments (CAIRS) or synthetic intrastromal corneal ring segments (ICRS) without concomitant corneal cross-linking. Methods: In this retrospective cohort study, 34 eyes with CAIRS were matched to 34 eyes with ICRS using the propensity score matching technique. Each group was matched on a oneto-one basis using multiple parameters such as central corneal thickness, vertical and horizontal coma, maximum anterior keratometry, steepest keratometry, and age. Visual, refractive, topographic, and aberrometric data were measured at baseline, 1 week, 1 month, 3 months, and 1 year postoperatively. Results: Initial preoperative parameters were similar between the two groups. Both groups showed significant improvement at last follow-up time in corrected distance visual acuity (CDVA) (0.52 ± 0.23 to 0.16 ± 0.18 logarithm of the minimum angle of resolution [logMAR], P <.001; 0.44 ± 0.27 to 0.17 ± 0.21 logMAR, P <.001), topographic astigmatism (4.45 ± 2.75 to 3.14 ± 1.93 diopters [D], P =.001; 3.66 ± 2.22 to 2.36 ± 1.46 D, P =.007), maximum anterior keratometry (55.85 ± 7.53 to 50.69 ± 6.38 D, P <.001; 54.59 ± 6.95 to 50.71 ± 4.51 D, P =.003), and vertical coma (1.49 ± 1.02 to 0.38 ± 0.65 D, P <.001; 1.22 ± 0.75 to 0.52 ± 0.57 D, P <.001) for CAIRS and ICRS, respectively. The improvements observed in both groups at the last follow-up visit were comparable; however, the CAIRS group demonstrated a higher percentage of eyes gaining two or more Snellen lines of CDVA (60% vs 31.58%, P =.04), and a greater magnitude of reduction in vertical coma compared to the ICRS group, although this difference did not reach statistical significance. No major complications were observed with both groups, and one eye lost one CDVA line in the ICRS group. The mean thickness of the CAIRS segments at the last follow-up visit was 401.06 ± 100.12 µm, compared to 435.29 ± 26.19 µm for ICRS. Both CAIRS and ICRS demonstrated significant compression of stromal thickness above the segment (36.19% and 32.00%, respectively). Conclusions: When adequately matched for preoperative disease type and severity, eyes with CAIRS had a similar and notable clinical improvement compared to ICRS, with possibly better improvement in vertical coma and CDVA. [J Refract Surg. 2024;40(11):e863–e876.] [ABSTRACT FROM AUTHOR]

Purpose: To investigate the reasons for the removal and/or exchange of posterior chamber phakic intraocular lenses (PCPIOLs) and the outcomes of these procedures. Methods: In this retrospective study, PCPIOL implantations performed between January 2015 and June 2023 in a single center were reviewed. The study group consisted of the files of eyes with removed and/or exchanged PCPIOL. Visual acuities, refraction errors, endothelial cell counts, and measurements of the vault before and after exchanges were recorded. Reasons for removal and/or exchange were evaluated. The tuck-and-pull technique was used in all explantations. Results: Twenty-three of 1,490 eyes with PCPIOL implantation required removal and/or exchange. Of the explanted eyes, 17 were implanted with PCPIOLs for myopia (1.21% of all myopic corrections) and 6 were implanted with PCPIOLs for hyperopia (6.59% of all hyperopic corrections). The most common reason for removal and/or exchanges after implantation was inappropriate vault (10 of the 23 total removals and/or exchanges), followed by cataract development (7 of the 23 total removals and/or exchanges). A comparison of the biometric characteristics of eyes with PCPIOL removal and/or exchange due to inappropriate vault with other PCPIOL implantations showed that anterior chamber depth, PCPIOL length, and white-to-white distance were significantly higher in the group of explanted eyes (P <.05). All eyes with high vault in myopic patients had a 13.2- or 13.7-mm length PCPIOL. Conclusions: The main reason for PCPIOL removal and/or exchange is vault values outside the ideal limits and cataract development. Before ordering 13.2- and 13.7-mm long PCPIOLs, biometric data of both eyes and recommended PCPIOL sizes should be carefully reviewed. [J Refract Surg. 2024;40(11):e797–e803.] [ABSTRACT FROM AUTHOR]

Background: A high‐frequency point‐of‐care (POC) ultrasound instrument was used to evaluate the microstructural and biomechanical properties of the anterior sclera in vivo using parameters computed from quantitative ultrasound (QUS) methods. Methods: In this cross‐sectional study, both eyes of 85 enrolled patients were scanned with the POC instrument and ultrasound data were processed to obtain QUS parameters. Pearson correlation and multi‐linear regression were used to identify relationships between QUS parameters and refractive error (RE) or axial length. After categorising eyes based on RE, binary support vector machine (SVM) classifiers were trained using the QUS or ophthalmic parameters (anterior chamber depth, central corneal thickness, corneal power, and intraocular pressure) to classify each eye. Classifier performance was evaluated by computing the area under the receiver‐operating characteristic curve (AUC). Results: Individual QUS parameters correlated with RE and axial length (p < 0.05). Multi‐linear regression revealed significant correlation between the set of QUS parameters and both RE (R = 0.49, p < 0.001) and axial length (R = 0.46, p = 0.001). Classifiers trained with QUS parameters achieved higher AUC (푝 = 0.06) for identifying myopic eyes (AUC = 0.71) compared to classifiers trained with ophthalmic parameters (AUC = 0.63). QUS‐based classifiers attained the highest AUC when identifying highly myopic eyes (AUC = 0.77). Conclusions: QUS parameters correlate with progressing myopia and may be indicative of myopia‐induced microstructural and biomechanical changes in the anterior sclera. These methods may provide critical clinical information complementary to standard ophthalmic measurements for predicting myopia progression and risk assessment for posterior staphyloma formation. [ABSTRACT FROM AUTHOR]

Non-compliance with spectacle wear undermines global health initiatives aimed at eliminating uncorrected refractive error—a preventable cause of visual impairment—by providing free or affordable spectacles to underserved populations. Non-compliance, however, is often identified too late, delaying effective health promotion strategies. This study evaluates the association between early-assessed vision-related quality of life (QoL) following spectacle correction and long-term compliance in adults. A comprehensive eye examination was conducted on 3052 university students to identify those visually impaired (presenting acuity ≥ Snellen 6/12 in the better eye) due to uncorrected refractive error. After refractive correction, participants achieving a best-corrected visual acuity of Snellen 6/6 completed the National Eye Institute 25-item Visual Function Questionnaire (NEI-VFQ-25) at baseline and within the first week of correction. A 6-month follow-up assessed compliance with spectacle wear. The average baseline NEI-VFQ-25 score improved from 67.35 (± 13.53%) to 90.56 (± 8.45%) with spectacle correction (P < 0.001) in the first week, with individual changes ranging from 2 to 70%. After 6 months, only 54 (47%) out of the 115 eligible participants (58 females; ages 18 to 29) were compliant. Following the adjustment for covariates, the results revealed that gains in NEI-VFQ-25 score below 40 were significantly associated with reduced compliance over the 6-month period (OR: 0.39, 95% CI: 0.06–0.99, P = 0.047). This supports an association between early vision-related QoL and long-term compliance. Scheduling a short follow-up to assess vision-related QoL within the first week after dispensing spectacles may help identify potential non-compliant wearers early, allowing for timely interventions. [ABSTRACT FROM AUTHOR]

Clinical relevance: In many sports, dynamic visual acuity is used. In order to improve dynamic visual acuity, it is important to understand the aspects of the visual system that can cause compromise. Background: To investigate the parameters of the visual system that may influence dynamic visual acuity in professional soccer players. Methods: In 2022, 40 professional players were analysed. Screening consisted of a survey, the measurement refractive error, and static and dynamic visual acuity and the binocular vision parameters. All athletes were men with a mean age of 24.9 ± 4.8 years. Results: The mean refractive error was −0.29 ± 0.61D, and 22.5% of athletes are myopic only and 7.5% hyperopic. Static visual acuity was R: −0.037 ± 0.094 LogMAR , L: −0.036 ± 0.098 LogMAR. Dynamic visual acuity was 0.154 ± 0.118 LogMAR. There is a positive and moderate correlation between monocular static visual acuity and dynamic visual acuity, with r = 0.524 (r2 = 0.275 , p < 0.001) for the right eye and r = 0.553 (r2 = 0.306, p < 0.001) for the left eye. For the component of astigmatism (J = 0) and for stereopsis in distance vision, the correlation was, r = –0.472 (r2 = 0.223, p = 0.002) and r = –0.467 (r2 = 0.218, p = 0.002), respectively. Conclusion: Athletes with lower static visual acuity in distance vision, or with worse stereopsis in distance vision or more myopic astigmatism, have lower dynamic visual acuity than other athletes. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the association between macula thickness and vessel density in African myopic and emmetropic eyes through the use of Spectral Domain Optical Coherence Tomography (OCT). Methods: The study population comprised African adults aged 18–35 years old. The study was conducted at a University eye clinic located in Durban, South Africa. Purposive sampling was utilised to obtain 59 participants of whom 24 were myopes and 35 were emmetropes. Vessel density (VD), foveal avascular zone (FAZ) and retinal thickness (RT) were obtained using the Heidelberg Spectralis OCT with angiography. Thereafter, a multivariate linear regression was used to investigate associations between the spherical equivalent myopic refractive error and VD, FAZ and RT for the myopic group only. Results: Myopic participants had a mean spherical equivalent (MSE) and standard deviation (SD) of −4.79 D (1.27) while the emmetropic group had an MSE (SD) of −0.32 D (0.46). Both superficial and deep VD were significantly decreased at the central fovea (radius (r) = 0.4 mm), peri‐foveal (r = 1.10–1.45 mm) and para‐foveal (r = 0.75–1.10 mm) sectors in myopes when compared with emmetropes. Myopes showed a significant reduction in RT in the inner retinal layer across the inferior and temporal zones of the peri‐foveal region as well as the inferior and temporal zones of the para‐foveal region when compared with emmetropes. A significantly smaller FAZ was found at both the superficial and deep vascular plexuses (p < 0.001). In African myopes, significant associations were not found between MSE and VD or FAZ and macula retinal thickness. Conclusion: Retinal vascular and thickness reduction may occur in young African adults with moderate myopia. A broad‐based study targeting VD and IRT in African myopes is proposed to confirm preclinical myopic macula disruptions in adults of African ethnicity. OCT angiography should be considered when monitoring progressive myopia. [ABSTRACT FROM AUTHOR]

Purpose: To present a set of closed‐form analytical equations to create a consistent eye model balance based on clinically measured input parameters in a single step. These models complement the existing iterative approaches in the literature. Methods: Two different approaches are presented, both considering the cornea and lens as equivalent thin lenses. The first, called the Gaussian model, starts by defining the refractive error as the difference between the axial power (or dioptric distance) and the whole eye power, which can be expanded by filling in the formulas for each power. The resulting equation can be solved for either the refractive error, axial length, corneal power, lens power or the distance between the cornea and the lens as a function of the other four parameters. The second approach uses vergence calculations to provide alternative expressions, assuming that the refractive error is located at the corneal plane. Both models are explored for a biometric range typically found in adult human eyes. Results: The Gaussian and vergence models each instantly balance the input data into a working eye model over the human physiological range and far beyond as demonstrated in various examples. The equations of the Gaussian model are more complicated, while the vergence model experiences more singularities, albeit in trivial or highly unlikely parameter combinations. Conclusions: The proposed equations form a flexible and robust platform to create eye models from clinical data. Possible applications lie in creating animal eye models or providing a generic reference for real biometric data and the relationships between the ocular dimensions. [ABSTRACT FROM AUTHOR]

Individuals with Down syndrome are known to have a greater prevalence of ocular conditions such as strabismus, nystagmus, elevated refractive error, poor accommodative function, elevated higher‐order optical aberrations and corneal abnormalities. Related to these conditions, individuals with Down syndrome commonly have reduced best‐corrected visual acuity at both far and near viewing distances across their lifespan. This review summarises the various optical sources of visual acuity reduction in this population and describes clinical trials that have evaluated alternative spectacle prescribing strategies to minimise these optical deficits. Although refractive corrections may still have limitations in their ability to normalise visual acuity for individuals with Down syndrome, the current literature provides evidence for eye care practitioners to consider in their prescribing practices for this population to maximise visual acuity. These considerations include accounting for the presence of elevated higher‐order aberrations when determining refractive corrections and considering bifocal lens prescriptions, even for young children with Down syndrome. [ABSTRACT FROM AUTHOR]

Introduction: Demands for myopia management are rising. A web‐based tool that allows home‐performed self‐assessments of visual acuity (VA) and refractive error may enable hybrid care pathways and aid in identifying those with deteriorating visual performance. The tool has been validated in adult populations, but has yet to be evaluated in children. This study compared home‐performed VA and refraction self‐assessments to conventional measurements obtained at the clinic in a population of myopic children. Methods: Myopic children aged ≥6 years old were invited to perform web‐based eye tests at home, assisted by a parent. At two myopia control clinics, they also underwent measurements of VA using a Snellen chart and refractive error using cycloplegic autorefraction. Agreement between the tests, repeatability of the web‐based test and associations between clinical characteristics and web‐based test accuracy were evaluated. Results: A total of 147 children were enrolled, of whom 116 (51% male; mean age 13 ± 3 years; mean spherical equivalent refraction (SEQ) −5.58 ± 3.05) performed the web‐based tests at home. Overall, the home‐performed VA self‐assessment and the Snellen chart assessment at the clinic agreed well (mean difference 0.03 ± 0.11 logMAR). A significant proportional bias was identified (β 0.65, p < 0.001), indicating underestimated web‐based VA scores when the child's vision declined. The sensitivity to detect VA poorer than 0.10 logMAR was 94%; the specificity was 71%. The web‐based refractive error algorithm measured more myopia progression compared to clinic observations (mean difference SEQ 0.40 ± 0.51 dioptres). Age, sex or use of atropine drops were not significantly associated with test accuracy. Conclusions: The web‐based test for self‐assessing vision, performed at home by children with assistance from their parents, yielded VA scores with a precision similar to Snellen chart testing conducted in a clinical setting. However, the web‐based refractive error algorithm overestimated myopia progression and requires recalibration for this specific age group. [ABSTRACT FROM AUTHOR]

Purpose We aimed to investigate the association between maternal fasting plasma glucose (FPG) trajectories during pregnancy and children's refractive errors at 6 years of age. Design Based on the Ma'anshan Birth Cohort (MABC) in China, a total of 1987 mother-child pairs were included in this study. Methods Using the group-based trajectory model, trajectory fitting was performed on FPG levels during the first, second, and third trimesters of pregnancy. Children's vision was measured at 6 years of age using the standard logarithmic visual acuity E-chart and cycloplegic refraction examination. Logistic regression models and multi-informant generalized estimating equations were used to analyze the association between maternal blood glucose level and 6-year-old children's visual acuity. Results Children born of mothers with high level FPG trajectory had a higher risk of developing refractive error (odds ratio [OR] = 1.46 [95% CI: 1.08, 1.97]), hypermetropia (OR = 1.64 [95% CI: 1.09, 2.46]), and astigmatism (OR = 1.60 [95% CI: 1.06, 2.41]) at age 6 compared to those with low level trajectory. Maternal blood glucose level in the first (β = −.012 [95% CI: −.024, −.001]) and the second (β = −.016 [95% CI: −.025, −.006]) trimesters was associated with 6-year-old children's distance vision value. Conclusion High level of FPG trajectories during pregnancy has been observed to be associated with 6-year-old children's refractive error, hypermetropia, and astigmatism. The first and the second trimesters may be critical periods for the effects of maternal blood glucose on children's vision. The long-term effect of maternal glucose metabolism on children's visual development deserves further study. [ABSTRACT FROM AUTHOR]

Background: Comprehensive research on the impact of various types of refractive errors (RE) and anisometropia on dry eye disease is still lacking. This study aimed to estimate the prevalence rates and potential lifestyle factors related to symptomatic dry eye (SDE) among adolescents in eastern China. Methods: A cross-sectional study was performed in 2023, and a stratified cluster sampling technique was used among adolescents in Nantong, China. Demographic information, including sex, age and BMI, were collected. All participants underwent optometric tests, while Ocular Surface Disease Index (OSDI) and self-designed questionnaires were administered. Both univariate and multivariate logistic regression analyses were used to assess associations between SDE and related parameters, and various types of RE and anisometropia were also included in the study. Results: A total of 1,518 participants were enrolled in the study, and the overall prevalence of SDE was 20.3% among adolescents in Nantong, China. Multiple logistic regression analyses showed that high myopia (aOR = 3.42, 95% CI = 1.60–3.36, p = 0.025), frequent use of eye drops (aOR = 2.31, 95% CI = 1.60–3.36, p<0.001), a history of allergic conjunctivitis (aOR = 1.93, 95% CI = 1.09–3.34, p = 0.025), and frequent blinking (aOR = 3.23, 95% CI = 2.31–4.53, p<0.001) were identified as risk factors for SDE. Conversely, male gender (aOR: 0.76, 95% CI: 0.58–0.99, p = 0.043), increased sleep time (6–7 h: aOR = 0.64, 95% CI = 0.46–0.89, p = 0.009; 7–8 h: aOR = 0.64, 95% CI = 0.43–0.95, p = 0.026; >8 h: aOR = 0.43, 95% CI = 0.23–0.82, p = 0.010), and timely intervention when vision decline occurred were protective factors against SDE (aOR = 0.61, 95% CI = 0.43–0.85, p = 0.004). Conclusion: High myopia was found to be independently associated with an increased risk of SDE., while hyperopia, astigmatism, and anisometropia were not independent risk factors for SDE. The identified risk and protective factors may help provide valuable insights for future research and interventions aimed at improving ocular health in adolescents. [ABSTRACT FROM AUTHOR]

Background: Dietary factors have been suggested as potential risk factors for myopia, but research findings on this relationship are inconclusive. The potential predisposing or protective role of macronutrient (carbohydrate, protein, fat) intake in the development of myopia was systematically reviewed, followed by data synthesis by meta-analysis. Methods: A systematic search was conducted in PubMed, Web of Science, Scopus, and Google Scholar up to the end of June 2023 to identify all relevant studies. All observational studies that assessed the relationship between macronutrient intake with myopia, axial length (AL) of eyes and spherical equivalent refractive error (SE) on individuals younger than 18 years old were included. Results: After removing duplicates and screening studies, four studies were included in the systematic review and meta-analysis. Pooled odds ratios regarding the association between myopia development and nutritional intake were 1.01 (95% CI: 0.94, 1.08), 0.97 (95% CI: 0.86, 1.08), and 0.99 (95% CI: 0.83, 1.18) for carbohydrates, proteins, and fats, respectively, indicating no significant associations. Intake of carbohydrates, proteins, and fats was not significantly associated with either SE or AL. Conclusions: Intake of carbohydrates, fats, or proteins did not influence the risk of myopia. The relationship between the intake of other macronutrients and myopia is suggested to be scrutinized in future studies. Registration: The systematic review protocol was registered on PROSPERO (registration number: CRD42024541369). [ABSTRACT FROM AUTHOR]

Background: This study aimed at investigating the relationship between the weekend catch-up outdoor duration (WCOD) and prevalence of myopia among students in China. Methods: This cross-sectional study recruited participants in 107 schools (six cities, 30 districts) from China from May to June 2021. Demographic characteristics (age, grade, sex, ethnicity, BMI, resident, and parents' myopia), optically habits (bad writing habits, working/studying time per day, continuous working/studying time per day, and screen time per day) and outdoor duration (weekday and weekend) were obtained from questionnaire. WCOD was defined as outdoor time 1 h longer on weekends than on weekdays. Spherical equivalent (SE) of refractive error were measured with non-cycloplegic refraction. Adjusted multivariate logistic regression analysis was performed to evaluate the relationship between WCOD and prevalence of myopia. Results: Students with myopia had shorter WCOD compared with those without myopia (P < 0.001). Adjusted multivariate logistic regression analyses showed negative associations between WCOD and prevalence of myopia in Chinese students, especially in students with WCOD of 2–3 h (OR = 0.577, P < 0.001) and 3–4 h (OR = 0.571, P = 0.004) when the weekday outdoor duration was 0.5–1 h, as well as students with WCOD of 2–3 h (OR = 0.614, P = 0.003) when the weekday outdoor duration was 1–2 h. Similar results were observed in students with high myopia. Students with high myopia had shorter WCOD compared with those without high myopia (P = 0.001). Negative associations between WCOD and prevalence of high myopia were significant in students with WCOD of 1–2 h when the weekday outdoor duration was < 0.5 h (OR = 0.585, P = 0.007) and 0.5–1 h (OR = 0.537, P = 0.018). Conclusion: Our study, for the first time, reported that a WCOD have a potential to reduce the prevalence of myopia and high myopia in Chinese students. [ABSTRACT FROM AUTHOR]

Background: Uncorrected refractive error (URE) is one of the main causes of visual impairments. URE may reduce interaction and learning in the classroom, leading to social isolation, irreversible amblyopia, lack of external knowledge, and restrictions on education and employment opportunities. Our aim was to investigate the prevalence and related factors of URE in adolescents using epidemiological surveys and questionnaire surveys related to lifestyle habits. Methods: A cross-sectional school-based study was conducted in Nantong, China, including adolescents 12–19 years of age from 16 schools. URE was defined as presenting visual acuity worse than 6/12 and improving to ≥ 1 lines after correction in either eye. Univariate and multivariate logistic regression analyses were used to investigate specific correlations between URE and related lifestyle parameters. Non-cycloplegic autorefraction was assessed for each adolescent. Results: A total of 2,910 adolescents were analyzed, of which 50.3% (n = 1,465) were male, and 49.7% (n = 1,445) were female. The mean age was 15.23 ± 1.77 years. The overall prevalence of URE was 23.7%. The total prevalence of REC and eREC was 85.1% and 71.7%, respectively, and both of them showed an increasing trend with age (Ptrend = 0.018 and Ptrend = 0.019, respectively). A higher prevalence of URE was related to myopia, anisometropia, and increased daily use of electronic products. Timely visual examination by medical institutions, more extracurricular homework, and older age were protective factors for URE. Among the 689 adolescents with URE, 362 (52.5%) did not receive any refractive correction, and 327 (47.5%) used corrected glasses. Conclusion: URE was highly prevalent among adolescents in China. Myopia was the most important risk factor for URE. The impact of anisometropia and increased daily use of electronic devices on URE was significant. Timely visual examinations by medical institutions served as an effective protective factor against URE. Further research on adjusting intervention strategies is therefore needed to eliminate preventable visual impairments. [ABSTRACT FROM AUTHOR]

Background: Myopia-26, a Mendelian form of early-onset high-myopia (eoHM) caused by mutations in the X-chromosomal ARR3 gene and predominantly affecting females, curiously, may provide an alternative route of investigation to unveil retinal mechanisms underlying pathological eye growth. We conducted a case-control cross-sectional prospective electrophysiological study in genetically characterized Myopia-26 patients (ARR3 heterozygous symptomatic females) compared with high myopes harboring intact ARR3 alleles and one carrier hemizygous male. Results: Participants were 26 volunteers: 10 healthy control females (E-CTRL, mean age = 31.5 ± 8.8 years), one healthy control male, one carrier male of the mutant ARR3 allele and 14 female eoHM patients (mean age = 27.0 ± 13.1 years) divided in two groups: seven without (M-CTRL) and seven with (MYP-26) genetic alteration in the ARR3 gene. The clinical evaluation included complete eye screening and full-field electroretinograms (ERGs) recorded from both eyes under mydriasis. Spherical equivalent was comparable (mean=-9.55 ± 2.46 and − 10.25 ± 3.22 for M-CTRL and MYP-26, respectively) and best corrected visual acuity (BCVA) was significantly different between M-CTRL and MYP-26 (1.0 vs. 0.406 ± 0.253, respectively). E-CTRL and M-CTRL showed similar light-adapted flash and flicker ERG amplitudes; however, the prior values were reduced by ~ 35% (a- and b-waves alike), the latter by ~ 55% in the MYP-26 group (F(2, 45) > 21.821, p < 0.00001). Dark-adapted a-wave amplitudes were slightly reduced (by ~ 20%) in all myopic patients compared to E-CTRL, irrespective of the ARR3 genotype (E-CTRL vs. eoHM, p = 0.038). Conclusions: The cone dysfunction observed in Myopia-26 patients is specifically linked to the mutation of ARR3, and is not the consequence of eoHM, i.e. elongation of the eye. It may play a role in myopic refractive error development through a yet unconfirmed pathomechanism. [ABSTRACT FROM AUTHOR]

Background: Uncorrected refractive errors and amblyopia are reported as the two main causes of childhood visual impairment and blindness worldwide. Our purpose was to evaluate refractive status, ocular alignment and effective refractive error coverage (eREC) of school-aged children from low-income areas of Sao Paulo city, Brazil. Methods: Data from the "Ver na Escola" Project were used for the current study. Children enrolled in the selected schools had an ophthalmic exam including eye alignment assessed by cover test, automatized and subjective dynamic and static refraction. The associations of demographic variables with occurrence and magnitude of refractive errors and eREC were investigated by multiple logistic regressions and multilevel mixed effect models. Results: A total of 17,973 children (51.12% females) with mean ± sd age 8.24 ± 3.54 years old examined from July 2018 to July 2019, were included in the study. Most of the participants (73%) showed orthoposition of the visual axis for both distance and near. Heterophoria was found in about 25% of participants (N = 4,498), with 71.7% of them (N= 3,222) classified as exophoria. Less than 2% (N = 232) showed strabismus, most of them (N = 160) esotropia. Overall, 1,370 (7.70%) of participants had myopia and 577 (3.24%) had hyperopia. Age was found to be significantly associated with increasing static subjective refraction spherical equivalent (Coefficient: -0.18; 95% Confidence Interval (CI): -0.21 to -0.16; p < 0.001). Female sex (Odds Ratio (OR) = 1.13; 95%CI: 1.01–1.27; p = 0.027) and older age (OR = 1.17; 95%CI: 1.16–1.19; p < 0,001) were significantly associated with myopia diagnosis. Older age decreased the odds of hyperopia (OR = 0.95; 95%CI: 0.93–0.98; p < 0.001). The overall effective refractive coverage was 51.76% and was significantly associated with age group, ranging from 32.25% in children aged 3 to 7 years to 61.35% in children aged 8 to 12 years. Conclusions: Most children have shown eye alignment for both distance and near assessments and no refractive error. Myopia was observed in 7.70% of the population and it was associated with older age and female sex. Hyperopia was observed in 3.24% and was associated with younger age. The overall eREC was 51.76%, significantly associated with age. [ABSTRACT FROM AUTHOR]

Background: Apart from the conventional utilization of ICL implantation for the correction of refractive errors, its recent applications extend to correcting refractive errors post laser refractive surgery. Notably, the development of cataracts stands out as a prevalent postoperative complication, often associated with low vault. Previous cases have demonstrated successful management of cataracts with ICL through the combination of FLACS and ICL removal coupled with IOL implantation, resulting in favorable postoperative visual outcomes. Herein, we present a case of cataract with low vault ICL following LASIK and its subsequent management. Case presentation: A 46-year-old male presented with vision loss in the right eye for 9 months, and he had undergone LASIK 22 years prior and had ICL implantation in both eyes 2 years ago to correct refractive error. One day after ICL implantation, both eyes exhibited the UDVA of 1.2 and 1.0, well-positioned ICLs, and approximate vault of 150 μm and 200 μm. Six months ago, the patient became aware of blurred vision in the right eye for a duration of 3 months. Examination revealed cloudy lens cortex in the right eye. During the current review, the UDVA of the right eye was 0.6, where nasal wedge-shaped clouding was evident and worsened, while the left eye lens remained transparent. AS-OCT demonstrated the vault of 54 μm in the right eye and 83 μm in the left eye. Considering the patient's history of LASIK and the presence of right eye cataract, a monovision approach was adopted. The patient underwent FLACS combined with ICL extraction and monofocal IOL lens implantation in the right eye. At 10 days postoperatively, the patient exhibited the UDVA of 1.0. Conclusions: Our report confirms the feasibility of FLACS in managing cataracts in patients with low vault ICL following LASIK. This procedure does not pose significantly greater challenges than in typical cataract cases, although meticulous care remains essential throughout every step of the surgery, particularly during laser scanning and positioning. With adequate preoperative preparation and precise calculation of the IOL power, surgical outcomes can meet expectations fully. [ABSTRACT FROM AUTHOR]

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Purpose: Bardet-Biedl Syndrome (BBS) is a rare autosomal recessive ciliopathy. Within corneal development, primary cilia serve a critical role. We sought to investigate the association of BBS with corneal astigmatism among a cohort of patients with BBS. Methods: This was a cross-sectional, retrospective study performed at a pediatric ophthalmology department of a tertiary hospital. The study enrolled 45 patients with genetically confirmed Bardet-Biedl syndrome, encompassing a total of 90 eyes observed from February 2011 to August 2021. Spherical and cylindrical refractive errors and keratometry outcome measures, including diopter (D) values at the flattest and steepest axes, were recorded. Corneal astigmatism of greater than 3D is considered extreme corneal astigmatism based on previously published data. Results: Among 45 patients (M:26; F:19), the mean age was 16.4 ± 8.2 years, and the mean best-corrected visual acuity was 20/60. The most common molecular diagnosis was BBS1, seen in 24 of 45 (53.3%). Among all the patients, the mean spherical refractive error was −2.9 ± 3.8D. The mean cylindrical refractive error was 2.6 ± 1.5D. The mean keratometry values at the flattest axis was 43.5 ± 5.3D (39.4–75.0) and at the steepest axis was 47.2 ± 7.3D(41.5–84.0). Among all the patients with BBS, the mean corneal astigmatism was 3.7 ± 1.0D(0.5–7.1), which is considered extreme. Conclusion: A cohort of individuals with BBS demonstrated high corneal astigmatism. These results suggest an association between corneal astigmatism and primary ciliary dysfunction and may assist in clinical management and future therapeutic targets among BBS and other corneal disorders. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore corneal curvature changes following strabismus surgery using a quadric surface fitting model to address ocular misalignment. Material and Methods: In this prospective cross-sectional study, 54 completed cases (84 eyes) of patients aged 6-60 years old (mean 10 years old) undergoing horizontal rectus muscle surgery were examined using placidobased keratometry with the Oculus Keratograph 5M system. Data on corneal curvature were collected one week preoperatively, and again one week, one month, and three months post-operation. Asphericity in the vertical meridian (Qy) and horizontal meridian (Qx), and surgically induced astigmatism (SIA) were calculated. Results: The 84 eyes included were categorized into three groups: horizontal muscle surgeries, oblique muscle surgery, and combined horizontal and oblique muscle surgeries. Significant corneal prolation (steep central, flat peripheral) was revealed in the vertical meridian (Qy) at 3 months postoperatively for lateral rectus (LR) recession in the first group (p < 0.001), and the mean SIA was 0.45 D (95% CI: 0.35-0.56 D). A similar effect was seen in the vertical meridian of the third group (p < 0.01), with a mean SIA at 3 months of 0.27 D (95% CI: 0.23-0.32 D). Conclusion: Lateral rectus muscle recession induces corneal vertical prolation for up to 3 months post-operation. Surgeons are thus advised to re-evaluate refraction and defer contact lens refitting, refractive surgery, and intraocular lens calculations for at least 3 months after the procedure. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess and compare the effectiveness and side effects of various concentrations of pilocarpine eye drops (1.5%, 1.25%, and 1%), with and without 0.1% brimonidine, in treating presbyopia, specifically in a Thai population. Materials and Methods: A prospective, randomized, double-blinded, and crossover trial was conducted at Siriraj Hospital from August 2022 to April 2023. The study included emmetropic individuals aged 40 to 60 with presbyopia (near visual acuity not exceeding J1+) and refractive errors within +/- 0.5D. Ten subjects were randomly assigned to six groups for the different concentrations and type of eye drops using a computer-generated systematic randomization to receive 1.5%, 1.25%, and 1% pilocarpine with and without 0.1% brimonidine. And visual outcomes including visual acuity at distance and near were measured at 2, 4, and 6 hours post-application, with adverse effects monitored. Primary outcome was visual acuity at near after applied topical eye drops. Results: Among the 10 participants (30% male, median age 46.5 years old), 1.25% pilocarpine and combined 1.25% pilocarpine + 0.1% brimonidine significantly improved near visual acuity at all time points (statistically significant with Bonferroni correction). Adverse effects, such as dry eye and irritation, were more common with 1.5% pilocarpine + 0.1% brimonidine. Conclusion: In this preliminary study, 1.25% pilocarpine and 1.25% pilocarpine + 0.1% brimonidine showed promise in effectively treating presbyopia in the Thai study population, with acceptable side effect rates. Further research with larger sample sizes is needed to confirm these findings and provide more robust insights into presbyopia management in the Asian demographic. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate the visual prognosis in craniosynostosis patients in order to identify ophthalmologic manifestations in craniosynostosis patients and strabismus surgery outcomes in these patients. Materials and Methods: The medical records craniosynostosis patients were reviewed retrospectively from January 2000 to June 2023. All the relevant patient data, such as age, sex, visual acuity, ophthalmologic examinations, and strabismus surgery outcomes were recorded. Results: In total, 123 patients were included in the study, among whom 65 (52.84%) were male. Overall, there were 70 cases (56.91%) of non-syndromic craniosynostosis, and 53 cases of syndromic craniosynostosis, comprising Crouzon syndrome (15 cases), Apert syndrome (8 cases), Pfeiffer syndrome (2 cases), and other syndromes (28 cases). The mean age at first examination was 3.11 years old. Out of 107 cases with visual impairment at the first visit, 92 (85.98%) showed no visual impairment at the last visit. Among the 87 patients with strabismus, 28 (32.18%) had strabismus at the primary position, with exotropia being the most common type (18 cases). Eight cases underwent strabismus surgery, and 4 cases achieved success (deviation < 10 prism diopters). Other ophthalmologic manifestations were lagophthalmos (17 cases, 13.82%), exposure keratopathy (15 cases, 12.2%), ptosis (11 cases, 8.94%), proptosis (10 cases, 8.13%), and nasolacrimal duction obstruction (10 cases, 8.13%). The syndromic group exhibited higher rates of visual impairment, strabismus, lagophthalmos, exposure keratopathy, proptosis and nasolacrimal duct obstruction compared to the non-syndromic group. Conclusion: Among the craniosynostosis cases, 85.98% had no visual impairment, with the common ophthalmologic manifestations being refractive errors, strabismus, lagophthalmos, and exposure keratopathy. The syndromic craniosynostosis cases showed worse visual outcomes and a higher incidence of ocular diseases than non-syndromic cases. The success rate for strabismus surgery in craniosynostosis patients was 50%. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to design a simple, handy prediction for the effect of spherical and cylindrical refractive error on the visual acuity degradation at different distances and validate this model on a clinical dataset. Methods: This study examined 70 eyes from 35 patients' post-cataract surgery with aberration-free intraocular lenses. Biometric and corneal data were analysed, and subjective refraction and visual acuity were evaluated by two experienced optometrists. The study computed the spherical equivalent (SEQ), and defocus equivalent via vector addition (DEQ vec), as the sum of absolute values (DEQ abs). Predictive models were developed using univariate regression, with confidence intervals (BCa 95%) calculated through non-parametric bootstrapping (10,000 cycles). Results: Various calculated equivalents included −0.44 D for spherical equivalent (SEQ), 0.70 D for defocus equivalent based on vector calculation (DEQ vec), and 0.89 D for defocus equivalent based on absolute values (DEQ abs). Uncorrected and corrected visual acuity averaged 0.07 logMAR and −0.04 logMAR, respectively. The absolute defocus equivalent (DEQ abs) exhibited the smallest confidence interval (BCa 95%) at 0.07. Conclusion: The defocus equivalent based on the addition of absolute values (DEQ abs) emerged as the most practical predictor for the described applications. Notably, it offers the advantage of easy calculability through a simple equation: VA loss = DEQ abs ⋅ 0.23. In 95% of cases, this predicted loss would have an accuracy of ±0.03 lines. [ABSTRACT FROM AUTHOR]

Purpose: This study examines the incidence of infection and resistance associated with Intracorneal Ring Segment (ICRS) implantation, a common outpatient surgical treatment for correcting refractive errors and corneal ectatic diseases. Although ICRS procedures are typically safe and reversible, there is a low but notable risk of microbial infections, which require prompt and sometimes invasive treatment. Methods: Three electronic databases, PubMed, Web of Science (WoS), and Scopus, were utilised to search for literature according to PRISMA guidelines to identify infections related to the implantation of ICRS in the cornea between January 2000 and December 2022. Results: Gram-positive organisms were involved in 86% of cases: 35.7% S. aureus, 25% coagulase-negative staphylococci species, 17.8% streptococci and 7.1% Nocardia species. Less commonly recorded were Gram-negative bacteria (14%), with Pseudomonas aeruginosa (circa 10%) and Klebsiella pneumonia (4%) being the most common Gram-negative bacteria. In rare cases, fungi have also been reported. ICRS-related bacterial infections can be categorised into early or late onset. Early onset infection typically manifests within the first few weeks after implantation and is often associated with contamination during surgery, unhygienic practices, or inadequate sterilisation techniques. On the other hand, late-onset infection may develop months or even years after the initial procedures and may be associated with persistent bacterial colonisation, secondary infections, or prolonged use of prophylactic antibiotics. S aureus is encountered in both early and late-onset infections, while Nocardia species and K. pneumoniae have generally been reported to occur in late-onset infections. In addition, vision recovery from S. aureus infections tends to be poor compared to other bacterial infections. Conclusion: S. aureus is a predominant pathogen that often requires surgical intervention with poor outcomes. Early infections result from incision gaps and ring segment rubbing, while late infections are linked to prolonged antibiotic use. Further research is needed on novel antimicrobial ICRS to procure the vision. [ABSTRACT FROM AUTHOR]

Background: Diabetic macular edema (DME) causes vision impairment and significant vision loss. Portable optical coherence tomography (OCT) has the potential to enhance the accessibility and frequency of DME screening, facilitating early diagnosis and continuous monitoring. This study aimed to evaluate the reliability of a portable OCT device (ACT100) in assessing DME compared with a traditional stationary OCT device (Cirrus 5000 HD-OCT plus). Methods: This prospective clinical investigation included 40 eyes of 33 patients with DME. Participants with significant refractive errors (myopia > −6.0 diopters or hyperopia > +3.0 diopters), vitreous hemorrhage, tractional retinal detachment, or other ocular diseases affecting imaging were excluded. Spectral-domain OCT was performed by a single examiner using both devices to capture macular volume scans under mydriasis. Central macular thickness (CMT) was evaluated using the analysis software for each device: Cirrus used version 6.0.4, and ACT100 used version V20. We analyzed inter-evaluator and inter-instrument agreements for qualitative assessments of the intraretinal fluid (IRF), subretinal fluid (SRF), and epiretinal membrane (ERM) using Cohen's kappa coefficient, whereas quantitative CMT assessments were correlated using Spearman's correlation coefficient. Results: Substantial inter-evaluator agreement for IRF/SRF (κ = 0.801) and ERM (κ = 0.688) with ACT100 and inter-instrument agreement (κ = 0.756 for IRF/SRF, κ = 0.684 for ERM) were observed. CMT values measured using ACT100 were on average 29.6 μm lower than that of Cirrus (285.8 ± 56.6 vs. 315.4 ± 84.7 μm, p < 0.0001) but showed a strong correlation (R = 0.76, p < 0.0001). Conclusions: ACT100 portable OCT demonstrated high reliability for DME evaluations, comparable to that of stationary systems. [ABSTRACT FROM AUTHOR]

Laser corneal reshaping is a safe and effective technique utilized to treat common vision disorders. An advanced laser delivery system equipped with a pulsed UV laser with specific parameters is used to ablate parts of the cornea surface to correct the existing refractive error. The argon fluoride (ArF) excimer pulsed gas laser at 193 nm is the most employed type in the commercial devices for such treatments. This laser is generated using a mixture of Argon, Fluorine, and a significant amount of Neon gases. However, due to the ongoing Russian‐Ukraine war, the availability of Neon gas is currently very limited, as this region is considered the primary supplier of pure Neon gas. Consequently we suggest replacing the common ArF laser source in the commercial devices with a solid‐state (forth harmonic neodymium‐doped yttrium aluminum garnet laser at 266 nm). This replacement uses the same operation parameters, optics, and scanning algorithm. Parameters from five commercial devices (Zeiss MEL 90, Technolas TENEO 317, Alcon Wave Light EX 500, Schwind Amaris 750 s, OptoSystems MICROSCAN VISUM) were compared with those of the i‐ablation device, a research device that uses a 266 nm laser source. Our goal is to reduce production costs through a simple modification that has a significant impact. Consequently, the present study aims to find an alternative laser source for the current ArF laser without exchanging the complete system's design. This recommendation is based on a numerical simulation study. The thermal effect on a human cornea model was numerically evaluated using finite‐element solutions of Pennes' bioheat equation on the COMSOL platform by applying two laser wavelengths. The results demonstrated that changing the laser source significantly impacts the thermal effect, even with the same laser settings. All studied devices showed a reduction in the thermal effect to below 40°C, compared with nearly 100°C under ordinary conditions. [ABSTRACT FROM AUTHOR]

Contrary to popular lore, optimal visual acuity is typically better than 20/20. Could correcting acuity beyond 20/20 offer any benefit? An affirmative answer could present new confounds in studies of aging, development, psychiatric illness, neurodegenerative disorders, or any other population where refractive error might be more likely. An affirmative answer would also offer a novel explanation of inter-observer variability in visual performance. To address the question, we had individuals perform two well-studied visual tasks, once with 20/20 vision and once with optical correction, so that observers could see one line better on an eye chart. In the contour integration task, observers sought to identify the screen quadrant location of a sparsely defined (integrated) shape embedded in varying quantities of randomly oriented "noise" elements. In the collinear facilitation task, observers sought to detect a low-contrast element flanked by collinear or orthogonal high-contrast elements. In each case, displays were scaled in size to modulate element visibility and spatial frequency (4–12 cycles/deg). We found that improving acuity beyond 20/20 improved contour integration for the high spatial frequency displays. Although improving visual acuity did not affect collinear facilitation, it did improve detection of the central low-contrast target, especially at high spatial frequencies. These results, which were large in magnitude, suggest that optically correcting beyond 20/20 improves the detection and integration of contour elements, especially those that are smaller and of higher spatial frequency. Refractive blur within the normal range may confound special population studies, explain inter-observer differences, and meaningfully impact performance in low-visibility environments. [ABSTRACT FROM AUTHOR]

Background: Knowing the prevalence of myopia at school age is essential to implement preventive measures and appropriate interventions, ensure access to vision care, promote a healthier educational environment and improve academic performance. The purpose of this study was to determine the prevalence of myopia and its associated sociodemographic risk factors, as well as to estimate the coverage of myopia correction among adolescents in center of Portugal. Methods: This cross-sectional study evaluated 1115 adolescents from the 5th to the 9th year of school, with an average of 12.9 years (SD = 1.5) ranging from 10.0 to 18.0 years. Optometric evaluations were carried out in a school environment and consisted of the evaluation of distance visual acuity, assessed using a logarithmic visual acuity chart (ETDRS charts 1 and 2) at 4 m, and measured by refractive error with a pediatric autorefractometer (Plusoptix), by non-cycloplegic. Myopia was defined as spherical equivalent (SE ≤ -0.50 diopter (D)) and uncorrected visual acuity (UVA ≤ 95VAR). Adjusted logistic regression analysis was applied to investigate risk factors. Results: We found a myopia rate of 21.5% and a high myopia rate of 1.4%. Higher school level and attendance at urban schools were associated with myopia, but no association was found with age or sex. Only 34.6% of myopic adolescents use the best optical correction and 26.4% do not use any type of optical correction. Conclusions: Data on the prevalence of refractive problems in Portugal are scarce and heterogeneous. This study, although regional, provides a valuable contribution with a clear and reproducible methodology, following international guidelines and filling gaps in the existing literature. The results show that the rate of myopia in this age group is similar to reports from other European studies. The high rate of adolescents with uncorrected or under-corrected myopia in Portugal is a problem that deserves attention. [ABSTRACT FROM AUTHOR]

Refractive error is becoming a significant public health issue. Photorefractive Keratectomy (PRK) is a corneal surface surgical technique that removes the corneal epithelium before stromal photoablation by ultraviolet radiation from the Excimer laser. We designed a retrospective study to characterize corneal remodeling after myopic Photorefractive Keratectomy and assess the accuracy of laser-predicted ablation depth (AD). This study took place in 15–20 National Ophthalmology Hospital, Paris, France. 150 eyes with preoperative manifest spherical equivalent between − 10.00D and − 0.25D and cylinder < 3D, treated with the WaveLight® EX500 laser between 01/2019 and 01/2023, were followed for at least three months. The main outcome measurements were postoperative changes in epithelial (ET) and stromal (ST) thicknesses measured with spectral domain optical coherence tomography and mean simulated keratometry (SimK) assessed with corneal topography. The central ET significantly decreased at M1, increased over the preoperative value from M1 to M6, and stabilized after M6. The increase in central ET after M1 was associated with an increase in mean SimK (r = 0.34). The achieved AD was 7.9 ± 8.0 µm greater than the laser-predicted AD. Stromal over-ablation was significantly and independently associated with myopia > 6D preoperative mean SimK > 44D and transepithelial procedures. [ABSTRACT FROM AUTHOR]

The extended depth-of-focus AcrySof IQ Vivity intraocular lens technology offers promising features for presbyopia management, evaluated in this research in a 6 months real-world setting. Prospective interventional mono-centric study including 40 patients who underwent elective bilateral phacoemulsification. We performed one pre-operative visit (V0) and one evaluation six months post-operatively (V1), evaluating uncorrected and corrected visual acuity for near (UNVA/CNVA), intermediate (UIVA/CIVA) and far (UDVA/UCVA), slit-lamp evaluation, tomography with static pupillometry, endothelial cell count and contrast sensitivity chart. In order to assess post-operative Quality of Life, we administered the patients McAlinden's Quality of Vision test and Morlock's Patient-Reported Spectacle Independence Questionnaire. We divided eyes in with Toric-IOL and with non-Toric IOL. A total of 36 eyes received non-tonic IOL implantation, whereas 44 eyes received toric IOL implantation. There were no statistically significant disparities observed in visual outcome measures and contrast sensitivity between the toric group and the non-toric group. Furthermore, we assessed the predictive preoperative refractive astigmatism (PPRA) and residual refractive astigmatism (RRA) in both cohorts, and no statistical significance was found between the two cohorts (p = 0.08). Twenty-one (53%) patients reported total independence from their glasses at all distances. The mean difference between the predicted and measured refractive error, as calculated by spherical equivalent, was 0.09 D. AcrySof IQ Vivity is a well-tolerated and effective IOL with optimal refractive target for both distant and intermediate vision, needing slight spherical addition for the best near vision. Great questionnaire-based satisfaction was reported by the patients. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to assess the prevalence of visual impairment and refractive error among learners who are deaf or hard of hearing in schools for Deaf students in Ghana. Methods: A descriptive cross-sectional study design was used to assess the distance visual acuity with the logMAR "E" chart, and ocular health was assessed with an ophthalmoscope and handheld slit lamp with a 90 D lens. Results: A total of 1,914 learners were examined in six schools for Deaf students in Ghana. Their ages ranged from 5 to 43 years (M = 15.18 ± 4.53 years). There were more males (55.5%) than females (44.5%) in the study. Among the learners, 91.1% were deaf, followed by mild hard of hearing (4.0%) and profound hard of hearing (1.8%), among others. Also, 94.8% of the learners had typical vision, followed by moderate visual impairment (2.5%), mild visual impairment (1.4%), and blindness (1.3%) before the provision of spectacles. There was no association between visual impairment (i.e., blindness and visual impairment) and sex among the learners (p <.05). The leading causes of visual impairments were refractive error and cataracts, while the leading cause of ocular morbidity was allergic conjunctivitis. The prevalence of visual impairment was reduced by almost 2-fold after the provision of spectacles. Discussion: The prevalence of deafblindness was low among the learners, with uncorrected refractive errors as the leading cause of mild and moderate visual impairment. If these learners had not been identified through this study, they would have continued to struggle to access the curriculum visually. Implications for Practitioners: There is a need to assess hearing and visual functions among learners with disabilities in developing countries like Ghana. [ABSTRACT FROM AUTHOR]

Background/Objectives: To evaluate the advanced lens measurement approach (ALMA) formula accuracy using different lens constants available on the user group for laser interference biometry (ULIB) and IOL Con platforms. Methods: In this retrospective, comparative, case-series study, 150 eyes of 160 patients with previous myopic Photorefractive Keratectomy (PRK) or laser-assisted in situ keratomileusis (LASIK), who underwent uneventful cataract surgery and IOL implantation, were examined. The ALMA formula was evaluated to calculate the refractive prediction error (PE), analysing four different categories of lens constants: both nominal and optimized A-Constant for SRKT, which are available on the ULIB and IOL Con platforms. An additional analysis was carried out in this study, evaluating if a decreased ULIB optimized constant (DUOC) with different fixed factors (−1.2 −1.3 −1.4 −1.5) could improve refractive outcomes. Median absolute error (MedAE) and percentage of eyes within ±0.50 and ±1.00 diopters (D) of prediction error were measured as the main outcomes. Results: Comparing the lens factors available on ULIB and IOL Con platforms, the ALMA formula reported a lower MedAE and higher percentages of eyes with a refractive PE within 1.0 D using ULIB nominal constants (all p < 0.05). Using DUOC (−1.3), and there was a statistically significant improvement of both MedAE and of the percentages of eyes with PE within ±0.50 D with the ALMA method compared to nominal ULIB constants (all p < 0.05). Conclusions: The impact of different lens factors in the IOL power calculation after myopic LRS should be carefully evaluated. The ALMA formula, in the absence of optimized constants by zeroing the mean error, should be used by subtracting 1.3 from the optimized ULIB constants available on the IOL Con website. This finding suggests further studies to test which of these constants could work better with the other post-refractive surgery formulas. [ABSTRACT FROM AUTHOR]

Clinical relevance: Knowing the agreement and interobserver variability of the 2WIN-S photorefractometer with cycloplegic retinoscopy and prism cover test is important for judging the clinical usefulness of the device. Background: This study aims to determine an agreement and interobserver reliability between 2WIN-S photorefractometer and cycloplegic retinoscopy for estimating refractive errors and between 2WIN-S and prism cover test for measuring horizontal ocular deviation in children. Methods: Two groups of 129 and 64 participants (range, 5 to 16 years) were recruited for the agreement and interobserver reliability studies, respectively. Non-cycloplegic 2WIN-S refraction was compared with cycloplegic retinoscopy for low and moderate myopia and hyperopia. Similarly, corneal reflex-function (CR-function) of 2WIN-S was compared with prism cover test for horizontal ocular deviation. Bland-Altman plots were used to depict agreement, and the intraclass correlation coefficient (ICC) was used for determining interobserver reliability of repeated measures. Results: The mean differences in spherical equivalent, J0 (Cartesian astigmatism) and J45 (oblique Jackson cross-cylinder) between cycloplegic retinoscopy and 2WIN-S were 1.10 (95% CI = 0.97 to 1.21, p < 0.001), −0.06 (95% CI = −0.09 to −0.03, p < 0.001) and 0.009 (95% CI = −0.01 to 0.03, p = 0.35), respectively. The overall median difference in the horizontal ocular deviation between prism cover test and 2WIN-S was −4.5 (Interquartile range = −12.0 to 4.0). For constant strabismus, this difference was insignificant (median= −2.0, interquartile range = −11.0 to 6.7, p = 0.19) between prism cover test and 2WIN-S. The ICC was high for the spherical equivalent (0.997; p < 0.001), J0 (0.932; p < 0.001) and J45 (0.901; p < 0.001), whereas it was low-to-moderate for horizontal ocular deviation (0.50; p < 0.001). Conclusion: 2WIN-S refraction was in agreement with cycloplegic retinoscopy for low and moderate myopia and hyperopia, and requires an adjustment for the consistent differences between cycloplegic retinoscopy and 2WIN-S refraction. The measurement of constant strabismus with 2WIN-S is comparable to that of prism cover test. [ABSTRACT FROM AUTHOR]

Clinical relevance: Measuring axial length is key in the field of myopia development and control. Hence, the precision and agreement of commercially available biometers is of vital interest to understand their variability and interchangeability in the paediatric population. Background: Different biometers are available to measure axial length and monitor myopia progression in clinical practice. The purpose of this study was to assess the precision (repeatability and reproducibility) and agreement of the MYAH and AL-Scan biometers in a paediatric population. Methods: Three consecutive measurements were performed using MYAH and AL-Scan biometers in each subject by the same operator to test for repeatability. To test for reproducibility, two measurements were performed for each subject by two different observers with a 5-min interval between measurements. To test the agreement, each subject was measured once with each instrument. Results: A total of 187 subjects, with a mean age of 8.5 ± 0.3 years and mean spherical equivalent refractive error of +0.22 ± 0.77 D participated in the study. For the repeatability study, the within-subject standard deviation was 0.01 mm, and the repeatability limit was 0.04 mm for both instruments, with no statistically significant differences among repeated measures (p = 0.162 for MYAH and p = 0.774 for AL-Scan). For the reproducibility study, the within-subject standard deviation was 0.01 mm and the repeatability limit was 0.04 mm. There were statistically significant differences for the repeated measures for the AL-Scan (p = 0.002) but not for the MYAH (p = 0.643). Regarding the agreement between both instruments, the 95% limit of agreement ranged from −0.04 to 0.05 mm, and the differences were statistically significant (p = 0.021). Conclusions: The repeatability, reproducibility, and agreement of the MYAH and AL-Scan biometers seem optimal for following children with myopia. [ABSTRACT FROM AUTHOR]

Clinical relevance: Currently eye examinations are usually based on autorefraction followed by subjective refraction (SR) with a phoropter. An automated phoropter that can also perform autorefraction may facilitate the optometric workflow. Background: The efficiency and feasibility of an objective autorefraction and correction system are assessed by comparing objective refractive measurements with SR on the same subjects and evaluating the visual acuity (VA) values obtained after the objective refractive measurement and correction. Methods: Objective autorefraction and correction was performed on 41 subjects using an automated binocular phoropter system. The auto-phoropter performs autorefraction by wavefront measurement and corrects the spherical and cylindrical errors with tunable fluidic lenses while the patient looks at a visual display inside the instrument. The instrument outputs are optometric constants of spherical and cylindrical aberrations. After measurement and automated correction of the refractive errors, the VA values were assessed by having the subjects look at an integrated Snellen chart. The objective measurement results were statistically compared with their SR. Results: The correlations between SR and objective autorefraction and correction spherical equivalents (M) were 0.98 (0.97–0.99) and 0.96 (0.93–0.98), the vertical Jackson cross cylinder (J0) were 0.96 (0.92–0.98) and 0.95 (0.91–0.97), and the oblique Jackson cross cylinder (J45) were 0.73 (0.55–0.85) and 0.82 (0.69–0.90), for the right and left eyes, respectively, with the 95% confidence interval (CI) values in parentheses. 89.0% of the 82 eyes had at least 6/7.5 VA. Conclusions: A significant agreement between the SR and objective autorefraction and correction was observed. An all-objective refractive assessment with instantaneous verification may improve the precision of eye prescriptions and possibly reduce the procedure time. [ABSTRACT FROM AUTHOR]

Background: Myopia and especially high myopia are recognised as major public health concerns. Although the prevalence of high myopia in young children is low, 10–20% of high school children in Asia have high myopia, with many still progressing, and one in three patients with high myopia develop visual impairment with age. Most participants in myopia control studies have low and moderate myopia; relatively little is known about myopia control in high myopia. Method: Literature searches were undertaken in MEDLINE and EMBASE to identify publications in English, investigating (Aim 1) the efficacy of myopia control strategies (environmental, pharmacological and optical) in high myopia (≤−6.00 D) and (Aim 2) the complications of high myopia using keywords. Outcomes included change in spherical equivalent refractive error (SE) and/or axial length (AL) to evaluate progression in high myopia. Results: Aim 1: Twelve studies were identified that reported the efficacy of optical and pharmacological (none on environmental) interventions on AL and SE for high myopia control. A statistically significant reduction in progression of SE and AL in high myopes was reported with 1% and 0.5% atropine. Defocus Incorporated Multiple Segment spectacle lenses had lower efficacy in slowing high myopia progression compared to moderate and low myopia. Ortho‐K lenses were equally effective in reducing myopia progression in low, moderate and high myopia. Aim 2: Myopic patients have an increased risk of myopic macular degeneration, retinal detachment, cataract and glaucoma, with the risk increasing with the level of myopia. Conclusions: High myopia has significant effects on quality of life, risk of pathological complications and vision impairment. Young children, excluding those with some syndromic associations, who are fast progressing moderate and high myopes require early intervention and close monitoring. Further research investigating the efficacy of myopia control strategies in highly myopic patients, both independently and through combination treatments, are necessary. [ABSTRACT FROM AUTHOR]

Introduction: Genetic aetiology is suspected in the development of early‐onset high myopia (spherical equivalent refractive error [SER] ≤−6.00 D at ≤6 years of age), considering that the role of environmental factors in inducing high myopia is improbable at an early age. Therefore, we aimed to understand if early‐onset high myopia is associated with parental myopia in a clinical setting. Methods: A retrospective study was conducted in which information about demographics, age of apparent onset of myopia, refractive error, axial length, number of myopic parents, time spent outdoors and time spent on near‐work was obtained from electronic medical records (EMR). It included 195 myopic individuals categorised into (1) Early‐onset high myopes (EOHM): SER ≤ −6.00 D with age of presentation ≤6 years, (2) Early‐onset low myopes (EOLM): SER > −6.00 D with age of apparent onset ≤6 years, (3) Late‐onset high myopes (LOHM): SER ≤ −6.00 D with age of presentation and age of apparent onset >6 years and (4) Late‐onset low myopes (LOLM): SER > −6.00 D with age of apparent onset >6 years. Results: Overall, 63% of individuals were found to have parental myopia. The proportion of individuals with EOHM, EOLM, LOHM and LOLM with parental myopia was 57%, 74%, 53% and 64%, respectively. After adjustment for age, gender and environmental factors, the odds of development of EOHM (Odds ratio: 0.78, 95% confidence interval: 0.25–2.48), EOLM (1.54, 0.65–3.67) or LOHM (0.70, 0.30–1.65) were similar in the presence of myopic parents, when compared with LOLM. The SER and axial length did not differ based on the number of myopic parents in any of these categories. Conclusion: This retrospective analysis reveals that the presence of parental myopia, which was self‐reported, did not induce additional risk for early‐onset high myopia. [ABSTRACT FROM AUTHOR]

Purpose: The prevalence of myopia in Scandinavia tends to be lower than in other parts of the world. This study aimed to investigate the incidence of myopia and its predictors in Swedish children to characterise this trend. Methods: A 2‐year longitudinal study was conducted following a cohort of schoolchildren aged 8–16 years. Myopia was defined as a spherical equivalent refraction (SER) ≤ −0.50 D. The study enrolled 128 participants, 70 (55%) females with a mean age of 12.0 years (SD = 2.4). Results: The cumulative incidence of myopia during the follow‐up period was 5.5%, and the incidence rate of myopia was 3.2 cases per 100 person‐years. Participants with myopia at baseline exhibited a faster increase in refractive error during the follow‐up period. Likewise, participants with two myopic parents exhibited a more marked change towards myopia, regardless of their initial refractive error. Conclusion: In the current study, similar to prevalence, the incidence of myopia was low when compared with other parts of the world. These results lead us to formulate a new hypothesis that the normal emmetropisation process may be protected by low educational pressure practised in Sweden during early childhood. Further research is necessary to test this new hypothesis. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to identify clinical guidelines that provide recommendations on prescribing refractive error correction in children, evaluate the overall quality of these guidelines using the Appraisal of Guidelines for REsearch and Evaluation II (AGREE II) tool and subsequently gain consensus on the prescribing recommendations from high‐quality guidelines using the modified Delphi technique. Methods: A comprehensive search for prescribing guidelines was conducted using databases and professional websites. The quality appraisal of eligible guidelines was undertaken by scoring the six AGREE II domains. Subsequently, the modified Delphi technique was used by 10 experts (sub‐specialist optometrists, ophthalmologists and orthoptists) to gain consensus on the prescribing recommendation statements extracted from guidelines that had been identified as high quality. Three rounds were conducted in which agreement of these statements were scored using a 9‐point Likert scale with a free‐text option for any additional comments. Results: Five eligible guidelines were identified. The AGREE II tool demonstrated that the guidelines varied substantially in quality, with only one guideline identified as being of high quality. A total of 168 prescribing statements were reviewed in the Delphi procedure. Of these, 95 statements reached expert consensus as being appropriate prescribing recommendations. Conclusion: There is significant scope for improving current guidelines for prescribing refractive error correction in children. We used the modified Delphi technique to find points of agreement on prescribing recommendations to support professionals prescribing refractive error correction in children. We recommend that further work is needed to address gaps in the guidelines. [ABSTRACT FROM AUTHOR]

Purpose: To conduct a large retrospective study of screening refractive error in young children. Methods: This retrospective study included children aged from 4 months to 8 years in Daxing District, Beijing, who underwent refractive examinations without cycloplegia. It included a cross‐sectional assessment of refractive error screening for all children, and a longitudinal component for a subgroup with data available for two to five visits. Results: A total of 14,987 children were included in the cross‐sectional study. In the group <1 year of age, the percentage of children with a spherical equivalent (SE) >+2.00 D or with cylinder <−1.50 D was 15.25% and 33.24%, respectively. These were significantly higher than for the 1‐ to 4‐year‐old group (SE 8.1% higher, cylinder 13.2% higher) (χ2 = 53.57, p < 0.001; χ2 = 790.39, p < 0.001). Furthermore, 34.83% of children in the 0‐year‐old group had amblyopia risk factors (ARFs). In the 4‐year‐old group, boys had a significantly longer axial length (AL) than girls (differences in the right and left eyes were 0.53 and 0.56 mm, respectively; z = 5.48 p < 0.001, z = 5.80, p < 0.001). AL increased with age, while the AL difference between boys and girls remained stable at 4–8 years of age. The percentage of children aged 5–8 years with myopia in 2020–2021 was significantly higher than that in 2018–2019 (H = 12.44, p = 0.006). In the longitudinal study of 4406 children (up to 12‐month follow‐up), annual changes in SE were −0.27, −0.06, 0.19 and 0.13 D between 0 and 3 years, and −0.38, −0.58, −0.70 and −0.75 D between 5 and 8 years. Conclusions: Children's refractive error varied significantly from ages 4 months to 1 year, with a high proportion having ARFs. Children aged 5–8 years showed a trend towards myopia. The prevalence of myopia in the cross‐sectional analysis in 2020–2021 was greater than in 2018–2019. Screening refraction changed minimally over a 12‐month period for children aged 1–3 years, but became more myopic for children aged 5–8 years. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the effect of individualized ocular refraction customized (IORC) spectacle lenses with different actual amounts of peripheral myopic defocus (MD) on myopia control over 1 year. These lenses compensate for the original peripheral refraction via the free‐form surface on the back of the lens. Methods: This 1‐year, double‐masked randomised clinical trial included 184 myopic schoolchildren aged 8–12 years. Participants were randomised to receive IORC lenses with high (IORC‐H group, +4.50 D), medium (IORC‐M group, +3.50 D) or low (IORC‐L group, +2.50 D) MD or single‐vision (SV) lenses. The spherical equivalent refractive error (SER) and axial length (AL) were measured at baseline and 6‐monthly intervals. Results: After 1 year, the mean (SD) changes in SER were −0.18 (0.37), −0.36 (0.37), −0.52 (0.39) and −0.60 (0.42) D for the IORC‐H, IORC‐M, IORC‐L and SV groups, respectively. Compared with the SV group, the effects of slowing myopia progression were 70%, 40% and 13% for the IORC‐H (difference of 0.47 D, p < 0.001), IORC‐M (difference of 0.32 D, p = 0.001) and IORC‐L (difference of 0.15 D, p > 0.05) groups, respectively. The mean (SD) changes in AL were 0.12 (0.16), 0.23 (0.17), 0.29 (0.17) and 0.36 (0.17) mm for the IORC‐H, IORC‐M, IORC‐L and SV groups, respectively. The axial elongation was 67%, 36% and 19% lower in the IORC‐H (difference of 0.25 mm, p < 0.001), IORC‐M (difference of 0.15 mm, p < 0.001) and IORC‐L (difference of 0.10 mm, p = 0.04) groups, respectively, compared with the SV group. The IORC‐H group exhibited significantly less axial elongation than the IORC‐M and IORC‐L groups (p = 0.01 and p < 0.001, respectively). Conclusion: Compared with the IORC‐M and IORC‐L lenses, the IORC‐H lens was found to have superior efficacy in inhibiting myopic progression and slowing eye growth in schoolchildren, with better myopia control efficacy in younger children. [ABSTRACT FROM AUTHOR]

Objectives: To collate data on partially accommodative esotropia (PAET) to better understand this condition's aetiology and to evaluate and predict the therapeutic effect of a hyperopic correction on PAET. Methods: Eighty‐nine consecutive patients diagnosed with PAET with a spherical equivalent (SE) refractive error >+2.50 D were included in this retrospective review. Clinical characteristics, including gender, age, SE, angle of esodeviation, accommodative convergence/accommodation (AC/A) ratio, near‐distance disparity (NDD) and anatomical features of the rectus muscles were compared among different PAET subgroups. Multiple linear regression was used to identify independent factors that influenced the therapeutic effect of a hyperopic correction on esotropia. Results: No significant differences were observed for the angle of esodeviation as a function of age in individuals with PAET. The incidence of SE in PAET participants >9 years old was significantly greater than in those <5 and 6–8 years of age. The therapeutic effect of hyperopic correction on esotropia was positively associated with SE both at distance and near. In addition, the limbus insertion distance (LID) of the lateral rectus (LR) muscle was positively associated with NDD at distance, but negatively associated at near. Conclusion: A greater incidence of hyperopia was observed in older (>9 years old) PAET patients. A hyperopic correction had a greater effect on esotropia in individuals with a higher SE, larger LID of the LR muscle and a smaller NDD. [ABSTRACT FROM AUTHOR]