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Purpose: To investigate whether myopia is becoming more common across Europe and explore whether increasing education levels, an important environmental risk factor for myopia, might explain any temporal trend., Design: Meta-analysis of population-based, cross-sectional studies from the European Eye Epidemiology (E(3)) Consortium., Participants: The E(3) Consortium is a collaborative network of epidemiological studies of common eye diseases in adults across Europe. Refractive data were available for 61 946 participants from 15 population-based studies performed between 1990 and 2013; participants had a range of median ages from 44 to 78 years., Methods: Noncycloplegic refraction, year of birth, and highest educational level achieved were obtained for all participants. Myopia was defined as a mean spherical equivalent ≤-0.75 diopters. A random-effects meta-analysis of age-specific myopia prevalence was performed, with sequential analyses stratified by year of birth and highest level of educational attainment., Main Outcome Measures: Variation in age-specific myopia prevalence for differing years of birth and educational level., Results: There was a significant cohort effect for increasing myopia prevalence across more recent birth decades; age-standardized myopia prevalence increased from 17.8% (95% confidence interval [CI], 17.6-18.1) to 23.5% (95% CI, 23.2-23.7) in those born between 1910 and 1939 compared with 1940 and 1979 (P = 0.03). Education was significantly associated with myopia; for those completing primary, secondary, and higher education, the age-standardized prevalences were 25.4% (CI, 25.0-25.8), 29.1% (CI, 28.8-29.5), and 36.6% (CI, 36.1-37.2), respectively. Although more recent birth cohorts were more educated, this did not fully explain the cohort effect. Compared with the reference risk of participants born in the 1920s with only primary education, higher education or being born in the 1960s doubled the myopia prevalence ratio-2.43 (CI, 1.26-4.17) and 2.62 (CI, 1.31-5.00), respectively-whereas individuals born in the 1960s and completing higher education had approximately 4 times the reference risk: a prevalence ratio of 3.76 (CI, 2.21-6.57)., Conclusions: Myopia is becoming more common in Europe; although education levels have increased and are associated with myopia, higher education seems to be an additive rather than explanatory factor. Increasing levels of myopia carry significant clinical and economic implications, with more people at risk of the sight-threatening complications associated with high myopia., (Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Objective: To develop a novel age-appropriate measure of functional vision (FV) for self-reporting by visually impaired (VI) children and young people., Design: Questionnaire development., Participants: A representative patient sample of VI children and young people aged 10 to 15 years, visual acuity of the logarithm of the minimum angle of resolution (logMAR) worse than 0.48, and a school-based (nonrandom) expert group sample of VI students aged 12 to 17 years., Methods: A total of 32 qualitative semistructured interviews supplemented by narrative feedback from 15 eligible VI children and young people were used to generate draft instrument items. Seventeen VI students were consulted individually on item relevance and comprehensibility, instrument instructions, format, and administration methods. The resulting draft instrument was piloted with 101 VI children and young people comprising a nationally representative sample, drawn from 21 hospitals in the United Kingdom. Initial item reduction was informed by presence of missing data and individual item response pattern. Exploratory factor analysis (FA) and parallel analysis (PA), and Rasch analysis (RA) were applied to test the instrument's psychometric properties., Main Outcome Measures: Psychometric indices and validity assessment of the Functional Vision Questionnaire for Children and Young People (FVQ_CYP)., Results: A total of 712 qualitative statements became a 56-item draft scale, capturing the level of difficulty in performing vision-dependent activities. After piloting, items were removed iteratively as follows: 11 for high percentage of missing data, 4 for skewness, and 1 for inadequate item infit and outfit values in RA, 3 having shown differential item functioning across age groups and 1 across gender in RA. The remaining 36 items showed item fit values within acceptable limits, good measurement precision and targeting, and ordered response categories. The reduced scale has a clear unidimensional structure, with all items having a high factor loading on the single factor in FA and PA. The summary scores correlated significantly with visual acuity., Conclusions: We have developed a novel, psychometrically robust self-report questionnaire for children and young people-the FVQ_CYP-that captures the functional impact of visual disability from their perspective. The 36-item, 4-point unidimensional scale has potential as a complementary adjunct to objective clinical assessments in routine pediatric ophthalmology practice and in research., (Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Objective: To describe the cause, management, and effect of chronic blepharokeratoconjunctivitis (BKC) on the cornea and visual function in children., Design: Noncomparative, interventional, retrospective case series., Participants: Twenty-seven children with BKC., Methods: Presenting age, best-corrected visual acuity (BCVA), refractive error, and any corneal or eyelid pathologic features were recorded. Treatment included modified lid hygiene, topical antibiotics, and steroids. Systemic therapy included oral antibiotics and, from 2003 onward, flaxseed oil as an alternative to long-term antibiotics. Amblyopia therapy included refractive correction, occlusion, or atropine therapy., Main Outcome Measures: Corneal and eyelid status, visual acuity (VA), and refractive error at final examination., Results: Mean age at presentation was 6.9 years (range, 7 months-15.9 years), and mean follow-up was 2.3 years (range, 5 months-6.1 years). All patients had discomfort, conjunctival injection, and signs of posterior blepharitis at presentation. Photophobia was reported in 14 patients (52%), whereas anterior eyelid inflammation was noted in 6 (22%). Acne rosacea was confirmed in 3 patients (11%). Corneal involvement occurred in 44 eyes (81%), and a history of recurrent chalazia was seen in 18 patients (67%). Median monocular BCVAs in affected eyes were 0.28 logarithm of the minimum angle of resolution (logMAR) units (interquartile range [IqR], 0.02-0.40) at presentation and 0.02 logMAR units (IqR, 0.00-0.18) at last visit. Best-corrected VA improved in 70% of affected eyes and remained unchanged in 30%. Superimposed amblyopia was present and treated in 15 patients (48%). All 8 patients (20%) who failed to achieve VA of 0.2 logMAR units or better at the final examination had bilateral corneal involvement at presentation. One child experienced a systemic side effect from oral antibiotics. No child had significant side effects from topical treatment. Twelve patients (44%) received flaxseed oil as part of their tapering regimen. A 2-year lag between symptom onset and treatment resulted, on average, in a reduction of 0.06 logMAR units of VA (95% confidence interval, 0.00-0.12; P = 0.054)., Conclusions: These findings suggest that visual loss may be significant in BKC and that delayed treatment may result in decreased final BCVA. Adequate management needs both topical and systemic treatment. Flaxseed oil may be an effective antiinflammatory nutritional therapy alternative to long-term antibiotics.

Objective: Trachoma is one of the leading preventable causes of blindness worldwide. We evaluate the impact of a health education program on the prevalence of active trachoma in children 3 to 9 years old., Design: Community randomized intervention study. Data were collected by means of cross-sectional surveys before and after intervention., Participants: Within 40 rural Ethiopian communities, households were selected at random, and all 3- to 9-year-old children within households were invited for examination., Methods: Health education messages broadcast by radio were received by all communities. Nongovernmental organization activities to prevent trachoma, based on the SAFE (surgery for trichiasis, antibiotic treatment, face washing, and environmental improvements) strategy, were received by 30 of the 40 communities. Ten of these communities received enhanced educational messages using videos. Cluster summary measures were compared across surveys and intervention arms. Active trachoma at follow-up was modeled using random-effects logistic regression, adjusting for baseline prevalence and study area variability, at the cluster and individual level., Main Outcome Measures: Active trachoma in 3- to 9-year-old children and adult knowledge and behavior related to the nature and transmission of trachoma infection., Results: At baseline, 1410 of 1960 (72%) children examined and, at follow-up, 1289 of 2008 (64%) had active trachoma. The overall reduction in prevalence at cluster level was 8% (95% confidence interval [CI], 4%-12%; P<0.001). There was a statistically significant increase in the awareness of trachoma. After adjustment for area and cluster level baseline prevalence, the odds of active trachoma were reduced in both intervention arms, standard (odds ratio [OR], 0.78; 95% CI, 0.53-1.16) and enhanced (OR, 0.76; 95% CI, 0.48-1.21), compared with the control arm, but not significantly., Conclusions: Overall, there was a small but statistically significant reduction in the prevalence of active trachoma between surveys, but differences between the 3 intervention arms were not statistically significant. Awareness of trachoma control increased in all communities, but there was little change in behavior associated with the transmission of Chlamydia trachomatis. It is therefore unlikely that observed reductions in active trachoma were solely due to health education.