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Purpose To evaluate the effect of low-dose atropine eyedrops on pupil metrics. Methods This study was based on a randomized, double-masked, placebo-controlled, and cross-over trial in mainland China. In phase 1, subjects received 0.01% atropine or placebo once nightly. After 1 year, the atropine group switched to placebo (atropine-placebo group), and the placebo group switched to atropine (placebo-atropine group). Ocular parameters were measured at the crossover time point (at the 12th month) and the 18th month. Results Of 105 subjects who completed the study, 48 and 57 children were allocated into the atropine-placebo and placebo-atropine groups, respectively. After cessation, the photopic pupil diameter (PD) and mesopic PD both decreased (− 0.46 ± 0.47 mm, P P = 0.008), and the constriction ratio (CR, %) increased (4.39 ± 7.54, P P P P Conclusion Pupil metrics and the CR could return to pre-atropine levels after cessation. Pupil metrics had no significant effect on myopia progression during treatment.

Background. To identify an optimal model for diabetic retinopathy (DR) prediction in Chinese rural population by establishing and comparing different algorithms based on the data from Handan Eye Study (HES). Methods. Five algorithms, including multivariable logistic regression (MLR), classification and regression trees (C&RT), support vector machine (SVM), random forests (RF), and gradient boosting machine (GBM), were used to establish DR prediction models with HES data. The performance of the models was assessed based on the adjusted area under the ROC curve (AUROC), sensitivity, specificity, and accuracy. Results. The data on 4752 subjects were used to build the DR prediction model, and among them, 198 patients were diagnosed with DR. The age of the included subjects ranged from 30 to 85 years old, with an average age of 50.9 years ( SD = 3.04 ). The kappa coefficient of the diagnosis between the two ophthalmologists was 0.857. The MLR model revealed that blood glucose, systolic blood pressure, and body mass index were independently associated with the development of DR. The AUROC obtained by GBM (0.952), RF (0.949), and MLR (0.936) was similar and statistically larger than that of CART (0.682) and SVM (0.765). Conclusions. The MLR model exhibited excellent prediction performance and visible equation and thus was the optimal model for DR prediction. Therefore, the MLR model may have the potential to serve as a complementary screening tool for the early detection of DR, especially in remote and underserved areas.

Background/Objectives This study aimed to provide a 24-month follow-up on the surgical success and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) combined with phacoemulsification and intraocular lens (IOL) implantation in the treatment of patients with primary open-angle glaucoma (POAG) combined cataract. Subjects/Methods We included 124 consecutive cases of POAG with microcatheter-assisted GATT or GATT combined with phacoemulsification and IOL implantation at Beijing Tongren Eye Centre between October 2019 and November 2020. Main outcome measures included surgical success rate, changes in IOP, number of antiglaucoma medications, best corrected visual acuity (BCVA), postoperative complications at baseline, and follow-up period of up to 24 months. Results In total, 58 eyes received GATT combined with phacoemulsification surgery and 66 eyes received GATT alone. The overall qualified success rate was 86.21% for eyes with GATT combined with phacoemulsification surgery, and 83.48% for eyes with GATT only at 24 months. IOP was reduced from 26.40 ± 6.37 mmHg on 3.12 ± 0.80 medications preoperatively to 14.61 ± 2.28 mmHg on 0.27 ± 0.71 medications at 12 months and 16.08 ± 2.38 mmHg on 0.45 ± 0.96 medications at 24 months after combined surgery. Additionally, mean BCVA improved from 0.75 ± 0.43 logMAR units preoperatively to 0.22 ± 0.18 logMAR units 24 months after combined surgery. No vision-threatening complications occurred during the 24-month follow-up. Conclusions The 24-month follow-up results of our study suggest that GATT combined with cataract surgery is a safe and effective treatment for decreasing IOP and number of medications in patients with POAG combined cataract.

To describe clinical and genetic characteristics in a series of Chinese patients with non-syndromic retinitis pigmentosa, a total of 20 unrelated Chinese pedigrees with non-syndromic retinitis pigmentosa were evaluated. Complete ophthalmic examinations data including the Humphrey visual field, spectral domain-optical coherence tomography, full-field electroretinography, and fundus fluorescence were collected and analyzed. Targeted exome sequencing was utilized to investigate variations in 260 known genes of inherited retinal disease, including the 90 known causative retinitis pigmentosa genes. We initially identified the potential candidate variants in the pedigrees, then validated the variants using the Sanger sequencing and performed segregation analysis to verify that the variants constituted disease-causing mutations in these pedigrees. We detected three novel (likely) pathogenic and eight previously reported (likely) pathogenic variations in nine genes reported to be related to non-syndromic retinitis pigmentosa in nine of the pedigrees. We report clinical characteristics of Chinese patients with retinitis pigmentosa and novel mutations responsible for non-syndromic retinitis pigmentosa in Chinese pedigrees, expanding the number of gene mutations associated with this disorder and clarifying its genetic basis in the Chinese population. These data will help with rapid and efficient molecular diagnosis and the study of targeted treatment for retinitis pigmentosa in this population.

Purpose To identify risk factors for surgical failure after gonioscopy-assisted transluminal trabeculotomy (GATT) in juvenile open angle glaucoma (JOAG). Design Prospective, interventional case series. Methods Seventy eyes of 70 patients with JOAG underwent GATT as the initial surgery. Surgical success was defined as a post-operative intraocular pressure (IOP) of ≤21 mmHg with at least a 20% reduction from pre-operative IOP with or without the use of anti-glaucoma medication (qualified and complete success, respectively) at each post-operative visit. IOP spike was defined as IOP >30 mmHg and an increase of at least 10 mmHg from IOP prior to the spike, and then reduced to ≤21 mmHg. Results The median age at the time of surgery was 19.3 (range: 4.9-37.5) years with a visual field mean deviation (MD) -17.4±10.6 dB. Mean IOP decreased from 31.3±9.5 mmHg pre-operatively to 15.8±2.7 at 12 months post-operatively. The complete and qualified success rates were 74.3% and 91.4%, respectively. Fifty-two (74%) eyes had an IOP spike with a median spike duration of 3.5 days (range 1-21). Longer duration of IOP spike (P=0.009) and older age at the time of surgery (P=0.025) were both associated with worse surgical outcomes. Advanced disease was associated with prolonged IOP spike (P=0.007). Conclusions GATT provided excellent outcomes in patients with severe JOAG. Older age and longer duration of post-operative IOP spike are risk factors for failure. Severe cases are more likely to have longer durations of IOP spike. Frequent IOP monitoring during the early post-operative period is needed to detect IOP spikes in these patients.

Purpose: Primary open-angle glaucoma (POAG) is a widespread neurodegenerative condition affecting brain regions involved in visual processing, somatosensory processing, motor control, emotional regulation and cognitive functions. Cerebral hemodynamic dysfunction contributes to the pathogenesis of glaucomatous neurodegeneration. We aimed to investigate cerebral blood flow (CBF) redistributed patterns in visual and higher-order cognitive cortices and its relationship with clinical parameters in POAG, and we hypothesized that CBF changes together across regions within the same functional network. Methods: Forty-five POAG patients and 23 normal controls underwent three-dimensional pseudocontinuous arterial spin labeling MRI to measure the resting-state CBF. Group comparisons of CBF and correlations between CBF changes and ophthalmological and neuropsychological indices were assessed. We determined CBF-based functional connectivity (CBFC) by calculating the correlations between specific regions and all other brain voxels and compared CBFC differences between groups. Results: The patients exhibited decreased CBF in visual cortices, postcentral gyrus, inferior parietal lobule and cerebellum and increased CBF in medial, middle, and superior frontal gyri, as well as the insula. The CBF in the visual cortices and medial frontal gyrus significantly correlated with the ophthalmological parameters. POAG patients showed disorganized connection patterns, mainly characterized by negative connections weakening or converting to mild positive connections, as well as positive connections converting to negative connections. Conclusions: Together, regional and interregional CBF properties confirmed that the aberrant brain regions extend beyond the visual pathway, including the somatosensory, emotional and cognitive networks, which highlights the importance of cerebral hemodynamic dysfunction in the pathophysiology of spreading neurodegeneration in POAG.

Purpose To describe the normative profile of ophthalmic parameters in a healthy cynomolgus monkey colony, and to identify the characteristic of the spontaneous ocular disease non-human primates (NHP) models. Methods The NHP eye study was a cross-sectional on-site ocular examination with about 1,000 macaques held in Guangdong Province, southeastern China. The NHPs (Macaca fascicularis, cynomolgus) in this study included middle-aged individuals with a high prevalence of the ocular disease. The NHP eye study (NHPES) performed the information including systematic data and ocular data. Ocular examination included measurement of intraocular pressure (IOP), anterior segment- optical coherence tomography (OCT), slit-lamp examination, fundus photography, autorefraction, electroretinography, etc. Ocular diseases included measurement of refractive error, anisometropia, cataract, pterygium, etc. Results A total of 1148 subjects were included and completed the ocular examination. The average age was 16.4 ± 4.93 years. Compared to the male participants, the females in the NHPES had shorter axial length and the mean Average retinal nerve fiber layer (RNFL) thickness (except for the nasal quadrants). The mean IOP, anterior chamber depth, lens thickness, axial length, central corneal thickness, choroid thickness and other parameters were similar in each group. Conclusion The NHPES is a unique and high-quality study, this is the first large macaque monkey cohort study focusing on ocular assessment along with comprehensive evaluation. Results from the NHPES will provide important information about the normal range of ophthalmic measurements in NHP.

Diabetes mellitus-induced hyperglycemia is responsible for multiple pathological ocular alternations from vasculopathy to biomechanical dyshomeostasis. Biomechanical homeostasis is crucial to maintain the normal physiological condition of the eyes. Biomechanical features vary in eye tissues regarding different anatomical positions, tissue components, and cellular functions. The disturbance in biomechanical homeostasis may result in different ocular diseases. In this review, we provide a preliminary sketch of the latest evidence on the mechano-environment of the eyeball and its possible influencing factors, thereby underscoring the relationship between the dyshomeostasis of ocular biomechanics and common eye diseases (e.g., diabetic retinopathy, keratoconus, glaucoma, spaceflight-associated neuro-ocular syndrome, retinal vein occlusion and myopia, etc.). Together with the reported evidence, we further discuss and postulate the potential role of biomechanical homeostasis in ophthalmic pathology. Some latest strategies to investigate the biomechanical properties in ocular diseases help unveil the pathological changes at multiple scales, offering references for making new diagnostic and treatment strategies targeting mechanobiology.

Introduction: This study sought to determine whether the application of 0.01% atropine eye drops could impact the disparity in refraction and axial length (AL) between the right and left eyes in Chinese children. Methods: The study was designed as a double-blind, placebo-controlled randomized trial. A total of 220 children aged 6-12 years were recruited from the Beijing Tongren Hospital in Beijing, China. Participants were randomized in a 1:1 ratio and were prescribed 0.01% atropine or placebo eye drops to be administered once a night to both eyes for the duration of one year. The cycloplegic refraction and AL was recorded including baseline, 6 months, and again at the twelve months. Results: After one-year follow-up period, 76 (69%) and 83 (75%) subjects of the initial 220 participants were identified as the 0.01% atropine and placebo groups, respectively. The inter-ocular difference in spherical equivalent refraction (SER) and AL demonstrated stable values in the 0.01% atropine treatment group (SER: p=0.590; AL: p=0.322) analyzed after one-year, but found a significant increase (SER: p

Background: Previous studies identified myopia as a risk factor for primary open-angle glaucoma (POAG). However, recent studies have shown different results, and the definitive relationship between myopia and POAG remains controversial. Objectives: The aim of this study was to investigate the relationship between myopia and POAG. Methods: Published articles were searched from PubMed, Embase, and Scopus databases between 1970 and 2020. A pooled analysis of the odds ratios (ORs) was performed using a random-effects model. Results: Data on the association between myopia and POAG were obtained from 16 cross-sectional studies, and the pooled OR was 2.26 (95% confidence interval [CI], 1.77–2.89, p < 0.001) in random-effects model (I2 = 86%; p < 0.01). For the relationship of myopia and POAG progression, data from 7 longitudinal cohort studies were included, and the pooled OR was 0.85 (95% CI, 0.73–0.99, p = 0.042) in the random-effects model (I2 = 88%; p < 0.01). Conclusion: Our findings demonstrated that myopia may be a risk factor associated with POAG and a possible protective factor for POAG progression. It may be due to myopia with the presence of a lamina cribrosa defect, slowing down the visual field loss and also POAG progression. Further research for underlying mechanisms is still needed.

Optic nerve head (ONH) astrocytes provide structural and metabolic support to neuronal axons in developmental, physiological, and pathological progression. Mechanosensitive properties of astrocytes allow them to sense and respond to mechanical cues from the local environment. We confirmed that ONH astrocytes express the mechanosensitive ion channel Piezo1 in vivo. By manipulating Piezo1 knockdown or overexpression in vitro, we found that Piezo1 is necessary but insufficient for ONH astrocyte proliferation. Loss of Piezo1 can lead to cell cycle arrest at G0/G1 phase, a possible mechanism involving decreased yes-associated protein (YAP) nuclear localization and downregulation of YAP-target cell cycle-associated factors, including cyclin D1 and c-Myc. Gene ontology enrichment analysis of differential expression genes from RNA-seq data indicates that the absence of Piezo1 affects biological processes involving cell division. Our results demonstrate that Piezo1 is an essential regulator in cell cycle progression in ONH astrocytes.

Objectives: To assess health-related quality of life (HRQOL) by EQ-5D among glaucoma patients in the Handan Eye Study (HES), as well as the factors that influence the quality of life. Methods: A central clinic in the county hospital, a temporary clinic in the targeted villages, or at the participant’s home. The Handan Eye Study (HES) is a population-based prevalence study of eye disease in rural Yongnian County, northern China. A total of 99 adults with glaucoma were enrolled for analysis, including 67 with primary open-angle glaucoma (POAG) and 32 with primary angle-closure glaucoma (PACG). And 256 selected people with better visual acuity and visual field but Without Primary Glaucoma. Results of ophthalmic examinations and socio-economic information were recorded. HRQOL was measured using the EQ-5D, and visual function (VF) and vision-related quality of life (VRQOL) were evaluated using a Visual function-quality of life (VF-QOL) instrument. Primary and secondary outcome measures: EQ-5D and VF-QOL score. Results： The mean ± standard deviation (SD) scores on the EQ-5D, VF, and VRQOL for the 99 glaucoma cases were 0.98±0.04, 87.9±15.2, and 95.5±12.8 respectively. Utility values were significantly lower among participants with glaucoma (0.98±0.04) compared to those without (0.99±0.02, P = 0.008), even after adjusting for age, gender, education level, family income, and comorbidity (P = 0.02). There was a significantly lower utility value (0.92±0.08) among patients with lower VRQOL total score (55.4 ± 11.5) compared to higher (0.99 ± 0.03, P = 0.036), even after adjustment for age and family income (P = 0.006). Conclusion: Patients with glaucoma, particularly those with poor VRQOL, exhibited lower HR-QOL than those without. Early diagnosis and prevention facilitated by government health insurance may enhance VF-QOL for glaucoma patients, especially for PACG.

The biological activity is related to the content of active substances, and the accumulation of active substances is closely related to the tree age. The relationship between the physicochemical characteristics and biological activities ofLycium barbarumpolysaccharides (LBPs) and tree ages was studied in this study. The physicochemical characteristics of LBPs at second (Y2), fourth (Y4), sixth (Y6), eighth (Y8), tenth (Y10) and fifteenth (Y15) tree ages, such as total carbohydrate content (TCC), protein content (PC), uronic acid content (UAC), monosaccharide composition, molecular weight distribution, infrared characteristics were determined. And effects of LBPs of different tree ages on PC12 cells and APRE-19 cells function were evaluated in vitro. The results indicated that there was no significant difference in PC of LBPs at different tree ages. The UAC and TCC of LBPs from Y4 to Y10 were not significantly different, but were significantly higher than those in Y2 and Y15. LBPs of different tree ages showed similar preliminary structural characteristics. Compared with the LBPs of other tree ages, the LBPs of Y4, Y6, Y8 and Y10 had a good role in resisting oxidative stress. These results indicated that molecular weight, TCC and UAC of LBPs had important effects on their antioxidant activity in vitro. The accumulation of UAC and TCC in LBPs was closely related to tree age. The physicochemical characteristics and biological activities of LBPs fromY4 to Y10 were better than Y2 and Y15. Therefore,Lycium barbarumL. from Y4 to Y10 should be selected when preparing LBPs.

Objective To analyze the rates of blindness with the demographics and clinical characteristics of patients with primary angle-closure disease (PACD) to provide a comprehensive epidemiologic reference in China. Methods A retrospective analysis was conducted in the Chinese Glaucoma Study Consortium database, which is a national multicenter glaucoma research alliance of 111 hospitals participating between December 21, 2015 and September 9, 2018. The diagnosis of PACD was made by qualified physicians through examination. Comparison of sex, age, family history, subtypes of PACD, and blindness were analyzed. Results A total of 5762 glaucoma patients were included, of which 4588 (79.6%) had PACD. Of PACD patients, 72.1% were female with the sex ratio (F/M) of 2.6, and the average age of patients was 63.8±9.3 years with the majority between 60 and 70 years. Additionally, 30% of these patients had low vision in one eye, 8.8% had low vision in both eyes, 1.7% had blindness in one eye, and 0.3% had blindness in both eyes. There were statistical differences with regards to age between male and female patients with PACD, with male patients being older on average. Primary angle-closure glaucoma was more commonly diagnosed in males (60%) compared to females (35.9%), whereas acute primary angle closure (APAC) was more commonly diagnosed in females (54.3%) compared to males (37.7%). The visual acuity in APAC patients was lower and the rate of low vision and blindness was higher than other subtypes. Conclusion PACD was the major type of glaucoma in Chinese hospitals. There were more female patients with PACD, mostly between 60 and 70 years old, with higher rates of APAC in women. APAC resulted in the worst visual outcomes of all PACD subtypes.

More than half of long-duration spaceflight astronauts have experienced ophthalmic abnormalities, collectively termed spaceflight-associated neuro-ocular syndrome (SANS). Microgravity-induced elevation in intracranial pressure(ICP), especially optic nerve cerebral spinal fluid pressure (ON-CSFp) due to headward fluid shifts is the primary hypothesized contributor to SANS. However there is limited non-invasive method to monitor ON-CSFp. The present longitudinal study aims to quantify the area of the optic nerve subarachnoid space(ONSSA) in the axial plane behind the optic disc, that is filled with CSF and expands when ON-CSFp is elevated, during and after head-down tilt (HDT) bed rest (BR) and assess its association with relative anthropometric and systemic parameters.72 eyes of 36 healthy male volunteers were included and underwent 90-day strict 6° HDT BR .The measurements were performed on day 30, 60, and 90 of HDT BR and at six recovery time points extending to 180-day in supine position. Portable B-scan ultrasound was performed binocularly, using a 12 MHz linear array probe. The measurement of the optic nerve sheath and calculation of the ONSSA from 3mm to 5mm posterior to the optic disc were performed with ImageJ 1.51 analysis software by two experienced observers in a masked manner. In comparison to recovery day 180, ONSSA from 3mm to 5mm posterior to the optic disc exhibited significant distention on BR day 30,60 and 90, with a mean change of 0.4mm2 (95% CI:0.12 to 0.7 mm2, P = .002), 0.35 mm2 (95% CI:0.02 to 0.69mm2, P = .001), and 0.4 mm2 (95% CI:0.05 to 0.75 mm2, P = .015), respectively. Univariate linear regression analysis showed increased ONSSA was correlated with increased mean blood pressure (Beta = 0.092; 95%CI, 0.016 to 0.169; P = .019). Terrestrially, ONSSA distension is associated with increased ICP. The results indicated that 90-day HDT BR induced elevated ICP especially ON-CSFp in comparison to supine level.Advanced quantitative portable ultrasound-based assessment of the ONSSA could better our understanding the role of ON-CSFp on SANS.

Purpose: The purpose of this study was to determine the prevalence of myopia among patients with primary angle closure disease (PACD) in rural China and their ocular biometric characteristics.Methods: Study subjects were recruited from the Handan Eye Study. A/B-mode scan (Cine Scan, Quantel Medical, Cedex, France) was used to measure the axial length, anterior chamber depth (ACD), and lens thickness (LT). PACD was defined as the anterior chamber angle being considered closed when 180 degrees or more of the posterior pigmented trabecular meshwork were not visible on the gonioscopy. Myopia was defined as a spherical equivalent (SE) refractive error ≤−0.5 diopter (D). Persons who did not meet PACD definition were classified as the open-angle (OA) group.Results: The overall prevalence of myopia in persons with PACD was 13.7% (11.6% in primary angle closure suspect [PACS], 21.6% in primary angle closure [PAC], 62.5% in primary angle closure glaucoma [PACG]). The age-specific prevalence of myopia in PACD eyes was 41.7% at 30 to 39 years old, 12.3% at 40 to 49 years old, 8.7% at 50 to 59 years old, 10.7% at 60 to 69 years old, and 31.7% at age 70 years and over. PACD had shorter AL (22.2 ± 0.8 vs. 22.9 ± 0.9 mm, P < 0.001), shallower ACD (2.3 ± 0.3 vs. 2.8 ± 0.4 mm, P < 0.001), and greater LT (5.0 ± 0.5 vs. 4.7 ± 0.5 mm, P < 0.001). PACD had even thicker lenses and deeper ACD with age than those with OA (all P ≤ 0.025) from 30 years to 70 years of age and over.Conclusions: Myopia was common among persons with PACD who were less than 40 years of age in this rural Chinese population, and over half of those with PACG were myopic.

ImportanceMyopia in school-aged children is a public health issue worldwide; consequently, effective interventions to prevent onset and progression are required.ObjectiveTo investigate whether SMS text messages to parents increase light exposure and time outdoors in school-aged children and provide effective myopia control.Design, Setting, and ParticipantsThis randomized clinical trial was conducted in China from May 2017 to May 2018, with participants observed for 3 years. Of 528 965 primary school–aged children from Anyang, 3113 were randomly selected. Of these, 268 grade 2 schoolchildren were selected and randomly assigned to SMS and control groups. Data were analyzed from June to December 2021.InterventionsParents of children in the SMS group were sent text messages twice daily for 1 year to take their children outdoors. All children wore portable light meters to record light exposure on 3 randomly selected days (2 weekdays and 1 weekend day) before and after the intervention.Main Outcomes and MeasuresThe co–primary outcomes were change in axial length (axial elongation) and change in spherical equivalent refraction (myopic shift) from baseline as measured at the end of the intervention and 3 years later. A secondary outcome was myopia prevalence.ResultsOf 268 grade 2 schoolchildren, 121 (45.1%) were girls, and the mean (SD) age was 8.4 (0.3) years. Compared with the control group, the SMS intervention group demonstrated greater light exposure and higher time outdoors during weekends, and the intervention had significant effect on axial elongation (coefficient, 0.09; 95% CI, 0.02-0.17;P = .01). Axial elongation was lower in the SMS group than in the control group during the intervention (0.27 mm [95% CI, 0.24-0.30] vs 0.31 mm [95% CI, 0.29-0.34];P = .03) and at year 2 (0.39 mm [95% CI, 0.35-0.42] vs 0.46 mm [95% CI, 0.42-0.50];P = .009) and year 3 (0.30 mm [95% CI, 0.27-0.33] vs 0.35 mm [95% CI, 0.33-0.37];P = .005) after the intervention. Myopic shift was lower in the SMS group than in the control group at year 2 (−0.69 diopters [D] [95% CI, −0.78 to −0.60] vs −0.82 D [95% CI, −0.91 to −0.73];P = .04) and year 3 (−0.47 D [95% CI, −0.54 to −0.39] vs −0.60 D [95% CI, −0.67 to −0.53];P = .01) after the intervention, as was myopia prevalence (year 2: 38.3% [51 of 133] vs 51.1% [68 of 133]; year 3: 46.6% [62 of 133] vs 65.4% [87 of 133]).Conclusions and RelevanceIn this randomized clinical trial, SMS text messages to parents resulted in lower axial elongation and myopia progression in schoolchildren over 3 years, possibly through increased outdoor time and light exposure, showing promise for reducing myopia prevalence.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR-IOC-17010525

BackgroundTo explore the outcomes and mechanisms of intraocular pressure (IOP) control using low-dose transscleral cyclophotocoagulation (LDTSCP) followed by phacoemulsification in patients with prolonged acute primary angle closure (APAC).MethodsPatients with prolonged APAC refractory to all other treatment modalities were prospectively recruited, and underwent LDTSCP (10 shots, 2 s duration, 120° treatment with the energy starting at 1500 mW and titrated to the level with audible burst but not exceeding 2000 mW) and anterior chamber paracentesis 1 week prior to phacoemulsification with intraocular lens implantation and viscogoniosynechiolysis. Postoperative IOP, vision, anatomic changes on anterior segment optical coherence tomography and complications were recorded.ResultsTwenty eyes with prolonged APAC were recruited. Median follow-up was 12 months (range 9–18), at which point the vision in all eyes had improved and IOP was ≤17 mm Hg on no antiglaucoma medications. Following LDTSCP at postoperative day (POD) 1, IOP decreased in all eyes to a median 15 mm Hg (range: 6–28 mm Hg). Post-LDTSCP supraciliary effusion (SCE) occurred in 90% of eyes on POD1 or POD7 and ciliary body defect (CBD) was detected in 30% of eyes and resolved in all cases by postoperative month 1. Lower post-LDTSCP IOP was associated with more number of bursts (r=−0.558, p=0.011) and higher grade of SCE (r=−0.877, pConclusionsLDTSCP-induced SCE may explain the post-LDTSCP IOP reduction seen in eyes with prolonged APAC. LDTSCP instead of traditional more extensive treatment, was sufficient to provide a relatively safe and effective bridge therapy prior to phacoemulsification.Trial registration numberChinese Clinical Trials Registry (ChiCTR1900023567).

To study the association of myopia progression with the morphological changes of optic disc and β-peripapillary atrophy (β-PPA) in 8–11 years old primary school students. This study was a prospective, school-based investigation. This study included 610 children (1008 eyes) who were continuously observed and had data available from 2016 to 2017 in the Sanhe Cohort Study of the Risk Factors for Myopia (SCSRFM). The children underwent a comprehensive eye examination including measurement of visual acuity, autorefractometry, and posterior segment of the eye. β-PPA regions and optic disc ovality index were identified and measured on the fundus photographs. The prevalence of myopia was 72.62% (732/1008) in 2016. In myopic children, the prevalence of the vertical β-PPA, the horizontal β-PPA, and the oval optic disc were 75.68% (554/732), 75.96% (556/732) and, 11.61% (85/732) respectively. From 2016 to 2017, with the progression of vertical β-PPA, horizontal β-PPA, area of β-PPA, and optic disc ovality index, the myopic diopter and the axial length (AL) were increased. The progression of horizontal β-PPA was significantly correlated with the progression of myopic diopter and AL (all p

BACKGROUND: This study used spectral-domain optical coherence tomography (SD-OCT) imaging to describe the distribution of macular ganglion cell complex (GCC) thickness and its association with ocular and systemic parameters in 7-year-old children in China. METHODS: The study involved a school-based, cross-sectional analysis of the Anyang Childhood Eye Study (ACES) and included 2,505 first-grade students from urban areas in Anyang, Henan Province, Central China. All participants underwent systemic and ocular examinations. Both GCC and retinal nerve fiber layer (RNFL) thickness were measured using the iVue-100 OCT (Optovue, Fremont, CA, USA). Intraocular pressure (IOP) was recorded with noncontact tonometer (Huvitz, HNT-7000). Axial length (AL) was measured using optical biometry (Lenstar LS 900, Haag-Streit Diagnostics, Koniz, Switzerland). RESULTS: The mean GCC thickness was 95.31±7.67 µm. GCC thickness had negative associations with AL (r=−0.124, P

To determine the impact of visual impairment (VI) on health-related quality of life (HRQoL) and to compare the health burden of VI in different areas in mainland China. A cohort of 6830 people from rural villages and a cohort of 3251 people from an urban city were included to receive comprehensive ophthalmologic examinations and complete the European Quality of Life-5 Dimensions 3 Levels (EQ-5D-3L) questionnaire. For urban and rural populations, a unified VI grouping standard was adopted: the eyes were classified into normal group, mild–moderate group, and severe group according to WHO standards, and then divided into 6 groups considering both eyes. We estimated the effects of VI on the EQ-5D index score using linear regression models and the association between VI and self-reported EQ-5D health problems using logistic regression models. Associations were assessed by the Spearman correlation coefficient. The prevalence of VI and the index scores of EQ-5D-3L for each subgroup of VI were higher for the rural cohort. In these two cohorts, the severity of VI in rural population (Spearman r = 0.205; p

To provide reference values of trans-laminar cribrosa pressure difference (TLCPD) and reveal the association of TLCPD with systemic biometric factors.In this cross-sectional study, 526 quasi-healthy subjects (including 776 eyes) who required lumbar puncture for medical reasons were selected from 4915 neurology inpatients from 2019 to 2022. Patients with any diseases affecting intraocular pressure (IOP) or intracranial pressure (ICP) were excluded. The ICPs of all subjects were obtained by lumbar puncture in the left lateral decubitus position. IOP was measured in the seated position by a handheld iCare tonometer prior to lumbar puncture. TLCPD was calculated by subtracting ICP from IOP. Systemic biometric factors were assessed within 1 h prior to TLCPD measurement.The TLCPD (mean ± standard deviation) was 4.4 ± 3.6 mmHg, and the 95% reference interval (defined as the 2.5th-97.5th percentiles) of TLCPD was -2.27 to 11.94 mmHg. The 95% reference intervals for IOP and ICP were 10-21 and 6.25-15.44 mmHg, respectively. IOP was correlated with ICP (r = 0.126, p 0.001). TLCPD was significantly negatively correlated with body mass index (r = -0.086, p = 0.049), whereas it was not associated with age, gender, height, weight, blood pressure, pulse, or waist and hip circumference.This study provides reference values of TLCPD and establishes clinically applicable reference intervals for normal TLCPD. Based on association analysis, TLCPD is higher in people with lower BMI.

The purpose of the study was to evaluate myopia progression and axial elongation after stopping 0.01% atropine eye drops through a 2-year cross-over study.This study was a randomized, double-masked, placebo-controlled, cross-over trial in mainland China. 220 children aged 6-12 years with spherical equivalent range of -1.00 D to -6.00 D in both eyes were enrolled in Phase 1 for 1 year. Children who had completed the first year's follow-up continued in the second phase. In Phase 2, the placebo group was crossed over to the 0.01% atropine group (referred to as the 'placebo-atropine group'), and the 0.01% atropine group was crossed over to the placebo group (referred to as the 'atropine-placebo group'). All children underwent the examination of cycloplegic refraction and axial length at a 6-month interval. Only data from right eyes were included in analysis.One hundred thirty-three subjects completed 2 years of follow-up. In the first year, the mean myopia progression in atropine-placebo group was 0.21 ± 0.08 D slower than that in placebo-atropine group. After cross-over treatment, the mean myopia progression in atropine-placebo group was 0.22 ± 0.07D faster than that in placebo-atropine group in the second year. Over 2 years, the mean myopia progression was -1.26 ± 0.66D and -1.25 ± 0.70D in the atropine-placebo and placebo-atropine groups (p = 0.954).The difference in myopia progression between atropine-placebo group and placebo-atropine group in Phase 1 was similar to Phase 2 during the cross-over treatment. Through our cross-over trial, the results suggest that there is no rebound effect after using 0.01% atropine eye drops to prevent progression of myopia.

The trabecular meshwork (TM) is responsible for intraocular pressure (IOP) homeostasis in the eye. The tissue senses IOP fluctuations and dynamically adapts to the mechanical changes to either increase or decrease aqueous humor outflow. Cationic mechanosensitive channels (CMCs) have been reported to play critical roles in mediating the TM responses to mechanical forces. However, how CMCs influence TM cellular function affect aqueous humor drainage is still elusive. In this study, human TM (HTM) cells were collected from a Chinese donor and subjected to cyclically equiaxial stretching with an amplitude of 20% at 1 Hz GsMTx4, a non-selective inhibitor for CMCs, was added to investigate the proteomic changes induced by CMCs in response to mechanical stretch of HTM. Gene ontology enrichment analysis demonstrated that inhibition of CMCs significantly influenced several biochemical pathways, including store-operated calcium channel activity, microtubule cytoskeleton polarity, toll-like receptor signaling pathway, and neuron cell fate specification. Through heatmap analysis, we grouped 148 differentially expressed proteins (DEPs) into 21 clusters and focused on four specific patterns associated with Ca2+ homeostasis, autophagy, cell cycle, and cell fate. Our results indicated that they might be the critical downstream signals of CMCs adapting to mechanical forces and mediating AH outflow.

Background Waardenburg syndrome is an autosomal dominant disorder with varying degrees of sensorineural hearing loss as well as abnormal pigmentation in hair, skin, and iris. There are four types of Waardenburg syndrome (1–4) with different characteristics. Mutations in six genes have been identified to be associated with the various types. Herein, we describe a case of Waardenburg syndrome type 4 combined with open-angle glaucoma. Case presentation A 43-year-old Han Chinese man had undergone trabeculectomy due to progression of visual field impairment and unstable intraocular pressure in both eyes. Slit-lamp examination revealed diffuse iris hypopigmentation in the left eye and hypopigmentation of part of the iris in the right eye. Fundus examination showed red, sunset-like fundus due to a lack of pigmentation in the retinal pigment epithelium layer, diffuse loss of the nerve fiber layer, and an excavated optic nerve head with advanced-stage glaucoma. Imaging was performed using anterior segment optical coherence tomography to detect the iris configuration. In the heterochromic iris portion, the normal part of the iris showed a clear hyperreflective signal of the anterior border layer, while atrophy of the pigmented anterior border layer showed a hyporeflective area of the anterior surface resulting in reduced light absorption. Two mutations of the endothelin receptor type B gene were recognized in this study. The first (c.1111G>A on exon 7) leads to an amino acid change from glycine to serine at codon 371. Sanger verification revealed that this mutation is inherited from the mother. The other mutation (c.553G>A) leads to an amino acid change from valine to methionine at codon 185. Sanger verification showed that this mutation was inherited from the father. Conclusion Waardenburg syndrome shows a remarkable diversity in clinical presentation and morphology. This disease can also present with open-angle glaucoma. Sequencing analysis revealed two heterozygous mutations in the EDNRB gene in this patient, inherited from his mother and father, respectively. These two sites constitute a compound heterozygous variation.

Background The objective of this study was to examine the association of an integrated model (composed of retinal arteriolar caliber, height, and sex) with blood pressure (BP) among a group of Chinese children, and assess the predictive value of the integrated model for childhood hypertension. Methods This study included 1460 candidates aged 12.634 ± 0.420 years. Height, weight, waist circumference, and BP were obtained and ophthalmological measurements were taken. The computer-imaging program (IVAN, University of Wisconsin, Madison, WI) was used to measure calibers of retinal vessels. Receiver-operating characteristic curve (ROC) analyses were performed to assess the accuracy of the integrated model as a diagnostic test of elevated BP in children. Results The accuracy of the integrated model (assessed by area under the curve) for identifying elevated BP was 0.777 (95% confidence interval: 0.742-0.812). The optimal threshold of the integrated model for defining hypertension was 0.153, and the calculation formula for the specific predictive risk was: Logit (p/1 - p) = -5.666 - 0.261 × retinal arteriolar caliber + 0.945 × sex + 0.438 × height. In identifying elevated BP, the sensitivity and specificity were 0.711 and 0.736, respectively. Conclusions The model containing eye message is a comprehensive and relatively effective index to identify elevated BP in 12-year-old children, which can offer assistance to further understand childhood microcirculation disease. Impact We firstly incorporated retinal vascular diameter, sex, and height into one integrated model to identify hypertension in 12-year-old children. The current discrimination of hypertension in children is difficult. There have been some studies to simplify the diagnosis of children's hypertension, but they were limited to anthropometric measurements. We proposed a composed model containing microcirculation information to predict childhood hypertension. Based on the knowledge that microcirculation is not only a means to study the manifestations but also early pathogenic correlates of hypertension, the combined model containing microcirculation message as a method may provide new insights into the diagnosis of childhood hypertension.

Purpose: To assess the safety and long-term scleral biomechanical stability of rhesus eyes after blue light scleral CXL by investigating the biomechanical and microstructural changes.Methods: Seven rhesus monkeys (14 eyes) were observed in this study. All right eyes received blue light scleral CXL at the superior temporal equatorial sclera, and the left eyes served as controls. Biological ocular parameters were followed up to 1 year after scleral CXL. Stress-strain measurements of three rhesus sclera were measured, three rhesus retinas were examined histologically by H&E and TUNEL staining. And the microstructure of both the sclera and retina were observed by transmission electron microscopy at 1 year.Results: As for the retinal thickness, choroidal thickness, flow density of retinal superficial vascular networks and flash electroretinography (f-ERG) results, no significant differences were observed between the paired eyes at 1 year (P >.05). At the same time, the scleral collagen fibril distribution was much tighter, and the scleral biomechanical properties were significantly increased in the experimental eyes. However, apoptotic cells and retinal ultrastructural changes could still be found in the retina of the experimental eyes.Conclusion: This study demonstrates that blue light scleral CXL could effectively increase the scleral stiffness of the rhesus eye for at least 1 year, but ultrastructural change was still observed in the retina of scleral CXL eye. Therefore, the long-term intraocular safety of the blue light scleral CXL technique for preventing myopia progression should be investigated further.

IntroductionIn its recent World Report on Vision, the WHO called for an updated approach to monitor eye health as part of universal health coverage (UHC). This project sought to develop a consensus among eye health experts from all world regions to produce a menu of indicators for countries to monitor eye health within UHC.MethodsWe reviewed the literature to create a long-list of indicators aligned to the conceptual framework for monitoring outlined in WHO’s World Report on Vision. We recruited a panel of 72 global eye health experts (40% women) to participate in a two-round, online prioritisation exercise. Two-hundred indicators were presented in Round 1 and participants prioritised each on a 4-point Likert scale. The highest-ranked 95 were presented in Round 2 and were (1) scored against four criteria (feasible, actionable, reliable and internationally comparable) and (2) ranked according to their suitability as a ‘core’ indicator for collection by all countries. The top 30 indicators ranked by these two parameters were then used as the basis for the steering group to develop a final menu.ResultsThe menu consists of 22 indicators, including 7 core indicators, that represent important concepts in eye health for 2020 and beyond, and are considered feasible, actionable, reliable and internationally comparable.ConclusionWe believe this list can inform the development of new national eye health monitoring frameworks, monitor progress on key challenges to eye health and be considered in broader UHC monitoring indices at national and international levels.

Purpose: To evaluate the relationship between corneal biomechanical parameters and lamina cribrosa (LC) curvature in normal tension glaucoma (NTG). Methods: 95 eyes of 56 NTG patients were enrolled in this prospective, observational study. Corneal biomechanical parameters, including stiffness parameters at applanation 1 (SP-A1), deformation amplitude ratio (DA ratio), inverse concave radius and biomechanically corrected intraocular pressure estimate (bIOP), were captured using the Corneal Visualization Scheimpflug Technology instrument (Corvis-ST). LC curvature was evaluated by mean adjusted LC curvature index (maLCCI) averaged by the measurements on 12 radial B-scan images obtained using swept-source optical coherence tomography (SS-OCT). Linear mixed models were constructed to assess the relationship between corneal biomechanical parameters and LC curvature. Results: The mean age of participants was 51.04 ± 13.74 years (range, 24–82 years). The SP-A1 and maLCCI were 93.50 ± 13.82 mm Hg/mm and 7.57 ± 1.58, respectively. In univariate and multivariate analysis, SP-A1 ( p Conclusions: The greater posterior LC curvature was associated with lower corneal stiffness parameters and younger eyes in NTG patients. Clinical Trial Registration: Chinese Clinical Trial Registry, ChiCTR1900021465.

Summary Background Vision loss is an important public health issue in China, but a detailed understanding of national and regional trends in its prevalence and causes, which could inform health policy, has not been available. This study aimed to assess the prevalence, causes, and regional distribution of vision impairment and blindness in China in 1990 and 2019. Methods Data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were used to estimate the prevalence of moderate and severe vision impairment and blindness in China and compare with other Group of 20 (G20) countries. We used GBD methodology to systematically analyse all available demographic and epidemiological data at the provincial level in China. We compared the age-standardised prevalences across provinces, and the changes in proportion of vision loss attributable to various eye diseases in 1990 and 2019. We used two different counterfactual scenarios with respect to population structure and age-specific prevalence to assess the contribution of population growth and ageing to trends in vision loss. Findings In 2019, the age-standardised prevalence was 2·57% (uncertainty interval [UI] 2·28–2·86) for moderate vision impairment, 0·25% (0·22–0·29) for severe vision impairment, and 0·48% (0·43–0·54) for blindness in China, which were all below the global average, but the prevalence of moderate and severe vision impairment had increased more rapidly than in other G20 countries from 1990 to 2019. The prevalence of vision loss increased with age, and the main causes of vision loss varied across age groups. The leading causes of vision impairment in China were uncorrected refractive error, cataract, and macular degeneration in both 1990 and 2019 in the overall population. From 1990 to 2019, the number of people with moderate vision impairment increased by 133·67% (from 19·65 to 45·92 million), those with severe vision impairment increased by 147·14% (from 1·89 to 4·67 million), and those with blindness increased by 64·35% (from 5·29 to 8·69 million); in each case, 20·16% of the increase could be explained by population growth. The contributions to these changes by population ageing were 87·22% for moderate vision impairment, 116·06% for severe vision impairment, and 99·22% for blindness, and the contributions by age-specific prevalence were 26·29% for moderate vision impairment, 10·91% for severe vision impairment, and −55·04% for blindness. The prevalence and specific causes of vision loss differed across provinces. Interpretation Although a comprehensive national policy to prevent blindness is in place, public awareness of visual health needs improving, and reducing the prevalence of moderate and severe vision impairment should be prioritised in future work. Funding China National Key Research and Development Programme and Beijing Municipal Special Funds for Medical Research on Public Welfare Development and Reform.

PurposeTo describe the normal macular thickness and assess its associations.MethodsThe Handan Eye Follow-up Study was conducted between 2012 and 2013. Macular thickness was scanned by spectral-domain optical coherence tomography (OCT). The built-in software generated a retinal thickness (RT) map, which was divided into three regions (central, internal and external regions) and nine quadrants (one in central and four in internal and external regions each).ResultsFor 5394 subjects in the Handan Eye Follow-up Study, 4793 received OCT examination, 2946 of whom (accounting for 61.46% of the total subjects, mean age 58.91±10.95, 55.6% were women) were included for analysis. The mean RT in central macula, inner and outer rings were (237.38 µm±23.05 µm), (309.77 µm±18.36 µm) and (278.29 µm±14.38 µm), respectively (overall difference, p＜0.001). In inner ring, the RT in temporal was thinnest, followed by nasal, superior and inferior. In outer ring, the RT in superior was thinnest, with the next subfields being temporal, inferior and nasal, respectively. The RT in central macula, inner and outer rings were significantly thicker in men than in women. Multivariate linear regression analysis showed that in central macula, RT increased in subjects younger than 60 years and thinned above the age of 60. In inner and outer rings, RT thinned along with age (p＜0.001).ConclusionsThis study finds that RT in central macula is the thinnest, followed by the outer ring, the RT in the inner ring is the thickest. Age and gender are related to RT. These associated factors need to be considered when explaining RT.

To investigate the characteristics of mutation myocilin proteins and glaucoma pathological phenotype in transgenic mice with full-length human Pro370Leu mutant myocilin gene (Tg-MYOC