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Axial length (AL) is an important contributor to refraction, and growth curves are gaining importance in the prediction of myopia. This study aimed to profile the distribution of ocular biometry parameters and to identify correlates of spherical equivalent refraction (SE) among school children in South India.The School Children Ocular Biometry and Refractive Error study was conducted as part of a school screening program in southern India. The enrolled children underwent tests that included vison check, refraction, binocular vision assessment, and biometry measurements.The study included 1382 children whose mean (standard deviation [SD]) age was 10.18 (2.88) years (range: 5-16 years). The sample was divided into 4 groups (grades 1-2, grades 3-5, grades 6-9, and grade 10) based on significant differences in right AL (p0.001). The mean (SD) AL (range: 20.33-27.27 mm) among the four groups was 22.50 (0.64) mm, 22.88 (0.69) mm, 23.30 (0.82) mm, and 23.58 (0.87) mm, respectively. The mean SE (range: +1.86 to -6.56 D) was 0.08 (0.65 D) in class 1 and decreased with increasing grade to -0.39 (1.20 D) in grade 10. There was a significant difference in all biometry parameters between boys and girls (p0.001). Age, AL, and mean corneal curvature were the main predictors of SE.This study provides a profile of ocular biometry parameters among school children in South India for comparison against profiles from other regions across the country. The study data will form a reference for future studies assessing myopia in this ethnicity.

This study was conducted to analyze the influence of binocular vision and accommodation anomalies on refraction dynamics. Our results may help to design more accurate autorefractors and to better understand the difficulties in prescribing an optical correction or adaptation to a correction.This study aimed to verify whether viewing conditions (open- or closed-field) or vision anomalies, such as ocular surface diseases, accommodative dysfunctions, and binocular vision anomalies, influence (1) the differences between subjective refraction and autorefraction and (2) the characteristics of the short-term refractive state variation.The subjective refraction of 64 subjects aged 23 to 60 years was measured during a comprehensive optometric examination, and the Ocular Surface Disease Index questionnaire was collected. Twenty successive measurements of automated refraction of each eye were obtained using a conventional autorefractor Nidek ARK-510A and an open-field autorefractor Shin-Nippon NVision-K 5001. Conventional notation of refractive error (sphere, cylinder, axis) was transformed to h-vectors, presented in scatterplots, and analyzed statistically.The three-way analysis of variance tests showed that there is no influence of accommodation dysfunctions (P = .22 for ARK-510A), binocular vision anomalies (P = .97 for ARK-510A), and ocular surface diseases (P = .20 for ARK-510A) on differences between autorefraction and subjective refraction. The binocular vision anomalies affected the results from open-field autorefractor, whereas the accommodation impacted closed-field refraction measurements. Changes in short-term refractive state variation occurred in sphere power, indicating accommodative state changes; however, 30 subjects demonstrated at least one outlier and/or polymodality of refractive state distributions.The study showed that the presence of accommodative dysfunctions or binocular vision anomalies might increase the range of short-term refractive state variation. The impact of vision anomalies differs between viewing conditions. The polymodal distribution of refractive state variation and the presence of outliers imply that automatic modes used typically in autorefractors with three to five readings may not accurately represent the refractive state of the eye.

Purpose: To compare the ability to detect refractive anomalies in children using automated refraction versus retinoscopic cycloplegic refraction. Methods: A pediatric population from a pediatric eye institute underwent complete ophthalmic examinations. Children were randomly assigned to one of two pediatric optometrists who performed manual cycloplegic refraction using retinoscopy and automated cycloplegic refraction using a handheld autorefractometer (Retinomax K-plus 5; Right Mfg. Co., Ltd.). Recorded patient data included refraction values for each eye (sphere, astigmatism, and axis), use of glasses, and degree of cooperation. Results: Two hundred thirteen children were included. The mean age was 6.2 years. For all ages, strong associations were found in sphere and spherical equivalent (SE) measurements between the two methods (b = 0.78, P < .001; b = 0.71, P < .001; respectively). Among children older than 5 years, associations between the two methods were significant in all parameters (sphere: b = 0.99, P < .001; astigmatism: b = 0.69, P < .001; axis: b = 0.19, P < .05; SE: b = 0.97, P < .001), whereas among children 5 years and younger, a significant association was found only in the axis measurements (b = 0.31, P < .01). Retinomax K-plus 5 measurements showed significantly more hyperopic results in sphere measurements and higher astigmatism in all children examined, but this difference was markedly higher in children 5 years and younger. Good cooperation was observed in 94.1% of children older than 5 years and 77% of children 5 years and younger ( P < .001). Conclusions: The Retinomax K-plus 5 may be used for screening in children older than 5 years. However, in all age groups, it may not be accurate enough for treatment and decision making, even with good cooperation. [ J Pediatr Ophthalmol Strabismus . 2022;59(6):380–387.]

Systemic retinoids are among the most prescribed drugs in dermatology, thanks to their activity as proliferation modulators and keratinisation normalisers. Common side effects such as blood lipid disorders, xerosis and photosensitivity are well established and usually dose dependent. Conversely, retinoid-associated ocular disturbances have been reported, yet with differences in terms of frequency and manifestations As data regarding a potential correlation with refractive errors are heterogenous and have not been previously thoroughly addressed, we performed a systematic review of the literature with the aim of comprehensively evaluating the current evidence regarding retinoid-associated myopia in dermatologic patients.A systematic review of the literature was carried out according to the PRISMA guidelines. A search on MEDLINE, Pubmed, Scopus, Cochrane Library was conducted using the MeSH terms: retinoid, isotretinoin, acitretin, bexarotene, etretinate, alitretinoin, myopia, refractive errors, via the Boolean term AND. Only manuscripts in English were considered, there was no restriction on type of article. Animal research and in vitro studies were excluded.Six articles were finally included in this systematic review. One well designed prospective study was able to show a slight myopic shift in the first six months, but id did not evaluate further development of the refractive error nor the effects of drug discontinuation. Another prospective study, with a smaller sample size showed no myopic progression at 12 months. Two case reports showed a myopic shift after two weeks from therapy start. Another case report showed a myopic shift associated with narrowing of the anterior chamber after one week from therapy start. Finally a large retrospective study based on spontaneous reporting systems and world's literature classified myopia as a certain side effect.Considering the current literature, it is not possible to define a clear correlation between the use of retinoids and the development or worsening of myopia. Some studies suggest that retinoids may cause a myopic shift and the pathophysiologyical mechanism is supported by some animal and in vitro studies, but there is a lack of large prospective and well-controlled studies. In case of ocular disturbances after retinoid use a prompt ophthalmological referral is advisable and in case of the detection of a myopic refractive error a relationship to retinoids should be ruled out, considering also other possible causes such as age and previous refractive status.

To assess and compare the visual performance of two extended depth-of-focus intraocular lenses (IOLs), Tecnis Symfony (Symfony; JohnsonJohnson Vision, Santa Ana, CA) and Acrysof IQ Vivity (Vivity; Alcon Inc, Fort Worth, TX).The medical records of patients undergoing cataract surgery with Symfony or Vivity implantation from May 2021 to September 2021 and the data available for the 3-month follow-up were reviewed. The main measures of the findings were uncorrected and corrected distance (4 m) visual acuity (VA), uncorrected intermediate (66 cm) VA (UIVA) and uncorrected near (40 and 33 cm) VA (UNVA), refractive error (RE), defocus profiles analysis, optical quality parameters, and patient-reported quality of vision questionnaire results.Of the 40 patients, 19 patients (31 eyes) were treated with the Symfony IOL and 21 (32 eyes) with the Vivity IOL. The mean age of the patients was 63.4±7.8 (range, 40-76) years in the Symfony group and 61.8±9.7 (range, 40-77) years in the Vivity group. There was no meaningful difference between the two groups in the preoperative parameters, except that the Vivity group had a better CDVA. Among the main measures of results, there was no statistically significant difference, except for the UNVA (33 cm). The Symfony group also showed a smoother defocus curve at 3 months postoperatively.There was no significant difference between the two groups regarding uncorrected/corrected distance VA, UIVA, UNVA (40 cm), RE, optical quality parameters, and patient-reported quality of vision questionnaire results. The Symfony group demonstrated a significantly superior UNVA (33 cm) and a smoother defocus curve with a broad landing zone.

Nonlinearity in the luminance profile of eccentric, infrared photorefraction may be used to differentiate corneal diseases such as keratoconus that distort the cornea, relative to regular refractive errors.This study aimed to determine the profile of eccentric, infrared photorefraction in keratoconus as a prototypical disease model for distorted corneas and identify a parameter in this profile for differentiating such disease conditions from healthy controls.Photorefraction reflex of 75 eyes with forme fruste to advanced keratoconic cases and that of 75 eyes of controls with regular refractive errors (spherical equivalent, +0.50 to -11.75 D; astigmatism, -0.50 to -4.50 D across 0 to 180° axes) were obtained over their natural pupils under unaided viewing using a custom-designed photorefractor placed at 1 m from the subject. The test was repeated in 10 controls with 4 and 6 D of trial-lens-induced myopia and myopic astigmatism at 0, 90, 45, and 135°. Linear regression was performed on the luminance profile across the pupil, and the departure of the data from linearity was estimated using the average residual error of the fit (Res avg ).Photorefraction profiles varied linearly across the pupil in controls, with slopes increasing with refractive error ( r = 0.87; P.001) and Res avg remaining invariant of refractive error ( r = -0.29; P.4). Corresponding profiles in keratoconus significantly departed from linearity, with Res avg progressively increasing with disease severity ( r = 0.66; P.001). Res avg of 0.03 gray-scale units/pixel distinguished keratoconus from controls with sensitivity increasing from 66.7 to 100% for mild to advanced keratoconus and specificity remaining ≥97.1% across disease severity. Induced myopia and myopic astigmatism produced predictable changes in luminance profile slopes but with no change in Res avg values.Unlike regular myopia and astigmatism, the photorefraction reflex is significantly nonlinear in keratoconus because of the distorted cornea. Measures of nonlinearity in luminance profile may be incorporated in commercial photorefractors for differentiating such disease conditions from regular refractive errors.

ImportanceRefractive error (RE) is the most common form of visual impairment, and myopic RE is associated with an increased risk of primary open-angle glaucoma (POAG). Whether this association represents a causal role of RE in the etiology of POAG remains unknown.ObjectiveTo evaluate shared genetic influences and investigate the association of myopic RE with the risk for POAG.Design, Setting, and ParticipantsObservational analyses were used to evaluate the association between mean spherical equivalent (MSE) RE (continuous trait) or myopia (binary trait) and POAG risk in individuals from the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort. To quantify genetic overlap, genome-wide genetic correlation analyses were performed using genome-wide association studies (GWAS) of MSE RE or myopia and POAG from GERA. Potential causal effects were assessed between MSE RE and POAG using 2-sample Mendelian randomization. Genetic variants associated with MSE RE were derived using GWAS summary statistics from a GWAS of RE conducted in 102 117 UK Biobank participants. For POAG, we used GWAS summary statistics from our previous GWAS (3836 POAG cases and 48 065 controls from GERA). Data analyses occurred between July 2020 and October 2021.Main Outcomes and MeasureOur main outcome was POAG risk as odds ratio (OR) caused by per-unit difference in MSE RE (in diopters).ResultsOur observational analyses included data for 54 755 non-Hispanic White individuals (31 926 [58%] females and 22 829 [42%] males). Among 4047 individuals with POAG, mean (SD) age was 73.64 (9.20) years; mean (SD) age of the 50 708 controls was 65.38 (12.24) years. Individuals with POAG had a lower refractive MSE and were more likely to have myopia or high myopia compared with the control participants (40.2% vs 34.1%, P = 1.31 × 10−11 for myopia; 8.5% vs 6.8%, P = .004 for high myopia). Our genetic correlation analyses demonstrated that POAG was genetically correlated with MSE RE (rg, −0.24; SE, 0.06; P = 3.90 × 10−5), myopia (rg, 0.21; SE, 0.07; P = .004), and high myopia (rg, 0.23; SE, 0.09; P = .01). Genetically assessed refractive MSE was negatively associated with POAG risk (inverse-variance weighted model: OR per diopter more hyperopic MSE = 0.94; 95% CI, 0.89-0.99; P = .01).Conclusions and RelevanceThese findings demonstrate a shared genetic basis and an association between myopic RE and POAG risk. This may support population POAG risk stratification and screening strategies, based on RE information.

A 23-year-old man with refractive error as in [figure 1A][1] was planned for LASIK (Laser assisted in-situ keratomileusis) refractive surgery (ZEISS MEL 90). After flap preparation, the subject was accidentally fired on by excimer laser at fluence test settings[1][2] instead of that for the

To compare progression of myopia and refractive error in former premature infants with retinopathy of prematurity (ROP) treated using intravitreal bevacizumab (IVB) or laser.Retrospective clinical cohort study.We identified premature infants with ROP treated using IVB from 2011 to 2020 and compared their longitudinal cycloplegic refraction data to that of infants with ROP treated using laser during the same timeframe. A subset of infants treated using IVB also underwent additional treatment using laser. We included cycloplegic refractions from 789 cumulative visits over a median 3.2 years. We used a linear mixed-effects model with a log decay function to evaluate how refraction changed with age after treatment.In aggregate, the model estimated a significant (P.001) trend in refraction-from slight hyperopia to relatively more myopic states. However, progression in laser-treated eyes was significantly (P.001) more rapid, regardless of treatment with IVB. The number of laser spots resulted in increased myopic progression by approximately 0.16 diopters per 100 laser spots. Both ROP stage and zone had a significant effect on myopic progression, with more severe disease resulting in faster myopic progression. Random effects, including individual subject variation with nested variance for left and right eye, accounted for 86.4% of the remaining variance not explained by age and treatment.Laser treatment for severe ROP increases the trend to severe myopia. In our sample, IVB did not affect myopic progression but did substantially reduce the amount of consequent laser required to treat ROP. The effect of laser persists after accounting for differences in ROP stage and zone.

To compare the accuracy of intraocular lens (IOL) power calculations among IOL formulas after phacovitrectomy.We prospectively enrolled 206 eyes of 206 patients who underwent 25-gauge phacovitrectomy, without gas tamponade, for macular pathology. Pre-operative optical biometry used the IOLMaster 700 to calculate the IOL power with the new formulas, i.e. the Barrett Universal II (BU II), Emmetropia Verifying Optical version 2.0, Hill-Radial Basis Function (RBF) version 3.0, Kane, and Ladas Super Formula, and conventional formulas, i.e. Haigis, Hoffer Q, Holladay 1, Holladay 2, and Sanders-Retzlaff-Kraff/T (SRK/T). A single-piece foldable IOL was implanted in all cases. Manifest refractions were measured before and 3 months after surgery.The BU II formula showed the lowest standard deviation and mean and median absolute errors and had the highest percentage of eyes with a refractive prediction error within ± 0.25 D. The absolute error was significantly lower with the four new formulas, except the Hill-RBF, than with the Hoffer Q (all p = ≤ 0.010) and Holladay 1 formulas (all p = 0.010). The absolute error with the BU II formula was also lower than that with the Holladay 2 (p = 0.012) and SRK/T (p = 0.024) formulas.Overall, the new IOL formulas, except the Hill-RBF, were superior to some of the conventional formulas for calculating IOL power in phacovitrectomy.

To compare the accuracy of intraocular lens (IOL) power calculations performed using the biometer-embedded Barrett True-K formula vs a multiple formula approach using the ASCRS postrefractive calculator in eyes with previous myopic or hyperopic refractive surgery.Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.Retrospective, consecutive case series.Patients who underwent cataract surgery with a history of corneal refractive surgery were included. For each formula, the IOL prediction error and refractive prediction error was calculated. Main outcome measures included mean absolute error (MAE) and the percentage of eyes within ±0.25 diopters (D), ±0.50 D, and ±1.00 D.96 postmyopic eyes and 47 posthyperopic eyes were analyzed. In the postmyopic cohort, the Barrett True-K formula had the lowest MAE (0.36 D), followed by the Haigis-L formula (0.41 D). The Barrett True-K formula had a significantly higher percentage (44.8%) of eyes within ±0.25 D in comparison with the Haigis-L formula (34.4%), which had the second highest percentage ( P.01). In the posthyperopic cohort, the Barrett True-K formula had the lowest MAE (0.41 D), followed by the ASCRS-mean (0.46). The Barrett True-K and ASCRS-mean formulas had the highest percentage of eyes within ±0.25 D (42.6% vs 38.3%, P = .16).The Barrett True-K formula built into the biometer performed equivalently to a multiple formula approach on the ASCRS online calculator in both postmyopic and posthyperopic eyes. This approach reduces the potential for transcription error from data entry for lens power calculation approaches that require manual data entry.

To evaluate differences between autorefraction measurements with and without cycloplegia among school-aged individuals and to explore factors associated with significant differences.Cross-sectional, retrospective study.Individuals between 3 and 22 years of age evaluated at the Illinois College of Optometry from September 2016 through June 2019 who underwent same-day noncycloplegic and cycloplegic autorefraction of the right eye.Demographic information including age, sex, and race or ethnicity were collected during the eye examination. Autorefraction was performed before and after cycloplegia. Myopia, defined as at least -0.50 diopter (D) spherical equivalent (SE), hyperopia, defined as at least +0.50 D SE, and astigmatism of at least 1.00 D cylinder were determined using noncycloplegic and cycloplegic autorefractions. Factors associated with at least 1.00 D more myopic SE or at least 0.75 D cylindrical difference by noncycloplegic autorefraction were assessed using logistic regression models.Differences between noncycloplegic and cycloplegic autorefraction measurements.The mean age was 10.8 ± 4.0 years for the 11 119 individuals; 52.4% of participants were female. Noncycloplegic SE measured 0.65 ± 1.04 D more myopic than cycloplegic SE. After adjusting for demographic factors and refractive error, individuals with at least 1.00 D of more myopic SE refraction by noncycloplegic autorefraction (25.9%) were more likely to be younger than 5 years (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.18-1.79) and 5 to younger than 10 years (OR, 1.32; 95% CI, 1.18-1.48) than those 10 to younger than 15 years. This difference of at least 1.00 D of more myopic SE was more likely to be observed in Hispanic people (OR, 1.23; 95% CI, 1.10-1.36) and those with hyperopia (OR range, 4.20-13.31). Individuals with 0.75 D or more of cylindrical difference (5.1%) between refractions were more likely to be younger than 5 years, to be male, and to have mild-moderate-high myopia or moderate-high hyperopia.Three quarters of school-aged individuals had1 D of myopic SE difference using noncycloplegic compared with cycloplegic autorefraction. Understanding measurement differences obtained for refractive error and associated factors may provide useful information for future studies or programs involving refraction in school-aged children.

Significance One of the first clinically observed changes in the retina with progressing myopia is in the form of optic disc crescents. If such a change is predictive of myopia progression, it could aid in myopia management interventions to target those at greatest risk of progression and subsequent ocular morbidity. Purpose To investigate the type, dimension and appearance of optic disc crescents and how they relate to the level of myopia. Methods Retrospective data collection analysing retinal photographs of healthy children and adults with a refractive error of ≤−0.50 D sphere and astigmatism ≤2.00 D. Crescent location, maximum crescent width and vertical disc diameter were measured from retinal images of right eyes only. Results Four-hundred eyes with a mean spherical error (SER) of −0.50 to −14.00 D (aged 7–81 years) were included (83.5% exhibited a discernible crescent). Mean (SD) maximum crescent width was 0.24 (0.24) mm. Univariate analysis showed a significant correlation between crescent width and age (r = 0.26, p

Contact lenses are a safe and effective method for correction of refractive error and worn by an estimated 45 million Americans. Because of the widespread availability and commercial popularity of contact lenses, it is not well appreciated by the public that contact lenses are U.S. Food and Drug Administration (FDA)-regulated medical devices. Contact lenses are marketed in numerous hard and soft materials that have been improved over decades, worn in daily or extended wear, and replaced in range of schedules from daily to yearly or longer. Lens materials and wear and care regimens have impact on the risks of contact lens-related corneal inflammatory events and microbial keratitis. This article reviews contact lens safety, with specific focus on the correction of refractive error in healthy eyes.

Purpose: To compare the refractive outcomes after cataract surgery between patients with and without pseudoexfoliation, and to evaluate the risk factors of refractive error.Methods: Retrospective review of 210 eyes with pseudoexfoliation (study group) and 510 normal eyes (control group) that underwent uneventful phacoemulsification with intraocular lens implantation. The study group included pseudoexfoliation syndrome and pseudoexfoliation glaucoma (PXG) subgroups. The main outcome measure was refractive error, defined as the difference between the target refraction and postoperative refraction in diopter (D). A refractive error >±1.0 D was identified as a large-magnitude refractive error. The frequency of the large-magnitude refractive error was compared between study and control groups, and also between each subgroup and normal eyes. The factors influencing refractive error were analyzed by logistic regression.Results: There was a significantly higher frequency of a refractive error >± 1.0 D and hyperopic error >1.0 D in the study group than in the control group (p = 0.001 and p = 0.003, respectively). In the multivariate logistic regression analysis, PXG and poor preoperative visual acuity were related with a large-magnitude refractive error (p = 0.001 and p = 0.02, respectively) Refractive error >± 1.0 D and hyperopic error >1.0 D were noted more often in PXG eyes that had an intraocular pressure spike >25 mmHg at postoperative first 24 hours (p = 0.01 and p=0.03, respectively).Conclusions: The eyes with pseudoexfoliation were at a high risk for refractive error, especially in the presence of glaucoma. In PXG, the only significant risk factor for refractive error was observed to be the presence of an intraocular pressure spike.

Purpose. To evaluate the incidence of laser enhancement following cataract surgery and refractive lens exchange (RLE) with FineVision Micro F trifocal lens implantation (PhysIOL, Liege, Belgium). Methods. Retrospective study of patients who had undergone cataract or RLE surgery and had received a FineVision Micro F intraocular lens. Laser enhancement of residual refractive error was determined. Visual acuity (VA) assessments were performed before and after surgery: uncorrected distance VA (UCDVA), best-corrected distance VA (BCDVA), uncorrected near VA (UCNVA), plus preoperative and postoperative spherical equivalent (SE) assessments. Results. Of the 1129 eyes from 596 patients, 61 (5.4%) required laser enhancement to correct residual refractive error (by group: 30/679 eyes [4.4%] cataract; 31/450 eyes [6.9%] RLE). Eleven eyes received FemtoLASIK; 50 eyes received PRK. Mean UCDVA before laser enhancement was 0.26±0.19 logMAR and 0.24±0.14 in the FemtoLASIK and PRK groups, respectively. After laser enhancement, these were 0.04±0.05 logMAR and 0.13±0.19, respectively; BCDVA values were 0.00±0.00 logMAR in the FemtoLASIK group and 0.06±0.11 in the PRK group. Laser enhancement improved UCNVA (Jaeger) from 2-3 to 1-2 in both groups. Enhancement reduced preoperative SE of -0.39±0.99 D and -0.53±0.58 D (FemtoLASIK and PRK groups, respectively) to 0.24±0.36 D and 0.04±0.47 D. Conclusions. The FineVision Micro F trifocal lens is an effective solution for gaining increased spectacle independence. The incidence of residual refractive error requiring laser enhancement is low, and laser procedures are a safe and effective solution for improving the quality of vision and patient satisfaction. Synopsis. Laser enhancement rates and outcomes were determined following cataract / refractive lens exchange surgery that used a trifocal IOL. Enhancement was safe and effective and rates were low (5.4%).

To investigate changes in refractive error in schoolchildren before and during the coronavirus disease 2019 (COVID-19) pandemic.This study included 2792 students, who underwent a 3-year follow-up from 2018 to 2020. All participants underwent yearly noncycloplegic refraction and ocular examinations. Time-related changes in sphere, cylinder, and spherical equivalent (SE) measurements in both genders were analyzed.The myopic sphere (- 0.78 ± 1.83 vs. - 1.03 ± 1.91 D; P = 0.025) and SE (- 1.04 ± 1.90 vs. - 1.32 ± 1.99 D; P = 0.015) progressed significantly from 2018 to 2019. Female participants had a significantly greater change in SE than male participants (P 0.05), and the low hyperopia, emmetropia, and mild myopia groups significantly deteriorated (P 0.001) from 2018 to 2019. Significant differences in sphere change (- 0.21 ± 0.97 vs. - 0.36 ± 0.96 D; P 0.001) and SE change (- 0.23 ± 0.99 vs. - 0.38 ± 0.98 D; P 0.001) were noted between 2019-2018 and 2020-2019, respectively. The respective changes in cylinder were statistically similar (- 0.03 ± 0.53 vs. - 0.05 ± 0.62 D; P = 0.400).The refractive status of schoolchildren showed an increasing myopic shift trend before and during the COVID-19 pandemic. The low hyperopia, emmetropia, and mild myopia groups were more sensitive to environmental changes during COVID-19 than before. The myopic shift was greater in female participants than male participants.

Anterior plagiocephaly results from early fusion of a unilateral coronal cranial suture, which affects 1/10,000 infants at birth and can be associated with ophthalmological complications. The study aimed to evaluate the frequency of oculomotor disorders and refractive errors in children with non-syndromic anterior plagiocephaly.Patients with anterior plagiocephaly undergoing surgery using a fronto-orbital advancement technique were included in this retrospective study between 2011 and 2017. The following data were collected: cycloplegic refraction in diopters (D), best-corrected visual acuity, manifest strabismus in primary position, ocular motility, head tilt in primary position, slit-lamp and fundus examination. The refractive errors were determined by autorefraction after cycloplegia with cyclopentolate.Among the sixteen patients included, hyperopia2.5D was found in 10 patients, astigmatism1D in 10 patients and anisometropia1D in 7 patients. Astigmatism was contralateral to the synostosis in 7 cases. In total, significant refractive errors were found in 92.9%. Amblyopia was found in 33.3% patients. Strabismus was found in 11 patients, most frequently combined horizontal and vertical, of which 4 required strabismus surgery. The most frequent vertical deviation was ipsilateral hypertropia in 54.5%. We found superior oblique muscle limitation in 3 patients. Optic disc pallor was found in 2 patients.In the years following fronto-orbital advancement for non-syndromic anterior plagiocephaly, refractive errors and oculomotor disorders are frequently encountered, mainly contralateral astigmatism and strabismus with both horizontal deviation and ispilateral hypertropia.

PURPOSE to investigate the clinical outcomes of transepithelial photorefractive keratectomy (tPRK) with actual epithelial thickness versus default software values. METHODS eighty-three patients with refractive spherical error of -1.50 to -7.00 diopters (D), and refractive astigmatism up to 4.00 D were consecutively enrolled and divided into two groups: group 1 undergone tPRK with actual central and peripheral epithelial thickness input in right eyes, group 2 undergone tPRK with actual central and 10 μm higher peripheral epithelial thickness in right eyes, left eyes underwent tPRK with default protocol in both groups. Outcome measures were induced refractive error, achieved optical zone (OZ), and wasted stromal tissue. SETTING Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, IranDesign: prospective controlled study. RESULTS Mean ± SD of induced spherical equivalent (SE) was +0.15 ± 0.39 D and +0.01 ± 0.35 D in right and left eyes of group 1 (p=0.01), and +0.04 ± 0.22 D and +0.03 ± 0.23 D in right and left eyes of group 2 (p=0.75), respectively. There was no statistically significant difference between wasted tissue between right and left eyes in group 1 and group 2 (p=0.77 and p=0.49, respectively). OZ contraction was significantly higher in right compared to left eyes in group 1 (p=0.05), but not in group 2 (p=0.95). CONCLUSION In tPRK, refractive outcomes, wasted tissue, and OZ contraction depend little on pre-existing corneal epithelial thickness in corneas with normal range epithelial thickness. However, OZ contraction may be a concern in lower amount of ablations.

To compare the predictive refractive error (PRE) of intraocular lens (IOL) power between retinal vascular and vitreomacular interface diseases after phacovitrectomy.We retrospectively reviewed patients who underwent phacovitrectomy for various retinal diseases. Patients with retinal vascular diseases and vitreomacular interface diseases were included in group A and group B, respectively. Age- and gender-matched senile cataract patients with phacoemulsification were set as controls. The mean PRE and absolute value of refractive error (ARE) among different groups were compared. The associated risk factors with ARE were also analyzed in the univariate and multivariate analyses.In total, 106 patients (Group A), 108 patients (Group B), and 110 patients as controls were included. The PRE in Group A (- 0.35 ± 0.83D) and Group B (- 0.53 ± 0.74D) were more myopic compared to the control group (- 0.11 ± 0.58D) (p 0.05). The ARE in Group A (0.70 ± 0.57D) and Group B (0.75 ± 0.51D) were significantly higher compared to the control group (0.47 ± 0.35D) (p 0.05). There were no significant differences in the PRE and ARE values between the two study groups (p = 0.267 and 0.861, respectively). There were no significant differences of the PRE and ARE in the eyes with silicone oil tamponade (- 0.63 ± 0.75D, 0.81 ± 0.54D) and gas tamponade (- 0.42 ± 0.83D, 0.74 ± 0.56D) (p = 0.693 and 0.988, respectively). In the multivariate model, preoperative LogMAR visual acuity (β = 0.162, 95%CI = 0.113-0.211, p 0.001), mean corneal curvature (β = 0.105, 95% CI = 0.074-0.135, p 0.001), and age (β = 0.012, 95% CI = 0.005-0.019, p = 0.001) were all positively correlated with the ARE.Postoperative myopic shift after phacovitrectomy may be comparable in retinal vascular diseases and vitreomacular interface diseases, no matter the gas or silicone oil tamponade. Older age, steeper corneal curvature, and worse preoperative visual acuity could produce more prediction errors.

Turner syndrome (TS) is associated with abnormalities across several organ systems, including the visual system. There is a relative paucity of literature describing ophthalmic manifestations of TS. We sought to investigate eye manifestations in our cross-sectional population of pediatric TS patients.All patients managed by the TS program of a tertiary children's hospital were identified. Patients with documentation of at least one eye exam were included for analysis. Chart review was retrospectively performed to identify all documented ocular abnormalities as well as patient demographics, including TS karyotype. Statistical analysis was performed to identify any association between karyotype and ocular abnormality.A total of 187 patients with TS were identified. The mean age of the cohort was 14.3 ± 7.2 years. Ametropia was the most common ocular abnormality, occurring in 79 patients (42%), followed by strabismus in 25 (13%). Of the patients with strabismus, 17 had exotropia and 8 had esotropia, with only 2 patients requiring surgical intervention. Posterior segment abnormalities were identified in five patients without accompanying visual deficits. Two patients had ocular tumors: one with retinoblastoma and one with retinal astrocytic hamartoma. There was no association between TS karyotype and occurrence of ocular abnormalities.Ophthalmic manifestations of TS were common, particularly ametropia and strabismus. Management of strabismus was conservative in the vast majority of patients. Ocular manifestations were not associated with TS karyotype. Early screening and routine ophthalmic evaluation of patients with TS is needed to prevent progression of potentially vision-threatening abnormalities.

Red signals signify danger in a range of situations, including train operations. Importantly, misperception of a red signal as yellow can have serious safety implications. This study investigated the effects of lens blur on incorrect colour perception of red signals, which has been implicated in previous train crashes.Participants included 15 young (26.6 ± 4.6 years) and 15 older (55.8 ± 3.1 years) visually normal adults. Red and yellow wayside train signals were simulated for two brightness levels (dim, bright) using a custom-built projection system. The effect of blur (best-corrected refraction [No Blur], +0.25 DS, +0.50 DS, +0.75 DS, +1.00 DS, +1.25 DS) on the number of incorrect colour perception responses of the signals was recorded. The order of conditions was randomised between participants.For incorrect responses to the red signal, there were significant main effects of blur (p 0.001) and signal brightness (p 0.001) and a significant interaction between blur and brightness (p 0.001). The effects of blur were greater for the dim compared to the bright signals, with significantly higher colour misperceptions for the dim signal for +0.50 DS blur and higher, compared with No Blur. Colour misperceptions of the yellow signals were low compared with that of the red signals, with only +1.25 DS blur resulting in a significantly higher number of incorrect responses than No Blur (p 0.001). There were no effects of age for the red or yellow colour misperceptions (p 0.19).Low levels of blur (+0.50 DS to +1.25 DS) resulted in a significant misperception of the red signals as orange-yellow, particularly for dim signals. The findings have implications for vision testing and refractive correction of train drivers to minimise the possibility of colour misperception of red train signals.

PURPOSE To assess a new polynomial regression formula integrating the refractive prediction error of the first operated eye in order to improve the intraocular lens (IOL) power calculation of the second eye in cataract surgery. SETTING Centre Hospitalier Universitaire, Toulouse, France. DESIGN Retrospective multicentric dataset study. METHODS A polynomial regression formula called WeOptimeye2nd (WO2nd) was developed using a machine-learning algorithm trained on a dataset of 534 patients who underwent sequential bilateral cataract surgery. A separate multicentric dataset was used to retrospectively calculate predicted refraction with WO2nd, SRK/T, Barrett Universal II, and 3 other methods of constant factors (CF) second eye refinement (CF0.38, CF0.35 and CF0.5). Mean absolute errors (MAE) and percentage of eyes within ±0.25, 0.5, and 1.0 diopters (D) from predicted spherical equivalent were compared between formulas. RESULTS The study comprised data on 722 patients. In the overall population, WO2nd had the lowest MAE: 0.339 versus 0.347 (p=0.137), 0.340 (p=0.956), 0.350 (p=0.066), 0.399 (p

Purpose The objective of this study was to compare the effects of horizontal muscle transposition and inferior oblique weakening combined with horizontal surgery performed for V-pattern exotropia (XT) and to determine the most successful approach. Methods In our retrospective study, 52 patients who underwent horizontal surgery due to V-pattern XT and were followed up for at least 6 months were divided into two groups. Group 1 (n = 26) consisted of patients who underwent vertical transposition of the rectus muscles combined with horizontal surgery, and group 2 (n = 26) consisted of patients who underwent inferior oblique weakening combined with horizontal surgery. The two groups were compared before and after surgery in terms of visual acuity, refractive errors, deviation angles, pattern strabismus, fusion, stereopsis, over/under correction and surgical success. Results There was no difference between the two groups in terms of age, follow-up period, visual acuity, refractive errors, fusion or stereopsis. The amount of horizontal deviation was smaller in group 2 at the 1-6-month follow-ups. There was no difference between the two groups in terms of pattern collapse; however, the amount of pattern postoperatively was lower in group 2. The two groups were similar in terms of overcorrection; however, the undercorrection rate was higher in group 1. The surgical success rate was higher in group 2. Conclusions Inferior oblique weakening combined with horizontal surgery due to V-pattern XT was found to be superior to vertical transposition of the horizontal muscles in terms of surgical success and the amount of pattern postoperatively.

PURPOSE: The relationship between ciliary muscle thickness (CMT), age and refractive error was investigated to determine if CMT, like other anterior ocular anatomy, differs in adults with Down syndrome (DS). METHODS: The CMT of 33 adults with DS was imaged using anterior segment optical coherence tomography. Images from the right eye obtained 45 minutes after cycloplegia (1% tropicamide, 2.5% phenylephrine) were analysed to calculate thickness at 1, 2 and 3 mm posterior to the scleral spur (CMT1, CMT2, CMT3), maximum thickness (CMTMAX) and apical thickness (AT = CMT1 – CMT2). Spherical equivalent refractive error was determined by clinical refraction using both non-dilated and dilated measures. Multivariate regression analysis evaluated the relationship between CMT and refractive error while controlling for subject age. RESULTS: Images were analysed from 26 subjects (mean age (SD) 29 years; mean refractive error (SD): −0.90 (5.03) D, range: −15.75 to +5.13D). Mean (SD) CMT decreased with posterior position (CMT1: 804 (83) μm; CMT2: 543 (131) μm; CMT3: 312 (100) μm). Mean (SD) CMTMAX and AT was 869 (57) μm and 260 (84) μm, respectively. There was a significant linear correlation indicating thinning CMT with increasing age for CMT1 and CMT2 (p ≤0.05). CMT2 and CMT3 had a significant negative correlation (thicker muscle with increasing myopic refractive error) (p ≤0.01). AT had a significant positive correlation (thicker muscle with increasing hyperopic refractive error) (p

To describe the preoperative characteristics of patients undergoing cataract surgery in our hospital, to determine the final visual and refractive results and to determine the preoperative characteristics that conditioned the presence of a residual refractive error (RRE) greater than one diopter.Retrospective analysis of cataract surgeries performed at Araba University Hospital between February 2017 and December 2019. Sociodemographic, eye comorbidity, biometric, surgical and post-surgical characteristics were collected.A total of 1419 patients and 1578 surgeries were included for analysis. Of these, 9.07% had preoperative legal blindness, 31.69% eye comorbidity and 4.18% had previous surgery. Overall, 95.82% of patients achieved a corrected final visual acuity (VA) ≥ 0.5 Snellen decimal and 63.12% ≥ 1, and 96.70% of patients improved VA after surgery. RRE was between ±0.5 diopters in 77.82% of patients and between ±1 diopter in 94.74%. The most prominent risk factors that conditioned the presence of RRE greater than 1 diopter were the use of ultrasonic contact biometer, a history of glaucoma surgery, the presence of white or hard cataract, and prior legal blindness.The visual results of cataract surgery were excellent, with 63.12% of patients obtaining corrected VA ≥ 1 and an RRE of ±1 diopter in 94.74%. Different risk factors influenced the achievement of poor refractive outcomes: preoperative conditions (previous surgeries, white/hard cataract, previous VA) and biometrics.

Identifying children at highest risk for rapid myopia progression and/or rapid axial elongation could help prioritize who should receive clinical treatment or be enrolled in randomized clinical trials. Our models suggest that these goals are difficult to accomplish.This study aimed to develop models predicting future refractive error and axial length using children's baseline data and history of myopia progression and axial elongation.Models predicting refractive error and axial length were created using randomly assigned training and test data sets from 916 myopic participants in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study. Subjects were 7 to 14 years of age at study entry with three consecutive annual visits that included cycloplegic A-scan ultrasound and autorefraction. The effect of adding prior change in axial length and refractive error was evaluated for each model.Age, ethnicity, and greater myopia were significant predictors of future refractive error and axial length, whereas prior progression or elongation, near work, time outdoors, and parental myopia were not. The 95% limits for the difference between actual and predicted change were ±0.22 D and ±0.14 mm without prior change data compared with ±0.26 D and ±0.16 mm with prior change data. Sensitivity and specificity for identifying fast progressors were between 60.8 and 63.2%, respectively, when the cut points were close to the sample average. Positive predictive value and sample yield were even lower when the cut points were more extreme.Young, more myopic Asian American children in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study were the most likely to progress rapidly. Clinical trials should expect average progression rates that reflect sample demographics and may have difficulty recruiting generalizable samples that progress faster than that average. Knowing progression or elongation history does not seem to help the clinical decision regarding initiating myopia control.

Purpose To determine the refractive outcome after treatment with laser photocoagulation, intravitreal antiangiogenic injection or both, for the treatment of type 1 ROP and/or aggressive posterior ROP using defocus equivalent terms. These results will be compared with the spherical equivalent (SE) notation in an initial refraction (during the first 3 years after treatment) and in a final evaluation (three years after treatment). Methods Clinical charts review of preterm patients who developed type 1 ROP and/or aggressive posterior ROP who were treated with laser photocoagulation, intravitreal antiangiogenic injection, or both, between January 2007 and December 2014 at Fundación Oftalmológica de Santander were reviewed. Refractive error was evaluated at two different time points in three different treatment groups. Results Seventy-seven eyes (56 patients) with ROP diagnosis treated with laser, antiangiogenics or in a combined scheme were included. Median gestational age was 29 weeks (IQR = 3), median birth weight was 1100 (IQR = 335) and mean corrected age at the time of treatment was 37.3 weeks (SD 2.2). Refractive outcomes in SE terms for the first refraction had a median of −0.50 diopters and in defocus terms, 4.00 diopters (D). For the second refraction, −3.00 diopters and 4.00 diopters (D), respectively. Pearson correlation test result for the first measurement was 93% (p = 0.000) and for the second evaluation was 99% (p = 0.000). Conclusions Low birth weight had a statistically significant association to the increase of the refractive outcome. The high correlation between SE and DE for refractive errors allows us to confirm that DE is an appropriate metric to report refractive outcomes in this group of patients due to the presence of combined refractive ametropias.

Introduction Among non-syndromic, single-suture craniosynostoses, unicoronal craniosynostosis (UCS) presents the highest rate of ophthalmic manifestations requiring a visual follow-up, due to the high risk of amblyopia. After birth or during childhood, children with UCS have a high risk to present an aniso-astigmatism and a strabismus. The aim of this study was to characterize clinical ophthalmologic findings associated with UCS in a paediatric cohort. Methods This retrospective study included children admitted in our unit between 2015 and 2021, with isolated UCS treated in our institution and complete ophthalmological assessment comprising visual assessment, refractive status and oculomotor examination. Children with associated craniofacial disorders were excluded. Results A total of 28 children met the inclusion criteria. Median age was 62 [13-192] months with a large proportion of girls (86%) and 71% of right-sided UCS. The mean best corrected visual acuity was 0.07 (±0.13) LogMAR, including 10 (36%) children with an amblyopia or history of amblyopia. Astigmatism was significantly higher on the contralateral side of the UCS than on the ipsilateral side, with a refractive cylinder error of 0.97 (±1.06) vs 0.56 (±0.68) diopters, respectively (p = 0.03). Strabismus was observed in 20 patients (71%) with a main pattern of esotropia with a vertical component. A pseudo-superior oblique palsy was found in 13 children (65%) with a median cyclodeviation of 8.7° [-5,4°-20.6°]. Conclusion Children with UCS experience a high rate of various visual manifestations. This study highlights their need for a strict ophthalmological follow-up, in order to early diagnose and prevent visual complications.

Objective We describe the Baltimore Reading and Eye Disease Study, report baseline ocular findings, and explore the feasibility of eye examinations in the school setting. Design Prospective, school-based cohort study. Participants Students in second and third grades. Methods Baseline eye examinations, including near and distance presenting visual acuity (VA), stereopsis, ocular alignment, dilated retinal examination, and cycloplegic refraction, were performed in 12 Baltimore public schools during the 2014–15 school year. Main outcome measures Presenting VA, prevalence of refractive error, and other ocular findings. Results Among the 1054 eligible students, 321 participated. There were 271 (84.4%) African American and 186 (57.9%) female students; mean age was 7.9 ± 0.8 years. Cycloplegia was achieved in 308. The mean presenting distance and near VA was 0.1 ± 0.2 logMAR (range −0.1 to 1.5) and 0.1 ± 0.2 logMAR (range 0.0–1.6) in the better-seeing eye, respectively. The most common ocular findings were +1.00 diopter (D) or greater hyperopia (34.7%), −0.50 D or greater myopia (29.5%), 1.00 D or greater astigmatism (23.4%), and convergence insufficiency (7.2%). Thirty-seven (11.5%) children needed referral to an eye care provider; 10% of students required glasses full-time. Conclusions Whereas the majority of second and third grade students in this study have good VA and minimal refractive error, 1 in 9 have an ocular finding necessitating further evaluation. It was feasible to conduct cycloplegic eye examinations in the school setting.

Purpose of reviewThe evaluation of refractive error is probably the most important and common procedure in eye care. The gold standard method for evaluating refractive error is subjective refraction, a process that has not significantly changed in 200years. This article aims to review recent technologies and novel approaches attempting to improve this traditional procedure.Recent findingsFrom laboratory prototypes to commercial instruments, the proposed methods aim to perform reliable and fast subjective refractions, following different approaches: using motorized phoropters in combination with automatic algorithms or even self-refraction, hybridizing objective and subjective measurements within the same instruments, or using new visual tasks beyond letter identification of blur estimation to obtain the refractive error subjectively.SummaryThe current trend in subjective refraction is to overcome the traditional manual blur reduction method, using automatic and self-refraction instruments, which can provide faster measurements with lower variability. Many of the technologies reported here are already in the market, and some have the potential of becoming the new standard in subjective refraction.

Calculating the intraocular lens (IOL) power in short eyes for cataract surgery has been a challenge. A meta-analysis was conducted to identify, among several classic and new IOL power calculation formulae, which obtains the best accuracy.All studies aiming at comparing the accuracy of IOL power calculation formulae in short eyes were searched up in the databases of PubMed, EMBASE, Web of Science and the Cochrane library from Jan. 2011 to Mar. 2021. Primary outcomes were the percentages of eyes with a refractive prediction error in ± 0.25D, ± 0.5D and ± 1.0D.Totally 1,476 eyes from 14 studies were enrolled in comparison of 13 formulae (Barrett Universal II, Castrop, Haigis, Hoffer Q, Holladay1, Holladay2, Kane, Ladas Super Formula, Okulix, Olsen, Pearl-DGS, SRK/T and T2). Pearl-DGS had the highest percentage within ± 0.25D. In the ± 0.5D range, Pearl-DGS obtained the highest percentage again, and it was significantly higher than Barrett Universal II, Haigis, Hoffer Q, Holladay1, Holladay2 and Olsen (P = 0.001, P = 0.02, P = 0.0003, P = 0.01, P = 0.007, P = 0.05, respectively). In the ± 1.0D range, Okulix possessed the highest percentage, and it was significantly higher than Barrett Universal II, Castrop, Hoffer Q and Holladay2 (P = 0.0005, P = 0.03, P = 0.003, P = 0.02, respectively).The new generation formulae, based on artificial intelligence or ray-tracing principle, are more accurate than the convergence formulae. Pearl-DGS and Okulix are the two most accurate formulae in short eyes.

Purpose To investigate the spherical shift of Intraocular lens (IOL) tilt after intrascleral fixationMethods We retrospectively reviewed the medical records of patients who underwent flanged intrascleral IOL fixation with transconjunctival 25- or 27-gauge pars plana vitrectomy at the Department of Ophthalmology of Jikei University Hospital with a minimum follow-up duration of three months. Second-generation anterior segment optical coherence tomography (CASIA2; TOMEY) was used to obtain the tilt and decentration of intrasclerally fixated IOL and postoperative anterior chamber depth. We investigated the relationship of the refractive error with these parameters, axial length, and keratometry. In addition to the clinical investigation, we performed optical simulations using the Zemax optical design program for studying the spherical shift of the IOL tilt by means of the through-focus response and change of spherical equivalent power.Results The study involved 72 eyes of 67 patients. The degree of IOL tilt was correlated with the amount of refractive error (Spearman's rank correlation coefficient [CC] = −0.32; P = 0.006). In particular, a tilt angle greater than 10° strongly influenced the refractive error. Postoperative anterior chamber depth also correlated with the refractive error (CC = 0.50; P < 0.001). The refractive error did not correlate with decentration (CC = −0.17; P = 0.15), axial length (CC = −0.08; P = 0.49), and keratometry (CC = −0.06; P =0.64). Optical simulations using the Zemax optical design program also showed a myopic shift exponentially as the tilt becomes greater. Conclusion An IOL tilt greater than 10 ° induces refractive error.

To determine how the position of the centre of rotation of the eyeball is related to axial length and refractive error when horizontal and vertical eye movements are performed.A custom-built eye tracker was used that determined the centre of rotation of the eye (COR) from lateral displacements of the pupil centre. Horizontal and vertical eye movements were studied in the right eyes, and each measurement performed five times in 59 subjects (32 females) with an average age of 36.6 ± 9.1 years. Spherical equivalent refractive errors ranged from -9.7 to +6.8 D with an average error of -1.5 ± 2.9 D. Axial lengths were measured with the ZEISS IOL Master 500.The mean horizontal centre of rotation (COR) of the right eye for a saccade from 0° to ±11.9° was 15.3 ± 1.5 mm behind the corneal apex, while the average vertical COR for the same angle of eccentricity was 12.5 ± 1.4 mm, indicating that the horizontal COR was 2.8 ± 1.7 mm behind the vertical COR. In right eyes, horizontal COR was significantly correlated with axial length (r = 0.28, p = 0.02) but not with the spherical equivalent refractive error (r = 0.39, p = 0.90). Similarly, vertical COR was significantly correlated with axial length (r = 0.25, p = 0.03) but not with the spherical equivalent refractive error (r = 0.17, p = 0.90).While it might be expected that the COR is dependent on axial length, the correlation was not strong. Interestingly, the location of the COR was substantially different for horizontal and vertical eye movements which may relate to the flatter curvature of the eyeball in the vertical meridian, compared to the horizontal, as described in previous studies.

Information on the refractive error prevalence in school-aged children will result in delivering the optimal eye health service to this group.Understanding the prevalence of refractive error in school-aged children is crucial to reduce the consequences of uncorrected refractive error. This study aims to investigate the prevalence of refractive error among school-aged children in Shiraz, Iran.In this cross-sectional population-based study, 2001 schoolchildren aged 6-12 years participated. All participants underwent cycloplegic refraction. Spherical equivalent (SE) of -0.50 dioptre or more was considered as myopia, SE of +2.00 dioptre or more as hyperopia, and astigmatism as cylinder power of 0.75 dioptre or more. The difference of 1.00 dioptre or more between two eyes defined as anisometropia.The prevalence of myopia was 11.6% (95% confidence interval [CI]: 10.2-13.1%), hyperopia 6.7% (95%CI: 5.6-7.9%), and astigmatism 28.9% (95%CI: 26.9-31.0%), out of which 82.1% had with the rule astigmatism. Anisometropia was detected in 4.0% (95%CI: 3.2-5.0%) of children. Astigmatism and anisometropia were significantly higher in boys (Astigmatism was the most common refractive error among primary school children. The prevalence of myopia was relatively higher than other studies conducted in Iran, and it increased with age. These results may highlight the role of lifestyle changes and increased near work activities on the myopic shift in school-aged children. The findings provide information for screening programmes in school-aged children.

We aimed to evaluate the time needed for effective cycloplegia after instillation of cyclopentolate 1% in patients with brown irides. A prospective analytical study involving 161 patients (322 eyes) with a mean (SD) age of 9.0 (3.1) years (range: 3-16 years), who attended outpatient eye clinic. All had brown irides, cyclopentolate 1% was instilled two times, 10 minutes apart, spherical equivalent (SE) was calculated using readings taken by Nidek AR-1000 autorefractometer before the first drop and at 15, 30, 45 and 60 minutes after the first drop. The time for effective cycloplegia was determined from the time point at which the 95% confidence interval of the differences between the average spherical equivalent (SE) at each point and its final value at 60 minutes was reached and remained within ±0.25 D. We found that maximum cycloplegia was reached 30 minutes after the instillation of first drop of cyclopentolate 1% in all refractive error categories (emmetropia, hyperopia and myopia) with the exception of high hyperopia subgroup (SE ≥ +6.0D) where at least 45 minutes were needed to achieve cycloplegia. Additionally no clinically significant difference in the minimum time required to achieve maximum cycloplegia was noticed in subjects under 10 years old and those aged 10 years or older with both groups needed at least 30 minutes to achieve maximum cycloplegia after the instillation of first drop of cyclopentolate 1%. In this group of patients with brown irides, most children reached maximum cycloplegia after 30 minutes of instillation of cyclopentolate 1% eye drops.

Our goal in this study is to compare the results of a photoscreener (Plusoptix A12C) with and without cycloplegia and to investigate its reliability as a function of biometric parameters.In total, 250 eyes of 125 children with a mean age of 6.77±1.59years were included in the study. The results of cycloplegic and noncycloplegic Plusoptix A12C measurements and autorefractometer with cycloplegia (CA) were compared. The spherical equivalent (SE) differences between CA and noncycloplegic Plusoptix A12C measurements (NPO) with CA and cycloplegic Plusoptix A12C measurements (CPO) were compared with axial length (AL), anterior chamber depth (ACD), corneal radius of curvature (CR), mean keratometry (meanK) and axial length/corneal radius of curvature ratio (AL/CR) values. The relationships between these were examined.According to amblyopia risk factors (ARFs) based on the criteria in the 2013 AAPOS guidelines, 33 eyes (13%) in the NPO results and 34 eyes (13.6%) in the CPO results were found to be at risk for amblyopia. According to the CA results, the NPO had 67.3% sensitivity and 94.5% specificity, and the CPO 69.4% sensitivity and 89.1% specificity in detecting the values of refractive amblyopia factors determined by the AAPOS. In regard to refraction values determined by the AAPOS for amblyopia, according to CA results, the NPO had 71.4% sensitivity and 88.4% specificity in detecting myopia; 33.3% sensitivity and 93.6% specificity in detecting hyperopia; and 79.4% specificity and 71.2% sensitivity in detecting astigmatism. With regard to refraction values determined by the AAPOS for amblyopia, according to CA results, the CPO had 80.9% sensitivity and 90% specificity in detecting myopia; 13.3% sensitivity and 89.2% specificity in detecting hyperopia; and 44.9% sensitivity and 30.8% specificity in detecting astigmatism. When the SE differences between the CA and NPO values were compared with biometric parameters, a negative correlation was observed with ACD, AL, and especially AL/CR ratio.Both the NPO and CPO showed moderate sensitivity and high specificity in detecting ARFs based on the criteria in the 2013 AAPOS guidelines. Sensitivity for detecting hyperopic risk factors was lower than for myopia and astigmatism. The CPO has no additional clinical advantage. A negative correlation was found between biometric parameters and NPO results. Thus, the NPO is more reliable in myopic children with higher axial lengths, deeper anterior chambers, and increased AL/CR ratios.

Introduction: Additional lenses implanted in the ciliary sulcus (AddOn) are one option for permanent correction of refractive error or generate pseudoaccommodation in the pseudophakic eye. The purpose of this paper was to model the power and magnification behaviour of toric AddOn and to show the effect sizes with a Monte Carlo simulation. Methods: Anonymized data of a cataractous population uploaded for formula constant optimization were extracted from the IOLCon platform. After filtering out data with refractive spherical equivalent (RSEQ) between −0.75 and 0.25 dpt and refractive cylinder (RCYL) lower than 0.75, for each of the N = 6,588 records, a toric AddOn was calculated which transfers the refraction error from spectacle plane to AddOn plane using a matrix-based calculation strategy based on linear Gaussian optics. The equivalent (AddOnEQ) and toric (AddOnCYL) power of the AddOn and the overall lateral magnification change and meridional magnification were derived for the situations before and after AddOn implantation, and a linear modelling was fitted for all 4 parameters. Results: RSEQ is the dominant effect size in the prediction of AddOnEQ and overall change in magnification (ΔM), whereas the lens position (LP), corneal thickness (CCT), and mean corneal radius (CPa) play a minor role. In a simplified model, AddOnEQ can be estimated by 0.0179 + 1.4104 RSEQ. RCYL and corneal radius difference (CPad) are the dominant effect sizes in the prediction of AddOnCYL and the change in meridional magnification (ΔMmer), whereas LP, CCT, CPa, and RSEQ play a minor role. In a simplified model, AddOnCYL can be predicted by −0.0005 + 0.0328 CPad + 1.4087 RCYL. Myopic eyes gain in overall magnification, whereas in hyperopic eyes, we observe a loss. Meridional distortion could be in general reduced to 35% on average with a toric AddOn. Conclusion: Our simulation shows that with a linear model, the equivalent and toric AddOn power, as well as overall change in magnification, meridional distortion before and after AddOn implantation, and the reduction in meridional distortion, can be easily predicted from the biometric data in pseudophakic eyes with moderate refractive error.

Purpose: To compare referral results from two photoscreening devices that are in wide use relative to a manual screening test protocol in preschool children. Methods: Children aged 3 to 5 years who attended preschools in two counties within the State of Michigan (N = 1,085) took part in the State's vision screening program, which included the Lea Symbols and Stereo Butterfly tests, during a 3-month period. All who failed this screening or were unable to be tested, and 20% of those who passed, were then invited to undergo testing with the Plusoptix Vision Screener Model S-12C (Plusoptix, Inc) and Welch Allyn SPOT Vision Screener Model VS-100 (Hill-Rom, Inc) photoscreening devices. Screening was conducted by State-trained technicians. With the State's test results considered the gold standard for screening, sensitivity and specificity of the two photo-screening devices were calculated. McNemar's test and logistic regression were used to evaluate the findings. Results: A total of 1,085 children took part in the State's screening program. Their mean ± standard deviation age was 48.8 ± 7.2 months, with a 51:49 female-to-male ratio, and a similar percentage were Black (34.1%) or White (33.3%). The sensitivity of the SPOT and Plusoptix screening was 61.0% and 65.2%, respectively. The specificity of the SPOT and Plusoptix screening was 92.9% and 82.4%, respectively. For 84 children who were unable to be tested by the State's screening, the SPOT and Plusoptix devices completed the screening on the majority (86.9% and 73.8%, respectively). Conclusions: The photoscreening devices yielded numerous false-negative results and fewer false-positive results. Their ability to screen many children who could not be screened by manual testing indicates a useful application. [ J Pediatr Ophthalmol Strabismus . 2022;59(1):46–52.]

Introduction: Uncorrected refractive error is one of the major causes of visual impairment in children and adolescents worldwide. During the COVID-19 epidemic, home isolation is considered a boost to the progression of children’s myopia. Under geographical conditions of high altitude and strong sunshine, the Tibetan plateau is the main residence of the Tibetan population, where little information is available about the refractive status and developmental trajectory. Therefore, this article aimed to evaluate the distribution, progression, and associated factors of the refractive status in second-grade children in Lhasa after COVID-19 quarantine. Materials and Methods: Students from 7 elementary schools completed comprehensive ocular examinations in the Lhasa Childhood Eye Study. Data regarding cycloplegic refraction and corneal biometry parameters, including axial length (AL), corneal power, anterior chamber depth (ACD), and other demographic factors, were analyzed. Results: A total of 1,819 students were included, with a mean age of 7.9 ± 0.5 years, of which 961 were boys (52.8%), and 95.1% were Tibetan. The prevalence of myopia, emmetropia, mild hyperopia, and hyperopia was 10.94%, 24.02%, 60.80%, and 4.24%, respectively. Besides, the average cycloplegic spherical equivalent refraction (SER) was +1.07 ± 0.92 diopter (D) before the COVID-19 quarantine and +0.59 ± 1.08D after the quarantine (p < 0.05), with a growth rate of 7%. Moreover, the prevalence of hyperopia in girls was significantly higher than that of boys (p < 0.001). Nonetheless, the proportion of myopia and emmetropia was similar (p = 0.75). Meanwhile, children in suburban schools had a significantly lower proportion of myopia (p < 0.001). The average AL, ACD, lens power (LP), and AL-to-corneal radius (AL/CR) ratio were 22.79 ± 0.78 mm, 3.54 ± 0.21 mm, 25.12 ± 1.48D, and 2.93 ± 0.08, respectively. The results of AL, ACD, and AL/CR for girls were significantly lower than for boys, while the result of LP is the opposite (p < 0.001). Finally, multivariate regression analysis revealed that SER was negatively correlated with AL, LP, and AL/CR ratio, while positively correlated with CR and ACD (p < 0.001). Conclusion: This study found that after the COVID-19 confinement, myopia progressed faster in Lhasa children but was still significantly lower than that of plain cities in China. Compared to short-term confinement, this acceleration was more likely related to the growth and general trend of myopia in children. Collectively, these findings help to explore the differences in ocular growth and development among children of different ethnic groups.

Clinical Relevance Reducing the time between drop instillation and refraction reduces the time paediatric patients and young adults spend in practice, facilitating more eye examinations daily. Background The current procedure for paediatric cycloplegic refraction is to wait for at least 30-minutes post-instillation of a cycloplegic before measuring spherical equivalent refraction. This study compared cycloplegia at 20- and 30-minutes following 0.5% proxymetacaine and 1.0% cyclopentolate in 12-13-year-olds. Methods Participants were 99 white 12-13-year-olds. One drop of proxymetacaine hydrochloride (Minims, 0.5% w/v, Bausch & Lomb, UK) followed by one drop of cyclopentolate hydrochloride (Minims, 1.0% w/v, Bausch & Lomb, UK) was instilled into both eyes. Spherical equivalent refraction was measured by autorefraction (Dong Yang Rekto ORK-11 Auto Ref-Keratometer) at 20- and 30-minutes post-instillation. Data were analysed through paired t-testing, correlations, and linear regression analysis. Results There was no significant difference in level of cycloplegia achieved at 20- (Mean spherical equivalent refraction (standard deviation) 0.438 (1.404) D) and 30-minutes (0.487 (1.420) D) post-eyedrop instillation (t (98) = 1.667, p = 0.099). The mean spherical equivalent refraction difference between time points was small (0.049 (0.294) D, 95% confidence interval =-0.108 ̶ 0.009D). Agreement indices: Accuracy = 0.999, Precision = 0.973, Concordance = 0.972. Spherical equivalent refraction at 20- and 30-minutes differed by ≤0.50D in 92% of eyes, and by

Background An increasing prevalence of mental disorders (MDs) has been reported among children and adolescents. However, only few studies have conducted ocular examinations, including those on refractive status, in these groups of patients. Thus, the purpose of this study was to evaluate the refractive status and ocular findings in children and adolescents with MDs compared with matched controls with similar socioeconomic backgrounds. Methods A total of 178 participants with MDs and 200 controls were recruited between April 2021 and May 2022. All the children and adolescents underwent cycloplegic or noncycloplegic autorefraction and retinoscopy, slit-lamp biomicroscopy, and dilated fundus examinations. Ocular alignment was assessed using Hirschberg, Krimsky, or prism cover tests. The prevalence of refractive errors and ocular findings was the main outcome. Results Twenty-seven percent of patients with MDs and 8% of controls had ocular findings, the most common of which were conjunctivitis, keratitis, and trichiasis. For refractive status, 70% (124/178) of patients with MDs had myopia ≤-1.00 DS, and 2% (4/178) had hyperopia ≥+2.00 DS. In the control group, 70% (140/200) of patients had myopia ≤-1.00 DS, and 1% (2/200) had hyperopia ≥+2.00 DS. No differences were observed between the MD and control groups. However, the patients in the MD group (14.25±2.69 years) were significantly more susceptible to strabismus (PPPPPPPP Conclusion Ophthalmological examinations should be performed in children and adolescents with MDs because MDs are associated with a high prevalence of refractive errors and ocular diseases. Detection and intervention of ocular and refractive findings in children and adolescents with MDs are necessary and effective in alleviating the economic burden in healthcare and improving individuals' quality of life

BACKGROUND AND OBJECTIVE: To report the clinical outcomes of the flanged intrascleral haptic fixation technique (FIHFT) with the Zeiss CT Lucia 602 three-piece intraocular lens (IOL). PATIENTS AND METHODS: This was a retrospective case series of patients who received FIHFT secondary implantation of the Zeiss CT Lucia 602 IOL from January 2018 to August 2020. Clinical and refractive outcomes were assessed including best-corrected visual acuity (BCVA), refractive prediction error, and complications. RESULTS: Of the 22 patients in the series, 19 were included in the study. Mean vision improved from logarithm of the minimum angle of resolution (log-MAR) 1.14 to 0.54 ( P = .03). BCVA of those without preoperative trauma improved from logMAR 0.68 to logMAR 0.25 ( P = .02). Refractive spherical equivalent improved from 2.46 diopters (D) to 0.50 D ( P = .07), but astigmatism increased from 1.09 D to 1.31 D ( P = .67). CONCLUSIONS: FIHFT with the Zeiss CT Lucia 602 three-piece lens is a safe and effective option for secondary IOL placement. [ Ophthalmic Surg Lasers Imaging Retina . 2021;52:658–662.]

Purpose To evaluate the accuracy of axial length, keratometry, and refractive measurement with Myopia Master in ametropic children. Methods In this randomized prospective cross-sectional study, 125 children with ametropia (250 eyes) were recruited (55 boys and 70 girls; age range: 3–15 years). All examinations were performed under full cycloplegic conditions. Measurements of axial length (AL), keratometry, and autorefraction acquired with the Myopia Master were compared with those from the IOLMaster 500, IOLMaster 700, Nidek ARK-1, and manifest refraction. The differences between the different methods were analyzed, and their correlation was assessed by interclass correlation coefficients (ICCs), Bland–Altman plot, and correlation test. Results The ALs (mm) measured with Myopia Master, IOLMaster 500, and IOLMaster 700 were 23.67 ± 1.26, 23.68 ± 1.26, and 23.70 ± 1.25, respectively. The mean values and standard deviations for AL and keratometry readings from these devices were similar (P ≥ 0.059). The ICC analysis also revealed high consistency between the measurements (ICC ≥ 0.943). Additionally, the correlation coefficients were relatively high (r > 0.9, p P ≤ 0.024), the agreement between these two measurements was excellent (ICC ≥ 0.858). The percentage of points outside the limits of agreements was Conclusions Myopia Master could be a highly efficient tool for clinical use as a three-in-one system (AL, keratometry, and refractive measurements) for screening in children with ametropia.

We present a case of ametropia corrected by small incision lenticule extraction (SMILE) in a corectopia eye after cataract surgery. The patient's optical zone, nomogram, and centration were carefully considered. The intended corrections were -6.60 - 1.25 × 175 OD and -6.85 - 0.50 × 10 OS. M-sized and S-sized cones were recorded in the right and left eye, respectively. The diameter of the right eye optical zone was 7.00 mm, whereas that of the left eye was 6.50 mm. The corneal vertex was determined using the film mark method as the scanning center. Three months after surgery, the uncorrected distance visual acuities were 20/20 OD and 20/13 OS. The effective optical zone was 6.5 and 5.5 mm in the right and left eyes, respectively. It is feasible to correct ametropia with SMILE in patients with corectopia after intraocular lens implantation. The large optical zone will compensate for the visual disturbance.

PURPOSE Antibody-drug conjugates (ADCs) are a class of cancer drug wherein some are associated with corneal abnormalities, but there is a dearth of published information on refractive shifts in patients receiving ADCs. Here, we evaluated the dynamics of refractive error and keratometry readings in patients with ADC-related keratopathy and microcyst-like epithelial changes (MECs). METHODS This study is a retrospective case series including 58 eyes of 29 patients with ADC-related keratopathy from a single tertiary care cancer referral center (MSKCC). One eye (29 total) was randomly assigned for statistical analysis. In addition, a subset analysis of MEC location-refractive error correlation was performed on 20 eyes. Clinical records including slitlamp examination, indirect ophthalmoscopy, calculated spherical equivalence (SE), keratometry, and visual acuity were recorded at baseline, during, and off treatment. RESULTS A subset analysis of MEC location-refractive error correlation of 20 eyes revealed the following: Peripheral MECs were significantly associated with hyperopic shifts (P value < 0.001) and paracentral/central associated with myopic shifts (P value < 0.001). In the full cohort and on drug, the greatest change in SE from baseline was myopic (68%, as high as -4.75 D) and hyperopic (32%, as much as +3.75 D). Eighty-nine percent had a change in vision from baseline while on drug, but at the 3-month follow-up off drug, SE and vision returned to baseline in 33% and 82% of eyes. CONCLUSIONS Peripheral MECs were significantly associated with hyperopic shifts, and paracentral/central MECs were associated with myopic shifts. While on drug, most eyes had a myopic refractive shift, which corresponded with corneal steepening.

PURPOSE To determine differences in cycloplegic vs. non-cycloplegic refractive error and factors associated with these differences in Chinese school students. METHOD In this cross-sectional school-based study, refractive error was measured in school students using a NIDEK autorefractor before and after administration of 0.5% tropicamide. Spherical equivalent (SER) in diopters (D) was calculated as sphere plus half cylinder. SER differences before vs. after cycloplegia were evaluated using mean, standard deviation (SD), 95% limits of agreement. Univariable and multivariable regression models were used to determine factors associated with SER differences. RESULTS Among 3604 students, 3450 (95.7%) provided data for analysis. Mean age (SD) was 9.7 (3.6) years. The mean SER (SD) was -1.12 (1.97) D before cycloplegia, and -0.20 (2.19) D after cycloplegia, with a mean difference of 0.92 D (95% limits of agreement: -0.93 to 2.78 D). Among 196 eyes with non-cycloplegic SER -6.0 D or worse (e.g., met high myopia definition), 71.4% had cycloplegic SER -6.0 D or worse, and among 3607 eyes with non-cycloplegic SER -0.5 D or worse (e.g., met myopia definition), 62.1% eyes had cycloplegic SER -0.5 D or worse. Cycloplegic SER was more correlated with axial length than non-cycloplegic SER (Pearson r = 0.82 vs. 0.72, p

The 22q11.2 deletion syndrome (22q11.2DS) is a multisystem disorder with an estimated prevalence of 1:3000 live births. Manifestations show a marked variability in expression and include speech- and language delay, intellectual disability, and neuropsychiatric disorders. We aim to provide an overview of ocular findings in 22q11.2DS in order to optimize recommendations for ophthalmic screening. We combined results from a systematic literature review with results from a multicenter cross-sectional study of patients with 22q11.2DS who were assessed by an ophthalmologist. Our systematic literature search yielded four articles, describing 270 patients. We included 132 patients in our cross-sectional study (median age 8.9 [range 0–56] years). Most reported ocular findings were retinal vascular tortuosity (32%–78%), posterior embryotoxon (22%–50%), eye lid hooding (20%–67%), strabismus (12%–36%), amblyopia (2%–11%), ptosis (4%–6%), and refractive errors, of which hyperopia (6%–48%) and astigmatism (3%–23%) were most common. Visual acuity was (near) normal in most patients (91%–94%). Refractive errors, strabismus, and amblyopia are treatable conditions that are frequently present in patients with 22q11.2DS and should be corrected at an early stage. Therefore, in 22q11.2DS, we recommend ophthalmic and orthoptic screening at the age of 3 years or at diagnosis, and a low-threshold referral in adults.

CLINICAL RELEVANCE Nunavik Inuit patients, in Northern Canada, have a significant burden of refractive error. The frequency at which they access eye care is insufficient. This exposes children of this population to a substantial risk of refractive amblyopia. BACKGROUND No data are available on eye health and services among Nunavik Inuit in Quebec, Canada. This study aims to describe the prevalence of ametropias, risk of refractive amblyopia, and eye health services uptake amongst a sample of Nunavik Inuit. METHODS Retrospective cohort using data from electronic records of the sole government-contracted eye team travelling to all 14 Nunavik villages, from 2006 to 2018. RESULTS Some 26,541 examinations were analysed, with data from 6,341 patients (median age 27 years (IQR 30); 32% aged under 19 years; 60.3% female) representing 48% of the census population. Population weighted prevalence of ametropias was myopia 46.5% (95% CI 45.3 - 47.6), hyperopia 17.1% (95% CI 16.2 - 18.1), astigmatism 39.6% (95% CI 38.4 - 40.8) and presbyopia 30.0% (95% CI 28.9 - 31.0). Some 5.9% of patients aged 0-9 years present a risk of refractive amblyopia. Mean frequency of examinations for all ages was once per 4 years (95% CI 4.0 - 4.0) and for children aged 5 - 19 years, frequency was once per 4.8 years (95% CI 4.8 - 5.0). In 2018, 74% of patients who were prescribed spectacles purchased them, with a median time of procurement of 21 days (IQR 247, skewness 2.7). CONCLUSION There is a high prevalence of ametropias amongst the clinical population of Nunavik Inuit. Most patients needing spectacles obtain them within a few weeks. Frequency of eye health services is insufficient to meet recommended guidelines, especially in children, for whom the risk of refractive amblyopia is pervasive.