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Purpose: Visual impairment (VI) in working-age individuals significantly impacts public health and the economy. However, the avoidable causes, defined as cataract and refraction disorders, have not been extensively investigated. This study aims to quantify global trends, inequalities, and projections for avoidable VI among this demographic., Design: Retrospective, observational, population-based trend study., Methods: We derived data on avoidable VI prevalence and population size data in working age from the Global Burden of Disease (GBD) 2021 study. We employed the joinpoint regression analysis to assess trends from 1990 to 2021 by age, sex, sociodemographic index (SDI), type, and severity at the global, regional, and national levels. Cross-country inequalities were evaluated using the slope index of inequality and the health inequality concentration index. Subsequently, we performed Bayesian age-period-cohort modeling to estimate the avoidable BVL burden in working age by 2040., Results: The prevalence of avoidable VI in working age decreased overall from 1990 to 2021, driven primarily by reductions in refraction disorders, with an average annual percentage change (AAPC) of -0.15 (95% confidence interval [CI], -0.18 to -0.12; P<0.001). We observed significant declines in severe vision loss and blindness, while moderate vision loss remained stable. Females exhibited a heavier burden of avoidable VI, but showed slower improvement compared to males. Socioeconomic disparities persisted, with lower SDI regions bearing a disproportionate burden, whereas the high SDI region showed an unfavorable increasing trend. From 1990 to 2021, the inequality slope index increased from 574.45 (95% CI, 914.95 to 233.95) to 652.27 (95% CI, 932.95 to 371.58), while the health inequality concentration index improved from -0.21 (95% CI, -0.26 to -0.17) to -0.17 (95% CI, -0.2 to -0.14). We project a continued decline in the global prevalence of avoidable working-age VI, but a 23.4% increase in avoidable VI cases by 2040, reaching approximately 146 million., Conclusions: Despite overall declines in avoidable VI among working-age individuals, significant improvement opportunities and disparities persist. The anticipated increase in avoidable VI cases necessitates integrated eye health strategies, substantial investment in eye care services to enhance accessibility and affordability, and fair employment policies for the visually impaired., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Twin studies, in the background of lack of twin registry in India, are a challenge. We report the response rates in tracing a hospital birth register-based cohort of twins using mail and door to door survey, ocular parameters influencing refractive errors, and their heritability., Methods: Twins born from 1991 to 1995 in a tertiary hospital in the Vellore District of South India from a database were traced by mail and home survey from March 2011 to September 2013. Consenting live twin pairs who presented to the eye department were examined, including best corrected visual acuity, cycloplegic refraction, slit lamp examination, measurements of intraocular pressure (IOP) by Goldmann Applanation tonometry, axial length (AL) and anterior chamber depth (ACD), central corneal thickness (CCT), specular microscopy for endothelial count (EC), and a dilated fundus examination. Zygosity was determined by a validated zygosity questionnaire. Heritability was determined using the Falconers formula., Results: Postal contact was made in 14%, and a home visit was successful in another 23% of the cohort. Of those presenting for examination, 51.3% were found to be monozygous. Heritability (h 2 ) of IOP was 0.34, that of ACD was 0.88, that of AL was 0.92, that of CCT was 0.96, and that of EC was 0.58., Conclusion: Tracing of twins using postal and home visits is challenging. Heritability for AL and CCT was found to be high, similar to that reported in other studies. This implies that a large proportion of variation found in AL and CCT is due to genetic causes as seen in twins from South India., (Copyright © 2024 Indian Journal of Ophthalmology.)

Clinical Relevance: Knowledge of contact lens prescribing trends can (a) assist practitioners to benchmark their own prescribing habits, (b) help the contact lens industry understand preferred products, and (c) support academics in scholarly writings., Background: This work aims to document contact lens prescribing trends in Australia over the past quarter of a century., Methods: An annual survey of contact lens prescribing trends was conducted in Australia each year from 2000 to 2024, inclusive, by asking optometrists to provide information relating to 10 consecutive contact lens fits undertaken between January and March., Results: Over the 25-year survey period, a total of 20,281 contact lens fits were reported. Lens wearers were 34.4 ± 14.7 years of age and 65% were female. Over the survey period, rigid lenses increased from 13% to 21% of all lens fits. Of all soft lens fits, silicone hydrogel lenses increased from 22% to 96%; soft torics increased from 24% to 30%; daily disposables increased from 7% to 63%; soft extended wear decreased from 16% to 5%; multifocals increased from 5% to 26%; and myopia control (first fit in 2011) reached 3% by 2024. Rigid lens extended wear (primarily orthokeratology) increased from 0.3% to 17% of rigid lens fits, primarily for myopia control. Multi-purpose lens care solutions are ubiquitous, and peroxide systems are seldom prescribed. Rigid lenses and monthly replacement soft lenses are largely worn full time, whereas daily disposables are worn full time and part time in equal measure. Australian and global prescribing trends are broadly consistent., Conclusions: Contact lens fitting trends this century can be characterised as: soft lenses - significant increase in silicone hydrogels, daily disposables, torics and multifocals; rigid lenses - dominance of high-Dk materials, and recent resurgence in scleral and orthokeratology fits. There is little extended wear fitting. Multi-purpose care systems are ubiquitous.

Purpose: The aim of this study was to investigate, using a power vector approach, whether corneal astigmatism follows a mirror symmetry pattern considering both the magnitude and axis, and whether age, sex and spherical equivalent refractive error can influence the pattern., Methods: The IOLMaster 700 optical biometer was used to measure the radii of curvature of the anterior corneal surface. Refractive error was determined by non-cycloplegic subjective refraction. Descriptive statistical analyses and inferential logistic regression were applied over the dichotomous variable of mirror symmetry using J 0 and J 45 power vector components. An evaluation was carried out based on the subject's age, sex and spherical equivalent refractive error., Results: A total of 2974 Caucasian adults were evaluated. This cross-sectional study revealed that axis orientation follows the isorule symmetry pattern, and in terms of both magnitude and axis orientation, mirror symmetry was present in 70.9% of cases. Age, sex and spherical equivalent refractive error were not significant factors and did not contribute to the clinical improvement of the model despite its statistical significance (refractive error, p = 0.001; age and sex, p = 0.23 and 0.36, respectively)., Conclusions: Among an adult Caucasian population, the prevalence of corneal astigmatism mirror symmetry was 70.9% and isorule symmetry was the most common pattern considering axis orientation only. The inclusion of age, sex and spherical equivalent refractive error did not improve the model., (© 2024 The Author(s). Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Clinical Relevance: Near Vision Impairment (NVI) is common in developing countries. A substantial proportion of NVI can be addressed by providing spectacles. Innovative eye care programmes are needed to address NVI. Population-based epidemiological studies can provide vital data to plan such eye care service delivery models., Background: To report the prevalence of NVI and effective Refractive Error Coverage (eREC) for near vision in West Godavari and Krishna districts in Andhra Pradesh, south India., Methods: A population-based cross-sectional study was carried out using a Rapid Assessment of Visual Impairment methodology. Presenting and pinhole distance visual acuity were assessed followed by near vision assessment using a N notation chart at a fixed distance of 40 cm. If the presenting near vision was worse than N8, the best corrected near visual acuity was recorded with age appropriate near vision correction. NVI was defined as presenting near vision worse than N8 among those without distance vision impairment (6/18 or better in the better eye). Effective Refractive Error Coverage for near was calculated as the proportion of individuals with an adequate correction to the total participants, including those with inadequate, adequate, and no correction for near vision., Results: Data of 2,228 participants aged ≥40 years were analysed. The mean age of these participants was 54.0 ± 10.4 years; 53.8% were women; 44.5% had no formal education. The prevalence of NVI was 27.1% (95% CI: 25.2-29.0%). NVI significantly associated with 70 and above age group (adjusted OR: 1.97; 95% CI: 1.45-3.70). Participants with formal education had lower odds for NVI (adjusted OR: 0.75; 95 % CI: 0.68-0.83). The eREC for near vision was 48.0%., Conclusion: NVI affects over a quarter of people aged ≥40 years in the West Godavari and Krishna districts of Andhra Pradesh. However, eREC is under 50% and there is scope for improving this by establishing eye care services to achieve universal eye health for all.

Purpose: To estimate the prevalence of amblyopia and refractive errors among 6-year-old children in Greenland and to assess the impact of incorporating autorefraction, stereoacuity and near visual acuity testing into vision screening., Methods: In this cross-sectional study, 517 children (238 girls and 279 boys) from 21 locations in Greenland were screened using HOTV charts for distance and near visual acuity (VA), stereoacuity test and non-cycloplegic autorefraction. Referral criteria for further ophthalmological examination included a VA of ≥0.2 logMAR on the worse-seeing eye or an interocular VA difference of ≥2 lines., Results: Initial screening identified amblyopia (defined as VA of ≥0.3 logMAR) in 7% (unilateral) and 3% (bilateral) of children. However, subsequent ophthalmological examinations confirmed amblyopia in under 40% of referrals. Significant interocular VA differences were found in 9%. The prevalence of refractive errors at the screening was 3% for myopia (≤-0.5 dioptres), 10% for hyperopia (>+2.0 dioptres) and 14% for astigmatism (≤-1.00 dioptres), while the corresponding prevalences at the ophthalmological examination were 4% for myopia, 8% for hyperopia and 6% for astigmatism. Combining screening measurements increased the positive predictive values, thereby enhancing screening accuracy. Specifically, the incorporation of autorefraction or stereoacuity with distance VA demonstrated to be the most effective combination. Six percent of the children were prescribed glasses after the screening procedure., Conclusion: This study provides the first visual profile of Greenlandic schoolchildren. Incorporating autorefraction, stereoacuity and near visual acuity in vision screenings enhanced the efficacy of detection of vision anomalies. Although this may lead to more false positives, accurate screening is crucial in regions with limited ophthalmological resources., (© 2024 The Author(s). Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To evaluate the progress in Qatar's eye care since 2009, focusing on effective cataract surgical and refractive error coverages, leading to enhanced eye health strategies and action plans., Methods: A modified Rapid Assessment of Avoidable Blindness (RAAB) survey was employed using multi-stage sampling in all persons 50 years and older in Qatar. The study focused on uncorrected refractive errors, cataract surgery coverage and effectiveness, and visual acuity assessment., Results: There were 339 individuals out of 3,206 examined participants who underwent cataract surgery, out of which 66.1% of 559 operated eyes obtained good post-operative outcomes (presenting visual acuity ≥ 6/12). Age -sex - adjusted eCSC for a cataract surgical threshold < 6/12 was 61.2% (95%CI 54.9-67.4). A poor post-operative outcome (presenting visual acuity < 6/60) was observed in 9.3% of all operated eyes, lower than the 14.9% reported in 2009. Cataract surgical coverage at the 6/18 threshold showed good coverage (94%) improving since 2009 (87%). Effective refractive coverage (eREC) was 74.3% (95%CI 70.9-77.7). Effective coverage of both services was lower among Qatari women compared to other population groups., Conclusion: Qatar's CSC improved since the 2009 RAAB, but there are disparities in effective coverage based on gender and nationality. WHO set a global target to achieve a 30%-point increase in eCSC and a 40%-point increase in eREC by 2030; accordingly, Qatar's targets should be 91.2% and 100% retrospectively by 2030. To meet these targets, efforts are needed to improve the quality of cataract surgery and access to refractive correction., Competing Interests: Declarations. Ethics approval: The study received ethical approval from the ethical committee of Primary health care corporation. Qatar (Ref. PHCC/DCR/2022/04/023). While the majority of participants provided written consent during their visits to health centers, 7 participants were severely ill and bedridden. These participants were chosen randomly, and their legal guardians accepted their participation in the study, signing the consent forms during home visits. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objectives: This study aimed to describe the temporal trends in the prevalence and disability-adjusted life years (DALYs) of refractive disorders (RD) in China and globally from 1990 to 2021 and provide predictions in China for the next decade., Methods: Utilizing open data from the Global Burden of Disease database (2021), this study conducted a comprehensive comparative analysis of the RD burden in China and globally, including changes in prevalence and DALYs. Joinpoint regression was employed to calculate the annual percentage change, the average annual percentage change, and its corresponding 95% confidence interval to reflect segmented trends in RD burden. The APC model was used to assess the net effects of age, period, and cohort. The ARIMA model was applied to predict future trends., Results: The temporal trend of the health burden of RD in China aligned with the global trend, though the magnitude of change was greater, and the gap between the two had been narrowing recently. In China, the age-standardized DALYs rate for the total population (per 100,000 population) decreased from 74 in 1990 to 66 in 2021 and was projected to fall to 29.43 by 2031. The age-standardized prevalence rate for the total population (per 100,000 population) was expected to decrease to 411.23 by 2031, down from 1568 in 1990 to 1468 in 2021. However, the number of cases and the crude rates of prevalence and DALYs exhibited upward trends. In terms of age-specific rates, older adults exhibited higher prevalence and DALYs rates than younger adults. Regarding gender stratification, females had higher prevalence and DALYs rates than males., Conclusion: The age-standardized rates of prevalence and DALYs for RD have decreased in recent years and may continue to decline over the next decade. However, the crude rates of prevalence and DALYs are on the rise. The health burden of RD remains substantial, with females and the older population bearing a higher burden than males and younger populations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Lai, Xia and Wang.)

Prematurity can lead to various ocular conditions, including strabismus, refractive errors, amblyopia, and cataracts. However, comprehensive data on these outcomes in preterm Thai infants is limited. This study aimed to investigate the incidence of retinopathy of prematurity (ROP) and assess long-term ocular sequelae, such as cataracts, refractive errors, strabismus, and amblyopia, among preterm infants at Phramongkutklao Hospital. A retrospective review of medical records was conducted for premature infants screened for ROP between January 2011 and April 2022. Data were collected at birth, and follow-up visits were analyzed at 6 months, 1 year, and 2 years of age. The primary outcomes included the incidence of ROP and the prevalence of long-term ocular sequelae. A total of 308 preterm infants were included in the study. The incidence of ROP was found to be 31.5%. At the 2-year follow-up, the prevalence of cataracts was 0.65%, strabismus 14.4%, and amblyopia 6%. Refractive errors were observed in 51.8% of the infants, with 18.1% showing myopia and 33.7% hyperopia. Logistic regression analysis indicated that delayed growth and development (adjusted odds ratio = 13.28, 95% confidence interval: 1.83-96.68) and amblyopia (adjusted odds ratio = 19.65, 95% confidence interval: 2.85-135.54) were significantly associated with an increased risk of developing strabismus, after adjusting for confounding factors. The study identified an ROP incidence of 31.5% in the preterm cohort. At 2 years, long-term ocular sequelae included a prevalence of cataracts (0.65%), strabismus (14.4%), amblyopia (6%), and refractive errors (51.8%). Delayed growth and development, along with amblyopia, were found to elevate the risk of strabismus development significantly., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: To estimate the prevalence and demographic characteristics of uncorrected refractive errors (URE) in people who attended eye care consultations in Colombia between 2015 and 2019, using the National Health Registry data., Methods: We identified ICD codes for myopia (H-52.1), degenerative myopia (H-44.2), hyperopia (H-52.0), and astigmatism (H-52.2) from the Integrated Social Protection Information System. Crude prevalence rates by age and sex were calculated for the population attending eye care services during these years. Additionally, we developed a standardized morbidity map across county departments., Results: In Colombia, the prevalence of URE among eye care consultations was 30.26%, increasing from 30.39% in 2015 to 35.14% in 2019. Of the 1,579,778 cases analyzed, 60.9% were females. Astigmatism emerged as the most prevalent URE, predominantly seen in individuals under 40 years old. Myopia showed the highest prevalence in the 10-30 age group, whereas hyperopia was most prevalent in the first decade of life. Geographically, the Andean region recorded most of URE cases, while more remote areas have seen a rising morbidity risk in recent years., Conclusions: The rising trend of URE in Colombia and its demographic and geographical variations underscores the urgent need for health professionals and government authorities to acknowledge and address this issue. This study provides crucial insights into the refractive error landscape across the country, highlighting the necessity for prevention programs specifically designed to cater to the country's unique needs.

Purpose: The relationship between refractive error at age 1 and the risk of developing amblyopia or accommodative esotropia, and the protection offered by early glasses, is unknown. These are determined in the Early Glasses Study, a prospective, population-based, longitudinal, randomized controlled study. We report baseline findings., Methods: Healthy children aged 12-18 months were recruited at Children's Healthcare Centres (CHCs) and received an entry orthoptic examination followed by cycloplegic retinoscopy. Children with amblyopia, strabismus, ophthalmic disease or very high refractive error were excluded. Those exceeding the AAPOS 2003 Criteria (> + 3.5D spherical equivalent (SE), > 1.5D astigmatism, > 1.5D anisometropia) were randomized into wearing glasses or not, and are followed-up by research orthoptists. Other children are followed-up by regular vision screening at CHCs and visual acuity is measured in all children at age 4., Results: Parents of 865 children were called, 123 were excluded. Of 742 children enrolled, 601 underwent the entry orthoptic examination at age 14.5 ± 1.7 months. Mean SE was + 1.73 ± 1.18D, astigmatism -0.70 ± 0.44D, anisometropia 0.21D (IQR: 0-0.25). Of 62 (10.3%) children exceeding the Criteria, 52 were randomized into wearing glasses or not. Of 539 other children, 522 are followed up at CHCs. In total, 31 were excluded: 2 had strabismus and amblyopia, 7 strabismus, 2 amblyopia suspect, 1 strabismus suspect, 1 squinting during sinusitis, 4 excessive refractive error, 9 myopia, 2 ptosis, 1 oculomotor apraxia, 1 Duane syndrome, 1 congenital nystagmus., Conclusion: Prevalence of strabismus (10/601) was as expected, but prevalence of amblyopia (2/601) was low, suggesting that common amblyopia develops later than generally thought., Key Messages: What is known High refractive errors cause amblyopia, but no study has determined the exact relationship between the kind and size of refractive error at age 1 and the risk to develop amblyopia, and assessed the protective effect of glasses in a controlled, population-based, longitudinal study. What is new At baseline, 601 children received a full orthoptic examination followed by retinoscopy in cycloplegia at the age of 14.5 ± 1.7 months; 10.3% had high refractive error exceeding spherical equivalent > + 3.5D, > 1.5D astigmatism, > 1D oblique astigmatism or > 1.5D anisometropia. The prevalence of amblyopia was lower (0.3%) than expected, suggesting that most amblyopia develops after the first year of life. The prevalence of anisometropia, associated with amblyopia in older children, was low (0.8%)., Competing Interests: Declarations. Ethics approval: The study was approved by the Medical Ethics Review Committee (MERC) of the Erasmus University Medical Center on April 30th, 2021, and was carried out in accordance with the ethical conduct and juridical laws laid down in the Declaration of Helsinki, version 2013. Consent to participate: All parents of enrolled children were required to provide written consent by both parents or legal representative or guardian prior to the Entry Orthoptic Examination. Consent for publication: Not applicable, all data is presented anonymously. Conflict of interest: The authors have no relevant financial or non-financial interest to disclose., (© 2024. The Author(s).)

Purpose: Quality-of-care in refractive error services is essential, as it directly affects vision outcomes, wellbeing, educational attainment, and workforce participation. In Cambodia, uncorrected refractive error is a leading cause of mild and moderate vision impairment in adults. We evaluated the quality of refractive error care in Cambodia by estimating the proportion of prescribed and dispensed spectacles appropriate for people's refractive error needs and factors associated with spectacle quality., Methods: A cross-sectional protocol was employed with 18 Khmer-speaking adult participants observing testing procedures in 156 optical services across six provinces in 2022. A total of 496 dispensed spectacles were assessed against spectacle quality indicators., Results: The analysis revealed that 35.1% of dispensed spectacles were of optimal quality. The most common error observed in sub-optimal spectacles was the presence of horizontal prism outside of tolerance limits. The study also found that 44.0% of emmetrope visits involved unnecessary prescription spectacle recommendations, and 18.3% of written prescriptions did not correspond with dispensed spectacles. Sex differences were observed, with men predominantly providing refractive error care and women more likely to be unnecessarily recommended prescription spectacles., Conclusion: The findings highlight the importance of prioritizing quality-of-care in refractive error services. A key recommendation is to consider regulatory mechanisms to ensure optical services employ appropriately qualified staff. Additionally, efforts should be made to eliminate unnecessary prescriptions -- especially for emmetropes and females -- standardize written prescriptions, ensure consistent pupil distance measurements, reduce reliance on autorefraction, and address the gender imbalance in the refractive error workforce.

Background: Uncorrected refractive error is reported to be the most common cause globally of vision impairment in school age children. However, little is known about the extent of uncorrected refractive error in Israel. The purpose of this study was to investigate the prevalence of vision impairment in schoolchildren recruited for the Israel Refraction, Environment, And Devices (iREAD) Study., Methods: Healthy boys, ages 5-13 years, were recruited to participate in the iREAD Study. Parents first answered a questionnaire to exclude children with a known history of amblyopia, strabismus, or hyperopia. A comprehensive eye exam was then performed. Presenting visual acuity < 6/12 was defined as vision impairment. Myopia and hyperopia were defined as cycloplegic spherical equivalent refraction  ≤ - 0.50 D, and ≥  + 0.50 D, respectively, and astigmatism as ≤ - 0.75 D. Amblyopia was defined as best corrected visual acuity ≤ 6/12 in at least one eye in the absence of any ocular pathology. Descriptive statistics were used to calculate the prevalence of each refractive error and amblyopia., Results: Two hundred five boys (average age 8.8 ± 1.7 years) presented for a comprehensive eye exam. The prevalence of vision impairment at initial presentation was 22.9% (N = 47), with 16.1% (N = 33) and 6.8% (N = 14) for both eyes and one eye, respectively. Of the children with vision impairment, 36.2% (N = 17) were wearing habitual correction. Of the children with vision impairment, 97.9% (N = 46) had refractive error, with 85.1% (N = 40) being myopic and 12.8% (N = 6) being hyperopic. In addition, 36.2% (N = 17) with vision impairment had astigmatism. Most children with vision impairment (N = 43) achieved good vision with refractive correction. However, amblyopia was observed in 2.0% (N = 4) of the children., Conclusions: A high prevalence of vision impairment was observed, primarily due to uncorrected or undercorrected refractive error. Children with amblyopia and/or hyperopia presented despite a parent questionnaire to exclude children with these conditions. Findings suggest that many parents are unaware of their children's visual and refractive status, even for children who already have glasses. In conclusion, improvements to the current system in Israel of vision screenings in first grade should be made to help insure children in need receive adequate follow-up throughout their education., Competing Interests: Declarations. Ethics approval and consent to participate: Informed consent was obtained from all subjects and/or their legal guardian(s). The study was approved by the ethics committee of Hadassah College and followed the tenets of the Declaration of Helsinki (approval #387). Consent for publication: Not applicable. Competing interests: All Authors declare that there is no conflict of interest., (© 2025. The Author(s).)

Purpose: To examine the prevalence and associations of anisometropia with spherical ametropia, cylindrical power, age, and sex., Methods: Anisometropia was analyzed for subjective refraction. In total, 134,603 refractive surgery candidates were included in the period from 2010 to 2020 at the CARE Vision Refractive Centers in Germany. Our study was approved by the local ethics committee at the University in Duesseldorf (approval date: February 9, 2021) and conducted according to the tenets of the Declaration of Helsinki and Good Clinical Practices Guidelines. The treatment contract included explicit patient consent to use medical data for scientific purposes. Correlations between anisometropia and explanatory variables were analyzed using the chi-squared test (χ2 test), nonparametric Kruskal-Wallis or Mann-Whitney U-tests, and binomial logistic regression. Power vector analysis was applied for further analysis of cylindrical power., Results: The median level of anisometropia (Asubj) in the whole population was 0.38 D. The prevalence of Asubj was 17.9%. In hyperopes, all explanatory variables (spherical ametropia, cylindrical power, age, sex) were independently associated with anisometropia. Asubj decreased with increasing cylindrical ametropia: an increase in cylindrical power by 7.8 D reduced the chance of observing anisometropia by half. It was also associated with male sex. Asubj decreased by half with a 16.7 D increase in spherical power and an increase in age by 22.7 years. In myopes, cylindrical power was most strongly associated with anisometropia: an increase in (negative) cylindrical power by 2.15 D doubled the chances of observing anisometropia in myopes. In addition, advancing age (double chance with an increase of 38.3 years), increasing spherical power (double chance with an increase of 8.15 D), and female sex correlated positively with increasing anisometropia in myopes., Conclusions: This retrospective analysis gives evidence for the independent association between anisometropia and spherical power, cylindrical power, age, and sex in myopic refractive surgery candidates. The relation of anisometropia with age was positive in myopes but negative in hyperopes. The analysis of sex revealed a positive relation of female sex and anisometropia in myopes and furthermore revealed a positive relation of male sex and anisometropia in hyperopes. Further clinical research into the underlying mechanisms behind our findings is indicated., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Deuchert et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Vision screening programs can provide epidemiological information regarding visual impairment in children. This study aims to report the characteristics of visual abnormalities diagnosed through the Primary School Nurse Health Readiness Program (PSNHRP) in Queensland, Australia., Methods: A retrospective review of vision screening records from the PSNHRP between January 2017 and December 2020 was undertaken. Children aged between 4 and 7 who underwent vision screening were included for review. Children with a visual acuity of worse than 6/9-1 using the Parr 4 m letter-matching chart or those who failed the SPOT Vision Screener were referred to an optometrist or ophthalmologist for review., Results: 164 890 children underwent vision screening. 12148 children failed visual screening (7.4%) and were referred for an eye assessment. 6011 (69.4%) of the 8659 children who attended ophthalmic review had a confirmed visual abnormality. Of 164 890 screened children, 1187 (0.72%) were confirmed to have anisometropia, 3843 (2.33%) had refractive error, 194 (0.12%) had strabismus, 755 (0.46%) had anisometropic amblyopia, 136 (0.08%) had strabismic amblyopia, and 1356 (0.82%) had an unspecific abnormality. There was no statistically significant difference in the age at screening between any visual abnormality (p = 0.94). Anisometropia, refractive error, and strabismus were significantly more common in females than males (p = 0.03, p < 0.01, and p = 0.03 respectively), whereas anisometropic amblyopia was more common in males (p < 0.01)., Conclusions: We report the prevalence of visual abnormalities detected through the PSNHRP vision screening program. Identification of medical or socioeconomic risk factors that are likely to be associated with visual abnormalities can help to optimise vision screening programs., (© 2024 The Author(s). Clinical & Experimental Ophthalmology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Ophthalmologists.)

Purpose: This study investigated the occurrence of keratoconus among first-degree relatives of patients with keratoconus and evaluated their refractive characteristics., Method: A cross-sectional observational study was conducted on 248 relatives of 52 patients with keratoconus in whom bilateral eye analysis was conducted. Corneal tomography was performed for all participants with a comprehensive analysis of various parameters, including K1, K2, Kmax, elevation, skewing, and thinnest location. In addition, the following data were also analyzed: uncorrected visual acuity, corrected distance visual acuity, refraction measurements alongside a slit-lamp examination, and fundus examination., Results: Among 248 participants, 19 (7.7%) had keratoconus, 3.2% had forme fruste, and 15.3% had suspected keratoconus. Among all studied cases, 73.8% had normal corneas. Significant differences ( P = 0.001) were found in the distribution of keratoconus prevalence among brothers, mothers, sons, and sisters (13.6%, 4.3%, 5.6%, and 12.1%, respectively). The presence of refractive errors also showed significant differences between the relatives ( P = 0.03)., Conclusions: Increased keratoconus prevalence among relatives of patients with keratoconus indicates the vulnerability of this population to the development of the disease, necessitating early screening of this group for detection of keratoconus as early as possible., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

NAA10-related (Ogden syndrome) and NAA15-related neurodevelopmental syndrome are known to present with varying degrees of intellectual disability, hypotonia, congenital cardiac abnormalities, seizures, and delayed speech and motor development. However, the ophthalmic manifestations of NAA10 and NAA15 variants are not yet fully characterized or understood. This study analyzed the prevalence of six ophthalmic conditions (cortical visual impairment, myopia, hyperopia, strabismus, nystagmus, and astigmatism) in 67 patients with pathogenic (P) or likely pathogenic (LP) variants in the NAA10 cohort (54 inherited, 10 de novo; 65 missense, 2 frameshift) and 19 patients with (L)P variants in the NAA15 cohort (18 de novo; 8 frameshift, 4 missense, 4 nonsense, and 1 splice site). Patients were interviewed virtually or in-person to collect a comprehensive medical history verified by medical records. These records were then analyzed to calculate the prevalence of these ophthalmic manifestations in each cohort. Analysis revealed a higher prevalence of ophthalmic conditions in our NAA10 cohort compared to existing literature (myopia 25.4% vs. 4.7%; astigmatism 37.3% vs. 13.2%; strabismus 28.4% vs. 3.8%; CVI 22.4% vs. 8.5%, respectively). No statistically significant differences were identified in the prevalence of these conditions between the NAA10 and NAA15 variants. Our study includes novel neuroimaging of 13 NAA10 and 5 NAA15 probands, which provides no clear correlation between globe size and severity of comorbid ophthalmic disease. Finally, anecdotal evidence was compiled to underscore the importance of early ophthalmologic evaluations and therapeutic interventions., (© 2024 The Author(s). American Journal of Medical Genetics Part A published by Wiley Periodicals LLC.)

Background: One of the major causes of reversible visual impairment is a refractive error, which can be corrected through refractive surgery. Data regarding the outcomes and complications of these procedures exist; however, there is a notable gap in understanding the factors leading to patient rejection, particularly in diverse populations like Israel., Objectives: To detect clinical risk factors of patients who intend to undergo LASIK procedure and to improve the conversion rates of LASIK procedure in this population., Methods: The study included a retrospective analysis of patients who were rejected from having refractive surgery in two Enaim Refractive Surgery Centers: Jerusalem and Tel Aviv. Comparisons between centers were conducted using the t-test for continuous variables and Fisher's exact test for categorical data., Results: Our study included 337 patients who were rejected from having refractive surgery, including 152 (45.1%) who were rejected permanently and 185 (54.9%) rejected temporarily. The most common reasons for permanent rejection were corneal irregularity (n=81, 53.3%), keratoconus (n=27, 17.8%), thin corneas (n=13, 8.6%), and amblyopia (n=10, 6.6%). The most common temporary reasons were unstable refraction (n=96, 51.9%), prolonged use of contact lenses (n=54, 29.2%), and corneal irregularity (n=16, 8.6%)., Conclusions: The leading permanent cause of rejection for refractive surgery was a corneal irregularity, whereas the primary temporary cause was unstable refraction. In a time of rapid technological advancements and growing demand for freedom from glasses, there is an increasing need for more informed and patient-focused refractive correction approaches.

Purpose: Trigonocephaly is associated with suboptimal visual outcomes in young children. However, the presence of orthoptic abnormalities after completed visual development remains unknown. The purpose of this study is to assess the prevalence of orthoptic abnormalities in trigonocephaly patients, after completed visual development., Methods: A retrospective study among non-syndromic trigonocephaly patients aged 8 years and older was conducted at the Dutch Craniofacial center. Ophthalmologic records were reviewed for refractive errors and a history of strabismus and amblyopia. Refractive errors were classified as follows: myopia: spherical equivalent (SE) ≤ -0.50 diopters (D), emmetropia: SE -0.50 D to + 0.50 D, hyperopia: ≥ + 0.50 D, astigmatism: cylinder error ≥ 1.00 D. The history of strabismus and amblyopia was assessed retrospectively. Prevalence and cumulative incidence of these abnormalities in healthy age-matched populations were retrieved from literature., Results: We included 78 trigonocephaly patients with a median (interquartile range) age of 10.0 (9.0-12.0) years. Thirty-four (43.6%) of these patients presented with a refractive error after the age of 8 years. Specific findings in these 78 patients versus controls were hyperopia in 35.9% vs 8.4%; myopia in 6.4% vs 11.4%; astigmatism in 20.5% vs 11.9%; strabismus in 14.1% vs 2.65%; amblyopia in 6.4% vs 3.4%., Conclusions: Trigonocephaly patients have a two-to-threefold higher risk of hyperopia, astigmatism, amblyopia, and strabismus, as compared to healthy populations. We recommend screening and, in case of abnormalities, regular follow-up before completed visual development. In addition, we recommend long-term surveillance of visual functioning by a pediatric ophthalmologist and/or orthoptist., Competing Interests: Declarations. Ethical approval: This study was exempted from review by the relevant institutional review boards (MEC-2016–312) in view of the retrospective nature of the study and the procedures being performed were part of the routine care. Conflict of interest: There are no conflicts of interest in relation to the materials or subject matter dealt with in this article., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Ophthalmic quality of life (OQoL) has been investigated in selected parts of general populations and in patients with ocular disease, but OQoL in unselected general populations has not been studied in detail. The present study reports OQoL obtained from a representative sample of the adult Danish population 2020-2022., Methods: The FORSYN study invited 10 350 citizen representatives for the adult Danish population for a non-mydriatic eye examination and answer the National Eye Institute Visual Function Questionnaire with 39 items in the validated Danish translation. The results from the 3384 (32.7%) persons who participated in the study were weighted on the basis of relevant socio-economic factors, and data were projected to represent the total population. Binocular visual acuity was below 0.1 corresponding to legal blindness in 0.22% of this population., Results: OQoL was positively correlated with binocular visual acuity up to better than 93 ETDRS letters, negatively correlated with age for persons younger than 60 years of age and again positively correlated with age for persons older than 60 years. OQoL was negatively correlated with increasing ametropia and refractive error above 1 dioptre and encompassed more OQoL parameters for hyperopic than for myopic persons., Conclusions: The study underlines the benefits of improving visual acuity even within the normal range and of adjusting uncorrected refraction errors in the general population. OQoL is positively correlated with age in older persons independently of visual acuity, sex, refractive power and previous cataract surgery., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The purpose of this study was to examine the association between refractive errors and common chronic diseases using blood biochemistry tests, and to investigate the associated modifiable risk factors, with the goal of informing and developing effective preventive strategies., Methods: A total of 116,245 participants with refractometry at baseline enrolled in the UK Biobank were included in this prospective cohort study. Restricted cubic spline and Cox proportional hazards models were used to detect associations between refractive error, blood biochemistry tests, and common chronic diseases. Interaction effects on the additive scale and effect modification analysis were used to explore excess modifiable risk factors for disease prevention., Results: Spherical equivalent significantly associated with vitamin D, sex hormone binding globulin, apolipoprotein A, blood glucose, and aspartate aminotransferase levels. Subjects with myopia demonstrated a 13% higher risk of type 2 diabetes mellitus (T2DM) incidence compared to those without myopia (hazard ratio [HR] = 1.13, 95% confidence interval [CI] = 1.08-1.19) throughout a median follow-up of 9.12 years. Interaction analysis revealed 15% (95% CI = 9%-21%) of this risk was due to myopia-obesity interaction. However, active engagement in physical activity could potentially mitigate this risk (HR = 1.06, 95% CI = 0.93-1.20)., Conclusions: Refractive errors were associated with specific blood indicators, particularly noting the association between myopia and higher T2DM incidence in middle-aged and elderly populations. This effect interacts with obesity, and promoting physical activity among myopia individuals provides greater benefits in the prevention of T2DM compared to non-myopic individuals.

Purpose: Visual and motility disorders have been reported in cases of syndromic and non-syndromic craniosynostosis. However, to the best of our knowledge, no regional or local studies have addressed the prevalence of ocular manifestations in craniosynostosis among Middle Eastern populations. The purpose of this study was to describe the frequency and nature of ophthalmic abnormalities in Arab children with craniosynostosis and to evaluate these findings pre- and post-craniofacial surgery., Materials and Methods: A prospective cohort study of 31 children with craniosynostosis. Demographic information was gathered along with genetic results and ophthalmic evaluations, including cycloplegic refraction., Results: Age at presentation to the ophthalmology service ranged from 14 months to 8 years, with a median of 3 years. Sixteen patients were female (52%), and 24 patients had undergone a cycloplegic refraction. Of these, 20.8% had significant refractive errors; of those with refractive errors, 40% were myopic and 60% were hyperopic. Eight patients (25.8%) had papilledema, with significant improvement after craniofacial surgery. Five patients (16%) had visual acuity≤20/30 in at least one eye at baseline with improvements in follow-up visits., Conclusion: Craniosynostosis has a significant impact on visual function in the Arab population. Potentially correctable cases of visual impairment, such as those caused by amblyogenic refractive error and papilledema, are commonly encountered; therefore, timely referral and regular ophthalmic evaluation are recommended for these patients., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: Comprehensive research on the impact of various types of refractive errors (RE) and anisometropia on dry eye disease is still lacking. This study aimed to estimate the prevalence rates and potential lifestyle factors related to symptomatic dry eye (SDE) among adolescents in eastern China., Methods: A cross-sectional study was performed in 2023, and a stratified cluster sampling technique was used among adolescents in Nantong, China. Demographic information, including sex, age and BMI, were collected. All participants underwent optometric tests, while Ocular Surface Disease Index (OSDI) and self-designed questionnaires were administered. Both univariate and multivariate logistic regression analyses were used to assess associations between SDE and related parameters, and various types of RE and anisometropia were also included in the study., Results: A total of 1,518 participants were enrolled in the study, and the overall prevalence of SDE was 20.3% among adolescents in Nantong, China. Multiple logistic regression analyses showed that high myopia (aOR = 3.42, 95% CI = 1.60-3.36, p = 0.025), frequent use of eye drops (aOR = 2.31, 95% CI = 1.60-3.36, p<0.001), a history of allergic conjunctivitis (aOR = 1.93, 95% CI = 1.09-3.34, p = 0.025), and frequent blinking (aOR = 3.23, 95% CI = 2.31-4.53, p<0.001) were identified as risk factors for SDE. Conversely, male gender (aOR: 0.76, 95% CI: 0.58-0.99, p = 0.043), increased sleep time (6-7 h: aOR = 0.64, 95% CI = 0.46-0.89, p = 0.009; 7-8 h: aOR = 0.64, 95% CI = 0.43-0.95, p = 0.026; >8 h: aOR = 0.43, 95% CI = 0.23-0.82, p = 0.010), and timely intervention when vision decline occurred were protective factors against SDE (aOR = 0.61, 95% CI = 0.43-0.85, p = 0.004)., Conclusion: High myopia was found to be independently associated with an increased risk of SDE., while hyperopia, astigmatism, and anisometropia were not independent risk factors for SDE. The identified risk and protective factors may help provide valuable insights for future research and interventions aimed at improving ocular health in adolescents., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Uncorrected refractive error (URE) is one of the main causes of visual impairments. URE may reduce interaction and learning in the classroom, leading to social isolation, irreversible amblyopia, lack of external knowledge, and restrictions on education and employment opportunities. Our aim was to investigate the prevalence and related factors of URE in adolescents using epidemiological surveys and questionnaire surveys related to lifestyle habits., Methods: A cross-sectional school-based study was conducted in Nantong, China, including adolescents 12-19 years of age from 16 schools. URE was defined as presenting visual acuity worse than 6/12 and improving to ≥ 1 lines after correction in either eye. Univariate and multivariate logistic regression analyses were used to investigate specific correlations between URE and related lifestyle parameters. Non-cycloplegic autorefraction was assessed for each adolescent., Results: A total of 2,910 adolescents were analyzed, of which 50.3% (n = 1,465) were male, and 49.7% (n = 1,445) were female. The mean age was 15.23 ± 1.77 years. The overall prevalence of URE was 23.7%. The total prevalence of REC and eREC was 85.1% and 71.7%, respectively, and both of them showed an increasing trend with age (Ptrend = 0.018 and Ptrend = 0.019, respectively). A higher prevalence of URE was related to myopia, anisometropia, and increased daily use of electronic products. Timely visual examination by medical institutions, more extracurricular homework, and older age were protective factors for URE. Among the 689 adolescents with URE, 362 (52.5%) did not receive any refractive correction, and 327 (47.5%) used corrected glasses., Conclusion: URE was highly prevalent among adolescents in China. Myopia was the most important risk factor for URE. The impact of anisometropia and increased daily use of electronic devices on URE was significant. Timely visual examinations by medical institutions served as an effective protective factor against URE. Further research on adjusting intervention strategies is therefore needed to eliminate preventable visual impairments., (© 2024. The Author(s).)

Background: Uncorrected refractive errors and amblyopia are reported as the two main causes of childhood visual impairment and blindness worldwide. Our purpose was to evaluate refractive status, ocular alignment and effective refractive error coverage (eREC) of school-aged children from low-income areas of Sao Paulo city, Brazil., Methods: Data from the "Ver na Escola" Project were used for the current study. Children enrolled in the selected schools had an ophthalmic exam including eye alignment assessed by cover test, automatized and subjective dynamic and static refraction. The associations of demographic variables with occurrence and magnitude of refractive errors and eREC were investigated by multiple logistic regressions and multilevel mixed effect models., Results: A total of 17,973 children (51.12% females) with mean ± sd age 8.24 ± 3.54 years old examined from July 2018 to July 2019, were included in the study. Most of the participants (73%) showed orthoposition of the visual axis for both distance and near. Heterophoria was found in about 25% of participants (N = 4,498), with 71.7% of them (N= 3,222) classified as exophoria. Less than 2% (N = 232) showed strabismus, most of them (N = 160) esotropia. Overall, 1,370 (7.70%) of participants had myopia and 577 (3.24%) had hyperopia. Age was found to be significantly associated with increasing static subjective refraction spherical equivalent (Coefficient: -0.18; 95% Confidence Interval (CI): -0.21 to -0.16; p < 0.001). Female sex (Odds Ratio (OR) = 1.13; 95%CI: 1.01-1.27; p = 0.027) and older age (OR = 1.17; 95%CI: 1.16-1.19; p < 0,001) were significantly associated with myopia diagnosis. Older age decreased the odds of hyperopia (OR = 0.95; 95%CI: 0.93-0.98; p < 0.001). The overall effective refractive coverage was 51.76% and was significantly associated with age group, ranging from 32.25% in children aged 3 to 7 years to 61.35% in children aged 8 to 12 years., Conclusions: Most children have shown eye alignment for both distance and near assessments and no refractive error. Myopia was observed in 7.70% of the population and it was associated with older age and female sex. Hyperopia was observed in 3.24% and was associated with younger age. The overall eREC was 51.76%, significantly associated with age., (© 2024. The Author(s).)

Objective: To comprehend the status and changing trend in the burden of refractive errors in China from 1990 to 2019, and to furnish data-driven support for the formulation of rational strategies in refractive error prevention and control. Methods: Using the Global Burden of Disease Database 2019, data on refractive error prevalence and years lived with disability (YLD) in China from 1990 to 2019 were extracted and their standardized rates were calculated. The trend of refractive error prevalence, age, period, and gender was analyzed using joinpoint regression models. Results: From 1990 to 2019, the number of cases, prevalence rate, and YLD rate of refractive errors in China showed an upward trend, which was consistent with global trends. However, the magnitude of the increase in these parameters was higher than the global average. Conversely, the age-standardized prevalence rate and age-standardized YLD rate demonstrated a declining trend, which was also consistent with global trends, but the reduction rate was less pronounced compared to global levels. Notably, all indicators for females, including prevalence and YLD, exceeded those of males. The prevalence and YLD rates of refractive errors in China increased with age. The older individuals had higher rates compared to younger individuals. In 1990, the highest prevalence and YLD rates were found in the ≥70 years group, while the lowest rates were in the <5 years group. The age group with the most substantial increase in the burden of refractive errors was the 15 to 49 years population, which remained consistent during the three decades. The joinpoint regression analysis results revealed a stage-wise fluctuation in the age-standardized prevalence and YLD rates of refractive errors in China from 1990 to 2019. Specifically, the age-standardized prevalence rate increased by 0.765% from 1990 to 2001, decreased by 0.963% from 2001 to 2014, increased by 4.214% from 2014 to 2017, and decreased by 3.029% from 2017 to 2019. In contrast, the age-standardized YLD rate decreased by 0.113% from 1990 to 1995, increased by 2.252% from 1995 to 2000, decreased by 1.102% from 2000 to 2014, increased by 4.326% from 2014 to 2017, and decreased by 5.090% from 2017 to 2019. Conclusions: The standardized prevalence of refractive errors and the standardized YLD rate in China showed a downward trend, which was less than the global average level, but the disease burden was still heavy. Gender and age emerged as significant influencing factors for the prevalence of refractive errors and YLD. It is imperative to enhance efforts in the prevention and treatment of refractive errors among the middle-aged and elderly population. Attention should also be directed towards the increasing burden in the<50 years population.

Significance: This study brings awareness of racial/ethnic difference of refractive error characteristics in clinics., Purpose: This study aimed to assess longitudinal change in refractive errors over a 36-month period in Hispanic and Black children., Methods: Children (2.4 to 15 years old) were studied. Cycloplegic refraction was measured annually. Spherical equivalent was calculated. Astigmatism was evaluated by magnitude of cylinder and power vector (J 0 and J 45 ). Absolute value of interocular spherical equivalent difference was used to calculate anisometropia. Mixed-linear model was used to analyze longitudinal annual change in spherical equivalent, cylinder, J 0 , and J 45 over 36 months., Results: A total of 485 participants (310 Black, 175 Hispanic) met the criteria. At the baseline examination, prevalence of myopia, emmetropia, and hyperopia was 39% (n = 187), 31% (n = 150), and 30% (n = 148), respectively. Spherical equivalent of Black children was not significantly different from that in Hispanic children (0.10 ± 2.92 vs. -0.37 ± 2.05 D, p=0.06); however, the Hispanic children had a significantly higher cylinder compared with Black children (Hispanic: 1.46 ± 1.57 D vs. Black: 0.92 ± 1.07 D; p<0.001). Both J 0 (p<0.001) and J 45 (p=0.01) were significantly different between two groups; the Hispanic children had more with-the-rule astigmatism and oblique astigmatism than the Black children. Prevalence of anisometropia (≥1 D) was higher in Black children (14%) compared with Hispanic children (5%, p=0.006). Over 36 months, spherical equivalent significantly decreased an average of 0.69 D (0.23 D/y, p<0.001) for both groups; neither astigmatism nor anisometropia changed significantly (p>0.05)., Conclusions: Astigmatism in the Hispanic children was significantly higher than in Black children. However, the Black children had a higher prevalence and degree of anisometropia than the Hispanic children., Competing Interests: Conflict of Interest Disclosure: The author (JW) is a nonremunerative advisory board member for Percept Corporation, which is not related to this article. All other authors have no disclosure., (Copyright © 2024 American Academy of Optometry.)

Purpose: To describe the prevalence and risk factors associated with amblyogenic refractive error in children with Coats disease., Methods: The medical records of children (<18 years of age) with unilateral Coats disease treated at a single tertiary care center were retrospectively reviewed. Data collected included patient demographics, ocular examinations, and treatments. Outcomes included the prevalence and factors associated with amblyogenic refractive error., Results: A total of 50 children (82% male) were included; of these, 37 (74%) had refractive data to review. The median age at presentation was 5 years (IQR, 2-10). The Coats disease classification was stage 1 in 1 (2%), stage 2 in 29 (58%), and stage 3 or greater in 20 (40%). Most children (76%) had at least one visit with a pediatric specialist; the rest were only seen by a retina specialist. Among patients with refractive data, amblyogenic refractive error was identified in 46%. Glasses were prescribed to 50% of children. Children diagnosed at an earlier age had increased odds of amblyogenic refractive error (OR = 0.72; 95% CI, 0.57-0.91; P = 0.006) than those diagnosed at an older age., Conclusions: Our results suggest that amblyogenic refractive error is prevalent among children with Coats disease, and refractions are not always performed. There is a need to coordinate care between pediatric and retina specialists caring for children with Coats disease to ensure timely diagnosis of amblyogenic refractive error to optimize visual outcomes in this population., (Copyright © 2024 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Introduction: Little is known about the prevalence of refractive errors and amblyopia among school children on the islands of East Coast Malaysia. This study aimed to investigate the prevalence of these conditions and their associated factors in this unique and remote geographical location., Materials and Methods: This multicentre cross-sectional school-based study included 480 children aged 7 to 12 year from primary schools on the islands of the East Coast of Malaysia. All children underwent visual acuity assessment, orthoptic evaluation, anterior and posterior segment examinations and manifest refraction. Demographic data, history of parental refractive error, parental education level, duration of digital screen time and time spent outdoors were documented in a questionnaire distributed to the parents., Results: The mean age was 9.53 ± 1.69 years, with an equal distribution of genders. The ethnic composition of the subjects was 99.4% Malay and 0.6% Orang Asli. The overall prevalence of refractive errors was 11.9% (95% CI: 9.1 to 15.1%), with myopia at 7.1% (95% CI: 5.0 to 9.8%), hyperopia at 2.5% (95% CI: 1.3 to 4.3%), astigmatism at 2.3% (95% CI: 1.1 to 4.1%) and amblyopia at 2.5% (95% CI: 1.3 to 4.3%). Older age, an absence of parental history of refractive error and reduced daily outdoor time were significantly associated with refractive errors (p < 0.05)., Conclusion: The prevalence of refractive error is 11.9% and amblyopia is 2.5% among primary school children on the islands of the East Coast of Peninsular Malaysia. Older age, an absence of parental history of refractive error and reduced daily outdoor time are associated with refractive error.

Purpose: To compare Hill-RBF 3.0 with Barrett Universal II (BU II), SRK/T, Hoffer Q, Haigis, and Holladay 1 in predicting the accuracy of post-cataract surgery refractive outcomes in Indian eyes., Methods: In this prospective, comparative, observational study, consecutive patients with uncomplicated age-related cataracts undergoing uneventful phacoemulsification with posterior chamber intraocular lens (IOL) implantation were included. The mean absolute errors (MAEs) and median absolute errors were used to determine the accuracy of predicted postoperative target refractions., Results: A total of 219 eyes of 173 patients were enrolled. Based on the axial lengths (AL), the patients were classified into: AL <22 mm (short), 22-24.5 mm (normal), and >24.5 mm (long). BU II exhibited the lowest MAE for normal ALs (0.2683 ± 0.2790 D) as well as for the entire population (0.2764 ± 0.2764 D). For the short ALs, Hill RBF 3.0 exhibited the lowest MAE (0.3268 ± 0.3268 D), while for the long ALs, SRK/T showed the lowest MAE (0.2823 ± 0.2642 D). BU II exhibited the highest percentage of eyes of 57.5%, 95.4%, and 98.6% within ±0.25, ±0.75, and ±1.0 D of postoperative target refractions respectively, whereas Hill RBF 3.0 had the highest percentages of eyes (88.1%) within ±0.5 D of postoperative target refraction., Conclusion: Hill-RBF 3.0 exhibited the least MAE for patients with short ALs, while BU II showed the least MAE for normal ALs as well as for the entire population and SRK/T for long ALs. This study is likely to aid surgeons in selecting the most appropriate IOL power formula, which thereby improves the refractive outcomes with utmost accuracy., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: To conduct a large retrospective study of screening refractive error in young children., Methods: This retrospective study included children aged from 4 months to 8 years in Daxing District, Beijing, who underwent refractive examinations without cycloplegia. It included a cross-sectional assessment of refractive error screening for all children, and a longitudinal component for a subgroup with data available for two to five visits., Results: A total of 14,987 children were included in the cross-sectional study. In the group <1 year of age, the percentage of children with a spherical equivalent (SE) >+2.00 D or with cylinder <-1.50 D was 15.25% and 33.24%, respectively. These were significantly higher than for the 1- to 4-year-old group (SE 8.1% higher, cylinder 13.2% higher) (χ 2  = 53.57, p < 0.001; χ 2  = 790.39, p < 0.001). Furthermore, 34.83% of children in the 0-year-old group had amblyopia risk factors (ARFs). In the 4-year-old group, boys had a significantly longer axial length (AL) than girls (differences in the right and left eyes were 0.53 and 0.56 mm, respectively; z = 5.48 p < 0.001, z = 5.80, p < 0.001). AL increased with age, while the AL difference between boys and girls remained stable at 4-8 years of age. The percentage of children aged 5-8 years with myopia in 2020-2021 was significantly higher than that in 2018-2019 (H = 12.44, p = 0.006). In the longitudinal study of 4406 children (up to 12-month follow-up), annual changes in SE were -0.27, -0.06, 0.19 and 0.13 D between 0 and 3 years, and -0.38, -0.58, -0.70 and -0.75 D between 5 and 8 years., Conclusions: Children's refractive error varied significantly from ages 4 months to 1 year, with a high proportion having ARFs. Children aged 5-8 years showed a trend towards myopia. The prevalence of myopia in the cross-sectional analysis in 2020-2021 was greater than in 2018-2019. Screening refraction changed minimally over a 12-month period for children aged 1-3 years, but became more myopic for children aged 5-8 years., (© 2024 College of Optometrists.)

Purpose: To evaluate refractive findings in patients with unilateral Duane's retraction syndrome (DRS)., Methods: This retrospective study included 40 patients followed for unilateral DRS. Detailed ophthalmological examinations of the patients were performed. The spherical and cylindrical refractive error, spherical equivalent, and type of refractive error in the eyes with DRS and the fellow eyes were determined. The patients were divided into three subgroups according to their type of DRS. The refractive properties of the eyes with DRS were examined in subgroup analyses. Eye movement limitation was graded between +1 and +4 and compared according to the refractive error type., Results: The mean age of the patients was 16.8±12.6 (range, 1-60) years. Of the eyes with DRS, 11 (27.5%) were emmetropic, four (10%) were hyperopic, two (5%) were myopic, 11 (27.5%) were myopic astigmatic, and 12 (30.0%) were hyperopic astigmatic. There was no statistically significant difference between the eyes with DRS and fellow eyes in relation to the spherical or cylindrical refractive errors or spherical equivalent (P>0.05 for all). The refraction values for the patients with type 1, type 2 and type 3 DRS were similar between groups (P>0.05). No statistically significant difference was detected in the degree of eye movement limitation according to refractive status (P>0.05)., Conclusion: In patients with unilateral DRS, there was no significant difference between the affected eyes and the fellow eyes in terms of refractive error values or types. Refractive status did not significantly differ according to the degree of eye movement limitation. Therefore, although extraocular muscles are affected by DRS, there may not be any significant refractive changes., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Purpose: As per the recent World Health Organization estimates, approximately 2.2 billion people have near and distance vision impairment (VI) globally, and out of this almost 50% is avoidable., Methods: The Rapid Assessment of Avoidable Visual Impairment survey was a cross-sectional study conducted in September 2021, using cluster random sampling in 42 clusters with a cluster size of 140, giving a total of 6000 participants. Two teams comprising of trained optometrists and social workers conducted the ocular examination which included unaided, pinhole, and aided visual acuity assessments followed by examination of the anterior segment and lens. Distance visual acuity was measured using simplified tumbling "E" charts of different sizes for VA of 6/12, 6/18, and 6/60. The lens assessment was done in an un-dilated pupil with torch light by the optometrist., Results: Overall, 6520 individuals aged 6 years and above were enumerated, of whom 5440 (83.4%) were examined. The response rate for examination was better among females (93.1%) than males (73.9%), and it decreased from 93.8% in the age group 6-15 years to 77.1% in the 45+ age group. The prevalence of blindness and VI were 0.18% (95% CI: 0.06-0.29) and 4.19% (95%CI: 3.65-4.72), respectively. The major causes of VI in all age groups were uncorrected refractive error (65.4%), cataract (23.7%), cataract surgical complications (2.6%), corneal opacity (0.4%), and other posterior segment diseases (7.5%). The effective cataract surgical coverage (eCSC) was 61.8%, effective refractive error coverage (eREC) for distance vision was 59.8%, and eREC for near vision was 47.0%., Conclusion: The RAAVI methodology is suitable to measure effective coverage in the general population, both for baseline measurement and periodic monitoring. The 2030 targets for the surveyed district are 90% eCSC and 100% eREC. Such exercises need to be conducted in each district of the country to determine the baseline and target values of effective coverage., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Background: This study aimed to investigate the difference between cycloplegic and noncycloplegic refraction and evaluate the pseudomyopia prevalence in Chinese preschool children during the outbreak of COVID-19., Methods: A cross-sectional study was conducted in the Tongzhou District of Beijing, China. Refractive error was measured under both noncycloplegic and cycloplegic conditions with autorefraction. The difference between noncycloplegic and cycloplegic spherical equivalent refraction (SER) and pseudomyopia prevalence were analyzed. Pseudomyopia was defined as SER ≤-0.50D in precycloplegic assessments and >-0.50D in post-cycloplegic assessments., Results: Out of the 1487 participants who were enrolled in the study, 1471 individuals (98.92%) between the ages of 3-6 years completed all required procedures. A statistically significant difference in refraction was observed between noncycloplegic and cycloplegic measurements, the median of difference in spherical equivalent refraction (SER) of 0.88D (dioptre)(0.50,1.38). There was a high intraclass correlation (ICC) between these two methods for cylinders (ICC = 0.864; 95% CI, 0.850-0.877). The median DSE for myopia, emmetropia and hyperopia were 0.25D (0.00, 0.38),0.25D (0.06, 0.50) and 1.00D (0.62, 1.38), an hypermetropes showed considerably greater differences than myopes and emmetropes (Kruskal-Wallis test, H = 231.023, P = 0.000). Additionally, girls displayed a greater DSE than boys. Furthermore, when comparing against-the-rule (ATR) and oblique astigmatism, it was found that with-the-rule (WTR) astigmatism had the largest DSE. The study found varying prevalence rates of myopia, emmetropia, and hyperopia with and without cycloplegia, which were 1.90% vs. 10.06%, 11.49% vs. 50.31%, and 86.61% vs. 39.63%, respectively. Additionally, the overall prevalence of pseudomyopia was determined to be 8.29%. Participants with pseudomyopia had a significantly higher mean difference in SER (DSE) compared to non-pseudomyopic participants., Conclusions: Cycloplegic refraction is more sensitive than a noncycloplegic one for measuring refractive error in preschool children. Pseudomyopia is prevalent in preschool children during the COVID-19 outbreak period. Our study indicates the possibility that cycloplegic refraction should be performed in preschool children routinely., (© 2024. The Author(s).)

Purpose: To investigate the prevalence and body mass index (BMI) associations of congenital lower epiblepharon in children in China and the difference in the refractive errors between children with and without epiblepharon., Methods: Children 6-12 years of age in Beichen District of Tianjin were screened for congenital epiblepharon from September to October 2017. All children underwent slit-lamp examination, strabismus screening, visual acuity examination and refraction. Weight and height were also recorded. The prevalence of lower epiblepharon in school-age children was evaluated, and its association with age, sex, BMI, and refractive error was analyzed., Results: A total of 28,225 children were examined; 564 had epiblepharon. The prevalence of epiblepharon was found to be, for 6-year-olds, 2.50%; for 7-year-olds, 2.13%; for 8-year-olds, 2.10%; for 9-year-olds, 1.97%; for 10-year-olds, 1.85%; for 11-year-olds, 1.67%; and for 12-year-olds, 1.19% (P < 0.05). The prevalence of overweight and obesity in children with epiblepharon was found to be 16.7% and 47.2%, respectively. The prevalence and degree of astigmatism was higher than in nonepiblepharon children. We found a possible association between severity of astigmatism and severity of epiblepharon., Conclusions: In our study, the prevalence of epiblepharon decreased with advancing age, and the majority of children with epiblepharon were found to be overweight or obese. Epiblepharon was associated with astigmatism., (Copyright © 2024 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Objective: This study determined the prevalence and aetiology of unilateral visual impairment (VI) and blindness and its associated factors in school children., Methods: We conducted a multistage, cross-sectional study in primary and secondary schools of Saki-East Local Government Area of Oyo State, Nigeria. Unilateral VI was defined as presenting visual acuity (PVA) worse than +0.3 LogMAR (6/12) and unilateral blindness as PVA worse than +1.3 LogMAR (3/60) in the worse eye. Detailed ocular examinations were performed for students with unilateral VI, and Logistic regression analysis was performed to explore associations with independent variables., Results: The mean age of participants was 11 ± 3.2 years. Thirty-six (0.98%) of 3671 children had unilateral VI, and fifteen children had unilateral blindness (0.41%), giving a combined prevalence of 1.39 ± 0.5%. History of ocular trauma was reported by 14 (27.5%) participants with unilateral VI and blindness. In addition, those with a history of ocular trauma were 6.5 times more likely to be blind or have a severe VI (95% CI 1.5-2.8) than those without a history of ocular trauma. Uncorrected refractive error was the major cause of unilateral VI in 26 (51%) participants, while traumatic cataract was the main cause of unilateral blindness seen in 5 (9.8%) participants, none of whom had a previous eye examination., Conclusion: Fourteen per thousand school children had unilateral VI in this study; the major causes were refractive error and cataract, which are treatable. Ocular trauma was a significant risk factor for unilateral VI and blindness., (© 2024. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Purpose: Indonesia is a rapidly growing county with over 262 million inhabitants, but among highly populated countries it has one of the lowest concentrations of eye care providers. This study evaluated the cost-effectiveness of a program implemented in South Sulawesi, Indonesia that trained school teachers to conduct vision screenings, organized in-school evaluations by opticians, and provided free eyeglasses to school children with refractive error (RE)., Methods: Schoolteachers across 6 districts in South Sulawesi were trained to screen children with possible RE for subsequent evaluation by opticians. All costs associated with designing and implementing the program (administration, training personnel, labor, service delivery, etc.) were assessed. Expenditures and outcomes data were utilized to calculate the cost per disability-adjusted-life-year (DALY) averted using both 2010 and 2016 Global Burden of Disease (GBD) weights., Results: 521 teachers screened 41,212 students across 172 schools in South Sulawesi. 4,506 (10.9%) students failed screening, 2,652 were seen by optometrists, and 2,038 received glasses.The total program cost was US$97,380, with glasses (39.6%) and labor (23.3%) accounting for the two biggest expenditures. In districts with school-based refraction services, the costs per student screened, refracted, and receiving glasses were $2.57, $31.33, and $41.40, respectively; costs were $2.04, $59.80, and $73.22 when district services were instead provided centrally. The estimated cost per DALY averted was US$89.04 based on GBD 2010 weights., Conclusion: Treating children with correctable RE in limited resource settings can be done cost-effectively through a school-based model.

Purpose: This study aims to investigate the relationship between the type and severity of refractive error and anisometropia development in preschool children., Design: Retrospective cohort study., Methods: Data from Maccabi Healthcare Services, Israel's second-largest Health Maintenance Organization (HMO), were analyzed. The study included all isometropic children aged 1 to 6 years, re-examined for refraction at least 2 years following their initial examination between 2012 and 2022. Anisometropia was defined as a ≥1 diopter interocular difference in spherical equivalent. Relationships were assessed using logistic regression models adjusted for key sociodemographic factors., Results: Among 33,496 isometropic children (51.2% male, mean age 3.2 ± 1.5 years), the prevalences of emmetropia, myopia, and hyperopia were 26.7% (n = 8944), 4.2% (n = 1397), and 69.1% (n = 23,155), respectively. Over a mean follow-up period of 5.1 ± 2.4 years, 2593 children (7.7%) were diagnosed with anisometropia. Adjusted odds ratios (ORs) for anisometropia gradually increased with baseline refractive error severity, reaching 13.90 (5.32-36.34) in severe myopia and 4.19 (3.42-5.15) in severe hyperopia. This pattern was also evident in cylindrical anisometropia, where ORs increased with greater baseline astigmatism, peaking at 12.10 (9.19-15.92) in children with high astigmatism (≥3 D). Associations remained consistent in sensitivity and subgroup analyses including across both sexes and when using a stricter anisometropia criterion., Conclusions: Children aged 1 to 6 years, initially without anisometropia but showing increasing severity of myopia, hyperopia, or astigmatism, are more likely to develop anisometropia. This underscores the importance of follow-up refractive measurements within this population to promptly diagnose and treat anisometropia and prevent potential visual complications., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Clinical Significance: Understanding the refractive profile, amblyopia prevalence, binocular status, and head position in patients with Brown syndrome help clinicians become more familiar with this syndrome., Background: Brown syndrome is identified as an active and passive restricted elevation of the eye in adduction. There is little information on clinical features, including refractive status, amblyopia, abnormal head posture (AHP), and types of deviation in these patients., Methods: This study retrospectively evaluated records of 100 Brown syndrome patients from 2015 to 2022 at Farabi Eye Hospital, Iran., Results: The mean age was 6.99 ± 6.33 years, including 48 (48%) males. A congenital source was found in 74 (74%) and 96 (96%) patients had unilateral involvement. The mean CDVA for the affected and non-affected eyes were 0.05 ± 0.11 and 0.03 ± 0.06 logMAR, respectively ( P  = 0.31). In unilateral cases, hyperopia, myopia, and emmetropia were observed in 55 (57.29%), 2 (2.08%), and 39 (40.63%) affected eyes, respectively. The most common type of deviation was pure hypotropia, which was found in 53 (53%) cases, followed by 'combined exotropia and hypotropia' observed in 26 (26%) patients. The mean angle of hypotropia and horizontal deviation in the primary position at distance was 12.10 ± 8.50 and 8 ± 13.20 prism dioptre, respectively. A V-pattern was found in 76 (76%) patients. Amblyopia was observed in 13 (21.67%) of 60 cooperative patients, and AHP was noticed in 66 (66%) patients, in which "combined chin up and contralateral face turn" was the most common type., Conclusion: About 75% of cases were congenital, 50% had pure hypotropia, 75% showed V-pattern, 20% had amblyopia, and AHP was observed in 67% of patients. The remarkable prevalence of amblyopia alongside the high occurrence of AHP should alert clinicians to carefully assess patients with Brown syndrome for sensory fusion and amblyopia.

Background: Uncorrected refractive error (URE) is a readily treatable cause of visual impairment (VI). This study provides updated estimates of global and regional vision loss due to URE, presenting temporal change for VISION 2020 METHODS: Data from population-based eye disease surveys from 1980-2018 were collected. Hierarchical models estimated prevalence (95% uncertainty intervals [UI]) of blindness (presenting visual acuity (VA) < 3/60) and moderate-to-severe vision impairment (MSVI; 3/60 ≤ presenting VA < 6/18) caused by URE, stratified by age, sex, region, and year. Near VI prevalence from uncorrected presbyopia was defined as presenting near VA < N6/N8 at 40 cm when best-corrected distance (VA ≥ 6/12)., Results: In 2020, 3.7 million people (95%UI 3.10-4.29) were blind and 157 million (140-176) had MSVI due to URE, a 21.8% increase in blindness and 72.0% increase in MSVI since 2000. Age-standardised prevalence of URE blindness and MSVI decreased by 30.5% (30.7-30.3) and 2.4% (2.6-2.2) respectively during this time. In 2020, South Asia GBD super-region had the highest 50+ years age-standardised URE blindness (0.33% (0.26-0.40%)) and MSVI (10.3% (8.82-12.10%)) rates. The age-standardized ratio of women to men for URE blindness was 1.05:1.00 in 2020 and 1.03:1.00 in 2000. An estimated 419 million (295-562) people 50+ had near VI from uncorrected presbyopia, a +75.3% (74.6-76.0) increase from 2000 CONCLUSIONS: The number of cases of VI from URE substantively grew, even as age-standardised prevalence fell, since 2000, with a continued disproportionate burden by region and sex. Global population ageing will increase this burden, highlighting urgent need for novel approaches to refractive service delivery., (© 2024. The Author(s).)

Purpose: To develop and validate machine learning (ML) models for predicting cycloplegic refractive error and myopia status using noncycloplegic refractive error and biometric data., Methods: Cross-sectional study of children aged five to 18 years who underwent biometry and autorefraction before and after cycloplegia. Myopia was defined as cycloplegic spherical equivalent refraction (SER) ≤-0.5 Diopter (D). Models were evaluated for predicting SER using R2 and mean absolute error (MAE) and myopia status using area under the receiver operating characteristic (ROC) curve (AUC). Best-performing models were further evaluated using sensitivity/specificity and comparison of observed versus predicted myopia prevalence rate overall and in each age group. Independent data sets were used for training (n = 1938) and validation (n = 1476)., Results: In the validation dataset, ML models predicted cycloplegic SER with high R2 (0.913-0.935) and low MAE (0.393-0.480 D). The AUC for predicting myopia was high (0.984-0.987). The best-performing model for SER (XGBoost) had high sensitivity and specificity (91.1% and 97.2%). Random forest (RF), the best-performing model for myopia, had high sensitivity and specificity (92.2% and 96.9%). Within each age group, difference between predicted and actual myopia prevalence was within 4%., Conclusions: Using noncycloplegic refractive error and ocular biometric data, ML models performed well for predicting cycloplegic SER and myopia status. When measuring cycloplegic SER is not feasible, ML may provide a useful tool for estimating cycloplegic SER and myopia prevalence rate in epidemiological studies., Translational Relevance: Using ML to predict cycloplegic refraction based on noncycloplegic data is a powerful tool for large, population-based studies of refractive error.

Background: Uncorrected refractive error (URE) is one of the leading causes of childhood vision impairment. Increasing effective refractive error coverage (e-REC) is one of the main indicators of WHO's 2030 global eye health targets. The aim of this study is to estimate the e-REC and spectacle coverage among school children in Telangana, South India., Methods: School children aged 4-15 years in the study locations underwent vision screening using 6/12 tumbling E optotype by trained community eye health workers in the schools. Those failing the initial vision screening and/or found to be having eye conditions were referred to a nearby referral centre appropriately, where they underwent detailed eye examination., Results: A total of 774,184 children were screened in schools of which 51.49% were boys. The mean age was 9.40 ± 3.27 years. The prevalence of URE was 1.44% (95%CI:1.41-1.46) of which myopia was 1.38% (95%CI: 1.35-1.41). In multivariate analysis, the risk of myopia was higher among older children (Adj.OR: 17.04; 95%CI: 14.64-19.85), those residing in urban areas (Adj.OR:3.05, 95%CI:2.60-3.57), those with disabilities (Adj.OR:2.61, 95%CI:2.00-3.39) and among girls (Adj.OR:1.30, 95%CI:1.25-1.35) (P < 0.001). The overall e-REC was 56.97% and the spectacle coverage was 62.83%., Conclusion: The need for interventions to improve e-REC to achieve 2030 global eye health target is eminent among children in this region. Improving refractive services through school eye health programs could aid in accelerating this process to achieve the target. Myopia being the most common type of RE, the risk factors included increasing age, urban location, and presence of disability., (© 2024. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Background/objective: To determine the prevalence of visual impairment (VI), uncorrected refractive errors (URE), and effective refractive error coverage among individuals aged 15-50 years in Koshi Province, Nepal., Methods: A population-based cross-sectional study was conducted in Koshi Province in which 4800 participants were selected from 80 clusters. The study teams visited the selected households and conducted eye examinations. This included monocular unaided (and aided) visual acuity assessment using a Snellen chart with tumbling E optotypes at a distance of 6 meters. Near vision was assessed binocularly using the N notation chart at a fixed distance of 40 cm for each individual. Torchlight examination and distance direct ophthalmoscopy was done. VI was defined as presenting visual acuity worse than 6/12 in the better eye. URE was defined as presenting visual acuity worse than 6/12 and improving to 6/12 or better on using a pinhole. Near Vision Impairment was defined as binocular presenting near vision worse than N8 among those age 35 years and older., Results: In total, 4057 were examined (84.5% response rate). The prevalence of VI was 3.52% (95% CI:2.89-4.13; n = 143). The prevalence of URE in the better eye was 1.95% (95% CI:1.54-2.42; n = 79). The Refractive Error Coverage and Effective Refractive Error Coverage were 34.8% and 31.3% respectively. The prevalence of NVI was 34.24% (95% CI: 32.1-36.40; n = 666)., Conclusion: The prevalence of VI and  URE was low, attributed to the availability and uptake of services in Koshi province in Nepal., (© 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Background: The purpose of this study was to quantify how much of the burden of visual impairment (VI) and unmet need in Talagang, identified by Rapid Assessment of Avoidable Blindness (RAAB) survey data, has been addressed by Community Eye Health (CEH) programme efforts., Methods: A RAAB survey was carried out in November 2018, with 2,824 participants in Talagang Tehsil, Punjab, Pakistan, aged 50 and over. Census data were used to extrapolate survey data to the population. Alongside this, a CEH programme was launched, consisting of community eye screening, and onward referral to rural health centres, secondary or tertiary ophthalmological services, as required. This health intervention aimed to address the eye care needs surfaced by the initial survey. From 2018 to 2022, 30,383 people aged 50 or over were screened; 14,054 needed referral to further steps of the treatment pathway and more detailed data collection. Programme data were compared to estimates of population unmet needs. Main outcome measures were prevalence of VI, and proportion of need met by CEH Programme, by cause and level of VI., Results: Among those aged 50 and over, 51.0% had VI in at least one eye. The leading causes were cataract (46.2%) and uncorrected refractive error (URE) (25.0%). In its first four years, the programme reached an estimated 18.3% of the unmet need from cataract, and 21.1% of URE, equally in both men and women., Conclusions: Robustly collected survey and programme data can improve eye health planning, monitoring and evaluation, address inequities, and quantify the resources required for improving eye health. This study quantifies the time required to reach eye health needs at the community level., (© 2024. The Author(s).)

Purpose: This study evaluates the recent trends in ocular morbidities and vision-related practices in "out-of-school" children in urban slums of Gurugram in North India., Methods: In this observational study, a validated questionnaire was administered to 161 students from two nonformal slum schools. Sociocultural, demographic data, vision-related practices, and visual acuity with subjective refraction of the children were recorded., Results: A total of 80 boys and 81 girls (9.17 ± 2.58 years) participated in this study. About 40% of the children were from lower socioeconomic status. The visual acuity recorded for all the children, except three children, was 6/6 in both eyes. One child had a pre-phthisical eye with no light perception, following a childhood trauma, with the other eye having 6/6 vision. Two children had refractive errors (myopia and compound myopic astigmatism), with a best corrected visual acuity (BCVA) of 6/6. Thirteen children (8%) had Bitot's spots and 67 (35.4%) had allergic conjunctivitis. Eight (5%) children complained of dry eye-related symptoms like redness and watering of eyes, while 19 (11.8%) had diffuse headache. Average number of years spent in school for these children was less than 1.7 years (range: 1 month-6 years). Only 10.5% of the children gave the history of watching television more than 30 h/week. Significant association was found between the income of father and use of digital devices in children below 10 years ( P = 0.003) and children playing outdoors ( P = 0.001). There was a significant association noted for age and use of digital devices ( P = 0.037)., Conclusion: The prevalence of refractive errors in "out-of-school" children of urban slum was much less than the national average. Almost one in three children suffered from eye allergies, while 8% children had Bitot's spots. The data about the prevalence of ocular comorbidities in underserved areas like urban slums can be used to update and strategize eye health-care delivery models for out-of-school children., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Objective: To assess the association between ethnicity and self-reported refractive errors (REs) among Peruvian children aged 7-11 years., Materials and Methods: We conducted a cross-sectional study incorporating a secondary data analysis of 2017-2021 data from the Peruvian Demographic and Health Survey (DHS). REs and ethnicity were obtained from focal child's mother's report. Four outcomes were assessed: hyperopia, myopia, astigmatism and any RE. We included potential confounders, such as age, sex, wealth index, area of residence, region of origin, frequency of watching TV and watching screens at less than 30 cm distance. Generalised linear models with the Poisson family and log link function were used to calculate crude prevalence ratio and adjusted prevalence ratio (aPR) with 95% confidence intervals (95% CI)., Results: Data from a total of 52,753 children were included. The prevalence of RE in children aged 7-11 years was 10.90% (95% CI 10.49-11.33), of which 5.19% were hyperopia, 3.35% myopia and 2.36% astigmatism. Those of the Aymara ethnicity were less likely to suffer from any RE and astigmatism (aPR = 0.68, 95% CI 0.46-0.99, p = 0.046; aPR = 0.70, 95% CI 0.53-0.92, p = 0.012, respectively), Members of Amazon groups were more likely to have hyperopia (aPR = 1.95, 95% CI 1.14-3.36, p = 0.015) and Quechuas were more likely to have myopia (aPR =1.29, 95% CI 1.02-1.62, p = 0.028), where all were compared to Mestizos., Conclusion: About 1 in 10 Peruvian children suffer from a RE. The most frequent RE in this study was hyperopia. Ethnic differences were seen in the frequency of RE., Competing Interests: Conflicts of interest None of the authors have any proprietary interests or conflicts of interest related to this submission., (Copyright © 2023. Published by Elsevier España, S.L.U.)

Purpose: In children under 20 years, refractive development targets a cycloplegic refractive error of +0.5 to +1.5D, while presbyopes over 40 years generally have non-cycloplegic errors of ≥ +1D. Some papers suggest these periods are separated by a period of myopic refractive error (i.e., ≤ -0.50D), but this remains unclear. Hence, this work investigates the mean cycloplegic refractive error in adults aged between 20 - 40 years., Methods: In 2002 a cross-sectional study with stratified cluster sampling was performed on the population of Tehran, providing cycloplegic and non-cycloplegic refractive error data for the right eyes of 3,576 participants, aged 30.6±18.6 years (range: 1-86 years). After grouping these data into age groups of 5 years, the refractive error histogram of each group was fitted to a Bigaussian function. The mean of the central, emmetropized peak was used to estimate the mean refractive error without the influence of myopia., Results: The mean cycloplegic refractive error at the emmetropized peak decreased from +1.10±0.11D (95 % confidence interval) to +0.50±0.04D before 20 years and remains stable at that value until the age of 50 years. The non-cycloplegic refractive error also sees a stable phase at 0.00±0.04D between 15 - 45 years. After 45 - 50 years both cycloplegic and non-cycloplegic refractive error become more hypermetropic over time, +1.14±0.12D at 75 years., Conclusions: The cycloplegic refractive error in adults is about +0.50D between 20 - 50 years, disproving the existence of the myopic period at those ages., Competing Interests: Declaration of competing interests There are no competing interests., (Copyright © 2023 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: To report the visual and refractive characteristics and the prevalence of amblyopia in patients with different types of Duane's Retraction Syndrome (DRS)., Method: This retrospective study was performed on hospital records of 582 DRS patients at Farabi Hospital, Iran, from 2012 to March 2022., Results: The mean age of patients was 19.4 ± 11.9 (range, 3-70) years [335 (57.6 %) females and 247 (42.4 %) males (P < .001)]. DRS type I, II, III, and IV were presented in 347 (59.6 %), 148 (25.4 %), 82 (14.1 %), and 5 (0.9 %) patients, respectively. There were 530 (91.1 %) patients with unilateral and 52 (8.9 %) with bilateral involvement. In the unilateral patients, the DRS eyes' corrected distance visual acuity (CDVA) and astigmatism were significantly worse than the Non-DRS Eyes (P < .001). The mean amount of all refractive and visual parameters in bilateral patients' right or left eyes was significantly lower than in unilateral patients' non-DRS eyes (all P < .05). Anisometropia was observed in 75(12.9 %) of the patients. Amblyopia was observed in 18.5 % (98 patients) and 36.5 % (19 patients) of unilateral and bilateral DRS patients, respectively (P < .001). In unilateral patients, amblyopia was found in 57 (16.4 %) patients with Type I, 22 (14.9 %) patients with Type II, 16 (19.5 %) patients with Type III, and 3 (60 %) patients with Type IV. Forty-four (37.6 %) of patients with amblyopia had anisometropia., Conclusion: This large-scale study indicates that DRS types differ in terms of refractive error, visual acuity, and the prevalence of amblyopia and anisometropia. Clinicians should be aware of the clinical features associated with different types of DRS., Competing Interests: Conflicts of interest The authors have no conflicts of interest to declare., (Copyright © 2023 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.)

Background/objectives: The See4School programme in Scotland is a pre-school vision screening initiative delivered by orthoptists on a national scale. The primary objective of any vision screening programme is to identify amblyopia, given the common understanding that this condition is unlikely to be detected either at home or through conventional healthcare channels. The target condition is not bilateral visual impairment, as it is believed that most children will be identified within the first year of life either through observations at home or as part of the diagnosis of another related disorder. This belief persists even though bilateral visual impairment is likely to have a more detrimental impact on a child's day-to-day life, including their education. If this hypothesis were accurate, the occurrence of bilateral visual impairment detected through the Scottish vision screening programme would be minimal as children already under the hospital eye service are not invited for testing. The overarching aim of this study was therefore to determine the prevalence of presenting bilateral visual impairment associated with refractive error detected via the Scottish preschool screening programme., Subjects/methods: Retrospective anonymised data from vision screening referrals in Scotland from 2013-2016 were collected. Children underwent an assessment using a crowded logMAR vision test and a small number of orthoptic tests., Results: During the 3-year period, out of 165,489 eligible children, 141,237 (85.35%) received the vision screening assessment. Among them, 27,010 (19.12%) failed at least one part of the screening and were subsequently referred into the diagnostic pathway, where they received a full sight test. The prevalence of bilateral visual impairment associated with refractive error and detected via the vision screening programme (≥ 0.3LogMAR) was reported to range between 1.47% (1.37-1.59) and 2.42% (2.29-2.57)., Conclusions: It is estimated that up to 2.42% (2.29-2.57) of children living Scotland have poorer than driving standard of vision (6/12) in their pre-school year, primarily due to undetected refractive error. Reduced vision has the potential to impact a child's their day-to-day life including their future educational, health and social outcomes., (© 2024. The Author(s).)