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Myopia is the most common refractive error in the world, and its’ prevalence continually increases. The potential pathological and visual complications of progressive myopia have inspired researchers to study the sources of myopia, axial elongation, and explore modalities to arrest progression. Considerable attention has been given over the past few years to the myopia risk factor known as hyperopic peripheral blur, the focus of this review. The primary theories currently believed to be the cause of myopia, the parameters considered to contribute and influence the effect of peripheral blur, such as the surface retinal area or depth of blur will be discussed. The currently available optical devices designed to provide peripheral myopic defocus will be discussed, including bifocal and progressive addition ophthalmic lenses, peripheral defocus single vision ophthalmic lenses, orthokeratology lenses, and bifocal or multifocal center distance soft lenses, as well as their effectivity as mentioned in the literature to date.

Purpose: To ascertain the effectivity of 0.01% atropine (A0.01%) treatment to inhibit myopia progression and the possible additive potency with peripheral defocus contact lenses over three years and the rebound effect one year after cessation of treatment. Methods: This prospective study included 127 children aged 8–15 years, divided into three treatment groups: A0.01% and single vision (SV) spectacles (At, n=36), A0.01% and peripheral defocus contact lens (At+PDCL, n=30), 0.01%At and dual focus (At+DF, n=25) and a control group prescribed SV spectacles (n=36). Cycloplegic spherical equivalence refraction (SER) was measured every six months during three years of treatment and one year after cessation. Results: Myopia progression decreased over three years of treatment, more during the second and third years than the first, to a statistically significant degree in the A0.01% monotherapy group(PConclusions: Low-dose atropine has been substantiated in this cohort as an effective treatment to decelerate myopia progression over three years, more effective in the second and third years of treatment. The combination treatment did not exhibit a statistically significant advantage over monotherapy in this cohort. The dual-focus lens group exhibited a statistically lower rebound effect than the monotherapy group.

This retrospective case series demonstrates the combination of 0.05% atropine with MiSight® 1 day (Cooper vision, Sar Ramon, CA, USA) in rapid progression of myopia of 4 children. MiSight® 1 day is a peripheral defocus, center-distance soft contact lens and is effective at controlling moderate progression of myopia during the course of 1 year. The current case series included 2 females and 2 males with an average age of 9.68 ± 0.26 years and an average axial length of 24.81 ± 0.92 mm. Their myopic progression during the previous year was −1.45 ± 0.27 D. The children had not attempted any myopia control thus far. This relatively high increase prompted a combination treatment of daily instillation of 0.05% atropine and MiSight, a daily replacement soft contact lens. Cycloplegic refraction and a slit-lamp evaluation were performed every 6 months to confirm no adverse reactions or staining was present. The 8-item contact lens dry eye questionnaire (CLDEQ-8) score of these children was 10.66 ± 1.52. The average myopia progression at the end of 1 year decreased to −0.41 ± 0.11 D, and the average axial length increase was 0.28 ± 0.08 mm. To the best of the authors’ knowledge, this is the first published study showing a combination of 0.05% atropine and peripheral defocus soft contact lenses indicating efficacy at controlling moderate myopia progression.

Presbyopia is the physiological, gradual, progressive loss of the ability to see clearly at near point which affects people as they age. It is primarily caused by the thickening and stiffening of the lens leading to an inability to adjust its shape to become convex enough to induce adequate plus power to see at short distances. Symptoms usually begin affecting individuals around 40 years of age, the most common being discomfort in or around the eyes after prolonged near work, blur at distance after near work, and eventually progressing to near blur, often with a natural tendency to distance the object by holding it farther away to try to see it better. At a certain point near tasks become impossible and the patient will seek an external solution. Various therapies are available and being developed to treat presbyopia, which include glasses, contact lenses, intraocular lens implants, corneal laser procedures, intracorneal implants, scleral alterations and pharmacological ocular drops. Untreated presbyopia negatively affects quality of life as well as the world productivity since presbyopia progresses from approximately an age when people are still an active part of the workforce. As the population and life expectancy grow, so will the number of presbyopes. This article will discuss the various options available to treat presbyopia.

The goal of this retrospective case series is to demonstrate the effectivity of combination low-dose atropine therapy with peripheral defocus, double concentric circle design with a center distance soft contact lenses at controlling myopia progression over 1 year of treatment. Included in this series are 3 female children aged 8–10 years with progressing myopia averaging −4.37 ± 0.88 D at the beginning of treatment. Their average annual myopic progression during the 3 years prior to therapy was 1.12 ± 0.75 D. They had not attempted any myopia control treatments prior to this therapy. The children were treated with a combination of 0.01% atropine therapy with spherical peripheral defocus daily replacement soft lenses MiSight® 1 day (Cooper Vision, Phoenix, AZ, USA). They underwent cycloplegic refraction, and a slit-lamp evaluation every 6 months which confirmed no adverse reactions or staining was present. Each of the 3 children exhibited an average of 0.25 ± 0.25 D of myopia progression at the end of 1 year of treatment. To the best of the authors’ knowledge, this is the first published study exhibiting that combining low-dose atropine and peripheral defocus soft contact lenses is effective at controlling children’s moderate to severe myopia progression during 1 year of therapy.

As life expectancy grows, so too will the number of people adversely affected by age. Although it is acknowledged that many conditions and diseases are associated with age, this mini-review will present a current update of the various visual changes that generally occur in healthy individuals disregarding the possible effects of illness. These alterations influence how the world is perceived and in turn can affect efficiency or the ability to perform ordinary daily tasks such as driving or reading. The most common physical developments include a decreased pupil size and retinal luminance as well as changes both in intercellular and intracellular connections within the retina along the pathway to the visual cortex and within the visual cortex. The quantity and the physical location of retinal cells including photoreceptors, ganglion and bipolar retinal cells are modified. The clarity of intraocular organs, such as the intraocular lens, decreases. These all result in common visual manifestations that include reduced visual acuity, dry eyes, motility changes, a contraction of the visual field, presbyopia, reduced contrast sensitivity, slow dark adaptation, recovery from glare, variation in color vision and a decreased visual processing speed. Highlighting these prevalent issues as well as current and possible future innovations will assist providers to formulate treatments and thereby conserve maximum independence and mobility in the modern mature population.

Context A correlation between myopia and insulin resistance has been suggested. Objective We investigated the association between myopia in adolescence and type 2 diabetes (T2D) incidence in young adulthood. Methods This population-based, retrospective, cohort study comprised 1 329 705 adolescents (579 543 women, 43.6%) aged 16 to 19 years, who were medically examined before mandatory military service during 1993 to 2012, and whose data were linked to the Israel National Diabetes Registry. Myopia was defined based on right-eye refractive data. Cox proportional models were applied, separately for women and men, to estimate hazard ratios (HRs) for T2D incidence per person-years of follow-up. Results There was an interaction between myopia and sex with T2D (P Conclusion For women, myopia in adolescence was associated with a significantly increased risk for incident T2D in young adulthood, in a severity-dependent manner. This finding may support the role of insulin resistance in myopia pathogenesis.

The COVID-19 pandemic of 2020 and its' accompanied lockdowns impacted the entire globe in ways the world is only beginning to comprehend. In Israel, children age 9-15 had not been in a frontal classroom and been socially restricted from March 2020 till March 2021. Fourteen of these children that had been under myopia control treatment which had been effective prior to the pandemic were included in this retrospective study to learn if their myopia continued to stay under control, or if the unique environmental modifications affected their progression. The results showed that average increase in spherical equivalent refraction and axial length, measured with optical biometer OA-2000 (Tomey GmbH, Nagoya, Japan), during the year of lockdowns was -0.73 ± 0.46D/0.46 ± 0.31 mm respectively, while the average increase in the year prior was -0.33 ± 0.27D/0.24 ± 0.21 mm. Though several articles have indicated the pandemic environment has influenced myopia progression in children, this communication indicates a possible significant impact of the environment on myopia increase even in individuals under effective atropine treatment. These children's' progression suggests practitioners consider and address multiple aspects simultaneously when attempting myopia control.

The severe acute respiratory syndrome (SARS-CoV-2) or coronavirus disease (COVID-19) is caused by a single-strand RNA virus that first began spreading in December 2019 and evolved to a global pandemic within a few months. It's transmission is primarily through direct contact of the virus with mucous membranes which possess angiotensin-converting enzyme) ACE2(. Ocular manifestations of COVID-19 are extremely rare and there is only evidence of low quantities of ACE2 in ocular tissue. Yet both the environment of the contact lens practice and the wearing of contact lenses present high potential risk of inadvertent infection. The data to date suggests no evidence of contracting COVID-19 through contact lenses and very little data supporting the possibility of coronavirus adherence to the ocular surface. To minimize opportunity for infection, practitioners may decide to delay non-essential visits. When they do examine, clinicians should wear personal protective gear as well as protective shields on equipment and include a thorough disinfecting of surfaces and equipment protocol between each examination. Patients should be reminded about the importance of appropriate contact lens hygene, namely hand washing with soap and water, drying with single use paper prior and after handling of lenses, proper disinfection and replacement of lenses and cases. Patients should not wear lenses when feeling ill and should be advised to consciously refrain from face touching to avoid unintentional contamination. This article reviews the information available to date related to contact lens wearers and their caregivers during this still-evolving crisis.

Several significant visual changes can occur during human aging. These include decreased visual acuity and binocular function, contraction of visual fields, presbyopia, dry eye, decreased contrast sensitivity, decreased dark adaptation, delayed glare recovery, change in color vision and decreased visual processing speed. The most common physical changes are decreased pupil size, decreased retinal luminance, changes in inter- and intracellular connections, both intra-retinal and connections to the cortex .There are changes both in quantity and physical location of various cells, such as photoreceptors ganglion and bipolar retinal cells, as well as changes in clarity of media such as the crystalline lens, all of which in turn cause the resulting visual changes. Among adversely affected tasks are near work such as reading and computer work, driving, maneuvering through crowded or unfamiliar surroundings, locating desired objects surrounded by clutter and even decreased balance ability that may cause falling. Some of the changes can be reversed or at least slowed, but some processes cannot be stopped. Some of the options at our disposal to help the patient can vary from early prevention, using single or a combination of external devices such as optical devices and various forms of medical treatments, surgical and other. Although the visual system is affected by other senses, vision also affects other systems in the body. The objective here is to isolate specifically visual-related changes that can occur as healthy people age and thereby expand the vocabulary and dialogue between health care providers with ophthalmologists and optometrists for ultimate better patient care. The following review attempts to present a brief current update of the accumulated data describing various physiological visual changes that can occur with aging in generally healthy individuals and in this article, disregards the effects of ocular diseases, even if they are usually associated with age.

BackgroundTo compare visual acuity and CSF improvement with perceptual learning versus part-time patching in limbal dermoid children after keratoplasty.MethodsAll children in the limbal dermoid and normal group underwent visual acuity and CSF evaluation, and the normal group wore the optical defocus to simulate the corresponding visual acuity of the limbal dermoid group. Among the limbal dermoid children, 9 underwent perceptual learning(PL), and 8 underwent part-time patching for 6 months and were followed for 6 months to evaluate visual acuity and CSF.ResultsRegarding CSF, the area under log CSF (AULCSF) and the cutoff spatial frequency (cutoff SF) were obviously reduced in the limbal dermoid group compared with the optical defocus group and normal viewing group (1.29±0.27 vs 0.40±0.05 vs 0.70±0.05, and 5.38±0.75 vs 8.81±0.74 vs 14.81±0.89, all p value

To evaluate the incidence of consecutive exotropia following bilateral medial rectus muscle recession surgery (BMR) for esotropia using non-absorbable compared with absorbable sutures in children undergoing strabismus surgery. A retrospective cohort study of all children with esotropia who underwent BMR by a single surgeon in a tertiary public hospital. As of February 2018, only non-absorbable sutures were used. The primary outcome was the incidence of consecutive exotropia. A total of 121 children were included in the analysis, 3.66 ± 2.62 years, 53% were male. In 80 children (66%) non-absorbable sutures were used (non-absorbable group) and in 41 children (34%) absorbable sutures were used (absorbable group). Consecutive exotropia (≥ 8 prism dioptres) occurred in ten children (24%) in the absorbable group and in three children (4%) in the non-absorbable group (OR = 8.28, 95% CI = 2.13–32.13; P = 0.002). This difference between groups remained significant after adjustment for potential confounders and follow-up time (HR = 4.98, 95% CI = 1.30–19.05, P = 0.019). Mean follow-up time was 22 and 12 months in the absorbable and non-absorbable groups, respectively (P

Purpose A recently described subtype of foveal hypoplasia with congenital nystagmus and optic-nerve-decussation defects was found to be associated with mutations in the SLC38A8 gene. The aim of this study is to advance the clinical and molecular knowledge of SLC38A8 gene mutations. Methods Five Israeli families with congenital foveal hypoplasia were studied, two of Karait Jewish origins and three of Indian Jewish origins. Subjects underwent a comprehensive ophthalmic examination including retinal photography and ocular coherence tomography. Molecular analysis including whole exome sequencing and screening of the SLC38A8 gene for specific disease-causing variants was performed. Results Eight affected individuals were identified, all had congenital nystagmus and all but one had hypoplastic foveal pits. Anterior segment dysgenesis was observed in only one patient, one had evidence of developmental delay and another displayed early age-related macular degeneration (AMD). Molecular analysis revealed a recently described homozygous mutation, c.95T > G; p.Ile32Ser, in two families of Jewish Indian descent, and the same mutation in two families of Karaite Jewish descent. In a patient with only one pathogenic mutation (c.95T > G; p.Ile32Ser), a possible partial clinical expression of the disorder was seen. One patient of Jewish Indian descent was found to be compound heterozygous for c.95T > G; p.Ile32Ser and a novel mutation c.490_491delCT; p.L164Vfs*41. Conclusions In five unrelated families with congenital nystagmus and foveal hypoplasia, mutations in the SLC38A8 gene were identified. Possible partial expression in a heterozygous patient was observed and novel potential disease-related phenotypes were identified including early-onset AMD and developmental delay. A novel mutation was also identified and a similar mutation in both Indian and Karaite Jewish ethnicities could be suggestive for common ancestry.

The precise correction of refractive error is especially important in young adults. It is unclear whether cycloplegic refraction is necessary in this age group. The purpose of this study was to compare the non-cycloplegic and cycloplegic spherical equivalent (SE) refractive error measured in young adults.This was a prospective study of 1400 eyes (n = 700) of enlisted soldiers aged 18 to 21 years who were consecutively evaluated in an outpatient army ophthalmology clinic. One drop of cyclopentolate 1 % was installed twice 10 min apart, and cycloplegic refraction was performed in both eyes 40 min later using an auto-refractor. The difference between non-cycloplegic and cycloplegic refractive measurements was analyzed.The mean difference in SE between non-cycloplegic and cycloplegic measurements was 0.68 ± 0.83 D (95 % CI, 0.64-0.72). Significantly greater differences were observed in hypermetropes than myopes (1.30 ± 0.90 D versus 0.46 ± 0.68 D, p 0.001). Moderate hypermetropes (2 to 5 D) demonstrated significantly greater refractive error than mild (0.5 to 2 D) or severe (5 D) hypermetropes (1.71 ± 1.18 D versus 1.19 ± 0.74 D and 1.16 ± 1.08 D respectively, p 0.001).Young hypermetropic adults possessed +1 to +2 D of latent hypermetropia. In contrast, young myopic adults revealed pseudomyopia of -0.5 D. Cycloplegic refraction should be performed in young hypermetropic adults complaining of various signs of asthenopia.

Myopia is the most common refractive error and is now endemic over the entire industrial world, particularly in Asia. High myopia is one of the major causes of blindness in the world. Slowing the progress of myopia is possible, the most effective treatment being atropine ophthalmic drops, given in a dose-dependent fashion. Although high-dose atropine (1% and 0.5%) was found to be highly effective in slowing myopia progression, low-dose atropine (0.01%) was found to have the lowest rebound effect (accelerated myopia progression after treatment cessation) and was therefore, the most effective treatment in the long term. Moderately effective treatments include pirenzepine drops, cyclopentolate drops, orthokeratology, contact lenses which are designed to reduce the peripheral hyperopic blur and distance-center soft multifocal contact lenses. Less effective treatments include multifocal spectacle lenses, bifocal spectacle lenses, bifocal soft contact lenses and outdoor activity in daylight. Visual therapy, biofeedback, full-spectacle correction, under-correction, spectacles designed to reduce the peripheral hyperopic blur, single-vision rigid gas-permeable contact lenses, single-vision soft contact lenses, tropicamide drops and timolol drops were all found to be ineffective.

Aim To evaluate the results of bilateral lateral rectus to superior rectus myopexy for the treatment of acquired adult distance esotropia. Methods The charts of all adult patients who were operated for esotropia by the first author at the Department of Ophthalmology, Assaf Harofeh Medical Center, Tel Aviv University, Zrifin, Israel, between the years 2010-2015 were analyzed. Patients with the following inclusion criteria were included: acquired esotropia (not present during childhood); deviation greater for distance than near by at least 4 prism diopters (PD); slight abduction deficit in one or both eyes and/or displacement of the lateral rectus downwards as evident by CT/MRI with or without superior rectus nasal shift and no neurologic abnormalities such as cranial nerve palsies or other. Results Eighteen patients were identified (age 31-80 years, mean 49.6 years, 77.7% females). Pre-operative esodeviation averaged 24.3 PD (range 14-35 PD) for distance and 15.7 PD (range 8-25 PD) for near. Thirteen patients (72%) had diplopia. All patients were myopic (average -5.54 diopters, range -2.00 to -13.00). All patients underwent bilateral superior rectus-lateral rectus myopexy. Seven patients needed additional single medial rectus recession of between 2-6 mm, and two had additional inferior rectus recession. After a follow-up period of 3-52 months (average 16 months), 16/18 patients (88%) had a deviation less than 5 PD. No overcorrections were noted. Conclusion Lateral to superior rectus myopexy is a safe and effective treatment for patients with distance esotropia in which displacement of these muscles is identified. Additional single medial rectus and/or inferior rectus recession may be needed in some patients.

Purpose: To describe ocular and extraocular abnormalities in two Ashkenazi Jewish families with infantile cataract and X-linked inheritance, and to identify their underlying mutations.Methods: Seven affected members were recruited. Medical history, clinical findings, and biometric measurements were recorded. Mutation analysis of the Nance–Horan syndrome (NHS) gene was performed by direct sequencing of polymerase chain reaction-amplified exons.Results: An unusual anterior Y-sutural cataract was documented in the affected male proband. Other clinical features among examined patients included microcorneas, long and narrow faces, and current or previous dental anomalies. A nonsense mutation was identified in each family, including a previously described 742 C>T, p.(Arg248*) mutation in Family A, and a novel mutation 2915 C>A, p.(Ser972*) in Family B.Conclusions: Our study expands the repertoire of NHS mutations and the related phenotype, including newly described anterior Y-sutural cataract and dental...

The purpose of this work is to establish a reference scale of optic nerve pathway measurements in pediatric patients according to age using MRI. Optic nerve pathway measurements were retrospectively analyzed using an orbits equivalent sequence on brain MRI scans of 137 pediatric patients (72 male, 65 female, average age = 7.7 years, standard deviation = 5.3). The examinations were performed on a 1.5-T or 3-T Siemens MR system using routine imaging protocols. Measurements include diameters of the orbital optic nerves (OON), prechiasmatic optic nerves (PON), optic tracts (OT), and optic chiasm (OC). Measurements were performed manually by 2 neuroradiologists, using post-processing software. Patients were stratified into five age groups for measurement analyses: (I) 0-1.49 years, (II) 1.5-2.99 years, (III) 3-5.99 years, (IV) 6-11.99 years, and (V) 12-18 years. The observed value range of OON mean diameter was 2.7 mm (Interquartile range (IQR) = 2.4-2.9), PON was 3.2 mm (IQR = 3.05-3.5), OT 2.6 mm (IQR = 2-2.9). A strong positive correlation was established between age and mean diameter of OON (r = 0.73, p .001), PON (r = 0.59, p .001), and OT (r = 0.72, p .001). A significant difference in mean OON diameters was found between age groups I-II (d = 0.3, p = .01), II-III (d = 0.5, p .001), III-IV (d = 0.5, p .001) followed by a plateau between IV-V (d = 0.l0, p = .19). OON/OT ratio maintained a steady mean value 1 (IQR = 0.93-1.1) regardless of age (p = .7). The diameter of optic pathways was found to increase as a function of age with consistent positive correlation between nerve and tract for all ages.

PURPOSE Retinitis pigmentosa (RP) is a group of clinically and genetically heterogeneous hereditary retinal diseases that result in blindness due to photoreceptor degeneration. Mutations in the rhodopsin (RHO) gene are the most common cause of autosomal dominant RP (adRP) and are responsible for 16% to 35% of adRP cases in the Western population. Our purpose was to investigate the contribution of RHO to adRP in the Israeli and Palestinian populations. METHODS Thirty-two adRP families participated in the study. Mutation detection was performed by whole exome sequencing (WES) and Sanger sequencing of RHO exons. Fluorescence PCR reactions of serially diluted samples were used to predict the percentage of mosaic cells in blood samples. RESULTS Eight RHO disease-causing mutations were identified in nine families, with only one novel mutation, c.548-638dup91bp, identified in a family where WES failed to detect any causal variant. Segregation analysis revealed that the origin of the mutation is in a mosaic healthy individual carrying the mutation in approximately 13% of blood cells. CONCLUSIONS This is the first report of the mutation spectrum of a known adRP gene in the Israeli and Palestinian populations, leading to the identification of seven previously reported mutations and one novel mutation. Our study shows that RHO mutations are a major cause of adRP in this cohort and are responsible for 28% of adRP families. The novel mutation exhibits a unique phenomenon in which an unaffected individual is mosaic for an adRP-causing mutation.

Background context Back problems are reported with increasing frequency in adults and adolescents. Most information is from self-reported questionnaires or studies with small sample sizes. Reports were usually focused on specific diseases and biased toward overdiagnosis. Purpose To assess the prevalence of common back disorders among a large cohort of 17-year-old males and females recruited by the Israel Defense Forces (IDF). Study design A retrospective cross-sectional prevalence study. Patient sample Seventeen-year-old Israeli male and female military recruits reporting as directed by the IDF for preinduction medical examination between January 01, 1998 and December 31, 2006. Outcome measures Military functional limitation Grades 1 to 7 per diagnosis category. Methods Military recruits were examined and classified based on medical and orthopedic diagnoses. They were referred for orthopedic consultation as necessary. Four orthopedic classifications were used: spinal deformity (including kyphosis and scoliosis), back pain (including neck and radicular syndromes), spondylolysis/olisthesis, and limitations resulting from trauma or spinal surgery. Data were coded into a central database, and descriptive statistics are presented. Results The overall prevalence of back disorders among 828,171 17-year-old military recruits (61.5% male) was 16.8%. Back disorders resulting in significant functional limitation were diagnosed in 0.8% of recruits. The most prevalent diagnoses were spinal deformities (kyphosis and scoliosis, females 11.9%, males 11.5%) and back pain (females 3.0%, males 5.6%). Most of these diagnoses were rated as mild. Conclusions When using objective criteria, overall back disorders in a large population of 17-year-old recruits were 17%, considerably lower than most reports. Back morbidity severe enough to prevent combat duty occurred at a rate of less than 1%, suggesting that serious back morbidity is not a frequent finding in this age group. Level of evidence Symptom prevalence study, Level III.

Purpose To assess the biomechanical and keratometric effects and the safety of treatment of progressive keratoconus with UV-riboflavin collagen cross-linking (CXL). Methods This is a prospective clinical controlled study. Fourteen eyes of 14 patients with progressive keratoconus were treated with CXL after corneal deepithelization. Patients were assessed preoperatively, at week 1 and at months 1, 3, 6, 9, 12, and 24 after treatment. We measured uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA) (logarithm of the minimum angle of resolution), refraction, biomicroscopy and fundus examination, intraocular pressure, axial length, endothelial cell density, corneal topography, minimal corneal thickness, macular optical coherence tomography, and corneal biomechanics with the ocular response analyzer. Results Comparing the preoperative results with 24-month postoperative results, we observed significant improvement in BCVA (0.21 ± 0.1 to 0.14 ± 0.1, P = 0.002) and stability in UCVA (0.62 ± 0.5 and 0.81 ± 0.49, P = 0.475). We observed a significant decrease in steepest-meridian keratometry (diopters) (53.9 ± 5.9 to 51.5 ± 5.4, P = 0.001) and in mean cylinder (diopters) (10.2 ± 4.1 to 8.1 ± 3.4, P = 0.001). Significant elongation of the eyes was observed, from 24.39 ± 1.7 mm to 24.71 ± 1.9 mm (P = 0.007). No significant change was observed in mean simulated keratometry, minimal corneal thickness, endothelial cell density, corneal hysteresis, and corneal resistance factor or foveal thickness. Conclusions Two years after CXL, the observation of stable UCVA, improved BCVA, and reduced keratometry suggests stabilization in progression of keratoconus. Unchanged corneal thickness, endothelial cell density, and foveal thickness suggest the long-term safety of this procedure. The observed increase in axial length and stability in corneal biomechanical parameters measured with the ocular response analyzer require further study for verification and explanation.

PURPOSE To assess the rate of clinically significant angle closure in a predominantly Caucasian, clinic-based population, and consequently find out whether gonioscopy should be included in the routine ophthalmic examination. METHODS Patients aged ≥40 years with hyperopia ≥1 D were consecutively recruited in a community general ophthalmology clinic. Detailed darkroom gonioscopy was done, and primary angle closure was diagnosed if there was iridotrabecular apposition >180 degrees not secondary to an identifiable ocular disorder. Biometric parameters were measured and compared between the eyes with and without angle closure. RESULTS Eighty-four eyes from 84 patients (aged 61.3±8.9 y) were enrolled. There were 52 female (62%) and 32 male. Fourteen patients (16.7%) were diagnosed with angle closure. A statistically significant difference was observed between the eyes with and without angle closure in mean axial length (22.07±0.72 vs. 22.61±0.97, P=0.028), anterior chamber depth (ACD) (2.45±0.33 vs. 2.89±0.32, P

To assess variations in the biomechanical properties and central corneal thickness (CCT) throughout the female menstrual cycle.Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin Israel.Case series.Young healthy women were prospectively recruited. Every participant was assessed at the beginning of the menstrual cycle, at ovulation, and at the end of the cycle. At every time point, corneal hysteresis (CH) and the corneal resistance factor (CRF) were measured with the Ocular Response Analyzer and the CCT was measured with an ultrasonic pachymeter.Twenty-two eyes of 22 women (mean age 19.5 years ± 1.5 [SD]) were included. The CH was statistically significantly decreased at ovulation (10.1 mm Hg) compared with the beginning (11.1 mm Hg, P.001) and the end (11.4 mm Hg, P.001) of the cycle. The CRF was also significantly decreased at ovulation (9.8 mm Hg) compared with the beginning (10.6 mm Hg, P.001) and the end (10.5 mm Hg, P.001) of the cycle. The central cornea was thinnest at the beginning (535 μm) and statistically significantly thicker at ovulation (542 μm, P.001) and at the end of the menstrual cycle (543 μm, P.001).The CCT and biomechanical parameters significantly varied during the menstrual cycle. The CH and CRF were temporarily decreased at ovulation. The cornea was thinnest at the beginning and thicker at ovulation and at the end of the cycle. Such corneal changes may be important to consider during screening of candidates for laser refractive surgery.

PurposeTO investigate the effect of long-term, not experimentally induced visual impairment on balance, and to clarify which means are used to compensate for this sensory deficit.MethodsPosturography was examined in 50 visually impaired subjects (11 with congenital blindness and 39 with acquired visual impairment) and 50 healthy controls. Examination was performed in 4 testing conditions: while standing on firm surface or foam pads (which decreases the somatosensory input) and with open or closed eyes (manipulating visual input).ResultsSubjects with acquired visual impairment were significantly less stable than controls when tested with open eyes, especially when standing on foam pads, but equal to controls when eyes were closed. Congenitally blind subjects performed equally to normal controls in all test conditions when tested with eyes open, and performed significantly better than controls with eyes closed. In comparison to subjects with acquired visual impairment, the congenitally blind were significantly more stable in all test conditions. Fourier analysis revealed that the visually impaired subjects showed decreased intensity values within the lowest frequency range of 0.1 Hz and below, a range believed to be sensitive to the function of the visual system.ConclusionsWe have found that vision impairment influenced postural control, especially if acquired and not congenital. The somatosensory and vestibular systems serve as compensatory mechanisms, which is utilized most effectively by the congenitally blind.

PURPOSE To assess the repeatability of endothelial cell density (ECD) measurements by the EM-935 endothelial microscope and their agreement with those of the Konan-Noncon Robo SP 6000 (Noncon Robo) specular microscope. METHODS We assessed the agreement between automated and semiautomated methods of analysis of the EM-935 and the Noncon Robo by measuring ECD in 40 eyes of 20 healthy subjects and calculating the 95% limits of agreement (LoA) and plotting Bland-Altman graphs. We then evaluated the repeatability of both the methods of the EM-935 by calculating the intraclass correlation coefficients (ICC) and coefficient of variation (CV). RESULTS The mean ECD of the 40 eyes was 2531+/-244 cells/mm2 for Noncon Robo and 2483+/-159 cells/mm2 for EM-935-automated. The difference between these 2 methods was not statistically significant. The mean ECD for EM-935-semiautomated was 2635+/-190 cells/mm2 and was statistically significantly higher than the 2 other methods (p

Purpose. To compare unilateral versus bilateral surgical treatment of esotropia associated with high myopia. Methods. This retrospective study comprised patients who underwent surgery for esotropia with high myopia performed by the first author (Y.M.) between 2003 and 2008. Surgical results and complications were compared between patients who underwent unilateral versus bilateral surgery. Results. Nine patients were identified with average age of 44.9 years (range 8–70 years). All had bilateral high myopia (average −13.35 D, range −9.00 to −17.50 D) and esotropia of 20–75 diopters, together with hypotropia in 5 cases. Bilateral displacement of the lateral rectus inferiorly and superior rectus medially was demonstrated in each patient by computed tomography scan of the orbits and by observation during surgery. Five patients underwent bilateral surgery and 4 underwent unilateral surgery. After an average follow-up of 29 months (range 4–47 months), 4/5 patients who underwent bilateral myopexy achieved good results with postoperative esotropia of less than 8 diopters, as opposed to 2/4 patients who underwent unilateral surgery. No complications were noted. Conclusions. Bilateral superior and lateral rectus myopexy is the preferred method of surgical correction of esotropia associated with high myopia. Additional unilateral or bilateral medial rectus recession is probably not indicated in most cases. Patients who prefer unilateral surgery can benefit from unilateral superior and lateral rectus myopexy together with medial rectus recession. This unilateral approach may yield good results particularly in young patients without markedly restricted and tight extraocular muscles.

Paediatric abusive head injury may have grave consequences, especially when characterized by repetitive acceleration-deceleration forces (shaken baby syndrome). Death occurs in approximately 30% and permanent neurologic damage in up to 80% of the victims. Retinal haemorrhages are a cardinal sign seen in approximately 85% of cases. In most cases haemorrhages are preretinal, intraretinal and subretinal, too numerous to count, and involving the entire retinal surface extending to the ora serrata. Traumatic macular retinoschisis is a lesion with important diagnostic significance. Vitreoretinal traction appears to be the mechanism of haemorrhage and schisis formation along with a possible role of orbital tissue trauma from repetitive acceleration-deceleration forces. Ophthalmologists must carefully document ocular findings. Appropriate autopsy examination should include ocular and orbital tissue removal. Although there is a wide differential diagnosis for retinal haemorrhages, clinical appearance, when considered in the context of systemic and laboratory findings, usually leads to the correct diagnosis. Language: en

Background: The aim of this study was to evaluate the change in prevalence of weight disorders and associated morbidity among young adults. Methods: Records of 1 021 211 subjects aged 17, who underwent a medical examination, were included. Results: Among female subjects the prevalence of underweight increased steadily from 13.2% to 15.6%. No statistically significant trend was found among male subjects. Among male subjects a twofold increase in the prevalence of obesity was observed, while among female subjects there was an increase of 57%. In obese versus normal-weight male subjects the OR, adjusted for origin, education and year of recruitment, of having high blood pressure, diabetes type 2 and type 1 and hyperlipidemia were 4.1 (95%CI 3.89–4.34), 5.56 (5.09–6.07), 1.00 (0.30–3.27) and 16.07 (8.29–31.15), respectively. For obese female nominees the OR were 5.56 (95%CI 5.09–6.07), 4.42 (3.90–5.00), 3.59 (0.77–16.87) and 9.00 (4.36–18.60), respectively. Conclusion: A significant increase in prevalence of obesity was observed with an increased risk of having diabetes type 2, hyperlipidemia and high blood pressure. An increase in the prevalence of being underweight was observed in female subjects. Policy makers have to plan appropriate effective interventions that will promote a healthy lifestyle in adolescents and reduce obesity on the one hand, and avoid the fashion for being underweight, with its possible development to anorexia, on the other.

Ocular parameters are influenced by sleep derivation and the use of chemical substances which are two major causes for traffic accidents. We assessed the use of these parameters as an objective screening tool for a driver's fitness for duty. Pupillary diameter, pupil reaction to light and saccadic velocity were measured in 29 army truck drivers every morning for two months and compared to baseline measurements taken while the subjects were alert. An index which expressed the difference between study and baseline measurements was calculated, and drivers with significant deviation from baseline were disqualified and interviewed. Non-disqualified drivers served as controls. Twenty-nine percent of disqualified drivers reported sleeping less than the minimum of 7 h required by army regulations compared with 8% of control drivers (p = 0.01). Disqualified drivers had worse sleep quality the night before the test (Groningen Sleep Quality Scale, p = 0.03) and incurred more accidents per driving day during their service (0.023 vs. 0.015 accidents/day, p = 0.03). Two disqualified drivers admitted to using alcohol or sleeping pills. Thus, these ocular parameters may serve as a screening tool for drivers that are at high risk for driving. Drivers who were disqualified even once, tend to be involved in more motor vehicle accidents than their peers.

PURPOSE To assess changes in biomechanical properties of human cornea after treatment of keratoconus with UV-A-riboflavin corneal collagen cross-linking (CXL). DESIGN Single-center, prospective, interventional study. METHODS Ten eyes of 10 patients aged 26.5 +/- 5.7 (mean +/- SD) years with progressive keratoconus were treated with UV-A-riboflavin CXL and assessed with the Ocular Response Analyzer (ORA) that measured corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal compensated intraocular pressure (IOPcc). Intraocular pressure was also measured by Goldmann applanation tonometry (GAT-IOP). Patients were assessed with ORA preoperatively, at week 1, months 1, 3, and 6 after treatment. Postoperative measurements at each visit were compared with preoperative values. RESULTS CH and CRF were transiently elevated after cross-linking treatment, with the difference not statistically significant (P > 0.3). IOPcc and IOPg were statistically significantly higher at 1 week and 1 month but not subsequently (P < 0.04). GAT-IOP was statistically significantly higher at 1 week and at 1 and 3 months (P < 0.01). CONCLUSIONS There were no significant differences in corneal biomechanical properties, as measured with the ORA parameters CH and CRF, after CXL in keratoconus. IOPcc, IOPg, and GAT-IOP values were transiently elevated after CXL treatment in our study. Whether this reflects a measurement artifact resulting from corneal changes or true elevation of intraocular pressure is unclear.

Background: Patients who suffer from ocular genetic diseases have special needs in terms of diagnosis and management of rare entities, low-vision needs, genetic counselling, and psychosocial adjustments that are usually not addressed by an ophthalmologist alone.The Ocular Genetics Program (OGP) at the Hospital for Sick Children,Toronto, was established in 1994 to provide comprehensive, multidisciplinary care of patients with inherited eye disorders.We now assess the benefits of such a program and of integrating research into the care of patients. Methods: We report our experience in developing a multidisciplinary ocular genetics program and the results of a pilot patient satisfaction survey that involved 61 patients. Results: The OGP multidisciplinary aspects are described. Of the 61 patients surveyed, 98% stated that they were satisfied with the OGP; 93%–96% of patients were content with "one day of appointments","understanding of eye problem", and "coordination of ancillary tests such as visual fields test, electrophysiology, and others"; and for 70%–86% of respondents "waiting time to get an appointment", "information received on current research", and "primary health care provider adequately informed" were satisfactory. Interpretation: The OGP is a unique service in Canada, which strives to provide the comprehensive care needed by ocular genetic patients.High patient satisfaction is an indicator of the success of this approach. Long waiting times for appointments and application of laboratory research in clinical care remain challenging.

Objective To compare axial length (AL) measurements obtained with ultrasound (US) and IOLMaster (software version 3.01.0294; Carl Zeiss Meditec, Jena, Germany) in eyes with diabetic clinically significant macular edema (CSME) and to examine the correlation between measurement difference and foveal thickness. Design Prospective nonrandomized clinical study. Participants Twenty-three healthy eyes of 23 participants and 21 eyes with CSME of 21 diabetic outpatients. Methods The authors prospectively measured AL using US and IOLMaster in eyes of both groups. Foveal thickness was measured with optical coherence tomography. The difference between both methods was assessed using the t test, and its correlation to foveal thickness was evaluated by Pearson coefficient. Main Outcome Measure Difference in AL measurements between IOLMaster and US. Results Mean±standard deviation foveal thickness in healthy and CSME eyes was 201±26 μm (range, 156–240) and 475±106 μm (range, 331–758), respectively. Mean AL by US and IOLMaster in healthy eyes was 23.17±1.07 mm (range, 21.17–25.18) and 23.25±1.10 mm (range, 21.17–25.26), respectively ( P = 0.51); in CSME eyes, it was 23.02±0.97 mm (range, 21.53–24.81) and 23.27±0.924 mm (range, 21.9–25.13), respectively ( P r = 0.18, P = 0.40) and CSME ( r = 0.02, P = 0.93) eyes. Conclusions Axial length measurements using applanation A-scan US and IOLMaster in eyes with CSME differ statistically and clinically significantly. This is likely a result of the fundamentally different methodology of the 2 methods in measuring eyes with a pathologically thickened retina. A conversion formula based on foveal thickness can not be provided at present.