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Purpose: To determine the characteristics of crystalline lens with varying refractive errors and relationship with axial elongation in young school children., Methods: A total of 1465 children aged 6-8 years were examined annually for 2 years. Each participant underwent a series of ophthalmic examinations, including cycloplegic autorefraction, crystalline lens and axial length measurement. Crystalline lens power was determined, and factors associated with different refractive statuses were investigated., Results: Crystalline lens power decreased with time; reduction in lens power in Year 1 was greater in children with emmetropia (-0.69 ± 0.59 dioptre [D]) than in those with hyperopia (-0.49 ± 0.56 D) or myopia (-0.45 ± 0.55 D) (p < 0.001). Among the emmetropes, there were no differences in loss of crystalline lens power between those who remained emmetropic (-0.63 ± 0.59 D) and those who became myopic at Year 1 (-0.74 ± 0.61 D) and Year 2 (-0.77 ± 0.57 D, p > 0.05) visits. Among myopes at Year 1 visit, there was a greater reduction at Year 2 in those who had baseline emmetropia (-0.61 ± 0.51 D) than those who had baseline myopia (-0.26 ± 0.49 D, p < 0.001). The trend was similar among children of the same age. There was a significant correlation between changes in lens power and axial elongation in non-myopia (β = -0.954, p < 0.001) and new myopia (β = -1.178, p < 0.001), but not in established myopia (β = -0.001, p = 0.539)., Conclusions: There is accelerated loss of lens power in emmetropia and early stage of myopia. However, this loss is retarded when myopia persists and is accompanied by disappearance of the compensatory effect of lens power against axial elongation. These findings provide new insights into human refractive development., (© 2021 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To describe the methodology and pilot data of the Shanghai Child and Adolescent Large-scale Eye Study (SCALE-HM)., Methods: This is a population-based, prospective, examiner-masked study with annual follow-up. Patients are 4- to 18-year-olds with high myopia. The participants will fill out questionnaires and then undergo visual acuity, axial length (AL), intraocular pressure, ophthalmologist assessment, microperimetry, cycloplegic refraction, Pentacam, wavefront aberration, fundus, blood and saliva examinations. To describe the pilot data, intergroup differences were assessed with t-tests or analysis of variance and a logistic regression model was used to determine the independent factors associated with peripapillary atrophy (PPA)., Results: Overall, 134 eyes of 79 participants met the pilot study recruitment criteria. The mean AL and spherical equivalent were 26.91 ± 1.07 mm and -9.40 ± 1.77 D, respectively. Peripapillary atrophy (PPA) (N = 112) and tessellated fundus (N = 67) were the most common fundus changes. The mean AL was significantly longer in PPA (27.08 ± 0.93 mm) than in non-PPA eyes (26.06 ± 1.31 mm; p < 0.001). Axial length (AL) (p = 0.041) was the only independent factor associated with PPA. Axial length (AL) was significantly longer in eyes with diffuse chorioretinal atrophy (N = 11; 28.02 ± 1.31 mm) than without myopic retinal lesions (N = 56; 26.48 ± 0.91 mm, p < 0.001) or with tessellated fundus (N = 67; 27.09 ± 0.97 mm, p = 0.012). The myopic degree was higher in eyes with diffuse chorioretinal atrophy than without myopic retinal lesions (-10.51 ± 2.76 D versus -9.06 ± 1.58 D, p = 0.039)., Conclusion: Peripapillary atrophy and tessellated fundus were common in children and adolescents with high myopia. Results from this prospective study will help to understand the mechanisms, development and prognosis of these changes and can guide early myopia screening., (© 2020 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To explore the subfoveal thickness of sclera (SST), choroid (SCT) and retina (SRT) as well as their relationship in healthy Chinese children with varying levels of refractive error., Methods: A total of 810 healthy Chinese schoolchildren and adolescents underwent a series of comprehensive ocular examinations, as well as swept-source optical coherence tomography (OCT) after induced cycloplegia. The thicknesses of the sclera, choroid and retina below the central fovea were measured manually, and each measurement was compared across different refractive statuses. Independent factors associated with the thickness of each layer were analysed., Results: The mean SST, SCT and SRT were 524 ± 57 μm, 195 ± 49 μm and 224 ± 19 μm, respectively. The SSTs and SCTs of myopes were significantly thinner than those of emmetropes and hyperopes (all p < 0.001). Although the choroid seemed to be thicker in hyperopes (225 ± 46 μm) than in emmetropes (211 ± 45 μm), no statistically significant difference was observed between emmetropes and hyperopes in the sclera and choroid. Thinner SSTs and SCTs were associated with greater levels of myopia, whereas the SRT was similar in children with different myopic levels. SST (p < 0.001) and SCT (p = 0.003) as well as age (p < 0.001), sex (p < 0.001) and axial length (p < 0.001) were independently associated with spherical equivalent refraction (SER). Older age (p = 0.013), myopic-shifted SER (p < 0.001), thicker SCT (p < 0.001) and thinner SRT (p = 0.012) were independently associated with a thinner SST., Conclusion: The subfoveal sclera and choroid were thinner in myopes than in emmetropes and hyperopes, while the retina remains constant. Age, refractive error and choroidal and retinal thicknesses are related to subfoveal scleral thickness., (© 2018 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica.)