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Significance: Clinicians and researchers would benefit from being able to predict the onset of myopia for an individual child. This report provides a model for calculating the probability of myopia onset, year-by-year and cumulatively, based on results from the largest, most ethnically diverse study of myopia onset in the United States., Purpose: This study aimed to model the probability of the onset of myopia in previously nonmyopic school-aged children., Methods: Children aged 6 years to less than 14 years of age at baseline participating in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study who were nonmyopic and less hyperopic than +3.00 D (spherical equivalent) were followed up for 1 to 7 years through eighth grade. Annual measurements included cycloplegic autorefraction, keratometry, ultrasound axial dimensions, and parental report of children's near work and time spent in outdoor and/or sports activities. The onset of myopia was defined as the first visit with at least -0.75 D of myopia in each principal meridian. The predictive model was built using discrete time survival analysis and evaluated with C statistics., Results: The model of the probability of the onset of myopia included cycloplegic spherical equivalent refractive error, the horizontal/vertical component of astigmatism (J0), age, sex, and race/ethnicity. Onset of myopia was more likely with lower amounts of hyperopia and less positive/more negative values of J0. Younger Asian American females had the highest eventual probability of onset, whereas older White males had the lowest. Model performance increased with older baseline age, with C statistics ranging from 0.83 at 6 years of age to 0.92 at 13 years., Conclusions: The probability of the onset of myopia can be estimated for children in the major racial/ethnic groups within the United States on a year-by-year and cumulative basis up to age 14 years based on a simple set of refractive error and demographic variables., Competing Interests: Conflict of Interest Disclosure: The authors listed report a financial conflict of interest (KZ, DOM: Vyluma, Inc.). The sponsor provided financial support but had no role in the study design, conduct, analysis and interpretation, or writing of the report. The authors were responsible for preparation of this manuscript and the decision to submit this article for publication. Each of the authors had limited access to the study data and takes full responsibility for their presentation in this article., (Copyright © 2024 American Academy of Optometry.)

Purpose: The purpose of this study was to perform genetic linkage analysis and association analysis on exome genotyping from highly aggregated African American families with nonpathogenic myopia. African Americans are a particularly understudied population with respect to myopia., Methods: One hundred six African American families from the Philadelphia area with a family history of myopia were genotyped using an Illumina ExomePlus array and merged with previous microsatellite data. Myopia was initially measured in mean spherical equivalent (MSE) and converted to a binary phenotype where individuals were identified as affected, unaffected, or unknown. Parametric linkage analysis was performed on both individual variants (single-nucleotide polymorphisms [SNPs] and microsatellites) as well as gene-based markers. Family-based association analysis and transmission disequilibrium test (TDT) analysis modified for rare variants was also performed., Results: Genetic linkage analysis identified 2 genomewide significant variants at 7p15.2 and 7p14.2 (in the intergenic region between MIR148A and NFE2L3 and in the noncoding RNA LOC401324) and 2 genomewide significant genes (CRHR2 and AVL9) both at 7p14.3. No genomewide results were found in the association analyses., Conclusions: This study identified a significant linkage peak in African American families for myopia at 7p15.2 to 7p14.2, the first potential risk locus for myopia in African Americans. Interesting candidate genes are located in the region, including PDE1C, which is highly expressed in the eyes, and known to be involved in retinal development. Further identification of the causal variants at this linkage peak will help elucidate the genetics of myopia in this understudied population.

Purpose: To determine the long-term longitudinal axial length changes in myopic and hyperopic adults with an iris-fixated phakic intraocular lens (pIOL)., Methods: The medical records of patients aged ≥18 years with myopia or hyperopia who were treated with pIOL implantation between 1996 and 2011 for refractive correction with a minimum follow-up of 5 years after pIOL implantation were analyzed. The main outcome measure was change in ocular axial length over time., Results: 149 eyes of 149 myopic patients and 27 hyperopic eyes of 27 patients were included in this study. Mean patient age was 37.1 ± 10.4 years (35% male) in the myopic group and 39.4 ± 9.4 years (4% male) in the hyperopic group. The eyes of the myopic patients showed a significant mean increase in axial length of 0.45 ± 0.61 mm after a mean follow-up time of 144 ± 38 months (p < 0.001). In 26 eyes (17%), the axial length had increased by ≥1 mm. The mean annual axial length increase was 0.04 ± 0.06 mm. Axial elongation was associated with a higher degree of myopia (p < 0.001) and younger age (p = 0.02). The eyes of the hyperopic patients showed no change in axial length over time., Conclusions: Myopic eyes corrected with an iris-fixated pIOL show continuous increase in axial length at an adult age. Although this study is limited to subjects with a pIOL, this is the first time myopization in Caucasian adults has been reported in a large long-term longitudinal study., (© 2020 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To evaluate posterior eye shape variations across a wide refractive error range using brain MRI in a multiethnic cohort., Methods: Adult subjects in the multiethnic Singapore Epidemiology of Eye Disease study were included. Spherical equivalent (SE) was measured using subjective refraction, and axial length (AL) was measured using optical biometry. MRI was performed using a 3-Tesla whole body scanner with a 32-channel head coil. The radii and asphericity based on fitting of the posterior two-thirds of the eye (240°) were calculated. The refractive error status was categorised as myopic (SE<-0.5 D) or non-myopic (SE≥-0.5 D)., Results: A total of 450 adult participants (mean age 64.2±6.5 years old) were included. Less oblate asphericity was associated with more myopic SE, longer AL and with a refractive error categorisation of myopia (p<0.001 for all). Asphericity values were less oblate in myopic compared with non-myopic eyes (p<0.001). Multivariate analysis showed that Chinese subjects had less oblate eyes than Malay and Indian subjects, especially in non-myopic eyes., Conclusions: A less oblate posterior eye shape was associated with myopic eyes. Chinese eyes have less oblate shapes than Malay and Indian eyes, especially in non-myopic eyes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Few studies have investigated the prevalence of myopia in Northwest China. This cross-sectional study aimed to investigate the prevalence and associated factors of myopia and high myopia in adults aged 40-80 years in the Han and Yugur populations living in Gansu Province, Northwest China. A total of 3,845 participants were included. The overall age- and sex-adjusted prevalence of myopia (spherical equivalent (SE) < -0.5 D), high myopia (SE < -6.0 D) and hyperopia (SE > + 0.5 D) were 16.4%, 0.7% and 26.2% in Yugur participants, respectively, and 34.3%, 5.0% and 19.2% in Han participants, respectively. The prevalence of myopia and high myopia in Han participants was significantly higher than that in Yugur participants (both P < 0.001). Yugur population, birth in rural areas, smoking history and outdoor work were found to be negatively associated with myopia. Higher education level and a family history of myopia were found to be positively associated with myopia in the study population. High myopia was negatively associated with Yugur population, aging, birth in rural areas and was positively associated with a family history of myopia. This study provided valuable information regarding the environmental risk factors of myopia and revealed an ethnic disparity in the prevalence of myopia in Gansu Province, Northwest China.

Corneal curvature, a highly heritable trait, is a key clinical endophenotype for myopia - a major cause of visual impairment and blindness in the world. Here we present a trans-ethnic meta-analysis of corneal curvature GWAS in 44,042 individuals of Caucasian and Asian with replication in 88,218 UK Biobank data. We identified 47 loci (of which 26 are novel), with population-specific signals as well as shared signals across ethnicities. Some identified variants showed precise scaling in corneal curvature and eye elongation (i.e. axial length) to maintain eyes in emmetropia (i.e. HDAC11/FBLN2 rs2630445, RBP3 rs11204213); others exhibited association with myopia with little pleiotropic effects on eye elongation. Implicated genes are involved in extracellular matrix organization, developmental process for body and eye, connective tissue cartilage and glycosylation protein activities. Our study provides insights into population-specific novel genes for corneal curvature, and their pleiotropic effect in regulating eye size or conferring susceptibility to myopia.

Purpose: To investigate the relationship between sleep duration and bedtime with myopia progression and axial elongation during a 4-year follow-up in primary school children., Methods: This study included 1887 children (aged 7.09 ± 0.41 years) who had cycloplegic refractions data at baseline and a fourth visit and 2209 children (aged 7.10 ± 0.41 years) for axial length. All children underwent comprehensive ophthalmologic examinations, including cycloplegic refraction and ocular biometry, and standardized questionnaires, including average night-time sleep duration (h/d) and bedtime (time to bed). Myopia was defined as spherical equivalent < -0.5 diopters., Results: At the last follow-up, the mean myopia progression and axial elongation for all children were -1.89 ± 1.28 diopters and 1.22 ± 0.57 mm. After stratifying the sleep duration into tertile groups, myopia progression and axial elongation were slower in children with highest sleep duration tertile (P = 0.04 and P =0.014) in girls but not in boys, compared with the middle sleep duration tertile. However, after adjusting for potential confounders, no significant association was found for sleep duration with myopia progression and axial elongation for the children (P = 0.255 and P = 0.068), and the association with axial elongation was only of borderline significance in girls (P = 0.045). The bedtime was not associated with myopia progression and axial elongation in the regression analyses (P = 0.538; P = 0.801)., Conclusions: These results show that there was no significant association between sleep duration and bedtime with myopia progression and axial elongation among children. The findings in girls might be related to the earlier onset of puberty.

Purpose: We investigated the adaptability and acceptance of a novel spectacle lens design that was recently reported to achieve a significant antimyopia effect., Design: A prospective, cross-over study., Methods: Twenty children were recruited to wear both Defocus Incorporated Multiple Segments (DIMS) and single vision (SV) lens, with a random assignment of which type of lens was experienced first. For each type of lens, high and low contrast central distant visual acuity (VA) and high contrast mid-peripheral near VA were measured at both 500 lux and 50 lux ambient illuminance after 30 minutes' and a week's wearing of the lens. A self-developed questionnaire was applied to evaluate the visual discomfort at the 1-week visit. All quantitative data were analyzed by paired t test, while qualitative data were analyzed with the χ 2 or Wilcoxon signed-rank tests., Results: Central VA was not affected by DIMS lens compared with SV lens in all circumstances (all P > .05). However, the mid-peripheral near VA was found to reduce by approximately 0.06 logarithm of minimal angle of resolution unit in 2 of 4 quadrants (500 lux; P < .05) and in 3 quadrants (50 lux; P < .05) for DIMS lenses. No improvement was detected in the 1-week visit. Mid-peripheral blurred vision was the main visual complaint, which was noticed only once or twice a day. Being aware of the average antimyopic efficacy, 90% of children subjects preferred DIMS lenses., Conclusion: Mid-peripheral vision through DIMS lenses was slightly affected compared with SV lenses. Otherwise, DIMS lenses received good tolerance and acceptance by Chinese children., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

To investigate the clinical characteristics and the genetic defect in a Chinese family with congenital lamellar cataract with myopia. Three generations of a single family were recruited in the present study. A detailed family history and clinical data were recorded. A total of 100 unrelated ethnically matched controls without family history of congenital cataracts and myopia were also recruited. Genomic DNA was extracted from peripheral blood leukocytes. The sequencing of candidate genes was performed to screen out the disease-causing mutation. The effects of amino acid changes on the structure of proteins were predicted by bioinformatics analysis. Affected individuals presented lamellar lens opacities and myopia. Direct sequencing revealed a heterozygous c. 34 C>T variation in the αA-crystallin protein (CRYAA) gene, which resulted in the replacement of a highly conserved arginine by cystine at codon 12 (p.R12C). This mutation co-segregated with all affected individuals and was not observed in unaffected members or the 100 normal controls. Bioinformatic analysis showed that a highly conserved region was located around Arg12, an increase in local hydrophobicity was shown around the substitution site and the secondary structure of the mutant CRYAA protein has been changed. This is the case of a congenital lamellar cataract phenotype with myopia associated with the mutation of Arg12Cys (p.R12C) in CRYAA. Our finding confirms the high rate of mutations at this dinucleotide. In addition, these results demonstrate a myopia susceptibility locus in this region, which might also be associated with the mutation in CRYAA., (© 2020 The Author(s).)

Purpose : This study was designed to evaluate and compare the sensitivity and specificity of the Belin/Ambrósio Deviation (BADD), Corneal Biomechanical Index (CBI) and Tomographic and Biomechanical Index (TBI) for the diagnosis of keratoconus in Chinese myopic eyes prior to undergoing corneal refractive surgery. Methods : A total of 125 patients (185 eyes) planned to undergo corneal refractive surgery were selected from the Refractive Center of Beijing Tongren Hospital between December 2017 and December 2018. They were divided into four groups: the normal group, bilateral keratoconus (BK) group, unilateral keratoconus (UK) group, and the forme fruste keratoconus (FFK) group. After determining the BADD, CBI, and TBI for each eye using the Corvis ST combined with Pentacam, the sensitivity and specificity of these three indices in diagnosing keratoconus were analyzed through receiver operating characteristic (ROC) curves. Results : The TBI exhibited the highest diagnostic efficiency in normal vs. UK (area under the ROC curve [AUROC]: 0.992), normal vs. UK+BK (AUROC: 0.988), normal vs. UK+BK* (*stand randomly selecting one eye of each patient in BK group) (AUROC: 0.982), normal vs. UK+BK+FFK (AUROC: 0.965), and normal vs. UK+BK*+FFK (AUROC: 0.953). The CBI demonstrated the highest diagnostic efficiency in normal vs. FFK (AUROC: 0.897). Finally, the BADD showed the highest diagnostic efficiency in normal vs. BK (AUROC: 0.998) and normal vs. BK* (AUROC: 0.996). Conclusion : The BADD, CBI, and TBI performed well in diagnosing keratoconus in Chinese myopic eyes. The CBI showed the highest diagnostic efficiency compared with normal for FFK. In addition, the TBI offered the greatest accuracy in detecting keratoconus and FFK eyes vs. the other parameters.

Background/purpose: To examine ethnic disparity in prevalence and associated factors of myopia in adolescents using the Unites States National Health and Nutrition Examination Survey (NHANES) dataset., Methods: Participants who were aged 12-19 years were included from NHANES (1999-2008). Logistic regression analyses were applied to identify risk factors associated with myopia after stratification by race., Results: A total of 9,960 participants were included in the prevalence analysis, and 6,571 in the risk factor analysis. Other race (excluded Mexican American, other Hispanic, non-Hispanic white, non-Hispanic black) participants had the highest frequency of myopia (42.77%). Multivariate analyses of the whole population suggested that the odds of myopia were significantly lower in participants with household smokers (odds ratio [OR] = 0.79, 95% confidence interval [CI]: 0.66-0.97), and significantly greater in Mexican American race (OR = 1.28, 95% CI: 1.01-1.62), other Hispanic (OR = 1.79, 95% CI: 1.10-2.92) and in participants with senior high school graduate education (OR = 1.79, 95% CI: 1.01-3.18), watched 2 hours of television daily (OR = 1.27, 95% CI: 1.02-1.59), used the computer for 1 hour daily (OR = 1.276, 95% CI: 1.02-1.57). When examined by race/ethnicity, 1 hour of computer use increased the odds of myopia in the non-Hispanic White group, in Mexican Americans a higher family poverty income ratio and 2 hours of television time was associated with myopia, and in the Other Hispanic group, a higher family poverty income ratio was associated with myopia, while males and those with a higher sugar had a lower risk of myopia., Conclusion: Risk factors for myopia vary with race/ethnicity., (Copyright © 2019 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Purpose: To evaluate the clinical characteristics and surgical outcomes of pediatric retinal detachments (RDs) in an Asian population., Methods: Retrospective review of 171 eyes of 152 pediatric patients with rhegmatogenous RD over a 20-year period., Results: Myopia was the most common risk factor in our population. At 6 months, primary anatomical success was 60.7%, and overall anatomical success was 86.7%. A total of 46.8% had best-corrected visual acuity of 20/40 or better, and 81.6% had best-corrected visual acuity of 20/200 or better. In primary RDs, high myopia (≤-6D) patients had a lower primary anatomical success compared to patients with moderate myopia (≤-2D) (59.3 vs. 100% P = 0.03). Increasing age and absence of proliferative vitreoretinopathy were associated with anatomical and visual success. Pars plana vitrectomy as the primary procedure was associated with decreased odds of anatomical success. A longer duration of symptoms, cataract, and a larger RD extent were associated with poorer functional outcome., Conclusion: Myopia was the commonest risk factor for pediatric RD in our population. Good anatomical and functional outcome can be achieved with surgery. Increasing age at presentation and absence of proliferative vitreoretinopathy was associated with anatomical and functional success. High myopia was associated with poorer anatomical and functional outcome.

Purpose: To assess the accuracy of intraocular lens (IOL) power calculation formulas in Chinese eyes with axial lengths (ALs) longer than 26.0 mm., Setting: Department of Cataract Surgery, Shanxi Eye Hospital, China., Design: Prospective case series., Methods: This study evaluated (1) two new formulas (Barrett Universal II and Hill-RBF 2.0), (2) three vergence formulas (Haigis, Holladay 1, and SRK/T), and (3) the original and modified Wang-Koch AL adjustment formulas with Holladay 1 and SRK/T. The User Group for Laser Interference Biometry lens constants were used for IOL power calculation. The refractive prediction error was calculated by subtracting the predicted refraction from the actual refraction postoperatively. The mean numerical error (MNE), percentage of eyes with hyperopic outcomes, and mean absolute error (MAE) were determined., Results: The study comprised 136 eyes. The Barrett and Hill-RBF formulas had MNEs close to zero (-0.09 D to 0.03 D), the Haigis, Holladay 1, and SRK/T produced hyperopic MNEs (0.25 to 0.70 D), and the original and modified Wang-Koch AL adjustment formulas induced myopic MNEs (-0.48 to -0.22 D). The original Wang-Koch formulas produced significantly lower percentages of eyes with hyperopic outcomes (15% to 18%) than all other formulas (28% to 91%). There were no significant differences in MAEs between the Barrett, Hill-RBF, Haigis, and original and modified Wang-Koch adjustment with the Holladay 1 (0.32 to 0.41 D)., Conclusion: The performances of the Barrett and Hill-RBF were comparable in long eyes. The incidence of hyperopic outcome with the Wang-Koch AL adjustment formula was significantly lower than other formulas., (Copyright © 2019. Published by Elsevier Inc.)

Purpose: To examine the prevalence of refractive error and some associated factors in Chinese preschool children., Methods: The Jinshan District Eye Study was a school-based survey of eye health in a large sample of 4- to 6-year-olds attending kindergartens from May 2013 to December 2013 in Shanghai. Refractive error was measured using an autorefractor under noncycloplegic conditions. Axial length (AL) was measured with an ocular biometry system. In addition, body height and weight were also recorded., Results: A total of 7,166 children successfully completed their refraction measurements. The median (interquartile range) of spherical equivalent (SE) for all the children was +0.25 D (-0.13 D to +0.62 D), and the range was -15.88 to +18.13 D. The mean AL for all the children was 22.35±0.70 mm, and the range was 18.20 to 27.71 mm. The overall prevalence of myopia (-1.00 D or less), hyperopia (+2.00 D or greater), and astigmatism (1.00 D or greater) were 5.9%, 1.0%, and 12.7%, respectively. After multivariate analysis, more myopic SE (or less hyperopic SE) was significantly associated with girls, longer AL, taller, and lighter., Conclusion: Shanghai has a high prevalence of refractive error in the world. However, longitudinal studies are needed to evaluate refractive changes over time in individual children and warranted to prevent the development of myopia.

Myopia is one of the most common ocular disorders in the world, yet the genetic etiology of the disease remains poorly understood. Specialized founder populations, such as the Pennsylvania Amish, provide the opportunity to utilize exclusive genomic architecture, like unique haplotypes, to better understand the genetic causes of myopia. We perform genetic linkage analysis on Pennsylvania Amish families that have a strong familial history of myopia to map any potential causal variants and genes for the disease. 293 individuals from 25 extended families were genotyped on the Illumina ExomePlus array and merged with previous microsatellite data. We coded myopia affection as a binary phenotype; myopia was defined as having a mean spherical equivalent (MSE) of less than or equal to - 1 D (diopters). Two-point and multipoint parametric linkage analyses were performed under an autosomal dominant model. When allowing for locus heterogeneity, we identified two novel genome-wide significantly linked variants at 12q15 (heterogeneity LOD, HLOD = 3.77) in PTPRB and at 8q21.3 (HLOD = 3.35) in CNGB3. We identified further three genome-wide significant variants within a single family. These three variants were located in exons of SLC6A18 at 5p15.33 (LODs ranged from 3.51 to 3.37). Multipoint analysis confirmed the significant signal at 5p15.33 with six genome-wide significant variants (LODs ranged from 3.6 to 3.3). Further suggestive evidence of linkage was observed in several other regions of the genome. All three novel linked regions contain strong candidate genes, especially CNGB3 on 8q21.3, which has been shown to affect photoreceptors and cause complete color blindness. Whole genome sequencing on these regions is planned to conclusively elucidate the causal variants.

Purpose: To explore the relationship between intraocular pressure (IOP) at baseline and myopia progression in Chinese children from the Anyang Childhood Eye Study., Design: Prospective school-based cohort study., Methods: A total of 1558 grade 7 students completed the entire 2-year study. Ocular biometry, cycloplegic refractions and pneumotonometry were performed. Three years of follow-up have been completed for the children aged 12 years. The refractive groups and the tertiles of IOP were assessed by analysis of variance, to look for differences in mean values of spherical equivalent and IOP, respectively., Results: The children's mean baseline IOP was 15.87±3.42 mm Hg. Mean IOP was significantly higher in girls by 0.57 mm Hg (p=0.024). In the whole sample, there was a mean change in spherical equivalent of -1.05 D over 2 years. The baseline IOP was 15.69 mm Hg in those progressing 1 D or more vs 16.09 mm Hg for those progressing <1 D (p=0.022). In the myopic group, myopes progressing >1 D had mean IOP of 15.94 vs 16.42 mm Hg for those myopes progressing 1 D or less (p=0.024)., Conclusions: In this sample of Chinese children, myopia progression over 2 years was inversely related to IOP, suggesting that IOP had essentially no relationship with myopia progression in school children. The lower IOP in progressing myopic eyes may indicate more compliant sclerae., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Myopia is one of most common eye diseases in the world and affects 1 in 4 Americans. It is a complex disease caused by both environmental and genetics effects; the genetics effects are still not well understood. In this study, we performed genetic linkage analyses on Ashkenazi Jewish families with a strong familial history of myopia to elucidate any potential causal genes., Methods: Sixty-four extended Ashkenazi Jewish families were previously collected from New Jersey. Genotypes from the Illumina ExomePlus array were merged with prior microsatellite linkage data from these families. Additional custom markers were added for candidate regions reported in literature for myopia or refractive error. Myopia was defined as mean spherical equivalent (MSE) of -1D or worse and parametric two-point linkage analyses (using TwoPointLods) and multi-point linkage analyses (using SimWalk2) were performed as well as collapsed haplotype pattern (CHP) analysis in SEQLinkage and association analyses performed with FBAT and rv-TDT., Results: Strongest evidence of linkage was on 1p36(two-point LOD = 4.47) a region previously linked to refractive error (MYP14) but not myopia. Another genome-wide significant locus was found on 8q24.22 with a maximum two-point LOD score of 3.75. CHP analysis also detected the signal on 1p36, localized to the LINC00339 gene with a maximum HLOD of 3.47, as well as genome-wide significant signals on 7q36.1 and 11p15, which overlaps with the MYP7 locus., Conclusions: We identified 2 novel linkage peaks for myopia on chromosomes 7 and 8 in these Ashkenazi Jewish families and replicated 2 more loci on chromosomes 1 and 11, one previously reported in refractive error but not myopia in these families and the other locus previously reported in the literature. Strong candidate genes have been identified within these linkage peaks in our families. Targeted sequencing in these regions will be necessary to definitively identify causal variants under these linkage peaks.

Previously we developed a mathematical model for describing the retinal nerve fiber bundle (RNFB) trajectories in the human retina. The model was based on Caucasian eyes that were not selected regarding refraction. The aim of this study was to determine the characteristics of the RNFB trajectories in Chinese myopic eyes. We collected high quality red free fundus images from 80 eyes of 80 Chinese myopic subjects (median [interquartile range/range] refraction -3.9 [-6.0 to -2.5/-10 to -1] D). We traced all visible RNFBs (n = 1460) and evaluated their trajectories using the previously published mathematical model. In the superior-temporal region, the RNFB trajectories of the Chinese myopic eyes were similar to that of the Caucasian eyes (86% of trajectories within the 95% central range of the Caucasian model). In the inferior-temporal region, the trajectories of the Chinese low to moderate myopic eyes were also similar to that of the Caucasian eyes (85%); trajectories of the high myopic eyes (spherical equivalent beyond -6.00 D) were clearly less curved (75%). Associations between individual deviations from the model and axial length, retinal vessel course, and optic disc anatomy were studied with multiple linear regression analysis. In the superior-temporal region, the trajectories were associated with retinal vessel course (P = 0.008) and optic disc size (P = 0.016). In the inferior-temporal region, there was a significant association with axial length (P < 0.001), retinal vessel course (P = 0.006), and disc torsion (P = 0.009)., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: To investigate the relationship between dietary intakes at six, nine and 12 months and risk of myopia in three-year-old children in a birth cohort., Methods: Three hundred and seventeen children from the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study were included. Dietary intake at six, nine and 12 months of age was ascertained using either 24-hour recalls or three-day food diaries completed by parents. Cycloplegia was achieved with three drops of one per cent cycloplentolate instilled at five minute intervals. Cycloplegic autorefraction and axial length (AL) were measured at three years of age with a table-mounted autorefractor and optical biometer, respectively. Myopia was defined as spherical equivalent (SE) of ≤ -0.50 D. Associations of dietary intake with SE, AL and myopia were examined by single dietary factor models using two multivariable regression models. Model 1 included adjusting for age, gender and total energy intake. Model 2 included additional adjustments for ethnicity, time spent outdoors, maternal education and parental myopia., Results: In the single dietary factor adjusted models, dietary intakes at six, nine and 12 months were not associated with SE, AL and myopia. In model 1, protein, fat and carbohydrate intakes were not associated with SE, AL and myopia at any of the three time points (p > 0.05). In model 2, protein, fat and carbohydrate intakes were not associated with SE, AL and myopia at any of the three time points (p > 0.05)., Conclusions: In this study, there was no evidence that diet at ages six, nine and 12 months was related to SE, AL or myopia at age three years. Further prospective studies with larger sample sizes are needed to understand the influence of diet on eye development in young children., (© 2018 Optometry Australia.)

Purpose: To evaluate the association between high myopia (HM) and single nucleotide polymorphisms (SNPs) in collagen, type XI, alpha 1 (COL11A1) and collagen, type XVIII, alpha 1 (COL18A1) genes in a Han Chinese population., Materials and Methods: A total of 869 patients with HM and 804 controls were recruited for this study. The genotyping of five SNPs in COL11A1 and COL18A1 was performed using the SNaPshot method. The genotyping data were analyzed using the χ 2 test, and the linkage disequilibrium block structure was calculated and examined by Haploview software., Results: No statistically significant differences (p > 0.05) were identified between HM cases and controls after a Bonferroni correction for multiple tests in the allele frequencies of COL11A1 and COL18A1 SNPs. However, the G allele of rs2236475 showed a susceptible effect for HM (p = 0.016, corrected p = 0.08, odds ratio [OR] = 1.26). Moreover, the carriers of rs2236475GG genotype displayed an increased risk of HM compared with the rs2236475AA and rs2236475AG+AA genotypes (p = 0.008, OR = 1.79, confidence interval [95% CI] = 1.18-2.64, uncorrected; p = 0.012, OR = 1.74, 95% CI = 1.12-2.57, corrected, respectively)., Conclusions: Our results suggested that common polymorphisms in these two candidate genes were unlikely to play major roles in the genetic susceptibility to HM. Nevertheless, to avoid filtering real myopia genes, the role of COL11A1 and COL18A1 in the pathogenesis of myopia requires more refinement in both animal models and human genetic epidemiological studies.

Central corneal thickness (CCT) is a highly heritable trait associated with complex eye diseases such as keratoconus and glaucoma. We perform a genome-wide association meta-analysis of CCT and identify 19 novel regions. In addition to adding support for known connective tissue-related pathways, pathway analyses uncover previously unreported gene sets. Remarkably, >20% of the CCT-loci are near or within Mendelian disorder genes. These included FBN1, ADAMTS2 and TGFB2 which associate with connective tissue disorders (Marfan, Ehlers-Danlos and Loeys-Dietz syndromes), and the LUM-DCN-KERA gene complex involved in myopia, corneal dystrophies and cornea plana. Using index CCT-increasing variants, we find a significant inverse correlation in effect sizes between CCT and keratoconus (r = -0.62, P = 5.30 × 10 -5 ) but not between CCT and primary open-angle glaucoma (r = -0.17, P = 0.2). Our findings provide evidence for shared genetic influences between CCT and keratoconus, and implicate candidate genes acting in collagen and extracellular matrix regulation.

The incidence of high myopia is increasing worldwide with myopic maculopathy, a complication of myopia, often progressing to blindness. Our two-stage genome-wide association study of myopic maculopathy identifies a susceptibility locus at rs11873439 in an intron of CCDC102B (P = 1.77 × 10 -12 and P corr  = 1.61 × 10 -10 ). In contrast, this SNP is not significantly associated with myopia itself. The association between rs11873439 and myopic maculopathy is further confirmed in 2317 highly myopic patients (P = 2.40 × 10 -6 and P corr  = 1.72 × 10 -4 ). CCDC102B is strongly expressed in the retinal pigment epithelium and choroids, where atrophic changes initially occur in myopic maculopathy. The development of myopic maculopathy thus likely exhibits a unique background apart from the development of myopia itself; elucidation of the roles of CCDC102B in myopic maculopathy development may thus provide insights into preventive methods for blindness in patients with high myopia.

PurposeTo describe the prevalence and associations of presenting near vision impairment (NVI) in Indigenous and non-Indigenous Australians.MethodsA sample of 3098 non-Indigenous Australians (aged 50-98 years) and 1738 Indigenous Australians (aged 40-92 years) living in 30 randomly selected Australian sites were examined as part of the population-based National Eye Health Survey (NEHS). Binocular presenting NVI was defined as near vision worse than N8 (20/50).ResultsIn total, 4817 participants (99.6% of the total sample, comprising 3084 non-Indigenous Australians and 1733 Indigenous Australians) had complete data on near visual acuity. The overall weighted prevalence of presenting NVI was 21.6% (95% CI: 19.6, 23.8) in non-Indigenous Australians and 34.7% (95% CI: 29.2, 40.8) among Indigenous Australians. In the non-Indigenous population, higher odds of presenting NVI were associated with older age (OR=1.68 per 10 years, P<0.001), fewer years of education (OR=0.95 per year, P<0.001) and residing in Remote geographical areas (OR=1.71, P=0.003) after multivariate adjustments. Among Indigenous Australians, older age (OR=1.69 per 10 years, P<0.001), fewer years of education (OR=0.91 per year, P=0.003) and residing in Inner Regional (OR=2.01, P=0.008), Outer Regional (OR=2.17, P=<0.001) and Remote geographical areas (OR=1.72, P=0.03) were associated with greater odds of presenting NVI.ConclusionsNVI represents a notable public health concern in Australia, affecting approximately 20% of non-Indigenous Australian and one-third of Indigenous Australian adults.

Purpose: To determine genetic linkage between myopia and Han Chinese patients with a family history of the disease., Methods: One hundred seventy-six Han Chinese patients from 34 extended families were given eye examinations, and mean spherical equivalent (MSE) in diopters (D) was calculated by adding the spherical component of the refraction to one-half the cylindrical component and taking the average of both eyes. The MSE was converted to a binary phenotype, where all patients with an MSE of -1.00 D or less were coded as affected. Unaffected individuals had an MSE greater than 0.00 D (ages 21 years and up), +1.50 (ages 11-20), or +2.00 D (ages 6-10 years). Individuals between the given upper threshold and -1.00 were coded as unknown. Patients were genotyped on an exome chip. Three types of linkage analyses were performed: single-variant two-point, multipoint, and collapsed haplotype pattern (CHP) variant two-point., Results: The CHP variant two-point results identified a significant peak (heterogeneity logarithm of the odds [HLOD] = 3.73) at 10q26.13 in TACC2 . The single-variant two-point and multipoint analyses showed highly suggestive linkage to the same region. The single-variant two-point results identified 25 suggestive variants at HTRA1 , also at 10q26.13., Conclusions: We report a significant genetic linkage between myopia and Han Chinese patients at 10q26.13. 10q26.13 contains several good candidate genes, such as TACC2 and the known age-related macular degeneration gene HTRA1 . Targeted sequencing of the region is planned to identify the causal variant(s).

Obesity rates have escalated to the point of a global pandemic with varying prevalence across ethnic groups. These differences are partially explained by lifestyle factors in addition to genetic predisposition to obesity. This review provides a comprehensive examination of the ethnic differences in the genetic architecture of obesity. Using examples from evolution, heritability, admixture, monogenic and polygenic studies of obesity, we provide explanations for ethnic differences in the prevalence of obesity. The debate over definitions of race and ethnicity, the advantages and limitations of multi-ethnic studies and future directions of research are also discussed. Multi-ethnic studies have great potential to provide a better understanding of ethnic differences in the prevalence of obesity that may result in more targeted and personalized obesity treatments., (© 2017 World Obesity Federation.)

Purpose: To document the distribution of ocular biometry and to evaluate its associations with refraction in a group of Chinese preschoolers., Design: Population-based cross-sectional study., Participants: A total of 1133 preschoolers 3 to 6 years of age from 8 representative kindergartens., Methods: Biometric measurements including axial length (AL), anterior chamber depth (ACD), and corneal radius of curvature (CR) were obtained from partial-coherence laser interferometry (IOL Master; Carl Zeiss Meditec, Oberkochen, Germany) before cycloplegia. Lens power (LP) and AL-to-CR ratio were calculated. Cycloplegic refraction (3 drops of 1% cyclopentolate) was measured using an autorefractor (KR8800; Topcon Corp., Tokyo, Japan), and spherical equivalent refraction (SER) was calculated. Biometric and refractive parameters were assessed as a function of age and gender. Multiple regression analysis was performed to explore the associations between refraction and ocular biometry., Main Outcome Measures: Ocular biometric distributions and their relationships to refraction., Results: Among the 1127 children (99.5%) with successful cycloplegic refraction, mean SER was 1.37±0.63 diopters (D). Prevalence of myopia increased from 0% at 3 years of age to 3.7% (95% confidence interval, 1.0%-6.5%) at 6 years of age. Biometric parameters followed Gaussian distributions with means of 22.39±0.68 mm for AL, 7.79±0.25 mm for CR, and 24.61±1.42 D for calculated LP; and non-Gaussian distributions with means of 3.34±0.24 mm for ACD and 2.88±0.06 for AL-to-CR ratio. Axial length, ACD, and AL-to-CR ratio increased from 3 to 6 years of age, CR remained stable, whereas LP declined. Overall, SER declined slightly. For the SER variance, AL explained 18.6% and AL-to-CR ratio explained 39.8%, whereas AL, CR, and LP accounted for 80.0% after adjusting for age and gender., Conclusions: Young Chinese children are predominantly mildly hyperopic, with a low prevalence of myopia by the age of 6 years. An increase of 1 mm in AL was associated with only 0.45 D of myopic change. Decreases in LP reduce the myopic shifts that normally would be associated with increases in AL, and thus play a key role in refractive development in this age group., (Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate longitudinal changes in refraction and biometry in Chinese adults., Design: Population-based prospective cohort study., Methods: 1817 subjects aged ≥ 35 years were randomly recruited from Yuexiu district, Guangzhou, China in 2008. Of which 1595 (87.8%) were reexamined in 2010 and 1427 (78.5%) were reexamined in 2014. Non-cycloplegic automated refraction and visual acuity test were performed at baseline and the 6-year follow-up examination for all participants. In addition, 50% of the participants were randomly selected for axial length (AL), anterior chamber depth (ACD) and lens thickness (LT) measurements using non-contact partial coherence laser interferometry. Lens power (LP) was calculated with the Bennett's equation., Results: A total of 1300 participants were included in current analysis (2008 mean [SD] age, 51.4 [10.6] years; 54.5% women). Mean change in spherical equivalence (SE) was +0.24 (95% confidence interval [CI], +0.19 to +0.30), +0.51 (95% CI, +0.46 to +0.57), +0.26 (95% CI, +0.15 to +0.38) and -0.05 (95% CI, -0.21 to +0.10) diopters (D) for individuals in the age groups of 35 to 44, 45 to 54, 55 to 64 and 65+ years at baseline, respectively. Corneal power, AL and LT increased while ACD and LP decreased during the follow-up. Baseline SE and changes in biometric factors could explain 97.2% of the variance in longitudinal SE change while LP solely could explain 65.2%. Six-year mean change in cylinder power was -0.16 (95% CI, -0.19 to -0.13) D, the axis of astigmatism changed from "with-the-rule" to "against-the-rule" in 16.4% of the participants and to "oblique" in 0.9%., Conclusions: This study confirms a hyperopic shift in the elderly before 65 years old and a myopic shift thereafter. Longitudinal refraction change could be well explained by corresponding biometry changes, especially LP. There is also a shift to "against-the-rule" astigmatism for the adult population.

Objective: To understand and evaluate the prevalence of myopia and its trend in children and adolescents aged 7-18 years in Han ethnic group in China from 2005 to 2014, and provide evidence for the prevention of myopia. Methods: The data of 2005, 2010 and 2014 Chinese National Students Constitution and Health Surveys were collected. The children and adolescents with complete detection data of binoculus were selected as study subjects. The sample size of three studies were 233 108, 215 319 and 212 743, respectively. The method of curve fitting was used to simulate the myopia detection increase model and analyze the gender and area specific myopia detection increase trends and characteristics from 2005 to 2014. Results: The overall myopia detection rate increased gradually in the children and adolescents aged 7 to 18, which was 47.5 % in 2005, 55.5 % in 2010 and 57.1 % in 2014, respectively. The increase slowed in 2014. A"parabola" shape of myopia detection increase rate was observed. Myopia detection rate increased with age before puberty and decreased with age after puberty gradually. A"cross phenomenon" of myopia detection increase was observed in boys and girls between urban and rural areas. The increase of myopia detection was mainly in urban students before puberty and in rural students after puberty. The age of myopia prevalence peak has become earlier constantly in children and adolescents aged 7-18 years from 2005 to 2014, which was 13 years old in 2005, 12 years old in 2010 and 11 years old in 2014. The increase rate was about 7 % . During 2005-2014, the increase rate of myopia detection gradually increased in younger students and tended to zero in older students. Conclusion: The detection rate of myopia was still high in children and adolescents in China. The age of myopia prevalence peak has become earlier gradually.

Objective: To investigate the characteristics of geographic distribution and change trend of myopia prevalence for children and adolescents aged 7-18 years old from 2005 to 2014, which provides the basis for the prevention of myopia. Methods: Research material was selected from the data of 2005, 2010, and 2014 Chinese National Survey on Students Constitution and Health, including 31 provinces (with the exception of Hong Kong, Macao, and Taiwan). The complete detection data of binoculus in children and adolescents aged 7-18 years old were selected as our research objects. The research objects of three studies were 233 505, 216 474, and 215 160, respectively. We analyzed the characteristics of geographic distribution and change trend of myopia prevalence for children and adolescents aged 7-18 years old in 31 provinces from 2005 to 2014. Results: The overall myopia detection rates in Chinese children and adolescents aged 7 to 18 years old in 31 provinces were 47.4% (111 707/235 505), 55.6% (120 456/216 474), and 57.2% (122 965/215 160) in 2005, 2010 and 2014, respectively. The growth range in this two phases were 8.0 percentage points, and 1.6 percentage points, respectively, and the difference was statistically significant ( P< 0.05). The detection rate of Myopia was growing quickly from 2005 to 2010 and only three provinces were in the situation of decline state including Tianjin, Hainan, and Ningxia. 90.3 percent (28/31) of provinces were in the situation of growth state and the growth range was 1.3%-22.3%. The growth of myopia was in the situation of slowdown from 2010 to 2014, and 38.7 percent (12/31) of the provinces were in negative growth districts including Hebei, Shanxi, Inner Mongolia, Zhejiang, Fujian, Shandong, Hubei, Guangxi, Guizhou, Tibet, Qianghai, and Xinjiang. The growth range in other provinces was 0.4%-24.7%. Conclusion: The myopia detection rate was at a higher level and growing constantly in China. There was large difference for myopia of children and adolescents among the 31 provinces. However, the overall growth rate of myopia in children and adolescents was in the situation of a relatively low level form 2010 to 2014.

Purpose: To estimate the prevalence of refractive errors in adult Chinese Americans, and to evaluate factors associated with myopia and high myopia., Design: A population-based, cross-sectional study., Methods: Chinese Americans 50 years and older residing in Monterey Park, California, were recruited. Noncycloplegic automated refraction with supplemental subjective refraction was performed. Myopia, high myopia, hyperopia, and high hyperopia were defined as a spherical equivalent of <-0.5 diopter (D), <-5.0 D, >+0.5 D, and ≥+3.0 D, respectively. Astigmatism and high astigmatism were defined as a cylinder of >0.5 D and >2.25 D, respectively. Risk factor assessment was guided by a conceptual model., Results: Data from 4144 participants were analyzed. The overall prevalence of myopia, high myopia, hyperopia, high hyperopia, astigmatism, and high astigmatism in the right eye was 35.1% (95% confidence interval, 33.6%-36.6%), 7.4% (6.6%-8.3%), 40.2% (38.7%-41.8%), 2.7% (2.2%-3.3%), 45.6% (44.1%-47.2%), and 3.7% (3.1%-4.3%), respectively. The prevalence of myopia and high myopia was lower among older individuals (P < .05). Reversed age trends were observed for the other refractive errors (P < .05). There was no sex difference in the prevalence of refractive errors, except for a higher prevalence of hyperopia among female subjects (P = .010). Age, acculturation, education, income, marital status, birth country, history of ocular disease, nonocular comorbidities, and recent eye examination were associated with prevalence of myopia. All of these factors, except for acculturation, were also associated with high myopia., Conclusions: Our data present the first population-based estimates of the prevalence of refractive errors among adult Chinese Americans. Compared with whites, Hispanics, and blacks, Chinese Americans have a higher burden of myopia, high myopia, and astigmatism., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: To report the thickness of the peripapillary retinal nerve fibre layer (pRNFL) in Chinese children and examine its association with refractive error, axial length (AL) and optic disc parameters., Design: Population-based cross-sectional study., Participants: A total of 2893 seven-year-old children from 11 randomly selected primary schools in Anyang, central China., Methods: Participants underwent ophthalmic examinations including optical biometry, cycloplegic autorefraction and spectral-domain ocular coherence tomography., Main Outcome Measures: Retinal nerve fibre layer thickness in 16 radial sections, cycloplegic spherical equivalent, AL., Results: The mean (SD) average RNFL thickness was 102.01(8.02) µm. The average RNFL thickness decreased with smaller disc area (r = 0.18, R 2  = 0.03, P < 0.0001), bigger cup area (r = -0.11, R 2  = 0.01, P < 0.0001), smaller rim area (r = 0.28, R 2  = 0.08, P < 0.0001), smaller nerve head volume (r = 0.27, R 2  = 0.07, P < 0.0001), longer AL (r = -0.15, R 2  = 0.02, P < 0.0001) and a negative spherical equivalent (r = 0.11, R 2  = 0.01, P < 0.0001). Hyperopic children had a thicker RNFL than emmetropic children [102.45(8.13) µm vs. 100.81 (7.18) µm, P < 0.001]. Myopic children had thinner RNFL than emmetropic children [99.17 (7.69) µm vs. 100.81 (7.18) µm, P < 0.05]., Conclusion: Retinal nerve fibre layer thickness decreased with increasing AL, higher myopia, bigger cup area, smaller disc and rim area, and a smaller nerve head volume, but the coefficient of determination for all these associations was small. The RNFL in myopes was significantly thinner than emmetropes or hyperopes, but with small absolute differences. The study provides RNFL values for healthy 7-year-old Chinese children. Follow up of this cohort to observe the change of RNFL thickness with myopia and possible change in detected associations with age is planned., (© 2016 Royal Australian and New Zealand College of Ophthalmologists.)

Purpose: To analyze early clinical outcomes of aspheric micro-monovision LASIK for correction of presbyopia and myopia with or without astigmatism., Methods: Prospective, non-comparative case series of 80 eyes of 40 patients with a mean age of 43.4 ± 4.9 years (range: 38 to 63 years) treated bilaterally using an aspheric micro-monovision protocol. The target refraction was plano for the distance eye and between -0.75 and -2.25 diopters (D) for the near eye. Visual acuity, ocular aberrations, contrast sensitivity, corneal topography, amplitude of accommodation, binocular sensorial function, and satisfaction score questionnaires were evaluated at 3 months after surgery., Results: Three months after surgery, the mean spherical equivalent (SE) refraction in the distance eye was -0.08 ± 0.27 D, whereas the attempted and achieved SE in the near eye were -1.41 ± 0.28 and -1.32 ± 0.35 D, respectively. Ninety-three percent of eyes were within ±0.50 D of target correction of SE. The uncorrected distance visual acuity (UDVA) after surgery was -0.10 ± 0.06 logMAR (20/15.5), 0.22 ± 0.12 logMAR (20/34), and -0.11 ± 0.06 logMAR (20/15), for distance eyes, near eyes, and binocularly, respectively. Ninety-five percent of patients achieved simultaneously uncorrected distance visual acuity 0.0 logMAR (20/20) or better and uncorrected near visual acuity J2 (20/25) or better. Stability was achieved from 1 week of follow-up. The overall satisfaction score for surgery was 92 ± 6., Conclusions: The aspheric micro-monovision protocol provided a well-tolerated and effective means for treating myopic astigmatism and alleviating presbyopic symptoms simultaneously. [J Refract Surg. 2016;32(10):680-685.]., (Copyright 2016, SLACK Incorporated.)

Purpose: To examine internal astigmatism (IA) in myopes and non-myopes using a new method to assess compensation of corneal astigmatism (CA) by IA, to look for predictors of high IA in young adult myopes, and to determine if as CA changes IA changes to reduce refractive astigmatism (RA) in an active compensatory process in myopes., Methods: Right eye keratometry and cycloplegic autorefraction were measured annually over 14 years in 367 myopes and once in 204 non-myopes age- (mean 21.91 ± 1.47 years), gender-, and ethnicity-matched to myopes at year 12. CA and RA at the corneal plane were expressed as J0, J45. IA = RA - CA. Inverse power transformation provided cylinder power and axis of IA for the compensation factor (IA/CA). Analyses included (1) paired and unpaired t-tests (refractive data), (2) chi-square tests (distributions of compensation factor), (3) logistic regression analysis (predictors of high IA), and (4) linear mixed models (time effect on RA, CA, and IA)., Results: The magnitude of IAJ0 varied by refractive error (myopes -0.25 ± 0.24 vs. non-myopes -0.32 ± 0.21, p < 0.001). Compensation of CA by IA was poorer in myopes than non-myopes (χ p < 0.001). When matched by CA, compensation remained poorer in myopes than non-myopes (χ all p ≤ 0.04). Within each refractive group, compensation was better when CA was low than high (χ p < 0.001). When CA was low in myopes, high IA (≥1.00D) was less likely (p = 0.01). Longitudinal follow-up of myopes found no evidence for an active compensatory role for IA as CA increased over time. There were differences in IAJ0 by ethnicity over time (p < 0.0001)., Conclusions: In myopic and non-myopic eyes with low amounts of CA, IA may reduce CA's contribution to RA, but IA is not a constant. However, there is no evidence for an active compensatory role for IA reducing CA in myopes.

The aim of this review was to quantify the global variation in childhood myopia prevalence over time taking account of demographic and study design factors. A systematic review identified population-based surveys with estimates of childhood myopia prevalence published by February 2015. Multilevel binomial logistic regression of log odds of myopia was used to examine the association with age, gender, urban versus rural setting and survey year, among populations of different ethnic origins, adjusting for study design factors. 143 published articles (42 countries, 374 349 subjects aged 1-18 years, 74 847 myopia cases) were included. Increase in myopia prevalence with age varied by ethnicity. East Asians showed the highest prevalence, reaching 69% (95% credible intervals (CrI) 61% to 77%) at 15 years of age (86% among Singaporean-Chinese). Blacks in Africa had the lowest prevalence; 5.5% at 15 years (95% CrI 3% to 9%). Time trends in myopia prevalence over the last decade were small in whites, increased by 23% in East Asians, with a weaker increase among South Asians. Children from urban environments have 2.6 times the odds of myopia compared with those from rural environments. In whites and East Asians sex differences emerge at about 9 years of age; by late adolescence girls are twice as likely as boys to be myopic. Marked ethnic differences in age-specific prevalence of myopia exist. Rapid increases in myopia prevalence over time, particularly in East Asians, combined with a universally higher risk of myopia in urban settings, suggest that environmental factors play an important role in myopia development, which may offer scope for prevention., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objective: To observe the accommodative accuracy of children with early-onset myopia at different near-work distances, and discuss the relationship between accommodative accuracy and early-onset myopia., Methods: This was a case-control study. Thirty-seven emmetropic children, 41 early-onset myopic children without correction, and 39 early-onset myopic children with spectacles, aged 7 to 13 years, were included. Measures of refractive errors and accommodative accuracy at four near-work distances, including 50 cm, 40 cm, 30 cm, and 20 cm, were made using the binocular fusion cross cylinder (FCC) of an automatic phoropter., Results: Most candidates showed accommodative lags, including the children with emmetropia. The ratio of lags in all candidates at different near-work distances was 75.21% (50 cm), 87.18% (40 cm), 92.31% (30 cm), and 98.29% (20 cm), respectively. All accommodative accuracies became worse, and the accommodative lag ratio and values of FCC increased, along with the shortening of the distance. The difference in accommodative accuracy among groups was statistically significant at 30 cm (χ(2)=7.852, P= 0.020) and 20 cm (χ(2)=6.480, P=0.039). The values of FCC among groups were significantly different at 30 cm (F=3.626, P=0.030) and 20 cm (F=3.703, P=0.028), but not at 50 cm and 40 cm (P>0.05). In addition, the FCC values of 30 cm and 20 cm had a statistically significant difference between myopic children without correction [(1.25±0.44) D and (1.76±0.43) D] and emmetropic children [(0.95±0.52) D and (1.41±0.58) D] (P=0.012, 0.008). The correlation between diopters of myopia and accommodative accuracy at different nearwork distances was not statistically significant (P>0.05). However, the correlation between diopters of myopia and the accommodative lag value (FCC) at 20 cm was statistically significant (r=0.246, P=0.028)., Conclusions: The closer the near-work distance is, the worse the accommodative accuracy is. This is more significant in early-onset myopia, especially myopia without correction, than emmetropia. Wearing spectacles may improve the threshold and sensitivity of accommodations, and the accommodative accuracy at near-work distances (<30 cm) to some extent. The poor accommodative accuracy at near-work distances may be not related to early-onset myopia, but the value of FCC (20 cm) is related to early-onset myopia. The higher the FCC value is, the higher the diopter is. (Chin J Ophthalmol, 2016, 52: 520-524).

Purpose: To investigate the effects of different near addition lenses and prisms on accommodative microfluctuations (AMFs) in Chinese early-onset myopic (EOM) and emmetropic (EMM) children., Methods: Twenty-one EMM and 27 EOM children aged between 9 and 14years participated in the study. At near, 23 children were exophoric (exo, <0 Δ), and 25 were esophoric (eso, ≥0 Δ). The AMFs and phoria through multiple addition lenses (-1.00, 0, +1.00, +2.00, and +3.00D on each eye) and prisms (base-in prism power: 3 Δ, 2 Δ, 1 Δ; and base-out prism power: 1 Δ and 2 Δ on each eye) were measured at 25cm under binocular viewing conditions with a Grand Seiko WAM-5500 auto-refractor and a modified Thorington card., Results: Higher AMFs were found in EOM than in EMM (EOM, 0.19±0.06D; EMM, 0.16±0.03D; p=0.035). Plus additions from +1.00 to +3.00D reduced the AMFs in both EMM and EOM, except +3.00D for EMM. In both refractive groups, -1.00D additions increased AMFs. Esophores showed greater AMFs compared with exophores (esophores, 0.20±0.01D; exophores, 0.16±0.01D; p=0.012). Prisms increased the AMFs in EMM and did not alter the AMFs in EOM., Conclusions: Microfluctuations of accommodation decreased with plus addition lenses and increased with negative addition lenses. Plus addition lenses of +2.00 to +3.00D for EOM and +2.00D for EMM decreased AMFs the least at a 25-cm working distance. Esophores had higher AMFs than exophores, indicating that phoria status influences AMFs.

Purpose: To determine the biometric and refractive changes after orbital decompression in Korean patients with thyroid-associated orbitopathy (TAO)., Methods: Retrospective, observational study (between October 2012 and September 2014) was performed. Patients with TAO undergoing orbital decompression for stable proptosis received ophthalmic examinations, including Hertel exophthalmometry, A-scan biometry, autorefraction measures, corneal topography, and wavefront aberration measures, before orbital decompression and again 2 months after surgery., Results: Included in the study were 43 eyes from 23 patients. The mean exophthalmometric value decreased by 4.1 mm 2 months after orbital decompression (P<0.001). On average, axial length (AL) increased significantly by 0.08 mm (P<0.001); specifically, 37 (86%) of the 43 eyes had increased AL. Whereas anterior chamber depth and lens thickness showed no significant changes (P=0.086 and P=0.905, respectively), the mean spherical refraction and spherical equivalent (SE) decreased by 0.35 and 0.48 D, respectively (P=0.008 and P<0.001, respectively). However, cylindrical refraction and axis showed no significant changes (P=0.057 and P=0.218, respectively). The changes in AL and SE were significantly correlated (R=-0.411, P=0.009). Notably, there were no changes in corneal topography or wavefront aberration after orbital decompression., Conclusions: TAO patients who underwent orbital decompression showed myopic refractive change via increase in AL. Possible refractive changes should be considered in cases of TAO complaining of decreased visual acuity after orbital decompression.

Background: There is very little published work on the visual needs of homeless people. This paper is the first study to investigate the visual needs of homeless people in the UK. Although similar work has been done in other countries, this study is unique because the United Kingdom is the only country with a National Health Service which provides free healthcare at the point of access. This study analysed the refractive status of the sample used, determined the demographics of homeless people seeking eye care and established if there is a need for community eye health with access to free spectacle correction in East London., Methods: This retrospective case study analysed the clinical records of 1,141 homeless people using the Vision Care for Homeless People services at one of their clinics in East London. All eye examinations were carried out by qualified optometrists and, where appropriate, spectacles were dispensed to patients. Data captured included age, gender, ethnicity and refractive error. Results were analysed using two-sample t-tests with Excel and Minitab., Results: Demographics of age, gender and ethnicity are described. Spherical equivalents (SE) were calculated from prescription data available for 841 clinic users. Emmetropia was defined as SE-0.50DS to +1DS, myopia as SE < -0.50DS, and hyperopia as SE > +1DS. The majority of clinic users were male (79.2 %, n = 923). Approximately 80 % (n = 583) of clinic users were white, 10 % (n = 72) were 'black', 4 % (n = 29) 'Asian' and the remaining 5.6 % (n = 40) were of 'mixed ethnicity' and 'other' groups. The mean age of females attending the clinic was significantly lower than that of males (45.9 years, SD = 13.8 vs' 48.4 years, SD = 11.8) when analysed using a two-sample t-test (t (317) = 2.44, p = 0.02). One third of service users were aged between 50-59 years. Myopia and hyperopia prevalence rates were 37.0 % and 21.0 % respectively. A total of 34.8 % of homeless people were found to have uncorrected refractive error, and required spectacle correction., Conclusions: This study has identified a high proportion of uncorrected refractive error in this sample and therefore a need for regular eye examinations and provision of refractive correction for homeless people.

Purpose: To evaluate the association between polymorphisms of RASGRF1 rs8027411 and high myopia in Chinese and Japanese populations., Methods: All eligible studies investigating the association between the RASGRF1 gene and high myopia listed in PubMed, EMBASE, the Cochrane Library, Web of Science, and the China Biologic Medical Database were retrieved. The effects were assessed with the pooled odds ratio (OR) and 95% confidence interval (CI). Heterogeneity between studies was evaluated with the Q-statistic test. Publication bias was tested with Begg's and Egger's linear regression tests. Subgroup analysis and sensitivity analysis were performed to identify the sources of heterogeneity., Results: In the present meta-analysis, 2,529 individuals with high myopia and 3,127 controls from four studies were included and divided into seven groups. The results indicated that RASGRF1 rs8027411 was significantly associated with high myopia in Chinese and Japanese populations. Carriers of the rs8027411 G allele had a lower risk of high myopia compared to carriers with the T allele (G versus T, OR=0.83, 95% CI=0.77-0.89; p<0.001). Low but not significant heterogeneity was found in a recessive model. No heterogeneity was found in other genetic models. The subgroup analysis indicated that the protective effect of rs8027411 variants was more prominent in Chinese populations (G versus T, OR=0.80 in Chinese and OR=0.86 in Japanese; GG versus TT, OR=0.65 in Chinese and OR=0.77 in Japanese; GT versus TT, OR=0.76 in Chinese and OR=0.81 in Japanese; (GG+GT) versus TT, OR=0.73 in Chinese and OR=0.80 in Japanese; and GG versus (GT+TT), OR=0.77 in Chinese and OR=0.87 in Japanese). Sensitivity analysis indicated that the study results were stable in allelic, homozygote, heterozygote, and dominant models but were not stable in the recessive model. No evidence of publication bias was found., Conclusions: Carriers of the rs8027411 G allele in the RASGRF1 gene may be at a lower risk of high myopia in Chinese and Japanese populations. The RASGRF1 gene may play a role in the development of high myopia, especially in Asians. Additional studies are required to validate these results.

Background: Differences in accommodation when reading Chinese, as compared to Latin, characters have been suggested to have a role in the higher prevalence of myopia in some Asian countries. Yeo and colleagues (Optom Vis Sci 2013; 90: 156-163) found that, in Chinese-literate children, accommodation was marginally more accurate (by less than 0.05 D), when reading Chinese text. This was attributed to the additional cognitive demand associated with interpreting the more complex Chinese symbols. The present study compared responses to single Chinese and Latin characters, while controlling for cognitive demand., Methods: The monocular accommodative response was measured in Chinese-illiterate adults (10 emmetropes, mean spherical equivalent: -0.07 ± 0.42 D, age: 29.9 ± 4.2 years; 11 myopes, mean spherical equivalent: -4.28 ± 2.84 D, age: 31.7 ± 4.6 years) with an open-field autorefractor. Four Chinese and three Latin characters (approximately 1.15 degrees subtense) were individually presented on a display screen one metre away from the subject, while their vergence was varied over the range zero to 5.00 D using spectacle trial lenses. The slope and the accommodative error index (AEI) were calculated from the accommodative stimulus/response curves (ASRC)., Results: No statistically significant differences were found between refractive groups or among characters within the same refractive group in ARSC slopes (Latin: 0.87 ± 0.14 for myopes versus 0.81 ± 0.12 for emmetropes; Chinese: 0.84 ± 0.12 for myopes versus 0.85 ± 0.12 for emmetropes). No significant differences were found between characters in accommodative error index either (Latin, 0.78 ± 0.42 D for myopes versus 1.15 ± 0.72 D for emmetropes; Chinese, 0.74 ± 0.37 D for myopes versus 1.17 ± 0.83 D for emmetropes). However, accommodative error indices and accommodative errors were significantly higher for emmetropes., Conclusion: Under controlled cognitive demand, Chinese and Latin characters elicited similar responses in both individual refractive groups. This study fails to support the hypothesis that development of myopia in some Asian populations is associated with larger lags of accommodation when reading or viewing Chinese characters., (© 2015 Optometry Australia.)

Purpose: To evaluate the accuracy of the Spot (V2.0.16) and Plusoptix S12 (ROC4, V6.1.4.0) photoscreeners in detecting astigmatism meeting AAPOS referral criteria in students from a population with high prevalence of astigmatism., Methods: Students attending grades 3-8 on the Tohono O'odham reservation were examined. Screening was attempted with both the Spot and Plusoptix photoscreeners. Results were compared to cycloplegic refraction. Screening attempts providing no estimate of refractive error were considered fail/refer. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for detection of refractive errors were determined using AAPOS referral criteria and receiver operating characteristic area under the curve (ROC AUC) analysis was conducted for measures of astigmatism. Agreement between screening and cycloplegic refraction measurements of astigmatism, spherical equivalent, and anisometropia were assessed using t tests and correlation analyses., Results: A total of 209 students were included. Of the total, 116 (55%) met examination-positive criteria based on cycloplegic refraction, with 105 of those (90%) meeting the criterion for astigmatism. Measurements success rates were 97% for Spot and 54% for Plusoptix. Comparing the Spot and the Plusoptix, sensitivity was 96% versus 100%, specificity was 87% versus 61%, PPV was 90% versus 76%, and NPV was 94% versus 100% for detection of refractive error. Both screeners overestimated astigmatism by 1/3 D to 2/3 D. AUC for astigmatism was 0.97 for Spot and 0.83 for Plusoptix., Conclusions: In this highly astigmatic population, the Spot and the Plusoptix had similar sensitivity, but the Spot had better specificity and measurement success rates. Compared with results from study samples with lower rates of astigmatism, our results highlight the need to assess the ability of screening instruments to detect individual types of refractive errors., (Copyright © 2015 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Purpose: To examine the associations of near work related parameters with spherical equivalent refraction and axial length in Chinese children., Methods: A total of 1770 grade 7 students with mean age of 12.7 years were examined with cycloplegic autorefraction and axial length. Questions were asked regarding time spent in near work and outdoors per day, and near work related parameters., Results: Multivariate models revealed the following associations with greater odds of myopia: continuous reading (> 45min), odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1-1.8; close television viewing distance (≤ 3m), OR, 1.7; 95% CI, 1.2-2.3; head tilt when writing, OR, 1.3; 95% CI, 1.1-1.7, and desk lighting using fluorescent vs. incandescent lamp, OR, 1.5; 95% CI, 1.2-2.0. These factors, together with close reading distance and close nib-to-fingertip distance were significantly associated with greater myopia (P<0.01). Among near work activities, only reading more books for pleasure was significantly associated with greater myopia (P=0.03). Television viewing distance (≤ 3 m), fluorescent desk light, close reading distance (≤20 cm) and close nib-to-fingertip distance (≤ 2 cm) were significantly associated with longer axial length (P<0.01). Reading distance, desk light, and reading books for pleasure had significant interaction effects with parental myopia., Conclusions: Continuous reading, close distances of reading, television viewing and nib-to-fingertip, head tilt when writing, reading more books for pleasure and use of fluorescent desk light were significantly associated with myopia in 12-year-old Chinese children, which indicates that visual behaviors and environments may be important factors mediating the effects of near work on myopia.

Background: To prospectively observe the effects of undercorrection of myopia on myopia progression and axial elongation in a population of 12-year-old Chinese children., Methods: A total of 2,267 children in the Anyang Childhood Eye Study were examined at baseline, and 1,769 were followed for 1 year. Ocular examinations included cycloplegic autorefraction, axial length, visual acuity, vertometry, and accommodative lag. Questionnaires were completed by children and parents. Undercorrection of myopia was determined at baseline if presenting visual acuity could be improved by at least 2 lines with subjective refraction., Results: Of 253 myopic children with spectacles and available information, 120 (47.4 %) were undercorrected (-4.63D  to -0.50D) and 133 (52.6 %) were fully corrected. In a multivariate model adjusting for age, gender, number of myopic parents, time spent on near work and outdoor activities per day, usage and time for wearing spectacles per day, children with undercorrection had significantly more baseline myopia (P < 0.01) and longer axial length (P = 0.03) than children with full correction. However, there were no significant differences in myopia progression (P = 0.46) and axial elongation (P = 0.96) at 1 year between the two groups of children. The regression analysis showed that myopia progression significantly decreased with increasing amount of undercorrection (r (2) = 0.02, P = 0.02) in all children. Accommodative lag significantly decreased with increasing amounts of undercorrection (P < 0.01)., Conclusions: Based on this 1-year study in Chinese children, undercorrection or full correction of myopia by wearing spectacles did not show any differences in myopia progression or axial elongation.

Introduction: This study aimed to evaluate the proportion of young patients with type 1 diabetes mellitus (T1DM) who have myopia, as well as the risk factors associated with myopia in this group., Methods: In this cross-sectional study, patients aged < 21 years with T1DM for ≥ 1 year underwent a comprehensive eye examination. Presence of parental myopia, and average hours of near-work and outdoor activity were estimated using a questionnaire. Annualised glycosylated haemoglobin (HbA1c), defined as the mean of the last three HbA1c readings taken over the last year, was calculated. Multivariate analysis using genetic, environmental and diabetes-related factors was done to evaluate risk factors associated with myopia., Results: Of the 146 patients (mean age 12.5 ± 3.6 years) recruited, 66.4% were Chinese and 57.5% were female. Myopia (i.e. spherical equivalent [SE] of -0.50 D or worse) was present in 96 (65.8%) patients. The proportion of patients with myopia increased from 25.0% and 53.6% in those aged < 7.0 years and 7.0-9.9 years, respectively, to 59.2% and 78.4% in those aged 10.0-11.9 years and ≥ 12.0 years, respectively. Higher levels of SE were associated with lower parental myopia (p = 0.024) and higher annualised HbA1c (p = 0.011)., Conclusion: Compared to the background population, the proportion of myopia in young patients with T1DM was higher in those aged < 10 years but similar in the older age group. Myopia was associated with a history of parental myopia. Environmental risk factors and poor glycaemic control were not related to higher myopia risk.

Background: To explore the changes in thickness in different areas and layers of the macula under different refractive conditions., Methods: Consecutive participants were enrolled in the study. Optical coherence tomography (OCT) images were obtained using a spectral-domain system. We studied the relationships of the full, inner and outer retinal thicknesses of the fovea, parafovea and perifovea relative to the spherical equivalent (SE) and axial length (AL)., Results: We included 107 eyes; the analysis revealed that the men had thicker foveas (man vs women: 236.70 ± 18.97 μm vs 247.25 ± 16.70 μm P = 0.002) and inner parafoveas (man vs women: 128.35 ± 8.80 μm vs 122.78 ± 6.75 μm P < 0.001) than the women had. Full foveal thickness was not correlated with AL or SE (all P > 0.05), whereas the full para- and perifoveal thicknesses had significant negative correlations with AL (r =  0.243 P = 0.006 and r = -0.446 P < 0.001, for para- and peri- respectively) and positive correlations with SE (r = 0.346 P < 0.001 and r = 0.464 P < 0.001, for para- and peri- respectively). Regarding the layers, the thickness of the inner layer of the fovea increased with the degree of myopia. The average inner and outer layer thicknesses of the para- and perifovea decreased with the degree of myopia (with the SE para, b = 0.307, peri b = 0.457; with the AL para, b = -0.266, peri b = -0.454),with the perifoveal thicknesses decreasing more rapidly., Conclusions: Macular thickness changes with the degree of myopia; however, the different areas and different layers change in different manners.

Purpose: To examine the relationship of choroidal thickness with axial length (AL) and myopia in young adult eyes in the ethnically diverse Correction of Myopia Evaluation Trial (COMET) cohort., Design: Cross-sectional, multicenter study., Methods: In addition to measures of myopia by cycloplegic autorefraction and AL by A-scan ultrasonography, participants underwent optical coherence tomography imaging of the choroid in both eyes at their last visit (14 years after baseline). Using digital calipers, 2 independent readers measured choroidal thickness in the right eye (left eye if poor quality; n = 37) at 7 locations: fovea and 750, 1500, and 2250 μm nasal (N) and temporal (T) to the fovea., Results: Choroidal thickness measurements were available from 294 of 346 (85%) imaged participants (mean age: 24.3 ± 1.4 years; 44.9% male) with mean myopia of -5.3 ± 2.0 diopters and mean AL of 25.5 ± 1.0 mm. Overall, choroidal thickness varied by location (P < .0001) and was thickest at the fovea (273.8 ± 70.9 μm) and thinnest nasally (N2250, 191.5 ± 69.3 μm). Multivariable analyses showed significantly thinner choroids in eyes with more myopia and longer AL at all locations except T2250 (P ≤ .001) and presence of peripapillary crescent at all locations except T1500 and T2250 (P ≤ .0001). Choroidal thickness varied by ethnicity at N2250 (P < .0001), with Asians having the thinnest and African Americans the thickest choroids., Conclusion: Choroids are thinner in longer, more myopic young adult eyes. The thinning was most prominent nasally and in eyes with a crescent. In the furthest nasal location, ethnicity was associated with choroidal thickness. The findings suggest that choroidal thickness should be evaluated, especially in the nasal regions where myopic degenerations are most commonly seen clinically., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to assess the ovality of the optic disc and its associations with myopia-related factors in primary school children in Beijing., Methods: This longitudinal school-based study included 382 grade 1 children and 299 grade 4 children who were followed for 2 years. Study participants underwent a comprehensive eye examination including autorefractometry, ocular biometry, and fundus photography., Results: Fundus photographs were available for 562 children (82.5%). The mean optic disc ovality (maximal-to-minimal disc diameter) was 1.17 ± 0.29 (range, 1.00-1.50). Oval discs defined by an ovality of ≥ 1.33 were detected in 37 children (prevalence: 6.6%; 95% confidence interval: 4.5-8.6). In multivariate linear regression analysis, higher optic disc ovality index was significantly associated with older age (P = 0.001), female sex (P = 0.005), larger parapapillary beta zone (P < 0.001), and shorter time spent indoors with studying (P = 0.003) and was marginally significant (P = 0.057), with greater increase in myopic refractive error from 2011 to 2013. From 2011 to 2013, myopic refractive error increased in the oval optic disc group by 1.03 ± 0.99 diopters compared to 0.67 ± 1.31 diopters in the nonoval disc group., Conclusions: The prevalence of oval optic discs in Beijing school children was markedly higher than in the elderly Beijing Eye Study population (6.6% vs. 0.36%), paralleling the higher prevalence of myopia in school children. The association between oval optic discs and less time spent indoors with studying after adjusting for longitudinal change in myopic refractive error, age, sex and parapapillary beta zone may warrant further exploration of external factors associated with oval optic discs.

Background: Cohen Syndrome (COH1) is a rare autosomal recessive disorder, principally identified by ocular, neural and muscular deficits. We identified three large consanguineous Pakistani families with intellectual disability and in some cases with autistic traits., Methods: Clinical assessments were performed in order to allow comparison of clinical features with other VPS13B mutations. Homozygosity mapping followed by whole exome sequencing and Sanger sequencing strategies were used to identify disease-related mutations., Results: We identified two novel homozygous deletion mutations in VPS13B, firstly a 1 bp deletion, NM&#95;017890.4:c.6879delT; p.Phe2293Leufs*24, and secondly a deletion of exons 37-40, which co-segregate with affected status. In addition to COH1-related traits, autistic features were reported in a number of family members, contrasting with the "friendly" demeanour often associated with COH1. The c.6879delT mutation is present in two families from different regions of the country, but both from the Baloch sub-ethnic group, and with a shared haplotype, indicating a founder effect among the Baloch population., Conclusion: We suspect that the c.6879delT mutation may be a common cause of COH1 and similar phenotypes among the Baloch population. Additionally, most of the individuals with the c.6879delT mutation in these two families also present with autistic like traits, and suggests that this variant may lead to a distinct autistic-like COH1 subgroup.

Purpose: We aimed to investigate the clinical variation of rhegmatogenous retinal detachments (RD) in patients of different ethnicities., Methods: Patients presenting with a primary RD from two ethnic groups were recruited from our tertiary referral hospital between August 2010 and December 2012. Patients who self-reported their ethnic origin either as European Caucasian (EC) or South Asian (SA) were included. Exclusion criteria included trauma, previous vitreoretinal procedures, age under 18 years, complicated cataract surgery and the presence of syndromes known to be associated with a high prevalence of RD. Detailed phenotypic data were collected. Descriptive and comparative statistical analyses were undertaken., Results: 1269 Patients were recruited. 1173 (92.4%) were EC. Mean age of onset was 58.3 years (EC) and 54.5 years (SA) (P=0.006). 75.3% EC and 58.4% SA were phakic (P<0.001). 12.8% of EC and 19.4% of SA patients had a lattice retinal degeneration in the affected eye (P=0.003). Refractive myopia was greater in SA patients (mean: -6.1DS) than EC (-4.2DS) (P=0.032). Additionally, SA patients had a greater mean axial length (25.65 mm) than EC (25.06 mm) (P=0.014). No differences were demonstrated in laterality, family history, type of retinal break or macular status., Conclusions: SA patients present with RD at an earlier age and have a more severe phenotype than ECs. Future management strategies for RD may need to reflect these differences.

Importance: Myopia (nearsightedness) has its onset in childhood and affects about one-third of adults in the United States. Along with its high prevalence, myopia is expensive to correct and is associated with ocular diseases that include glaucoma and retinal detachment., Objective: To determine the best set of predictors for myopia onset in school-aged children., Design, Setting, and Participants: The Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study was an observational cohort study of ocular development and myopia onset conducted at 5 clinical sites from September 1, 1989, through May 22, 2010. Data were collected from 4512 ethnically diverse, nonmyopic school-aged children from grades 1 through 8 (baseline grades 1 through 6) (ages 6 through 13 years [baseline, 6 through 11 years])., Main Outcomes and Measures: We evaluated 13 candidate risk factors for their ability to predict the onset of myopia. Myopia onset was defined as -0.75 diopters or more of myopia in each principal meridian in the right eye as measured by cycloplegic autorefraction at any visit after baseline until grade 8 (age 13 years). We evaluated risk factors using odds ratios from discrete time survival analysis, the area under the curve, and cross validation., Results: A total of 414 children became myopic from grades 2 through 8 (ages 7 through 13 years). Of the 13 factors evaluated, 10 were associated with the risk for myopia onset (P < .05). Of these 10 factors, 8 retained their association in multivariate models: spherical equivalent refractive error at baseline, parental myopia, axial length, corneal power, crystalline lens power, ratio of accommodative convergence to accommodation (AC/A ratio), horizontal/vertical astigmatism magnitude, and visual activity. A less hyperopic/more myopic baseline refractive error was consistently associated with risk of myopia onset in multivariate models (odds ratios from 0.02 to 0.13, P < .001), while near work, time outdoors, and having myopic parents were not. Spherical equivalent refractive error was the single best predictive factor that performed as well as all 8 factors together, with an area under the curve (C statistic) ranging from 0.87 to 0.93 (95% CI, 0.79-0.99)., Conclusions and Relevance: Future myopia can be predicted in a nonmyopic child using a simple, single measure of refractive error. Future trials for prevention of myopia should target the child with low hyperopia as the child at risk.