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Significance: This study explores the difference between cycloplegic and noncycloplegic refraction in young adult myopes., Purpose: From the available literature, it is unclear whether cycloplegia is necessary when refracting young adults. This study investigates the agreement between noncycloplegic autorefraction and cycloplegic autorefraction and investigates factors affecting the agreement between the two methods., Methods: In total, 125 myopes with ages ranging between 18 and 26 years were included from Australia and Vietnam. Each participant underwent noncycloplegic autorefraction and cycloplegic autorefraction. Cycloplegia was induced with 1% ophthalmic tropicamide., Results: The mean spherical equivalent difference (95% confidence interval) between noncycloplegic autorefraction and cycloplegic autorefraction was -0.20 D (-0.25 to -0.14 D; t124 = -7.18, p<0.0001 ) . A mean difference of >0.25 D was seen in 46.8% of eyes. The lower and upper limits of agreement were -0.80 and 0.41 D, respectively. With univariate analysis, factors including age, degree of refractive error, accommodation amplitude, and distance phorias showed no impact on the average difference between cycloplegic autorefraction and noncycloplegic autorefraction. Yet, eyes with near exophoria ( F2,120 = 6.63, p=0.0019) and Caucasian eyes ( F3,121 = 2.85, p=0.040) exhibited the smallest paired differences. However, in the multivariate analysis, only near exophoria was associated with a lower mean difference. A significantly smaller proportion (34.9%) of eyes with near exophoria had a paired difference of -0.25 D or more compared with esophoria (50%) and orthophoria (65%; χ2 = 6.6, p=0.038)., Conclusions: Noncycloplegic autorefraction results in more myopic refractive error than cycloplegic autorefraction in young adults., Competing Interests: Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest., (Copyright © 2024 The Author(s).)

Purpose: To characterize peripapillary intrachoroidal cavitation (PICC) in highly myopic participants and its associated risk factors., Methods: This observational, cross-sectional study recruited 890 Chinese participants with bilateral high myopia, defined as ≤-6.00 diopters spherical power. Fundus photography and spectral-domain optical coherence tomography were used to determine the presence of PICC, defined as a yellow-orange lesion adjacent to the disc border with a corresponding intrachoroidal hyporeflective space., Results: Among 890 participants, 884 right eyes were included for analysis. The rate of PICC was 3.6% (32 eyes). Peripapillary intrachoroidal cavitation was observed in two eyes without myopic retinal lesions, nine eyes with tessellated fundus only, 16 eyes with diffuse chorioretinal atrophy, and five eyes with patchy chorioretinal atrophy. The most commonly affected area was inferior disc border (87.5%), followed by multiple (9.4%) and superior (3.1%) disc borders. The multiple linear logistic regression model showed that older age, more myopic spherical equivalent, and longer axial length were associated with the presence of PICC., Conclusion: Peripapillary intrachoroidal cavitation was present in 3.6% of highly myopic eyes. It was more common in eyes with a higher myopic maculopathy category. Older age, more myopic spherical equivalent, and longer axial length were risk factors for the presence of PICC.

Purpose: To explore the associations between diffuse chorioretinal atrophy (DCA) and age, sex, axial length, spherical equivalent, and best-corrected visual acuity (BCVA) among highly myopic eyes., Methods: This study included right eyes of 857 bilaterally highly myopic individuals from the ZOC-BHVI Cohort Study. Participants underwent examinations, including BCVA, ocular biometry, autorefraction, and color fundus photography. An Early Treatment Diabetic Retinopathy Study grid was applied on the fundus photographs to evaluate the location of DCA, which was graded into four categories (D0-D3). The characteristics and ocular biometry were compared between participants' eyes with and without DCA., Results: Diffuse chorioretinal atrophy was found in 177 (20.6%) eyes. The proportion of participants with DCA in age groups of 7 to 11, 12 to 18, 19 to 39, and ≥ 40 years old was 20.9%, 9.2%, 23.1%, and 52.9%, respectively. The proportion of DCA significantly increased with longer axial length and worse myopic spherical equivalent. Eyes with DCA had poorer BCVA (Snellen visual acuity 20/36, logarithm of minimal angle of resolution 0.26 ± 0.25) than those without DCA (Snellen visual acuity 20/23, logarithm of minimal angle of resolution 0.06 ± 0.14) (P < 0.001). The BCVA gradually declined as the lesion got closer to the fovea (P for trend < 0.001)., Conclusion: The proportion of DCA increased with older age, longer axial length, and more myopic spherical equivalent. Diffuse chorioretinal atrophy is a vision-threatening complication of high myopia where BCVA gradually worsens with foveal involvement.

Significance: This study demonstrates that mean axial length/corneal radius of curvature ratio (AL/CR) can be used to detect low and high myopia but cannot clinically monitor myopia progression because the relationship between AL/CR and progression in myopia is different between low and high myopia., Purpose: The purpose of this study was to investigate the relationship of AL/CR with magnitude and progression of myopia., Methods: Retrospective analysis was conducted comparing the right eyes of those with high myopia (n = 308; age, 7 to 16 years; myopia sphere, -6.00 diopters or worse) with those with low myopia (n = 732; age, 7 to 16 years; myopia sphere, between -0.50 and -3.50 diopters; cylinder, ≤1.00 diopters). Baseline axial length, corneal radii of curvature, and cycloplegic objective refraction were analyzed. Myopia progression in the low-myopia group at 6- and 12-month follow-up was measured, and the differences in slopes of AL/CR were compared for slow (<0.75 diopters) and fast progressing (≥0.75 diopters)., Results: Mean AL/CR values were significantly different (P < .001) between high myopia (3.46 ± 0.10) and low myopia (3.16 ± 0.07). In high and low myopia, slopes of axial length versus corneal curvature radius were not significantly different (P > .05), and slopes of AL/CR versus spherical equivalent were significantly different after adjusting for spherical equivalent and age (P < .05). Slopes of AL/CR progression and spherical equivalent progression were significantly different in low myopia between fast and slow progressing (P < .001), but the relationship between progression in AL/CR and progression in spherical equivalent was not strong., Conclusions: The AL/CR can be used to classify different grades of myopia, but it is not useful in determining the magnitude of myopia or monitoring progression because AL/CR is not linearly related to spherical equivalent and because progression in AL/CR is not strongly related to spherical equivalent progression.

Significance: Some studies reported that optic disc tilt and rotation might be risk factors for the susceptibility of high myopic eyes to develop glaucoma. However, data regarding optic disc manifestations in high myopia participants are few. It is crucial to characterize the features of optic disc manifestations among high myopes., Purpose: To describe optic disc characteristics of Chinese highly myopic eyes and to investigate associated factors., Methods: This cross-sectional, observational study included 890 Chinese with bilateral high myopia (defined as ≤-6.00 diopters spherical power) in 2012. All subjects underwent cycloplegic autorefraction, ocular biometry, and fundus photography. The optic disc tilt ratio, degree of rotation, and β-zone peripapillary atrophy area were measured from the 45°optic disc-centered fundus photographs. Optic disc tilt was defined as optic disc tilt ratio, the ratio of maximum to minimum diameter of optic disc, exceeding 1.3. The definition of optic disc rotation was using optic disc rotation degree, the angle from long diameter and the vertical meridian, of >15°., Results: Among 890 participants, 2 were excluded by ungradable optic disc-centered fundus photographs. In the 888 studied right eyes, the mean spherical power was -9.36 ± 3.46 diopters with a mean axial length of 27.51 ± 1.63 mm. The proportion of optic disc tilting, rotation, and β-zone peripapillary atrophy were 81.2%, 48.3%, and 92.8%, respectively. The mean ratio of optic disc tilting and rotation degree was 1.78 ± 0.53 and 21.08 ± 19.91°; the mean area of β-zone peripapillary atrophy/optic disc head was 1.11 ± 1.22. A multiple linear regression showed that older age (P < .001), female (P = .02), and more myopic spherical equivalent (P = .005) were related to the greater optic disc tilting ratio., Conclusions: Beta-zone peripapillary atrophy, optic disc tilting, and rotation are very common in highly myopic eyes in Chinese population. Older age, female, and more myopic spherical equivalent are risk factors of higher degree of optic disc tilting.

Purpose: To measure the power profile across the optic zone (OZ) of four commercially available soft contact lenses and establish the impact on the peripheral refractive error of the eye., Methods: The power profiles of a spherical conventional hydrogel contact lens (etafilcon A, J&J Vistakon, Jacksonville, FL USA) and three spherical silicone hydrogel contact lenses (lotrafilcon A and B, CIBA Vision, Duluth, GA USA; enfilcon A, CooperVision, Pleasanton, CA USA) with a labeled power of -3.00 and -6.00 diopters were measured using a Shack-Hartmann wavefront sensor power mapping device. Central and peripheral refraction across the horizontal meridian (nasal and temporal visual field at 20, 30, and 40 degrees) was measured with an open-field autorefractor (Shin Nippon NVision K5001, Osaka Japan) with and without contact lenses in 26 myopic subjects. The relative peripheral refractive error on the eye was estimated and compared with and without contact lenses and between contact lenses., Results: Differences in the distribution of the power profile across the OZ were apparent between contact lens types and powers. No significant differences (p > 0.05) were found between contact lens types for their effect on on-axis refraction. Significant differences (p < 0.05) were found at all peripheral retinal eccentricities between contact lens types., Conclusions: For a given central power, the four contact lenses exhibited variations in optical power across the OZ of the lens. The distribution of optical power across the OZ has an influence on the peripheral refractive error of the eye.

Purpose: Type and incidence of adverse events and rate of discontinuations for 2 years of daily wear with silicone hydrogel contact lenses in Chinese children with myopia., Methods: Two hundred forty children aged 7 to 14 years were enrolled in a prospective randomized clinical trial from November 2008 to April 2009. Children with myopia of up to -3.50 diopters (D) spherical equivalent with astigmatism less than or equal to -0.75 D were randomized to one commercial and three experimental lens designs of Lotrafilcon B silicone hydrogel lenses (four groups) used bilaterally on a daily wear, monthly replacement schedule. The main outcome measures were incidence per 100 patient-years (incidence, in percentage) of adverse events and rate of discontinuations., Results: There were no events of microbial keratitis. Fifty-five adverse events (incidence, 14.2%) were seen. There were also 12 recurrent events. The type and incidence percentage were contact lens papillary conjunctivitis (16 events, 4.1%), superior epithelial arcuate lesions (SEALs, six events, 1.5%), corneal erosions (eight events, 2.1%), infiltrative keratitis (five events, 1.3%), asymptomatic infiltrative keratitis (seven events, 1.8%), and asymptomatic infiltrates (13 events, 3.42%). There were differences in the incidence of SEALs between groups (p = 0.023), with the incidence of SEALs being greater with one of the experimental designs. No event resulted in any vision loss. Seventy participants (29.2%) discontinued, with one-third (26 participants, 10.8%) occurring in the first month of lens wear. Discomfort and non-lens-related reasons such as safety concern and disinterest were frequently cited reasons for discontinuations., Conclusions: Adverse events with daily wear of silicone hydrogels in children were mainly mechanical in nature, and significant infiltrative events were few. The large number of dropouts in the early days of lens wear and their reasons for discontinuation suggest that adaptation and patient motivation are critical for survival in lens wear.

Significant advances during the past decade in silicone hydrogel lenses have made them the primary mode for new contact lens wear. Their dominance in the market place is driven largely by the elimination of structural and physiological changes induced by contact lens-induced hypoxia, as exemplified especially by the reduction in limbal redness. However, end-of-day dryness and discomfort still drives many to discontinue lens wear. Evidence also indicates that the rate of serious adverse events, such as microbial keratitis, have not been impacted with the use of silicone hydrogel lenses. Moreover, there are additional challenges relating to 'corneal staining' and corneal infiltrates associated with the incompatibility of lens care product with contact lens polymers. On the other hand, technological advances enabled by the high oxygen platform present opportunities for expanding the use of contact lenses in areas that have exhibited limited uptake in the past such as astigmatism, presbyopia, and importantly myopia control. The challenges and opportunities facing the field will be discussed.

Purpose: To identify risk factors for contact lens-related corneal inflammatory events and mechanical events in wearers of silicone hydrogel lenses on a 30-night extended wear (EW) schedule in India., Methods: An interventional study with 188 subjects wearing silicone hydrogel lenses bilaterally on a 30-night EW schedule. Subjects were dispensed with lenses and reviewed at scheduled visits up to 6 months of EW. Multivariate logistic regression, after adjusting for within subject correlation, was used to develop the statistical model., Results: Occupations in non-ideal environments were found to predispose a lens wearer to inflammatory events (p = 0.003). Wearers in the non-ideal group, who had varying degrees of exposure to ocular irritants in their work environment had highest incidence of inflammatory events (19.2%). Wearers in a controlled, ideal environment had lowest levels of events (3.3%). Students occupied a position between the two groups (9.3%). Inflammatory rate was higher among wearers with increased microbial contamination of lenses (p = 0.002). Wearers with an inflammatory event had mean colony forming unit of 1.97 log compared with mean colony forming unit of 1.45 log in group with no inflammatory event. Corneal vascularization was associated with the development of inflammatory events (p = 0.001) with 50% of wearers with vascularization experiencing events compared with 7.6% of subjects with no vascularization. Reduced lens movement was associated with inflammatory events with subjects more likely to develop inflammatory events compared with those wearers with optimal lens movement (p = 0.027)., Conclusions: A multitude of factors, including environmental influences, lens contamination, ocular characteristics, and lens fit, contributes to the development of inflammatory events, information that is of clinical relevance to practitioners worldwide. Occupational environment was also a contributory factor, confirming that a duty of clinicians is to ascertain the nature of the work environment of lens wearers (and potential wearers) and to balance the needs of the wearer with the potential risks.

Purpose: Contact lens acute red eye (CLARE) and infiltrative keratitis (IK) are inflammatory responses of the eye associated with extended wear of soft contact lenses and are associated with bacterial colonization of contact lenses. Development of animal models to study these conditions is of importance in confirming risk factors and developing preventative strategies., Methods: Silicone hydrogel contact lenses contaminated with a human CLARE isolate of Pseudomonas aeruginosa at inocula ranging from 1 x 10 to 6 x 10 colony-forming units (CFUs) for 15 minutes, 1 hour, or 24 hours were worn by guinea pigs for times up to 48 hours in 3 models designed to simulate contamination during wear and contact lens care regimens. Eyes were examined by slit-lamp biomicroscopy and histology to evaluate ocular responses and inflammation., Results: Three different models for the effects of bacterial contamination on the etiology of CLARE/IK were developed and tested in the guinea pig eye. Bacterial contamination of contact lenses was confirmed to be a major risk factor for the development of CLARE/IK and a dose response shown. The pathological features of CLARE/IK in the guinea pig were virtually identical to those observed in human eyes., Conclusion: The models characterized here provide a useful tool for development of interventional and therapeutic strategies for these important ocular inflammatory conditions.

Purpose: The purpose of this study was to evaluate and compare the Complete Ophthalmic Analysis System (COAS) G200 Aberrometer (Wavefront Sciences Inc., Albuquerque, NM) and Canon RK-F1 Autorefractor (Canon Inc., Tokyo, Japan) for measuring refractive errors in young children., Methods: The Sydney Myopia Study is a population-based study of refractive error and eye health in young Australian children. Cycloplegic refractions were performed on 1504 school year 1 students (mostly 6 years old) and 890 school year 7 (mostly 12 years old) students using both the COAS G200 Aberrometer and Canon RK-F1 autorefractor. Refractive data were analyzed using power vectors. Mean differences and 95% limits of agreement were determined for refractive components between the two instruments., Results: The mean age +/- standard deviation was 6.7 +/- 0.4 years (range, 5.5-9.1 years) and 12.6 +/- 0.5 years (range, 11.1-14.4 years) for the year 1 and year 7 students, respectively. Mean paired differences for the M component (spherical equivalent) between the COAS G200 and Canon RK-F1 were <0.25 D in both age groups and were statistically significant in the year 1 group only (p < 0.001). Small significant differences were found in the astigmatic components (J0 and J45) in both groups. A smaller coefficient of agreement for the M component was found in the older group (0.54 D), whereas the coefficients of agreement of the astigmatic components (J0 and J45) were similar for both groups., Conclusions: The COAS G200 aberrometer was an easy-to-use instrument for the measurement of refractive error in children. In addition to being able to measure higher and lower order aberrations, the COAS G200 provides refractive error measurements comparable to those of an autorefractor.

Background: Superior epithelial arcuate lesions (SEALs) are an infrequent and often asymptomatic complication of conventional soft contact lens wear. The characteristic arcuate pattern of the full-thickness corneal epithelial lesion usually occurs in the area covered by the upper eyelid, within 2 to 3 mm of the superior limbus in the 10- and 2-o'clock region., Methods: Literature on SEALs and recent clinical records from clinical trials using two types of prototype high Dk soft contact lenses were reviewed to gain greater insights into the etiology of SEALs., Results and Conclusions: The reported low incidence of SEALs is partly because SEALs are not usually symptomatic. The etiology of SEALs is multifactorial. Our current hypothesis is that SEALs are produced by mechanical chaffing at the peripheral cornea. This chaffing occurs as a result of inward pressure of the upper lid, in an area where the peripheral corneal topography and lens design, rigidity, and surface characteristics combine to create excessive "frictional" pressure and abrasive shear force on the epithelial surface. Patient characteristics such as gender, age, and specific corneal and lid topographies also appear to influence the occurrence of SEALs. Prototype silicone hydrogel lenses are made from higher modulus materials with surfaces that seem to differ subtly in wettability in some patients. The prevalence of SEALs may well increase with the first generations of these lenses.

Purpose: It has been said that Langerhans cells can be induced to migrate into the central cornea by various stimuli. We investigated whether extended wear of hydrogel lenses induced the migration of Langerhans cells into the central cornea., Methods: Guinea-pig eyes were fitted with hydrogel contact lenses, and the number of adenosine triphosphatase (ATPase)-positive dendritic cells at the limbus, peripheral, and central corneal epithelium was quantified after 1, 2, 4, and 8 nights of extended wear. The cells were identified with histochemical procedures using ATPase stain., Results: At baseline, ATPase-positive dendritic cells were seen at the limbus and peripheral cornea, with the density decreasing from limbus to peripheral cornea. There were no cells in the central cornea. With extended wear, cells increased in number at the peripheral cornea from 2 nights onward, and cells were seen in the central cornea from 4 nights onward., Conclusion: Extended wear of hydrogel lenses induced migration of ATPase-positive dendritic cells (Langerhans cells) into the central cornea. It is possible that they may play a role in the pathophysiology of some of the adverse events seen with contact lens wear.

Purpose: Contact lens-induced peripheral ulcer (CLPU), a sudden-onset adverse event observed with extended wear of hydrogel lenses, is characterized by a single, small, circular, focal anterior stromal infiltrate in the corneal periphery or midperiphery. The condition is always associated with a significant overlying epithelial loss and resolves in a scar. The aim was to determine, by using histopathologic techniques, the nature and type of the corneal infiltrate of these events., Methods: Three CLPUs observed in three patients using disposable hydrogel lenses on an extended-wear schedule were examined. The eye was topically anesthetized, and a corneal section including all of the infiltrate was taken. A small triangular piece of conjunctiva immediately adjacent to the infiltrate was sectioned. The tissue was immediately fixed, processed, stained using hematoxylin and eosin and periodic acid-Schiff stains, and examined by using light microscopy., Results: The diameter of these three corneal infiltrates varied from 0.3 to 0.6 mm. Histopathology of the corneal sections revealed a focal epithelial loss corresponding to the infiltrated stroma in all three patients. The adjacent epithelium was thinned. Bowman's layer was intact in two patients and had a localized area of loss in the remaining patient. The anterior stroma was densely infiltrated with polymorphonuclear leukocytes and had focal areas of necrosis. The infiltration was most dense in the region immediately underlying Bowman's layer. No other infiltrative cell type was seen in any of the sections. Histopathology of the conjunctiva revealed features consistent with normal conjunctival tissue., Conclusions: On histopathology of CLPU, distinctive features (i.e., focal corneal epithelial loss, an intact Bowman's membrane, and a localized infiltration of the anterior stroma with polymorphonuclear leukocytes) were seen. These features suggest that the event is an acute inflammatory process and probably noninfective in nature.

Purpose: To report the association between colonization of contact lenses with Streptococcus pneumoniae and the observation of corneal infiltrative events in a group of patients wearing disposable hydrogel lenses on an extended-wear schedule., Methods: In a prospective clinical trial, 330 patients wore disposable hydrogels on a 6-night extended-wear and replacement schedule. The contact lens, lid, and conjunctival microbiota of these subjects was analyzed at frequent intervals and at the time of an adverse event., Results: Streptococcus pneumoniae was an uncommon isolate and was recovered from only one of the 3,763 conjunctival samples, five (0.1%) of the 3,764 lid samples, and 33 (0.8%) of the 4,315 contact lens samples. Of the 33 lens samples, 10 (30%) were associated with corneal infiltrative events. Many of the events were mild inflammatory responses and resolved rapidly on discontinuation of lens wear. The presence of S. pneumoniae on the contact lens was associated with a significant risk of development of corneal infiltrates (odds ratio, 3.0; p = 0.0227, logistic-regression analysis)., Conclusions: Presence of S. pneumoniae on hydrogel lenses is a significant risk factor for the development of corneal infiltrates.