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Background: This research aims to generate normative values of hyperopia reserve and refractive progression as effective tools to estimate the risk of myopia., Methods: A 1-year follow-up study was conducted among Chinese children and adolescents aged 3-16 years selected from schools and kinder gardens using cluster sampling. All participants underwent examinations including visual acuity, axial length and cycloplegic autorefraction (1% cyclopentolate). Percentiles of spherical equivalent (SE) were calculated using Lambda-Mu-Sigma (LMS) method. Age-specific refractive progression and hyperopia reserve were determined by backward calculation., Results: Of 3118 participants, 1702 (54.6%) were boys with a mean baseline age of 7.30 years. The 50th percentile of SE estimated by LMS decreased from 1.04 D at 3 years to -2.04 D at 16 years in boys, while from 1.29 D to -2.81 D in girls. The 1-year refractive progression of myopes (0.81 D) was greater than that of non-myopes (0.51 D). The normative value of hyperopia reserve was 2.64 (range: 2.40 D-2.88 D) at 3 years and -0.35 (range: -0.50 to -0.17) D at 16 years, with the maximum progression of 0.35 D at the age of 6 years., Conclusion: Age-specific normative values of hyperopia reserve and yearly myopic shift in children and adolescents aged 3-16 years were provided, helping identify and monitor myopia and giving prevention in advance., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: This study aimed to investigate the influence of peripapillary atrophy (PPA) area and axial elongation on the longitudinal changes in macular choroidal thickness (ChT) in young individuals with myopia., Methods and Analysis: In this longitudinal investigation, 431 eyes-342 categorised as non-high myopia (non-HM) and 89 as HM-were examined for 2 years. Participants were examined with swept-source optical coherence tomography. The macular ChT, PPA area and axial length (AL) were measured at baseline and follow-up visits. Multiple regression analysis was performed to identify factors associated with ChT changes. The areas under the receiver operating characteristic curves were analysed to ascertain the predictive capacity of the PPA area and axial elongation for the reduction in macular ChT., Results: Initial measurements revealed that the average macular ChT was 240.35±56.15 µm in the non-HM group and 198.43±50.27 µm in the HM group (p<0.001). It was observed that the HM group experienced a significantly greater reduction in average macular ChT (-7.35±11.70 µm) than the non-HM group (-1.85±16.95 µm, p=0.004). Multivariate regression analysis showed that a greater reduction of ChT was associated with baseline PPA area (β=-26.646, p<0.001) and the change in AL (β=-35.230, p<0.001). The combination of the baseline PPA area with the change in AL was found to be effective in predicting the decrease in macular ChT, with an area under the curve of 0.741 (95% CI 0.694 to 0.787)., Conclusion: Over 2 years, eyes with HM exhibit a more significant decrease in ChT than those without HM. Combining the baseline PPA area with the change in AL could be used to predict the decrease of macular ChT., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To identify the relationship of macular outward scleral height (MOSH) with axial length (AL), macular choroidal thickness (ChT), peripapillary atrophy (PPA), and optic disc tilt in Chinese adults., Methods: In this cross-sectional study, 1088 right eyes of 1088 participants were enrolled and assigned into high myopia (HM) and non-HM groups. MOSH was measured in the nasal, temporal, superior, and inferior directions using swept-source optical coherence tomography images. The clinical characteristics of MOSH and the association of MOSH with AL, macular ChT, PPA, and tilt ratio were analysed., Results: The mean age of participants was 37.31 ± 18.93 years (range, 18-86 years), and the mean AL was 25.78 ± 1.79 mm (range, 21.25-33.09 mm). MOSH was the highest in the temporal direction, followed by the superior, nasal, and inferior directions (all p < 0.001). The MOSH of HM eyes was significantly higher than that of non-HM eyes, and it was positively correlated with AL in the nasal, temporal, and superior directions (all p < 0.001). Macular ChT was independently associated with the average MOSH (B = -0.190, p < 0.001). Nasal MOSH was positively associated with the PPA area and the presence of a tilted optic disc (both p < 0.01). Eyes with a higher MOSH in the superior (odds ratio [OR] = 1.008; p < 0.001) and inferior directions (OR = 1.006; p = 0.009) were more likely to have posterior staphyloma., Conclusion: MOSH is an early indicator of scleral deformation, and it is correlated positively with AL and negatively with ChT. A higher nasal MOSH is associated with a larger PPA area and the presence of a tilted optic disc. Higher MOSH values in the superior and inferior directions were risk factors for posterior staphyloma., Clinical Trial Registration: The study was registered at www., Clinicaltrials: gov (Reg. No. NCT03446300)., (© 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Purpose: To investigate the effectiveness and cutoffs of axial length/corneal radius (AL/CR) ratio for myopia detection in children by age., Methods: Totally, 21 kindergartens and schools were enrolled. Non-cycloplegic autorefraction (NCAR), axial length (AL), horizontal and vertical meridian of corneal radius (CR1, CR2), and cycloplegic autorefraction were measured. Receiver operating characteristic (ROC) curve was used to obtain the effectiveness and cutoff for myopia detection., Results: Finally, 7803 participants aged 3-18 years with mean AL/CR ratio of 2.99 ± 0.16 were included. Area under the ROC curve (AUC) of AL/CR ratio for myopia detection (0.958 for AL/CR1, 0.956 for AL/CR2, 0.961 for AL/CR) was significantly larger than that of AL (0.919, all P < 0.001), while AUCs of the three were similar with different cutoffs (> 2.98, > 3.05, and > 3.02). When divided by age, the ROC curves of AL/CR ratio in 3- to 5-year-olds showed no significance or low accuracy (AUCs ≤ 0.823) in both genders. In ≥ 6-year-olds, the accuracies were promising (AUCs ≥ 0.883, all P < 0.001), the cutoffs basically increased with age (from > 2.93 in 6-year-olds to > 3.07 in 18-year-olds among girls, and from > 2.96 in 6-year-olds to > 3.07 in 18-year-olds among boys). In addition, boys presented slightly larger cutoffs than girls in all ages except for 16 and 18 years old. For children aged 3-5 years, AL/CR ratio or AL combined with NCAR increased AUC to > 0.900., Conclusion: AL/CR ratio provided the best prediction of myopia with age-dependent cutoff values for all but preschool children, and the cutoffs of boys were slightly larger than those of girls. For preschool children, AL/CR ratio or AL combined with NCAR is recommended to achieve satisfactory accuracy. AL/CR ratio calculated by two meridians showed similar predictive power but with different cutoffs., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aim: To assess the role of the corneal radius of curvature (CR) in the identification of fundus tessellation in children with low myopia., Methods: In the cross-sectional study, students aged 9-12 years from 24 primary schools in Shanghai were enrolled by cluster sampling. Participants underwent measurements including cycloplegic refraction and axial length. Fundus images and choroidal thickness were obtained by swept-source optical coherence tomography. Fundus tessellation was classified into four grades according to fundus photographs., Results: A total of 1127 children with low myopia (spherical equivalence (SE) >-3.00 dioptre (D) but ≤-0.50 D) were included, with a mean age of 10.29±0.60 years and a mean SE of -1.44±0.69 D. Fundus tessellation was found in 591 (52.4%) cases (grade 1: 428, 38.0%; grade 2: 128, 11.4%; grade 3: 35, 3.1%). Choroidal thickness decreased as fundus tessellation grade increased (p trend <0.001). According to regression analysis, higher fundus tessellation grade was independently associated with larger CR (OR, 7.499; 95% CI 2.279 to 24.675, p=0.001). For those with CR >7.9 mm, along with CR, degree and proportion of fundus tessellation increased sharply., Conclusion: Fundus tessellation existed in more than half of children with low myopia. Preliminary fundus photography conducted in children with low myopia with large CR would be necessary and beneficial to the early management of myopic fundus changes. Trial registration number NCT02980445., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Purpose: To analyse the topographic characteristics in macular choroidal thickness (mChT) and ocular biometry in myopic maculopathy and to explore the potential cut-off value for prediction of myopic maculopathy (MM)., Methods: All participants underwent detailed ocular examinations. MM was subdivided into thin choroid, Bruch's membrane (BM) defects, choroidal neovascularization (CNV), and myopic tractional maculopathy (MTM) according to OCT-based classification system. Peripapillary atrophy area (PPA), tilt ratio, torsion, and mChT were individually measured., Results: A total of 1947 participants were included. In multivariate logistics models, older age, longer axial length, larger PPA area, and thinner average mChT were more likely to have MM and different type of MM. Female participants were more likely to have MM and BM defects. A lower tilt ratio was more likely to be associated with CNV and MTM. The area under the curve (AUC) of single tilt ratio, PPA area, torsion, and topographic of mChT for MM, thin choroid, BM Defects, CNV, and MTM were 0.6581 to 0.9423, 0.6564 to 0.9335, 0.6120 to 0.9554, 0.5734 to 0.9312, 0.6415 to 0.9382, respectively. After combining PPA area and average mChT for predicting MM, thin choroid, BM defects, CNV, and MTM, the AUC of the combination were 0.9678, 0.9279, 0.9531, 0.9213, 0.9317, respectively., Conclusion: Progressive and continuous PPA area expanding and thin choroid play a role in the development of myopic maculopathy. The present study showed that a combination of peripapillary atrophy area and the choroidal thickness could be used to predict MM and each type of MM., (© 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Purpose: To investigate whether choroidal vascularity participates in high-dose atropine's antimyopia and rebound mechanisms., Methods: A mediation analysis was embedded within a randomized controlled trial. In total, 207 myopic children were assigned randomly to group A/B. Participants in group A received 1% atropine weekly (phase 1) and 0.01% atropine daily (phase 2) for 6 months each. Those in group B received 0.01% atropine daily for 1 year. Four plausible intervention mediators were assessed: total choroidal area (TCA), luminal area (LA), stromal area (SA), and choroidal vascularity index (CVI)., Results: In group A, LA, SA, and TCA increased significantly after receiving 1% atropine for 6 months. The increment diminished after tapering to 0.01% atropine. In group B, those parameters remained stable. TCA mediated approximately one-third of 1% atropine's effect on spherical equivalent progression in both phases. In phase 1, the mediation effect of TCA was shared by LA and SA, while only that of LA remained significant in phase 2. No mediation effect of CVI was found., Conclusions: One percent atropine induced choroidal thickening by increasing both LA and SA, while 0.01% atropine had little choroidal response. The choroidal changes following 1% atropine treatment diminished after switching to 0.01% atropine. TCA, but not CVI, partially explains atropine's antimyopic and myopic-rebound mechanisms. SA may serve as a potential biomarker to predict the postrebound treatment efficacy of high-dose atropine. (ClinicalTrials.gov number, NCT03949101.).

Purpose: To investigate the clinical characteristics, internal correlations and risk factors for different locations of retinoschisis (RS) in an elderly high myopia (HM) population., Methods: A total of 448 eyes (304 participants) were analysed and classified into no retinoschisis (no-RS), paravascular retinoschisis (PVRS), peripapillary retinoschisis (PPRS) and macular retinoschisis (MRS) groups. Each participant underwent comprehensive ophthalmic examinations, and posterior scleral height (PSH) was measured in swept-source optical coherence tomography images. PSH, vitreoretinal interface abnormities and myopic atrophy maculopathy (MAM) were compared among groups., Results: Retinoschisis was found in 195 (43.5%) eyes, among which 170 (37.9%) had PVRS, 123 (27.5%) had PPRS, and 103 (23.0%) had MRS. MRS was found to be combined with PVRS in 96 of 103 (93.2%) eyes. MAM was one of the risk factors for RS (odds ratio [OR], 2.459; p = 0.005). Higher nasal PSH was the only risk factor for PVRS (OR, 9.103; p = 0.008 per 1-mm increase). Elongation of axial length (AL) (OR, 1.891; p < 0.001 per 1-mm increase), higher PSH in nasal (OR, 5.059; p = 0.009 per 1-mm increase) and temporal (OR, 13.021; p = 0.012 per 1-mm increase), epiretinal membrane (ERM; OR, 2.841; p = 0.008) and vitreomacular traction (VMT; OR, 7.335; p = 0.002) were risk factors for MRS., Conclusions: Paravascular retinoschisis is the most common type of RS in HM and MRS is mostly combined with PVRS. MAM is one of the risk factors for RS. In addition to longer AL and higher PSH, the presence of VMT and ERM also play an important role in the formation of MRS., (© 2022 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: The aim of this study was to investigate the association between morphological characteristics of Bruch's membrane opening distance (BMOD), border length (BL), border tissue angle (BTA), peripapillary atrophy (PPA) as well as axial length (AL) and incident decreased macular choroidal thickness (mChT) in young healthy myopic eyes., Methods: A total of 323 participants aged 17-30 years were included in the current 2-year longitudinal study. Each participant underwent detailed ocular examinations at baseline and follow-up. Data of AL, refraction error, PPA area, BMOD, BL, BTA and mChT were measured individually. Incident decreased mChT was defined as follow-up mChT of participants decreased into the lowest quartile of baseline mChT., Results: Subjects with longer AL, longer BMOD were more likely to have incident decreased mChT (odds ratio [OR], 1.56; 2.09, respectively, per 1 Z-score increment), whereas larger BTA was less likely to develop decreased mChT (odds ratio [OR], 0.51, per 1 Z-score increment). The area under the receiver operating curve (AUROC) of basic risk model for incident decreased mChT was 0.6284. After adding BMOD, BTA and AL separately to the basic risk model, the AUROC of the combination could reach 0.6967, 0.6944 and 0.7383, respectively. After combining BMOD, BTA and AL to the basic model, the AUROC of the combination showed the highest AUROC of 0.7608., Conclusions: Bruch's membrane opening distance and AL are significant risk factors for incident decreased mChT, whereas BTA played protective role in the deterioration of mChT. In addition, a combination of BMOD, BTA and AL could serve as earlier predictors of the attenuation of mChT in myopia progression., (© 2022 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To evaluate the efficacy of time outdoors per school day over 2 years on myopia onset and shift., Design: A prospective, cluster-randomized, examiner-masked, 3-arm trial., Participants: A total of 6295 students aged 6 to 9 years from 24 primary schools in Shanghai, China, stratified and randomized by school in a 1:1:1 ratio to control (n = 2037), test I (n = 2329), or test II (n = 1929) group., Methods: An additional 40 or 80 minutes of outdoor time was allocated to each school day for test I and II groups. Children in the control group continued their habitual outdoor time. Objective monitoring of outdoor and indoor time and light intensity each day was measured with a wrist-worn wearable during the second-year follow-up., Main Outcome Measures: The 2-year cumulative incidence of myopia (defined as cycloplegic spherical equivalent [SE] of ≤-0.5 diopters [D] in the right eye) among the students without myopia at baseline and changes in SE and axial length (AL) after 2 years., Results: The unadjusted 2-year cumulative incidence of myopia was 24.9%, 20.6%, and 23.8% for control, test I, and II groups, respectively. The adjusted incidence decreased by 16% (incidence risk ratio [IRR], 0.84; 95% confidence interval [CI], 0.72-0.99; P = 0.035) in test I and 11% (IRR = 0.89; 95% CI, 0.79-0.99; P = 0.041) in test II when compared with the control group. The test groups showed less myopic shift and axial elongation compared with the control group (test I: -0.84 D and 0.55 mm, test II: -0.91 D and 0.57 mm, control: -1.04 D and 0.65 mm). There was no significant difference in the adjusted incidence of myopia and myopic shift between the 2 test groups. The test groups had similar outdoor time and light intensity (test I: 127 ± 30 minutes/day and 3557 ± 970 lux/minute; test II: 127 ± 26 minutes/day and 3662 ± 803 lux/minute) but significantly more outdoor time and higher light intensity compared with the control group (106 ± 27 minutes/day and 2984 ± 806 lux/minute). Daily outdoor time of 120 to 150 minutes at 5000 lux/minutes or cumulative outdoor light intensity of 600 000 to 750 000 lux significantly reduced the IRR by 15%～ 24%., Conclusions: Increasing outdoor time reduced the risk of myopia onset and myopic shifts, especially in nonmyopic children. The protective effect of outdoor time was related to the duration of exposure and light intensity. The dose-response effect between test I and test II was not observed probably because of insufficient outdoor time achieved in the test groups, which suggests that proper monitoring on the compliance on outdoor intervention is critical if one wants to see the protective effect., (Copyright © 2022 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

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

Aims: To elucidate the influence of age and myopic shift on retinal development., Methods: This 1-year longitudinal study included 769 participants aged 6-17 years. Cycloplegic refraction, axial length and swept-source optical coherence tomography were examined at baseline and follow-up. The thickness changes in the retina, ganglion cell complex (GCC) and outer retinal layers (ORL) in the macular region were calculated, and their relation with age and myopic shift was analysed with multiple linear regression analysis., Results: The thickness of the central foveal retinal layers was increased in children (<10 years) but unchanged or decreased in adolescents (>13 years). The thickness changes in the retina, GCC and ORL decreased with age (r=-0.24,-0.23, -0.15, respectively, all p<0.01). Multiple regression analysis showed that the changes in central foveal retinal thickness (RT) and GCC thickness were independently associated with age and baseline spherical equivalent (SE), while the changes in ORL thickness were associated with age and SE changes. In children 8-9 years, a greater increase was observed in central foveal ORL thickness in those with no myopic shift (p<0.01). The thickness of the most parafoveal and perifoveal retinal layers was less increased or more decreased in children <9 years with myopic shift (p<0.05)., Conclusions: Retinal development and its relation with myopic shift varies from childhood to adolescence. Myopia-related retinal thinning may result from less increase in the RT in childhood rather than a decrease in RT in adolescents. Children under 9 years old could be at a critical age for future myopia-related retinal thinning., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: China contributes to a significant proportion of the myopia in the world. The study aims to investigate the utilization of various correction methods and health service in urban China, and to estimate the cost of myopia treatment and prevention. In addition, we aimed to estimate the cost of productivity loss due to myopia., Methods: The study was a cross-sectional investigation carried out in urban areas in three provinces located in the east (Shanghai), middle (Anhui) and west part (Yunnan) of China, in 2016. A total of 23819 people aged between 5 to 50 years were included. Health utilization and the cost of myopia were analyzed from patients' perspective., Results: The total number of people with myopia in the urban China was estimated to be 143.6 million. The correction rate was 89.5%, 92.1%, and 92.7% for Anhui, Shanghai, and Yunnan (χ 2  = 19.5, P  < 0.01). Over the recent year, 20.6%, 16.8%, and 28.8% of myopic subjects visited hospital due to myopia, in Anhui, Shanghai and Yunnan. The annual cost of treatment and prevention of myopia was 10.1 billion US dollar (US$, floating from 9.2 to 11.2 billion US$), and the cost per person was 69US$. The annual cost of loss of productivity was estimated to be 6.7 billion US$ for those with mild to moderate visual impairment (floating from 6.1 to 7.4 billion US$), and 9.4 billion US$ (floating from 8.5 to 10.4 billion US$) for those with severe visual impairment to blindness. Therefore, the total economic burden of myopia was estimated as 173.6 billion CNY (26.3 billion US$)., Conclusions: The present study shows that myopia leads to substantial economic burden in China. The loss of productivity caused by myopia is an important part of the disease burden compared to the cost of correction and treatment paid by individuals. Therefore, the focus of myopia prevention and control should be to decrease the myopia prevalence, and prevent the uncorrected refractive errors and the irreversible damage of visual acuity by high myopia., Competing Interests: Competing interests: The authors completed the ICMJE Declaration of Interest Form (available upon request from the corresponding author), and declare no conflicts of interest., (Copyright © 2022 by the Journal of Global Health. All rights reserved.)

Purpose: To identify the association between the choroidal thickness (ChT) with age and axial length (AL) under different refractive errors (REs) in Chinese adults., Methods: Swept-source optical coherence tomography was used to measure ChT in 2126 right eyes of 2126 participants. The participants were classified as having pathologic myopia (PM), high myopia without PM (HM), low myopia (LM), and nonmyopia (non-M) according to their REs and META-PM (the Meta-Analysis of Pathologic Myopia) classification criteria., Results: The mean age was 52.49 ± 20.39 years (range, 18-93 years), and the mean RE was -5.27 ± 5.37 diopters (D; range, -25.5 to +7.75 D). The mean average ChT was 159.25 ± 80.75 µm and decreased in a linear relationship from non-M to PM (190.04 ± 72.64 µm to 60.99 ± 37.58 µm, P < 0.001). A significant decline in ChT was noted between 50 and 70 years (r = -0.302, P < 0.001) and less rapidly after the age of 70 years (r = -0.105, P = 0.024). No correlation was noted between age and ChT under 50 years (P = 0.260). A significantly higher association with AL was noted in the central fovea (βHM = -23.92, βLM = -23.88, βNon-M = -18.80, all P < 0.001) and parafoveal ChT (βHM = -22.87, βLM = -22.31, βNon-M = -18.61, all P < 0.001) when compared with the perifoveal region (βHM = -19.80, βLM = -18.29, βNon-M = -13.95, all P < 0.001). Within each group of PM, HM, LM, and non-M, regression analysis showed that the coefficients of age and AL with different macular regions of ChT varied significantly., Conclusions: ChT was negatively correlated with age after 50 years. The thinning of the choroid was more prominent in the center and parafoveal regions as AL increased. Varied distributions of ChT decrease associated with AL and age were noted among different refractive groups.

Purpose: To compare the accuracy for various screening tests and their combined uses for myopia screening among children and adolescents and explore age-specific cutoffs., Design: Cross-sectional study., Methods: A total of 6017 children and adolescents aged 4 to 15 years participated in the study. Uncorrected visual acuity (UCVA, recorded in decimal notation), cycloplegic and noncycloplegic refraction (NCR), axial length (AL), and corneal curvature radius (CR) examinations were performed. Cycloplegic spherical equivalent ≤-0.50 D was considered as the gold standard for myopia. Receiver operating characteristic (ROC) curves were drawn to determine optimal cutoffs for all age groups, and sensitivity, specificity, as well as screening prevalence of myopia were calculated., Results: The overall estimate of myopia prevalence was 31.8% using the gold standard. The sensitivity and specificity of the UCVA alone for the commonly used cutoff (1.0) were 97.7% and 33.1%, respectively. The areas under the ROC curve were optimally estimated to be 0.985 (95% CI, 0.982-0.988) for the combined use of UCVA and NCR tests, and 0.987 (95% CI, 0.983-0.989) for the combined use of AL/CR and NCR tests, with no significant difference (P = 0.208). The best cutoffs for UCVA-NCR combinations were UCVA <1.0 and NCR <-0.25 D in 4 to 6 years; UCVA <1.0 and NCR <-0.50 D in 7 to 12 years; UCVA <0.8 and NCR <-0.75 D in 13 to 15 years. If those screening positive were all referred to clinics and corrected with cycloplegic autorefraction data, the relative difference between screening prevalence and the actual prevalence by the gold standard would reduce from 13.2% to 4.7%., Conclusions: UCVA test alone for detecting myopia demonstrated a poorer accuracy among these tests. The combined use of UCVA and NCR tests and the combined use of AL/CR and NCR tests achieved optimal accuracy for myopia screening. Setting age-specific cutoffs would increase the accuracy, and the prevalence obtained from primary screening should be corrected according to the data of cycloplegic refraction after referral, especially in younger ages., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2022 Asia-Pacific Academy of Ophthalmology. Published by Wolters Kluwer Health, Inc. on behalf of the Asia-Pacific Academy of Ophthalmology.)

Objectives: To report on: (a) overall myopia and high myopia prevalence, and (b) the impact of education on the spherical equivalent refractive error in children across Shanghai., Design: Cross-sectional study., Setting: Across all 17 districts of Shanghai., Participants: 910 245 children aged 4-14 years from a school-based survey conducted between 2012 and 2013., Main Outcome Measures: Data of children with non-cycloplegic autorefraction, visual acuity assessment and questionnaire were analysed (67%, n=6 06 476). Prevalence of myopia (≤-1.0 D) and high myopia (≤-5.0 D) was determined. We used a regression discontinuity design to determine the impact of school entry cut-off date (1 September) by comparing refractive errors at each age, for children born pre-September to post-1 September, and performed a multivariate analysis to explore risk factors associated with myopia. Data analysis was performed in 2017-2018., Results: Prevalence rates of myopia and high myopia were 32.9% (95% CI: 32.8% to 33.1%) and 4.2% (95% CI: 4.1% to 4.2%), respectively. From 6 years of age onwards, children born pre-September were more myopic compared with those born post-1 September (ahead in school by 1 year, discontinuity at 6 years: -0.19 D (95% CI: -0.09 to -0.30 D); 14 years: -0.67 D (95% CI: -0.21 to -1.14 D))., Conclusions: Our findings suggest that myopia is associated with education, that is primarily focused on near-based activities. Efforts to reduce the burden should be directed to public awareness, reform of education and health systems., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To investigate morphological differences between two types of Bruch's membrane (BM) defects-patchy atrophy (PA) and CNV-related macular atrophy (CNV-MA) METHODS: Eyes presenting with PA or CNV-MA were included. Scleral thickness (ST), choroidal thickness (CT), and scleral morphological characteristics were obtained by swept-source optical coherence tomography (SS-OCT). Fundus photographs were performed to measure the size of PA and CNV-MA lesions., Results: Among a total of 167 eyes evaluated, 106 eyes had PA and 61 eyes had CNV-MA. In addition, dome-shaped macula (DSM) was identified in 20 (18.87%) and 10 (16.39%) eyes among PA and CNV-MA, respectively. The eyes of CNV-MA without DSM showed a thicker subfoveal ST (278.61 ± 56.17 vs 231.58 ± 66.09 mm, P < 0.001), a thinner subfoveal CT, and a higher rate of scleral perforating vessels (70.6% vs 50.0%, P = 0.021) when compared with those of PA without DSM. The size of PA/CNV-MA lesions was associated with CT in eyes without DSM. However, it was only associated with bulge height in eyes with DSM (r = 0.5, P = 0.013)., Conclusions: The eyes with CNV-MA had a thicker sclera than those with PA, which add another evidence to indicate the absence of the progressive relationship between two types of BM defects. The enlargement of lesions in BM defects between eyes with and without DSM may be caused by different mechanical forces. SS-OCT, which focuses on scleral and choroid morphology, may be necessary for more accurate classification of pathologic myopia.

Purpose: To examine the changes in choroidal thickness (ChT) after 6 months of 1% or 0.01% atropine treatment and the independent factors associated with eye elongation., Methods: A total of 207 myopic children aged 6 to 12 years were recruited and randomly assigned to groups A and B in a ratio of 1:1. Participants in group A received 1% atropine once a day for 1 week, and then once a week for 23 weeks. Participants in group B received 0.01% atropine once a day for 6 months. ChT and internal axial length (IAL) were measured at baseline, 1 week, 3 months, and 6 months., Results: In group A, the ChT significantly increased after a 1-week loading dose of 1% atropine (26 ± 14 µm; P < 0.001) and the magnitude of increase stabilized throughout the following weekly treatment. The internal axial length did not significantly change at the 6-month visit (-0.01 ± 0.11 mm; P = 0.74). In contrast, a decreased ChT (-5 ± 17 µm; P < 0.001) and pronounced eye elongation (0.19 ± 0.12 mm; P < 0.001) were observed in group B after 6 months. Multivariable regression analysis showed that less increase in ChT at the 1-week visit (P = 0.03), younger age (P < 0.001), and presence of peripapillary atrophy (P = 0.001) were significantly associated with greater internal axial length increase over 6 months in group A., Conclusions: One percent atropine could increase the ChT, whereas 0.01% atropine caused a decrease in ChT after 6 months of treatment. For participants receiving 1% atropine, the short-term increase in ChT was negatively associated with long-term eye elongation. Younger age and the presence of peripapillary atrophy were found to be risk factors for greater eye elongation.

Purpose: This study aimed to explore the morphological characteristics of Bruch's membrane opening distance (BMOD), border length (BL), border tissue angle (BTA), vertical tilt angle, and peripapillary atrophy (PPA), as well as their associations with choroidal thickness (ChT) in young healthy highly myopic eyes., Methods: A total of 167 patients with high myopia and 172 individuals without high myopia were enrolled. All of the subjects were divided by axial length. The PPA area was measured on fundus photographs. BMOD, BL, BTA, vertical tilt angle, macular ChT (mChT), and peripapillary ChT (pChT) were measured on swept-source optical coherence tomography scans., Results: The PPA area (P < 0.0001) and vertical tilt angle (P < 0.0001) were larger, BMOD (P < 0.0001) and BL (P < 0.0001) were longer, and BTA (P < 0.0001) was smaller in the high-myopia group compared with the group without high myopia. Every 1-µm increase in BMOD was associated with a 35.80-µm decrease in mChT; every 1° decrease in BTA was correlated with a 0.32-µm decrease in mChT and a 0.26-µm decrease in pChT; and no association was found between PPA area and ChT in the multivariate linear regression model., Conclusions: PPA area, BL, BMOD, and vertical tilt angle increased, but BTA decreased with axial elongation of the globe in young, healthy patients with myopia. Longer BMOD was positively correlated with lower mChT, and smaller BTA was positively correlated with lower mChT and pChT in this population.

Background: Wearable smart watches provide large amount of real-time data on the environmental state of the users and are useful to determine risk factors for onset and progression of myopia. We aim to evaluate the efficacy of machine learning algorithm in differentiating indoor and outdoor locations as collected by use of smart watches., Methods: Real time data on luminance, ultraviolet light levels and number of steps obtained with smart watches from dataset A: 12 adults from 8 scenes and manually recorded true locations. 70% of data was considered training set and support vector machine (SVM) algorithm generated using the variables to create a classification system. Data collected manually by the adults was the reference. The algorithm was used for predicting the location of the remaining 30% of dataset A. Accuracy was defined as the number of correct predictions divided by all. Similarly, data was corrected from dataset B: 172 children from 3 schools and 12 supervisors recorded true locations. Data collected by the supervisors was the reference. SVM model trained from dataset A was used to predict the location of dataset B for validation. Finally, we predicted the location of dataset B using the SVM model self-trained from dataset B. We repeated these three predictions with traditional univariate threshold segmentation method., Results: In both datasets, SVM outperformed the univariate threshold segmentation method. In dataset A, the accuracy and AUC of SVM were 99.55% and 0.99 as compared to 95.11% and 0.95 with the univariate threshold segmentation (p < 0.01). In validation, the accuracy and AUC of SVM were 82.67% and 0.90 compared to 80.88% and 0.85 with the univariate threshold segmentation method (p < 0.01). In dataset B, the accuracy and AUC of SVM and AUC were 92.43% and 0.96 compared to 80.88% and 0.85 with the univariate threshold segmentation (p < 0.01)., Conclusions: Machine learning algorithm allows for discrimination of outdoor versus indoor environments with high accuracy and provides an opportunity to study and determine the role of environmental risk factors in onset and progression of myopia. The accuracy of machine learning algorithm could be improved if the model is trained with the dataset itself.

Purpose : To evaluate common strategies for screening myopia. Methods : A total of 2,248 children aged 6 to 12 years from five randomly selected primary schools were included for the screening. Enrolled study participants underwent distant uncorrected visual acuity (UCVA, Standard Logarithmic Visual Acuity E Chart) and non-cycloplegic auto-refraction (NCAR, Topcon KR-8800). Among them, 1,639 children (72.9%) accepted cycloplegic auto-refraction. Taking rejection of cycloplegia into account, receiver operating characteristic curves were drawn to compare the accuracies of the four strategies (I, Cycloplegic auto-refraction; II, NCAR; III, UCVA; IV, Combination of UCVA and NCAR). Decision curve analysis (DCA) was used to compare net benefits. Tenfold cross-validation was used for statistical analyses. Results : For myopia (spherical equivalent refraction, SE ≤ -0.5D) screening, the mean sensitivities were 73.79% (SD: 5.40%), 85.57% (6.84%), 59.71% (13.49%), and 85.06% (6.68%) for Strategy I to IV; with mean specificities of 100% (0%), 87.43% (4.27%), 89.74% (10.25%), and 88.65% (5.07%), respectively. For screening early myopia (SE ≤ -0.5D and ≥-1.0D), the mean sensitivities were 73.44% (7.69%), 82.39% (5.32%), 54.27% (14.58%), and 81.76% (9.60%) for Strategy I to IV; with mean specificities of 100% (0%), 79.13% (4.86%), 85.48% (9.86%), and 81.17% (4.16%). Based on DCA, the net benefits of Strategy IV were the highest, with the probability thresholds ranging from 12% to 50%, after adjusting the TestHarms. For early myopia, the net benefits of Strategy IV were the highest with the probability threshold ranging from 5% to 34%. Conclusion : Combination of UCVA and NCAR produced the highest net benefits for myopia screening.

Purpose: To explore the characteristics of tilted optic disc and peripapillary atrophy (PPA), and their associations with choroidal thickness (ChT) in young myopic patients., Methods: A total of 821 patients were enrolled in this cross-sectional study. Optic disc tilt ratio, PPA area, macular ChT (mChT), and peripapillary ChT (pChT) were measured. Subjects were divided into four groups purely on the basis of the axial length (AL). Relationships between ChT and the morphologic characteristics of optic disc were analyzed using logistic regression., Results: The prevalence of tilted optic disc and PPA increased as myopia severity increased. Every 0.1-mm2 increase in PPA area was associated with a 14.93-μm decrease in mChT and a 9.54-μm decrease in pChT; and every 0.1 increase in tilt ratio was correlated with a 5.38-μm increase in mChT and a 6.21 decrease in pChT. After stratifying by myopia severity, these trends were still observed in the high myopia group. A larger PPA area (odds ratio [OR] = 2.33; P < 0.01), a longer AL (OR = 1.34; P < 0.01), an increased pChT (OR = 1.11; P < 0.01), and a decreased mChT (OR = 0.93; P < 0.01) were associated with higher odds of having tilted optic disc., Conclusions: In young myopic patients, mChT was negatively associated with PPA area and positively associated with tilt ratio, while pChT was negatively associated with PPA area and tilt ratio. In this population, larger PPA area, longer AL, and thinner mChT were associated with higher odds of tilted optic disc.

Purpose: To elucidate the development of the choroid and retina in children, and to explore changes in these during myopic shift., Methods: A total of 118 children aged 7 to 12 years participated in this 1-year longitudinal study. Children underwent several examinations at baseline and follow-up, including cycloplegic refraction, axial length measurement, and swept-source optical coherence tomography. Thickness changes in the choroid and retina were compared among children with or without myopic shift., Results: Eighty-eight children (74.6%) developed a myopic shift after 1 year, and their central foveal choroid was significantly attenuated (P < 0.01). No significant change was observed in choroids of children without myopic shift (P = 0.83). Choroidal thickness decreased in all subfields during myopic shift, whereas the thickness of the retinal layers increased or were unchanged in most subfields. Axial length increase and central foveal choroidal thinning were associated with myopic shift (R = 0.157, P < 0.01), but axial length increase was not significantly related to choroidal thinning (P > 0.05)., Conclusion: Choroidal thinning occurs early in myopic progression. Axial length increase and choroidal thinning are independently associated with myopic shift.

Importance: Myopia is a major public health concern worldwide, while outdoor time is indicated to be protective against the onset of myopia., Background: To describe the methodology and baseline data of the Shanghai Time Outside to Reduce Myopia (STORM) trial., Design: A 2-year, school-based, prospective, cluster randomized trial., Participants: Children from grade I and II classes of 24 schools from eight districts in Shanghai, China, were randomized to either a control group, a test group I (40-min outdoor time/day) or test group II (80-min outdoor time/day)., Methods: At baseline and annual intervals, cycloplegic autorefraction and axial length measurement will be performed. Time outdoors and light exposure will be monitored via parent/carer questionnaires and a wearable device., Main Outcome Measures: Spherical equivalent, prevalence of myopia and time outdoors in each group., Results: A total of 6295 eligible children (age 7.2 ± 0.7 y [6-9 y]) were randomized to control (n = 2037), test group I (n = 2329) and test group II (n = 1929). At baseline, spherical equivalent was +0.98 ± 1.02D, +1.02 ± 1.02D and +1.00 ± 0.99D (P = 0.708), myopia prevalence was 8.9, 7.7 and 7.8% (P = 0.270) and time outdoors was 58.5 ± 35.8, 59.8 ± 34.7 and 58.5 ± 35.3 min/d (P = 0.886) for control, test groups I and II, respectively., Conclusions and Relevance: Myopia prevalence was high at nearly 8 to 9% in school children aged 7 years in Shanghai, China. The current trial will help evaluate if increased time outdoors has a role to play in reducing the incidence of myopia and/or slow the progression of myopia., (© 2018 Royal Australian and New Zealand College of Ophthalmologists.)

Purpose: The purpose of this project is to explore the changes in and factors associated with asymmetry between the superior and inferior hemiretina in children with different refractive levels., Materials and Methods: A total of 2964 children from 12 primary and middle schools in Shanghai, China, were included. The mean thickness of the GCL+ layer (ganglion cell layer+ inner plexiform layer), the GCC layer (ganglion cell complex, a combination of the retinal nerve fiber layer and the GCL+ layer), and the neural retina was measured according to the sectors defined by the Early Treatment of Diabetic Retinopathy Study (ETDRS) grid with swept-source optical coherence tomography. The asymmetry index (AI), calculated via the formula AI = |log 10 (superior/inferior hemiretinal layer thickness) |, was used to assess the asymmetry of each retinal layer., Results: The mean age of the children was 11.67 (3.45) years old. The AIs of all retinal layers were larger in myopes than in hyperopes and emmetropes in the perifoveal region (all p < 0.001), and the AIs became even larger in the GCL+ layer and neural retina in children with a higher degree of myopia. However, no statistical differences were observed between various refractive groups in the parafoveal region. Regression analyses indicated that with increasing myopia, the asymmetry of retinal layers increased in the perifoveal region (all p < 0.001) and slightly decreased in the parafoveal region (all p < 0.05)., Conclusions and Relevance: The vertical asymmetry of retinal layers increased in the perifoveal region in myopic children, and the change in asymmetry was more obvious in the GCL+ layer and neural retina than in the GCC layer.

The burden associated with the rising prevalence of myopia and high myopia, and the associated vision impairment and sight-threatening complications, has triggered the need to evaluate strategies to control the progression of myopia. We provide an overview of the literature on the use of optical (spectacles, contact lenses, and orthokeratology) and pharmaceutical approaches to slow progress of myopia. The evidence indicates that myopia progression can be slowed by varying degrees using these strategies. All approaches play a role in the management of myopia as needs and requirements of an individual vary based on age, suitability, affordability, safety of the approach, subjective needs of the individual, and rate of progression. This review also identifies and discusses the lack of long-term efficacy data and rebound on discontinuation of myopia control products., (Copyright 2018 Asia-Pacific Academy of Ophthalmology.)

Importance: Cohort studies could not only reveal associations between change of refractive components and onset/progression of myopia, but also risk factors, which is important for understanding mechanism and providing strategies., Background: Prevalence of myopia is high in Shanghai, being reported to be 52.2% in children aged 10 years old., Design: Cohort study., Participants: A total of 1856 students from six randomly selected primary schools in Baoshan District, Shanghai., Methods: Children underwent comprehensive ocular measurement, including axial length (AL), corneal curvature radius and cycloplegic auto-refraction. Questionnaires about eye usage time were collected. Grade 1 students were followed for 4 years, and grade 2 and 3 students for 2 years., Main Outcome Measures: (i) Change of spherical equivalent (SE) and AL and (ii) risk factors for progression and incidence of myopia., Results: The average 2-year progress of SE was 0.91D, 0.91D and 1.11D for grade 1, 2 and 3, respectively, and the average elongation of AL was 0.70 mm, 0.64 mm and 0.71 mm, respectively. Only parental myopia, but not near work time, near work diopter time, outdoor activity time or attending tutoring classes, was associated with myopia incidence and progression in the present population. Using baseline SE could be a simple and effective indicator for myopia prediction., Conclusions and Relevance: Incidence and progression of myopia is relatively high in schoolchildren in Shanghai compared with children of Western countries, East Asia and other parts of China. Effective strategies to control myopia prevalence are in urgent need., (© 2018 The Authors Clinical & Experimental Ophthalmology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Ophthalmologists.)

Purpose: To determine the relationship between choroidal thickness (ChT) at the posterior pole and refractive error and to explore the difference between the macular and peripapillary regions in children with myopia., Methods: A total of 340 healthy Chinese children underwent a series of comprehensive ocular examinations including cycloplegic refraction. Swept-source optical coherence tomography was used to measure the ChT in the macular and peripapillary regions. The Early Treatment of Diabetic Retinopathy Study grid was applied to define the sectors., Results: The mean spherical equivalent (SE) of the participants was -1.71 ± 2.22 diopter (D; range from -7.63 to 4.25 D). The mean ChT in the central foveal, parafoveal, and perifoveal regions were 229 ± 65 μm, 227 ± 60 μm, and 215 ± 50 μm, respectively, and the mean global peripapillary choroidal thickness (PPCT) was 136 ± 33 μm. The choroid in the macular region and the global PPCT was thinner in myopes compared to hyperopes. The area between the central fovea and the optic disc underwent the largest change as myopia worsened. SE, uncorrected visual acuity, cornea curvature radius (CR), retinal thickness (RT), and retinal nerve fiber layer thickness (RNFLT, except for the central fovea) were the independent factors of ChT in the macular region. SE, CR, RT, and RNFLT were the independent factors of PPCT temporally, inferiorly, and globally, while only CR, RT, and RNFLT were independently associated with PPCT superiorly and nasally., Conclusions: Choroidal thinning might be uneven during the development of myopia. SE only influenced the macular area and sectors temporal and inferior to the optic disc.

Background: In 2010, there were ~ 36 million migrant children under 18 y old in China. This study compared patterns of myopia prevalence and progression between migrant and resident children., Methods: Eight hundred forty-two migrant children from 2 migrant schools and 1081 from 2 local schools in Baoshan District, Shanghai, were randomly chosen. Baseline measurements were taken on children in grades one through four, and children in grades one and two were followed for 2 y. The children underwent comprehensive ophthalmic examinations, including cycloplegic refraction and axial length. The average time per week spent on homework and outdoor activities were investigated., Results: Migrant children in grades one and two showed a lower myopia prevalence than resident children; however, from grades three to four, the prevalence accelerated and exceeded that of residents. In the follow-up, the myopia incidence did not significantly change from grades one to two in resident children but was significantly higher in grade two in migrant children. Correspondingly, for migrant children, increased progression of refraction and axial length was observed; however, it decreased in resident children. The average time spent on homework increased from grades two to three in parallel with the acceleration of myopia prevalence for migrant children; however, the time spent outdoors did not correspondingly change., Conclusion: The patterns of myopia prevalence and progression are different between migrant and non-migrant children. The acceleration of myopia in migrant children might be a result of a change in their environment, such as intensive education pressure.

Outdoor time is considered to reduce the risk of developing myopia. The purpose is to evaluate the evidence for association between time outdoors and (1) risk of onset of myopia (incident/prevalent myopia); (2) risk of a myopic shift in refractive error and c) risk of progression in myopes only. A systematic review followed by a meta-analysis and a dose-response analysis of relevant evidence from literature was conducted. PubMed, EMBASE and the Cochrane Library were searched for relevant papers. Of the 51 articles with relevant data, 25 were included in the meta-analysis and dose-response analysis. Twenty-three of the 25 articles involved children. Risk ratio (RR) for binary variables and weighted mean difference (WMD) for continuous variables were conducted. Mantel-Haenszel random-effects model was used to pool the data for meta-analysis. Statistical heterogeneity was assessed using the I 2 test with I 2  ≥ 50% considered to indicate high heterogeneity. Additionally, subgroup analyses (based on participant's age, prevalence of myopia and study type) and sensitivity analyses were conducted. A significant protective effect of outdoor time was found for incident myopia (clinical trials: risk ratio (RR) = 0.536, 95% confidence interval (CI) = 0.338 to 0.850; longitudinal cohort studies: RR = 0.574, 95% CI = 0.395 to 0.834) and prevalent myopia (cross-sectional studies: OR = 0.964, 95% CI = 0.945 to 0.982). With dose-response analysis, an inverse nonlinear relationship was found with increased time outdoors reducing the risk of incident myopia. Also, pooled results from clinical trials indicated that when outdoor time was used as an intervention, there was a reduced myopic shift of -0.30 D (in both myopes and nonmyopes) compared with the control group (WMD = -0.30, 95% CI = -0.18 to -0.41) after 3 years of follow-up. However, when only myopes were considered, dose-response analysis did not find a relationship between time outdoors and myopic progression (R 2  = 0.00064). Increased time outdoors is effective in preventing the onset of myopia as well as in slowing the myopic shift in refractive error. But paradoxically, outdoor time was not effective in slowing progression in eyes that were already myopic. Further studies evaluating effect of outdoor in various doses and objective measurements of time outdoors may help improve our understanding of the role played by outdoors in onset and management of myopia., (© 2017 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To investigate the choroidal and retinal thickness in myopic, emmetropic, and hyperopic Chinese children by swept-source longer-wavelength optical coherence tomography., Design: Cross-sectional study., Methods: Two-hundred and seventy-six schoolchildren aged 7-13 years underwent comprehensive ophthalmic examinations, including cycloplegic refraction, and swept-source optical coherence tomography measurements. The thickness of the choroid, retina, ganglion cell layer, and nerve fiber layer were compared among children of different refractive status. The topographic variation and factors related to the thickness of the choroid and retinal layers were analyzed., Results: Compared to emmetropic subjects, those with myopia had a significantly thinner choroid in all regions (P < .01), and hyperopic subjects had a thicker choroid in most regions (P < .05). The myopic retinas were thinner than those of emmetropic or hyperopic subjects in the superior parafoveal and all 4 perifoveal subfields (P < .05), but no other subfields differed significantly among different refractive groups (P > .05). The axial length and refractive diopters were independently related to central foveal choroidal thickness (R(2) = 0.17, P < .01), while age and intraocular pressure were independently associated with central fovea retinal (R(2) = 0.15, P < .01) and ganglion cell layer thicknesses (R(2) = 0.10, P < .01) after adjustment for other systematic and ocular factors. Central foveal choroidal and retinal thickness were unrelated in children of different refractive status (P > .05)., Conclusions: Choroidal thickness, but not retinal thickness, correlated closely with axial length and refractive diopters in Chinese children. Choroid thinning occurs before retina thinning early in myopic progression., (Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate the characteristics of various near work related behaviors among primary students and their associations with changes in myopia related ocular biometric parameters during one-year of follow up., Methods: A school-based sample of 4,814 primary 1st to 4th grade students aged 6-10 years old were selected by cluster randomization based on probability proportion to size in 2013. At baseline, students together with their parents filled in a self-administered questionnaire on 9 aspects of near work related behaviors and some important covariants of myopia. A comprehensive set of eye examinations including axial length (AL) and cycloplegic refraction was conducted both at baseline and one year later., Results: With the grade level increase, students did increasingly better at finding various ways to have an eye break, but they were increasingly likely to continuously do long-time near work without an eye break. Keeping a reasonable eye distance and correct hand posture for reading, writing, or watching TV became worse for the first time before grade 2, but then became better at grade 3. In contrast, selecting appropriate lighting environments or situations and keeping a balanced diet became better for the first time before grade 2, but then became worse at grade 3. At one-year follow up, the mean AL increased by 0.32 ± 0.35 mm, the ratio of AL divided by the mean corneal radius of curvature (AL/CR ratio) increased by 0.032 ± 0.054, the myopic spherical equivalent (SE) increased by -0.51 ± 0.51 diopters and the incidence of myopia was 16.0% (237/1,477). After controlling for the confounding effects of parental myopia, student's age, gender, height, daily near work time, daily outdoor activity time and all of the other near work related behaviors, keeping a reasonable distance when reading, writing and watching TV was associated with elongation of the AL [standard coefficient beta = -0.062, P = 0.004], a change in SE [beta = -0.072, P = 0.020] and incident myopia [adjusted odds ratio (aOR) = 0.90, 95% confidence interval (CI): 0.84-0.96]. Selecting an environment with adequate light for visual comfort to read and write was related to elongation of the AL [beta = -0.039, P = 0.034] and increase of AL/CR ratio [beta = -0.030, P = 0.048]. Also, not continuing to do near work for more than 30-40 minutes without an eye break was related to increase of the AL/CR ratio [beta = -0.028, P = 0.044] and a change in SE [beta = -0.064, P = 0.023]., Conclusion: Various near work related behaviors changed according to grade level in primary school students. Independent of hereditary factors, daily near work load and outdoor activity, near work related behaviors such as keeping an inappropriate eye distance for near work, selecting inadequate lighting environments, and continuing to do near work without an eye break were risk factors for myopic shifts.

Objective: To evaluate the impact of amplitude of accommodation on controlling the development of myopia in orthokeratology., Methods: Forty-nine children aged 7 to 14 years were enrolled in this prospective clinical study.Orthokeratology was performed to correct the refractive errors of these children after measurement of refraction, corneal topography, amplitude of accommodation and axial length. Axial length (AL) and amplitude of accommodation was measured after treatment. The average amplitude of accommodation was calculated and was used as the cutting point for dividing the cohort into "amplitude of accommodation above average" vs. "amplitude of accommodation below average". Data were analyzed by paired t-test, independent t-test, repeated measures-ANOVAs and Pearson correlation analysis., Results: The AL before and after 1- year and 2-year treatment was (24.98 ± 0.75) mm, (25.13 ± 0.74) mm and (25.32 ± 0.78) mm, respectively. AL increased significantly throughout the observed 24-month period (F = 75.848, P < 0.001) . Amplitude of accommodation increased from (13.68 ± 2.65) D to (16.12 ± 2.41) D in 2 years (t = -6.461, P < 0.001) and amplitude of accommodation significantly affected axial growth (F = 7.395, P = 0.009) . The axial growth of subjects with below average amplitude of accommodation and those with above average amplitude of accommodation was (0.23 ± 0.25) and (0.44 ± 0.30) mm, indicating a statistically difference(t = -2.719, P = 0.009). AL change in subjects with below average amplitude of accommodation was 55.81% that of the subjects with above average amplitude of accommodation. Baseline amplitude of accommodation was positively correlated to axial growth at 24-month visit (r = 0.502, P < 0.001). Linear regression analysis was used between baseline amplitude of accommodation and 2-year axial growth: Axial growth = 0.055· Baseline amplitude of accommodation-0.409(F = 15.806, P < 0.001). The change of amplitude of accommodation for subjects with below average amplitude of accommodation and those with above average amplitude of accommodation after 2-year was (4.04 ± 2.16) D and (0.91 ± 2.15) D, indicating statistically difference (t = 5.084, P < 0.001)., Conclusions: Myopic control effect would be more beneficial to lower amplitude of accommodation children than that to higher amplitude of accommodation children in orthokeratology. The enhancement of accommodation provides some basis for slowing myopia progression with orthokeratology.

Purpose: To explore the effectiveness of combining uncorrected visual acuity (UCVA) and noncycloplegic autorefraction (NCAR) for large-scale myopia screening in schoolchildren with a high prevalence of myopia., Methods: A total of 1687 children aged between 6 and 12 years, from five primary schools in the Baoshan district of Shanghai participated in the study. We measured UCVA and autorefraction before and after cycloplegia by a Topcon KR-8800. We drew receiver operating characteristic curves to achieve the best cutoff points and their corresponding sensitivities and specificities for the UCVA and NCAR, respectively. We then combined the UCVA and NCAR in serial order to explore the optimal criterion and its effectiveness. A specificity of 90% was set to compare the sensitivities among the three tests. The children were divided into three age groups (aged 6 to 7, 8 to 10, 11 to 12 years) to further examine this new method., Results: A total of 1639 children with an average age of 9.35 (SD, 1.6) years were finally included, among which 428 (26.11%) children were diagnosed as being myopic (spherical equivalent refraction (SER) less than or equal to -0.5 diopters [D]). For the UCVA, the cutoff point is 0.2 logarithm of the minimum angle of resolution (20/32), with a sensitivity and specificity of 63.6% and 94.0%, respectively. For NCAR, the cutoff point is SER less than or equal to -0.75 D, with a sensitivity and specificity of 88.6% and 86.1%, respectively. When UCVA is combined with NCAR, the best cutoff point is UCVA less than or equal to 0 logarithm of the minimum angle of resolution (20/20) and SER less than or equal to -0.75 D, with a sensitivity and specificity of 84.4% and 90.5%, respectively. At a specificity of 90%, the sensitivities are 63.55%, 78.50%, and 84.35%, respectively, for UCVA, NCAR, and the combination test. In all age groups, the combination test had the highest sensitivities among the three tests., Conclusions: In a population with a high prevalence of myopia, combining the UCVA and NCAR in serial order achieved higher sensitivity than either of the two tests alone, when specificity was set at 90%.

Purpose: To investigate macular pigment optical density (MPOD) and its relationship with refractive status and foveal thickness in Chinese school-aged children., Methods: Ninety-four healthy Chinese children, 6 to 12 years old, were recruited to the study. MPOD was measured with a heterochromatic flicker photometer (HFP), and foveal thickness, including both minimum and central foveal thicknesses (MFT and CFT, respectively), were measured by optical coherence tomography (OCT) with fast macular map scan. A noncontact tonometer was used to measure intraocular pressure (IOP) followed by determination of the refraction using an autorefractor after cycloplegia. Information on body mass index (BMI) was obtained. The correlation between MPOD values and foveal thickness, spherical equivalent (SE) refraction, IOP, BMI, sex, and age was statistically analyzed using SAS 8.2 statistical software., Results: The MPOD in examined school-aged children was 0.56 ± 0.25, without any significant difference between boys and girls (p = 0.12). MPOD showed no significant association with age, BMI, IOP, SE, MFT, or CFT. In the myopia group, however, there was an inverse relationship between MPOD and MFT (R =-0.66, p = 0.028) and a positive relationship between MPOD and CFT (R = 0.67, p = 0.025)., Conclusions: MPOD was inversely related to MFT and positively related to CFT in Chinese school-age children with low-to-moderate myopia. MPOD showed no significant association with age, BMI, IOP, SE or foveal thickness.

Purpose: To investigate the effectiveness and cutoffs of axial length/corneal radius (AL/CR) ratio for myopia detection in children by age. Methods: Totally, 21 kindergartens and schools were enrolled. Non-cycloplegic autorefraction (NCAR), axial length (AL), horizontal and vertical meridian of corneal radius (CR1, CR2), and cycloplegic autorefraction were measured. Receiver operating characteristic (ROC) curve was used to obtain the effectiveness and cutoff for myopia detection. Results: Finally, 7803 participants aged 3–18 years with mean AL/CR ratio of 2.99 ± 0.16 were included. Area under the ROC curve (AUC) of AL/CR ratio for myopia detection (0.958 for AL/CR1, 0.956 for AL/CR2, 0.961 for AL/CR) was significantly larger than that of AL (0.919, all P < 0.001), while AUCs of the three were similar with different cutoffs (> 2.98, > 3.05, and > 3.02). When divided by age, the ROC curves of AL/CR ratio in 3- to 5-year-olds showed no significance or low accuracy (AUCs ≤ 0.823) in both genders. In ≥ 6-year-olds, the accuracies were promising (AUCs ≥ 0.883, all P < 0.001), the cutoffs basically increased with age (from > 2.93 in 6-year-olds to > 3.07 in 18-year-olds among girls, and from > 2.96 in 6-year-olds to > 3.07 in 18-year-olds among boys). In addition, boys presented slightly larger cutoffs than girls in all ages except for 16 and 18 years old. For children aged 3–5 years, AL/CR ratio or AL combined with NCAR increased AUC to > 0.900. Conclusion: AL/CR ratio provided the best prediction of myopia with age-dependent cutoff values for all but preschool children, and the cutoffs of boys were slightly larger than those of girls. For preschool children, AL/CR ratio or AL combined with NCAR is recommended to achieve satisfactory accuracy. AL/CR ratio calculated by two meridians showed similar predictive power but with different cutoffs. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to investigate the efficacy and safety of consecutive use of 1% and 0.01% atropine compared with 0.01% atropine alone over 1 year. Methods: A total of 207 participants aged 6–12 years with myopia of − 0.50 to − 6.00 D in both eyes were enrolled in this randomized, controlled, non-masked trial and randomly assigned (1:1) to groups A and B. Group A received 1% atropine weekly and were tapered to 0.01% atropine daily at the 6-month visit, and group B received 0.01% atropine daily for 1 year. Results: Of the 207 participants, 109 were female (52.7%) and the mean (± standard deviation) age was 8.92 ± 1.61 years. Ninety-one participants (87.5%) in group A and 80 participants (77.7%) in group B completed the 1-year treatment. Group A exhibited less refraction progression (− 0.53 ± 0.49 D vs. − 0.74 ± 0.52 D; P = 0.01) and axial elongation (0.26 ± 0.17 mm vs. 0.36 ± 0.21 mm; P < 0.001) over 1 year compared with group B. The changes in refraction (− 0.82 ± 0.45 D vs. − 0.46 ± 0.35 D; P < 0.001) and axial length (0.29 ± 0.12 mm vs. 0.17 ± 0.11 mm; P < 0.001) during the second 6 months in group A were greater than those in group B, with 72.5% of participants presenting refraction rebound. No serious adverse events were reported. Conclusions: The 1-year results preliminarily suggest that consecutive use of 1% and 0.01% atropine confers an overall better effect in slowing myopia progression than 0.01% atropine alone, despite myopia rebound after the concentration switch. Both regimens were well tolerated. The long-term efficacy and rebound after the concentration switch and regimen optimization warrant future studies to determine. Trial Registration Number: Clinical Trials.gov PRS (Registration No. NCT03949101). [ABSTRACT FROM AUTHOR]

Purpose: To investigate the prevalence and associated factors of fundus tessellation in highly myopic children and adolescents. Methods: A total of 513 high myopes (spherical equivalent [SE] ≤ −5.0 D, 4–19 years of age) without any advanced pathological myopic lesions were enrolled. Fundus photographs and choroidal thickness (ChT) data were collected by SS‐OCT. A novel grading approach was adopted to classify fundus tessellation into four categories on colour fundus photography, referring to the location of tessellation divided by an Early Treatment Diabetic Retinopathy Study grid centred on the fovea, through which closer to the fovea represents higher grades of fundus tessellation. Peripapillary atrophy (PPA) area and ovality index were also measured. Results: Among the participants, with a mean age of 13.47 ± 3.13 years and mean SE of − 8.34 ± 1.91 D, there were 29 (5.7%), 95 (18.5%), 233 (45.4%) and 156 (30.4%) participants with grade 0 to grade 3 fundus tessellation, respectively. The ChT in both the macular and peripapillary area was negatively correlated with the fundus tessellation grade (R = −0.763 and −0.537, respectively, all p < 0.001). Higher grades of fundus tessellation were independently associated with thinner macular ChT (OR = 1.734, 95% CI: 1.621–1.856, p < 0.001), longer axial length (OR = 1.368, 95% CI: 1.105–1.695, p = 0.004), larger PPA area (OR = 1.391, 95% CI: 1.073–1.802, p = 0.013) and the female sex (OR = 1.605, 95% CI: 1.092–2.359, p = 0.016). Conclusion: The fundus tessellation grade could reflect the ChT, representing the severity of myopic maculopathy among young high myopes who rarely had any advanced lesions of pathological myopia. Fundus tessellation grade might be a potential index for assessing early‐stage myopic maculopathy in children and adolescents. [ABSTRACT FROM AUTHOR]

Purpose: To investigate morphological differences between two types of Bruch's membrane (BM) defects—patchy atrophy (PA) and CNV-related macular atrophy (CNV-MA) Methods: Eyes presenting with PA or CNV-MA were included. Scleral thickness (ST), choroidal thickness (CT), and scleral morphological characteristics were obtained by swept-source optical coherence tomography (SS-OCT). Fundus photographs were performed to measure the size of PA and CNV-MA lesions. Results: Among a total of 167 eyes evaluated, 106 eyes had PA and 61 eyes had CNV-MA. In addition, dome-shaped macula (DSM) was identified in 20 (18.87%) and 10 (16.39%) eyes among PA and CNV-MA, respectively. The eyes of CNV-MA without DSM showed a thicker subfoveal ST (278.61 ± 56.17 vs 231.58 ± 66.09 mm, P < 0.001), a thinner subfoveal CT, and a higher rate of scleral perforating vessels (70.6% vs 50.0%, P = 0.021) when compared with those of PA without DSM. The size of PA/CNV-MA lesions was associated with CT in eyes without DSM. However, it was only associated with bulge height in eyes with DSM (r = 0.5, P = 0.013). Conclusions: The eyes with CNV-MA had a thicker sclera than those with PA, which add another evidence to indicate the absence of the progressive relationship between two types of BM defects. The enlargement of lesions in BM defects between eyes with and without DSM may be caused by different mechanical forces. SS-OCT, which focuses on scleral and choroid morphology, may be necessary for more accurate classification of pathologic myopia. [ABSTRACT FROM AUTHOR]

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

Background: Myopic maculopathy (MM) is the most serious and irreversible complication of pathologic myopia, which is a major cause of visual impairment and blindness. Clinic proposed limited number of factors related to MM. To explore additional features strongly related with MM from optic disc region, we employ a machine learning based radiomics analysis method, which could explore and quantify more hidden or imperceptible MM-related features to the naked eyes and contribute to a more comprehensive understanding of MM and therefore may assist to distinguish the high-risk population in an early stage.Methods: A total of 457 eyes (313 patients) were enrolled and were divided into severe MM group and without severe MM group. Radiomics analysis was applied to depict features significantly correlated with severe MM from optic disc region. Receiver Operating Characteristic were used to evaluate these features' performance of classifying severe MM.Results: Eight new MM-related image features were discovered from the optic disc region, which described the shapes, textural patterns and intensity distributions of optic disc region. Compared with clinically reported MM-related features, these newly discovered features exhibited better abilities on severe MM classification. And the mean values of most features were markedly changed between patients with peripapillary diffuse chorioretinal atrophy (PDCA) and macular diffuse chorioretinal atrophy (MDCA).Conclusions: Machine learning and radiomics method are useful tools for mining more MM-related features from the optic disc region, by which complex or even hidden MM-related features can be discovered and decoded. In this paper, eight new MM-related image features were found, which would be useful for further quantitative study of MM-progression. As a nontrivial byproduct, marked changes between PDCA and MDCA was discovered by both new image features and clinic features. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to investigate age‐specific normative retinal oxygen saturation values and explore the associated factors in healthy Chinese school‐aged children with different refractive statuses. Design: Population‐based observational cross‐sectional study. Methods: Children aged 7–19 years were enrolled. Each participant underwent a series of comprehensive ocular examinations, including axial length (AL), cycloplegic refraction and Oxymap T1 imagery following cycloplegia. The acquired oximetry images were measured, and the values of the retinal oxygen saturation parameters were calculated. The independent factors of the retinal oxygen saturation were analysed using multiple linear regression. The oxygen saturation of retinal arteries (SaO2) and veins (SvO2) as well as the differences between the arteries and veins (AVD) were measured as the main outcomes. Results: In total, 1461 participants were included in the study. The mean age of the participants was 12.1 ± 3.2 years, and 53.0% were boys. The mean SaO2, SvO2 and AVD values were 83.7 ± 6.4%, 50.1 ± 5.4% and 33.6 ± 5.4%, respectively, and the values increased with age. Girls had higher SvO2 and lower AVD than boys (p < 0.05). The Pearson correlation coefficients among spherical equivalent (SE) and SaO2, SvO2 and AVD were −0.372, −0.203 and −0.240, respectively (all p < 0.001), while the correlations between AL and SaO2, SvO2 and AVD were 0.276, 0.106 and 0.221, respectively (all p < 0.001). The myopia group had significantly higher SaO2, SvO2 and AVD than the emmetropia and hyperopia groups (p < 0.001), but the high myopia group had lower SaO2 and SvO2 than the moderate myopia group. When age, gender, body mass index (BMI), intraocular pressure (IOP) and axial length (AL) were included as factors in the multiple regression, older age was associated with higher SaO2, SvO2 and AVD, while longer AL was associated with higher SaO2 and AVD. Gender was an independent factor predicting SvO2, while gender and BMI were the independent factors predicting AVD. Age explained more variance than AL in SaO2, SvO2 and AVD. Conclusions: Our population‐based study provides age‐specific profiles of retinal oxygen saturation in Chinese children and adolescents. Older age and longer AL were important independent factors of increased retinal oxygen saturation. [ABSTRACT FROM AUTHOR]

Abstract: Importance: Nearly half of children suffering vision impairment reside in China with myopia accounting for the vast majority. Background: To describe the design and methodology of the Shanghai Child and Adolescent Large‐scale Eye Study (SCALE). Design: The SCALE was a city wide, school‐based, prospective survey. Participants: Children and adolescents aged 4–14 years from kindergarten (middle and senior), primary schools and junior high schools of all 17 districts and counties of the city of Shanghai, China were examined in 2012–2013. Methods: Each enrolled child underwent vision assessment (distance visual acuity; uncorrected and with corrective device if worn) and their parent/carer completed a questionnaire designed to elicit risk factors associated with myopia. Additionally, non‐cycloplegic autorefraction and ocular axial length was measured in a subset of the larger sample. Main Outcome Measures: Prevalence and the associated factors of vision impairment, myopia and high myopia in Shanghai. Results: In 2012–2013, a total of 910 245 of the eligible 1 196 763 children and adolescents identified from census (76%, mean age 9.0 ± 2.7 years [4–14 years]) were enrolled with visual acuity screened in the city of Shanghai. Of these, 610 952 children (67% of the entire sample) underwent non‐cycloplegic autorefraction and 219 188 (24% of the entire sample) had both non‐cycloplegic autorefraction and axial length measurements. Conclusions and Relevance: The study results will provide insights on the burden of vision impairment, myopia and high myopia in children and adolescents in a metropolitan area of China, and contribute to the policies and strategies to address and limit the burden. [ABSTRACT FROM AUTHOR]

Purpose. To investigate the refraction and ocular biometry characteristics and to examine the prevalence of refractive errors in preschool children aged 3 to 6 years in Shanghai, China. Methods. A school-based cross-sectional study was conducted in Jiading and Xuhui District, Shanghai, in 2013. We randomly selected 7 kindergartens in Jiading District and 10 kindergartens in Xuhui District, with a probability proportionate to size. The children underwent comprehensive eye examinations, including cycloplegic refraction and biometric measurements. Myopia, hyperopia, astigmatism were defined as spherical equivalent (SE) ≤ −0.50 D, SE ≥ +2.00 D, and cylindrical diopters ≤ −1.00 D. Results. The mean SE for 3- to 6-year-old children was +1.20 D (standard deviation [SD] 1.05), and the mean axial length (AL) was 22.29 mm (SD 0.73). The overall prevalence of myopia and astigmatism was 3.7% and 18.3%, respectively. No difference in prevalence of astigmatism was found across age groups. There was a statistically significant association between lower cylindrical diopters and higher spherical diopters (Spearman’s correlation: −0.21, P<0.001). Conclusion. Chinese children aged 3 to 6 years in the Shanghai area were mostly mildly hyperopic, with a low prevalence of myopia. Refractive astigmatism for children may be relatively stable throughout the preschool stage. Astigmatism was significantly associated with refractive error. [ABSTRACT FROM AUTHOR]

Background: In 2010, there were ~ 36 million migrant children under 18 y old in China. This study compared patterns of myopia prevalence and progression between migrant and resident children.Methods: Eight hundred forty-two migrant children from 2 migrant schools and 1081 from 2 local schools in Baoshan District, Shanghai, were randomly chosen. Baseline measurements were taken on children in grades one through four, and children in grades one and two were followed for 2 y. The children underwent comprehensive ophthalmic examinations, including cycloplegic refraction and axial length. The average time per week spent on homework and outdoor activities were investigated.Results: Migrant children in grades one and two showed a lower myopia prevalence than resident children; however, from grades three to four, the prevalence accelerated and exceeded that of residents. In the follow-up, the myopia incidence did not significantly change from grades one to two in resident children but was significantly higher in grade two in migrant children. Correspondingly, for migrant children, increased progression of refraction and axial length was observed; however, it decreased in resident children. The average time spent on homework increased from grades two to three in parallel with the acceleration of myopia prevalence for migrant children; however, the time spent outdoors did not correspondingly change.Conclusion: The patterns of myopia prevalence and progression are different between migrant and non-migrant children. The acceleration of myopia in migrant children might be a result of a change in their environment, such as intensive education pressure. [ABSTRACT FROM AUTHOR]

Purpose To systematically analyse the differences between cycloplegic and noncycloplegic refractive errors ( RE) in children and to determine if the predictive value of noncycloplegic RE in categorizing RE can be improved. Methods Random cluster sampling was used to select 6825 children aged 4-15 years. Autorefraction was performed under both noncycloplegic and cycloplegic (induced with 1% cyclopentolate drops) conditions. Paired differences between noncycloplegic and cycloplegic spherical equivalent ( SE) RE were determined. A general linear model was developed to determine whether cycloplegic SE can be predicted using noncycloplegic SE, age and uncorrected visual acuity ( UCVA). Results Compared to cycloplegia, noncycloplegia resulted in a more myopic SE (paired difference: −0.63 ± 0.65D, 95% CI: −0.612 to −0.65D, 6017 eligible right eyes) with greater differences observed in younger participants and in eyes with more hyperopic RE and smaller AL. Using raw noncycloplegic data resulted in only 61% of the eyes being correctly classified as myopic, emmetropic or hyperopic. Using age and uncorrected VA in the model, the association improved and 77% of the eyes were classified correctly. However, predicted cycloplegic SE continued to show large residual errors for low myopic to hyperopic RE. Applying the model to only those eyes with uncorrected VA <6/6 resulted in an improvement ( R2 = 0. 93), with 80% of the eyes correctly classified. A higher VA cut-off (i.e., ≤6/18) resulted in 97.5% of eyes classified correctly. Conclusion Noncycloplegic assessment of RE in children overestimates myopia and results in a high error rate for emmetropic and hyperopic RE. Adjusting for age and applying uncorrected VA cut-offs to noncycloplegic assessments improves detection of myopic RE and may help in identifying myopic RE in situations where cycloplegia is not available but does not help in identifying the magnitude of refractive error and therefore is of limited value. [ABSTRACT FROM AUTHOR]

Purpose: To report calculated crystalline lens power and describe the distribution of ocular biometry and its association with refractive error in older Chinese adults. Methods: Random clustering sampling was used to identify adults aged 50 years and above in Xuhui and Baoshan districts of Shanghai. Refraction was determined by subjective refraction that achieved the best corrected vision based on monocular measurement. Ocular biometry was measured by IOL Master. The crystalline lens power of right eyes was calculated using modified Bennett-Rabbetts formula. Results: We analyzed 6099 normal phakic right eyes. The mean crystalline lens power was 20.34 ± 2.24D (range: 13.40–36.08). Lens power, spherical equivalent, and anterior chamber depth changed linearly with age; however, axial length, corneal power and AL/CR ratio did not vary with age. The overall prevalence of hyperopia, myopia, and high myopia was 48.48% (95% CI: 47.23%–49.74%), 22.82% (95% CI: 21.77%–23.88%), and 4.57% (95% CI: 4.05–5.10), respectively. The prevalence of hyperopia increased linearly with age while lens power decreased with age. In multivariate models, refractive error was strongly correlated with axial length, lens power, corneal power, and anterior chamber depth; refractive error was slightly correlated with best corrected visual acuity, age and sex. Conclusion: Lens power, hyperopia, and spherical equivalent changed linearly with age; Moreover, the continuous loss of lens power produced hyperopic shifts in refraction in subjects aged more than 50 years. [ABSTRACT FROM AUTHOR]

Purpose: To explore the effectiveness of using a series of tests combining near visual acuity (NVA) and distance visual acuity (DVA) for large-scale screenings for significant refractive error (SRE) in primary school children. Method: Each participant underwent DVA, NVA and cycloplegic autorefraction measurements. SREs, including high myopia, high hyperopia and high astigmatism were analyzed. Cycloplegic refraction results were considered to be the gold standard for the comparison of different screening measurements. Receiver-operating characteristic (ROC) curves were constructed to compare the area under the curve (AUC) and the Youden index among DVA, NVA and the series combined tests of DVA and NVA. The efficacies (including sensitivity, specificity, positive predictive value, and negative predictive value) of each test were evaluated. Only the right eye data of each participant were analysed for statistical purpose. Result: A total of 4416 children aged 6 to 12 years completed the study, among which 486 students had right eye SRE (SRE prevalence rate = 11.01%). There was no difference in the prevalence of high hyperopia and high astigmatism among different age groups. However, the prevalence of high myopia significantly increased with the age (χ² = 381.81, p<0.01). High hyperopia was the biggest SRE factor associated with amblyopia（p＜0.01，OR = 167.40, 95% CI: 75.14∼372.94). The DVA test was better than the NVA test for detecting high myopia (Z = 2.71, p<0.01), but the NVA test was better for detecting high hyperopia (Z = 2.35, p = 0.02) and high astigmatism (Z = 4.45, p<0.01). The series combined DVA and NVA test had the biggest AUC and the highest Youden Index for detecting high hyperopia, myopia, astigmatism, as well as all of the SREs (all p<0.01). Conclusion: The series combined DVA and NVA test was more accurate for detecting SREs than either of the two tests alone. This new method could be applied to large-scale SRE screening of children, aged 6 to 12, in areas that are less developed. [ABSTRACT FROM AUTHOR]