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Background: In experimental studies, intravitreally applied antibodies against epidermal growth factor (EGF), EGF family members (amphiregulin, neuregulin-1, betacellulin, epigen, epiregulin) and against the EGF receptor (EGFR) were associated with a reduction in lens-induced axial elongation and decrease in physiological eye elongation in guinea pigs and in non-human primates. Here, we investigated the intraocular tolerability and safety of a fully human monoclonal IgG2-antibody against EGFR, already in clinical use in oncology, as a potential future therapeutic approach for axial elongation in adult eyes with pathological myopia., Methods: The clinical, monocentre, open-label, multiple-dose, phase-1 study included patients with myopic macular degeneration of stage 4, who received intravitreal injections of panitumumab in various doses and in intervals ranging between 2.1 months and 6.3 months., Results: The study included 11 patients (age:66.8±6.3 years), receiving panitumumab injections in doses of 0.6 mg (4 eyes; 1×1 injection, 3×2 injections), 1.2 mg (4 eyes; 1×1 injection, 2×2 injections, 1×3 injections) and 1.8 mg (3 eyes; 1×1 injection, 2×2 injections), respectively. None of the participants showed treatment-emergent systemic adverse events or intraocular inflammatory reactions. Best-corrected visual acuity (1.62±0.47 logarithm of the minimal angle of resolution (logMAR) vs 1.28±0.59 logMAR; p=0.08) and intraocular pressure (13.8±2.4 mm Hg vs 14.3±2.6 mm Hg; p=0.20) remained unchanged. In nine patients with a follow-up of >3 months (mean:6.7±2.7 months), axial length did not change significantly (30.73±1.03 mm vs 30.77±1.19 mm; p=0.56)., Conclusions: In this open-labelled, phase-1 study with a mean follow-up of 6.7 months, panitumumab repeatedly administered intravitreally up to a dose of 1.8 mg was not associated with intraocular or systemic adverse effects. During the study period, axial length remained unchanged., Trial Registration Number: DRKS00027302., Competing Interests: Competing interests: JBJ and SP-J: Patent holder with Biocompatibles UK (Franham, Surrey, UK) (Jonas JB, Wallrapp C, Geigle P, Panda-Jonas S, Thoemes E): (Title: Treatment of eye diseases using encapsulated cells encoding and secreting neuroprotective factor and / or anti-angiogenic factor; Patent number: 20120263794), and European patent EP 3 271 392, JP 2021-119187, and US 2021 0340237 A1: Agents for use in the therapeutic or prophylactic treatment of myopia or hyperopia; Patent application: European patent application: WO 2021/198369 A1; PCT/EP2021/058500: Agents for the use in the therapeutic or prophylactic treatment of retinal pigment epithelium associated diseases., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: There is a relative paucity of self-reported vision problems data in European countries., Methods: In this context, we investigated self-reported vision problems through European Health Interview Survey 2, a cross-sectional European population survey based on a standardized questionnaire including 147 medical, demographic and socioeconomic variables applied to non-institutionalized individuals aged 15 years or more in 28 European countries, in addition to Iceland and Norway., Results: The survey included 311 386 individuals (54.18% women), with overall crude prevalence of self-reported vision problems of 2.07% [95% CI; 2.01-2.14]. Among them, 1.70 % [1.61-1.78] of men, 2.41% [2.31-2.51] of women and 4.71% [4.53-4.89] of individuals aged 60 or more reported to have a lot of vision problems or to be not able to see. The frequency of self-reported vision problems was the highest in Eastern European countries with values of 2.43% [2.30-2.56]. In multivariate analyses, limiting long-standing illness, depression, daily smoking, lack of physical activity, lower educational level and social isolation were associated with self-reported vision problems with ORs of 2.66 [2.42-2.92], 2.16 [2.01-2.32], 1.11 [1.01-1.23], 1.31 [1.21-1.42], 1.29 [1.19-1.40] and 1.45 [1.26-1.67], respectively, while higher income was associated with less self-reported vision problems with OR of 0.80 [0.73-0.86]., Conclusions: This study demonstrated inequalities in terms of prevalence of self-reported vision problems in Europe, with higher prevalence in Eastern European countries and among women and older individuals., (© 2020 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta OphthalmologicaScandinavica Foundation.)

Purpose: To investigate the progression of myopic maculopathy and associated factors in highly myopic Chinese children., Methods: In this retrospective observational case series, biometric fundus features were morphometrically measured on photographs. Myopic maculopathy was defined as recommended by the Meta-analysis of Pathologic Myopia Study Group., Results: The study included 274 children (mean age: 11.7 ± 2.5 years; mean refractive error: -7.66 ± 1.87 diopters [D]) with a mean follow-up of 4.9 ± 1.2 years. Myopic maculopathy progression was detected in 52 eyes (18.9%; 95% confidence interval [CI]: 14.3-23.7%). In multivariable analysis, myopic maculopathy progression was associated with a decrease in refractive error (odds ratio [OR]: 0.72; 95% CI: 0.56-0.92; P < 0.001) (i.e., higher myopization) and enlargement of parapapillary gamma zone (OR: 7.68; 95% CI: 1.63-36.2; P = 0.002). Incident peripapillary diffuse choroidal atrophy, noted in 47 of 236 eyes (20.0%; 95% CI: 14.8-25.2%), was correlated with a decrease in refractive error (OR: 0.70; 95% CI: 0.54-0.92; P = 0.009) (i.e., higher myopization) and greater gamma zone enlargement (OR: 8.28; 95% CI: 1.33-51.7; P = 0.02)., Conclusion: Myopia in schoolchildren may have a considerable risk of progressing to myopic maculopathy. Enlargement of parapapillary gamma zone was a main independent risk factor., (Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.)

Pathologic myopia is a major cause of visual impairment worldwide. Pathologic myopia is distinctly different from high myopia. High myopia is a high degree of myopic refractive error, whereas pathologic myopia is defined by a presence of typical complications in the fundus (posterior staphyloma or myopic maculopathy equal to or more serious than diffuse choroidal atrophy). Pathologic myopia often occurs in eyes with high myopia, however its complications especially posterior staphyloma can also occur in eyes without high myopia. Owing to a recent advance in ocular imaging, an objective and accurate diagnosis of pathologic myopia has become possible. Especially, optical coherence tomography has revealed novel lesions like dome-shaped macula and myopic traction maculopathy. Wide-field optical coherence tomography has succeeded in visualizing the entire extent of large staphylomas. The effectiveness of new therapies for complications have been shown, such as anti-VEGF therapies for myopic macular neovascularization and vitreoretinal surgery for myopic traction maculopathy. Myopia, especially childhood myopia, has been increasing rapidly in the world. In parallel with an increase in myopia, the prevalence of high myopia has also been increasing. However, it remains unclear whether or not pathologic myopia will increase in parallel with an increase of myopia itself. In addition, it has remained unclear whether genes responsible for pathologic myopia are the same as those for myopia in general, or whether pathologic myopia is genetically different from other myopia.

Purpose: Although there have been many population-based studies of age-related macular degeneration (AMD), only limited information is available in Asia on the epidemiology of geographic atrophy (GA). We aimed to determine the prevalence and patterns of GA through an analysis of multiple studies conducted within the Asian Eye Epidemiology Consortium (AEEC)., Design: Cross-sectional meta-analyses., Participants: A total of 97 213 individuals aged 40 years and older., Methods: Data from 22 population-based studies from countries belonging to the AEEC were included. In all studies, AMD was defined on the basis of standardized grading systems. Geographic atrophy was defined as an area of pallor in the fundus with visibility of the underlying choroidal blood vessels and sharply defined borders. Random-effects meta-analysis was performed to estimate overall and age-, gender-, and region-specific pooled prevalence of GA., Main Outcome Measures: Prevalence of GA per 1000 persons., Results: The mean age was 60.8 ± 10.0 years, and 42 673 (43.9%) were male. Overall, a total of 223 individuals (0.2%) had GA. The pooled overall prevalence of GA was 1.57 per 1000 persons (95% confidence interval [CI], 1.04-2.10), which was 3 times less than that of neovascular AMD of 5.20 per 1000 persons (95% CI, 3.97-6.43). Compared with those aged 50 to 59 years, the prevalence of GA increased from 0.34 per 1000 persons (95% CI, 0.07-0.62) to 2.90 per 1000 persons (95% CI, 1.55-4.25) in those aged ≥70 years. The GA prevalence per 1000 persons was similar between urban (2.22; 95% CI, 1.22-3.23) and rural residents (1.33; 95% CI, 0.70-1.96). Geographic atrophy was more prevalent in South Asia (based on studies from India and Nepal, 3.82 per 1000 persons; 95% CI, 1.72-5.93) compared with East Asia (based on studies from China, Korea, Hong Kong, Taiwan, and Japan, and the Singapore Chinese Eye Study, 0.76 per 1000 persons; 95% CI, 0.31-1.22, P = 0.005)., Conclusions: Geographic atrophy is uncommon in Asian populations compared with those of European ancestry. Even within Asia, geographic differences in GA prevalence were seen. The findings of this meta-analysis suggest that better dissection of risk factors in the Asian population for GA may provide insights into the biological pathways that drive these late-stage manifestations, thus suggesting better targets for prevention., (Copyright © 2020 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate the prevalence of epiretinal membranes (ERMs) and their risk factors in a Chinese population., Methods: The community-based Kailuan Eye Study included 14,440 participants (9835 male, 4605 female) with a mean age of 54.0 ± 13.3 years (range, 20-110 years). They underwent a systemic and ophthalmologic examination. ERMs were diagnosed on fundus photographs., Results: Retinal photographs assessable for the presence of ERMs were available for 13,295 (92.0%) individuals (9094 male) with a mean age of 53.6 ± 13.3 years (range, 20-110 years). ERMs were found in 1013 participants (1489 eyes) with a prevalence of 7.6% (95% confidence interval [CI], 7.1%-8.1%). Secondary ERMs caused by intraocular reasons were found 46 (4.5%) individuals (69 [4.6%] eyes). A higher prevalence of any ERMs (and of primary ERMs) was associated with older age (odds ratio [OR]: 1.08; 95% CI:1.07-1.10), higher body mass index (OR: 1.05; 95% CI: 1.00-1.11), higher prevalence of smoking (OR:1.43; 95% CI: 1.01-2.03), higher serum concentration of glucose (OR: 1.08; 95% CI: 1.04-1.13), and lower serum concentration of uric acid (OR: 0.99; 95% CI: 0.99-1.00). Visual acuity was significantly (P = 0.002) lower in eyes with premacular fibroses than in eyes with cellophane macular reflexes., Conclusions: In our cross-sectional community-based study, the prevalence of all ERMs was 7.6%. Among the group of participants with ERMs, secondary ERMs caused by intraocular reasons were detected in 46 (4.5%) individuals (69 [4.6%] eyes). A higher prevalence of any ERM and of primary ERMs was associated with older age, higher body mass index, higher prevalence of smoking, a higher serum concentration of glucose, and a lower serum concentration of uric acid.

Purpose: To reveal clinical features of patchy atrophy in pathologic myopia and investigate the status of the Bruch membrane and retinal pigment epithelium by swept-source optical coherence tomography., Methods: This study reviewed highly myopic patients who visited the high myopia clinic between January 2015 and February 2018. Wide-field photographs and wide-field fundus autofluorescence fundus images were used as the primary method for identifying PAs, and swept-source optical coherence tomography images were used for investigating the retinochoroid status of PAs., Results: Four hundred fifty-six PAs were detected in 137 eyes (118 patients). Patchy atrophys were located most often in the macular area (28.3%), followed by the inferior (25.9%), temporal (18.9%), nasal (14.5%), and superior (12.5%) region. All 210, PAs which had been fully or partially scanned by swept-source optical coherence tomography, showed a retinal pigment epithelium defect, and 174 (82.9%) PAs showed a Bruch membrane defect on the available scans. In 101 (82.8%) of 122 PAs with clearly detectable borders of the retinal pigment epithelium and Bruch membrane defect, the Bruch membrane defects were smaller than the retinal pigment epithelium defects. A dome-shape inward bulging of the sclera was observed in 10 PAs., Conclusion: These morphological findings may provide a basis for exploring the biomechanical etiology of the PAs as part of the development of pathologic myopia.

Background: To determine the prevalence and causes of blindness and vision impairment (VI) in East Asia in 2015 and to forecast the trend to 2020., Methods: Through a systematic literature review and meta-analysis, we estimated prevalence of blindness (presenting visual acuity <3/60 in the better eye), moderate-to-severe vision impairment (MSVI; 3/60≤presenting visual acuity <6/18), mild vision impairment (mild VI: 6/18≤presenting visual acuity <6/12) and uncorrected presbyopia for 1990, 2010, 2015 and 2020. A total of 44 population-based studies were included., Results: In 2015, age-standardised prevalence of blindness, MSVI, mild VI and uncorrected presbyopia was 0.37% (80% uncertainty interval (UI) 0.12%-0.68%), 3.06% (80% UI 1.35%-5.16%) and 2.65% (80% UI 0.92%-4.91%), 32.91% (80% UI 18.72%-48.47%), respectively, in East Asia. Cataract was the leading cause of blindness (43.6%), followed by uncorrected refractive error (12.9%), glaucoma, age-related macular degeneration, corneal diseases, trachoma and diabetic retinopathy (DR). The leading cause for MSVI was uncorrected refractive error, followed by cataract, age-related macular degeneration, glaucoma, corneal disease, trachoma and DR. The burden of VI due to uncorrected refractive error, cataracts, glaucoma and DR has continued to rise over the decades reported., Conclusions: Addressing the public healthcare barriers for cataract and uncorrected refractive error can help eliminate almost 57% of all blindness cases in this region. Therefore, public healthcare efforts should be focused on effective screening and effective patient education, with access to high-quality healthcare., Competing Interests: Competing interests: JBJ: Consultant for Mundipharma Co. (Cambridge, UK); Patent holder with Biocompatibles UK Ltd. (Farnham, Surrey, UK) (Title: Treatment of eye diseases using encapsulated cells encoding and secreting neuroprotective factor and/or anti-angiogenic factor; Patent number: 20120263794), and Patent application with University of Heidelberg (Heidelberg, Germany) (Title: Agents for use in the therapeutic or prophylactic treatment of myopia or hyperopia; Europäische Patentanmeldung 15 000 771.4). JHK: consultant for Gilead (DSMC Chair), Santen (protocol design). SR: consultant for Brien Holden Vision Institute., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To report on a progressing ridge-shaped macula parallel to Bruch membrane defects and a macular suprachoroidal cavitation., Method: Single case report., Result: The right eye of a 54-year-old man with an axial length of 30.96 mm showed 2 extrafoveal Bruch membrane defects with a partial herniation of the retina into the choroidal space and an ophthalmoscopically yellowish area inferior to one of the Bruch membrane defects. Optical coherence tomography revealed a horizontal transfoveal ridge of the sclera, Bruch membrane, and macula and a deepening of the suprachoroidal space, corresponding to the ophthalmoscopically detectable yellowish area and fulfilling the criteria of a macular suprachoroidal cavitation. After a follow-up of 10 years, the height of the ridge increased parallel to a further deepening of the macular suprachoroidal cavitation and an increase in axial length by 0.67 mm., Conclusion: The findings support the notion of a progression of a ridge-shaped macula parallel to a further deepening of a macular suprachoroidal cavitation in an axially elongating eye.

Purpose: To assess and compare clinical features of a ridge-shaped macula (defined as macular elevation only in one meridian across the fovea) in individuals younger than 20 years with those of a dome-shaped macula (DSM) in patients aged 20+ years., Methods: The retrospective observational case series study included 185 highly myopic eyes of 100 consecutive patients younger than 20 years, who were compared with highly myopic patients with DSMs, aged 20+ years and examined in previous studies., Results: Seventeen (9.2%) eyes of the highly myopic young patients showed macular elevations all of which ran only in the horizontal direction across the vertical optical coherence tomographic section fulfilled the definition of a ridge and did not show any staphylomas or any macular Bruch membrane defects. By contrast, in the older patients with DSMs, the DSMs were significantly higher and had a narrower base than the ridges in the young patients, and showed macular Bruch membrane defects in their vicinity, with the axial length being significantly longer, the myopic maculopathy more severe, and the subfoveal choroid thinner., Conclusion: Macular elevations detected in children and adolescents are usually ridge-shaped maculas and do not have the characteristics of DSMs. In comparison with DSMs, ridge-shaped maculas do not show a spatial association with macular Bruch membrane defects or posterior staphylomas and have a wider basis and smoother elevation slope. As a hypothesis, ridge-shaped maculas may be due to a folding of Bruch membrane at the posterior pole, potentially caused by an asymmetrical enlargement of Bruch membrane in the equatorial region.

Background: Horizontal eye movements have been proposed to induce biomechanical stress and strain on optic nerve head. Since strabismus may lead to sustained adduction or abduction, we investigate the effects of long lasting unilateral horizontal strabismus on the morphology of optic disc., Methods: The observational cross-sectional study included patients with unilateral constant horizontal strabismus lasting for more than two years. The patients underwent an ophthalmological examination including refraction and morphometry of the optic nerve head. A prism cover test using right angle glass prism was performed to measure the magnitude of the ocular deviation., Results: The study included 70 patients with a unilateral constant strabismus (35 esotropic patients, 35 exotropic patients) with a mean age of 26 ± 19 years, mean refractive error of - 0.72 ± 3.3 diopters, mean axial length of 23.8 ± 1.7 mm, and a mean angle of deviation of 87 ± 36 prism diopters (Chinese right-angle glass method) in the esotropic group and - 97 ± 29 prism diopters in the exotropic group. In the whole study population and taken separately in the esotropic group and exotropic group, the disc ovality index (defined as ratio of minimal-to-maximal optic disc diameter) did not differ significantly between the deviating eyes and the contralateral fixating eyes (all P > 0.05). As a corollary, the disc ovality index and the prevalence of parapapillary beta/gamma zone did not differ significantly between the esotropic group and the exotropic group (all P > 0.05)., Conclusions: Optic disc ovality did not differ markedly among long-lasting esotropic eyes, exotropic eyes, and non-strabismic eyes. It suggests that optic disc shape may not be markedly influenced in non-highly myopic eyes by a potential backward pull of the optic nerve on the optic disc structures in adduction or abduction.

Background: To assess prevalence and causes of vision impairment in South-east Asia and Oceania regions from 1990 to 2015 and to forecast the figures for 2020., Methods: Based on a systematic review of medical literature, prevalence of blindness (presenting visual acuity (PVA) <3/60 in the better eye), moderate and severe vision impairment (MSVI; PVA <6/18 but ≥3/60), mild vision impairment (PVA <6/12 but ≥6/18) and near vision impairment (>N5 or N8 in the presence of normal vision) were estimated for 1990, 2010, 2015 and 2020., Results: The age-standardised prevalence of blindness for all ages and both genders was higher in the Oceania region but lower for MSVI when comparing the subregions. The prevalence of near vision impairment in people≥50 years was 41% (uncertainty interval (UI) 18.8 to 65.9). Comparison of the data for 2015 with 2020 predicts a small increase in the numbers of people affected by blindness, MSVI and mild VI in both subregions. The numbers predicted for near VI in South-east Asia are from 90.68 million in 2015 to 102.88 million in 2020. The main causes of blindness and MSVI in both subregions in 2015 were cataract, uncorrected refractive error, glaucoma, corneal disease and age-related macular degeneration. There was no trachoma in Oceania from 1990 and decreasing prevalence in South-east Asia with elimination predicted by 2020., Conclusions: In both regions, the main challenges for eye care come from cataract which remains the main cause of blindness with uncorrected refractive error the main cause of MSVI. The trend between 1990 and 2015 is for a lower prevalence of blindness and MSVI in both regions., Competing Interests: Competing interests: JBJ: Consultant for Mundipharma Co. (Cambridge, UK); Patent holder with Biocompatibles UK Ltd. (Farnham, Surrey, UK) (Title: Treatment of eye diseases using encapsulated cells encoding and secreting neuroprotective factor and/or ant-angiogenic factor; Patent number: 20120263794), and Patent application with University of Heidelberg (Heidelberg, Germany) (Title: Agents for use in the therapeutic or prophylactic treatment of myopia or hyperopia; Europäische Patentanmeldung 15 000 771.4., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To describe features of posterior staphylomas in nonhighly myopic eyes with retinitis pigmentosa (RP)., Methods: The retrospective observational case series study included patients with RP and an axial length of <26.5 mm and searched for eyes with posterior staphylomas. All study participants underwent fundus photography and optical coherence tomography., Results: The study identified 13 eyes of 7 patients with a narrow macular staphyloma. Mean age was 40.9 ± 17.9 years (range 9-62 years) and mean axial length was 24.90 ± 0.69 mm. The staphyloma edges corresponded to the margin between the retinal atrophic area in the fundus midperiphery and the relatively unaffected fundus center. On vertically orientated optical coherence tomography images, the staphyloma edges showed a slight inward protrusion of the sclera and a ring-like localized choroidal thinning with choroidal rethickening in direction toward the fovea and toward the periphery of the fundus. The upper and lower staphyloma edges did not differ in steepness. The thickness of the subfoveal choroid (138.6 m ± 50.1 µm) was thinner than the normal range after adjusting for age and axial length in all eyes. Two eyes with advanced RP in the macula showed a subfoveal choroidal thickness of 95 µm and 88 µm., Conclusion: Narrow macular staphylomas can occur in nonhighly myopic eyes with RP and, in contrast to staphylomas in highly myopic eyes, show a less marked thinning of the subfoveal choroid. The occurrence of posterior staphylomas in nonhighly myopic eyes with RP may provide hints to unravel the etiology of posterior staphyloma formation.

Purpose: To investigate the relationships between myopic macular retinoschisis (MRS) and posterior staphylomas and to reveal the characteristics of other retinal lesions associated with MRS., Design: Retrospective, observational case series., Participants: Seven hundred twenty-nine eyes of 420 patients with high myopia, which was defined as myopic refractive error of more than -8.0 diopters or an axial length longer than 26.5 mm., Methods: Highly myopic eyes were examined by ultrawide-field (UWF) swept-source (SS) OCT with scan width of up to 23 mm and scan depth of 5 mm. The OCT features of MRS and posterior staphylomas and their spatial relationship were examined in UWF SS OCT images., Main Outcome Measures: Associations between MRS and staphylomas., Results: In 729 eyes with mean axial length of 30.2±2.1 mm, posterior staphyloma was detected in 482 eyes (66.1%) and MRS was detected in 136 eyes (18.7%). All 136 eyes with an MRS showed outer retinoschisis, and 40 eyes (29.4%) also showed inner retinoschisis. Posterior staphyloma was detected significantly more frequently in eyes with MRS (117/136 [86.0%]) than in eyes without MRS (365/593 [61.6%]; P < 0.001). In all eyes with both staphyloma and outer retinoschisis, the area of the outer retinoschisis was restricted to the area within the staphyloma. In 1 of the 19 eyes with outer retinoschisis but without staphyloma, the outer retinoschisis extended beyond the range of the scanned fundus area. Among the 40 eyes with inner retinoschisis, the inner retinoschisis was located within the region of the outer retinoschisis in 39 eyes (97.5%). In all eyes with inner retinoschisis, retinal lesions causing an inward-directed tractional force were found within the area of the inner retinoschisis., Conclusions: In highly myopic eyes, the sites of the MRS and staphylomas were spatially related to each other. Posterior-directed force in association with staphylomas, and an inward-directed force resulting from epiretinal membranes or vitreoretinal attachments, may act as causative factors for MRS. However, the exact mechanisms related to the development of an MRS are probably diverse and complex., (Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate the progression pattern of myopic maculopathy and associated factors in a population-based study., Design: Population-based longitudinal study., Participants: The Beijing Eye Study including 4439 participants in 2001 was repeated in 2011, with 2695 individuals (66.4%) being re-examined in 2011., Methods: The study participants underwent detailed ophthalmic and general examinations. Using fundus photographs obtained in 2001 and 2011, we assessed the progression of myopic maculopathy in highly myopic eyes with a refractive error ≥-6 diopters in 2001. Myopic maculopathy was differentiated into tessellated fundus (category 1), diffuse chorioretinal atrophy (category 2), patchy chorioretinal atrophy (category 3), and macular atrophy (category 4), with lacquer cracks and choroidal neovascularization as additional plus signs., Main Outcome Measures: Progression pattern of myopic maculopathy., Results: Of 110 highly myopic eyes (70 individuals) at baseline, 39 eyes (35.5%) showed progression observed in 15 of 79 eyes (19%) with tessellated fundus at baseline, in 17 of 24 eyes (71%) with diffuse chorioretinal atrophy, in all 6 eyes with patchy chorioretinal atrophy, and the 1 eye with macular atrophy. Lacquer cracks detected in 2 eyes in 2001 developed into a small patchy atrophy (1 eye) or widened during the follow-up (1 eye). Five eyes demonstrated new lacquer cracks. In binary regression analysis, progression of myopic maculopathy was associated with longer axial length (P < 0.001; odds ratio [OR], 7.13; 95% confidence interval [CI], 2.49-20.4), older age (P = 0.001; OR, 1.25; 95% CI, 1.10-1.42), higher prevalence of staphylomas (P = 0.03; OR, 24.3; 95% CI, 2.89-204), smaller parapapillary γ-zone in 2011 (P = 0.01; OR, 0.61; 95% CI, 0.41-0.91), and female gender (P = 0.04; OR, 9.78; 95% CI, 1.06-90.6)., Conclusions: The 10-year progression rate of myopic maculopathy in this elderly Chinese population was 35.5%, increasing from 15 of 79 eyes (19%) in category 1 of myopic maculopathy at baseline to 17 of 24 eyes (71%) in category 2 and 6 of 6 eyes (100%) in category 3. Risk factors for myopic maculopathy progression were longer axial length, pre-existing staphylomata, smaller parapapillary γ-zone, older age, and female gender., (Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to determine the prevalence of myopic retinopathy (MR) in rural Central India., Methods: The population-based Central India Eye and Medical Study included 4711 subjects (aged 30+ years). The participants underwent a detailed eye examination, including fundus photography. Myopic retinopathy was defined according to the Pathologic Myopia Study Group., Results: Readable fundus photographs were available on 4561 (96.8%) subjects (8846 eyes). Myopic retinopathy was present in 15 (0.17 ± 0.04%; 95% confidence interval (CI):0.08%, 0.26%) eyes of 11 (0.24 ± 0.07%; 95%CI: 0.01, 0.04) individuals. Myopic retinopathy occurred only in eyes with an axial length of >26 mm. Eyes with MR had significantly larger optic discs than eyes without MR (3.69 ± 1.22 mm 2 versus 2.52 ± 0.77 mm 2 ; p < 0.001). In binary regression analysis, higher prevalence of MR was associated with longer axial length (p < 0.001; odds ratio (OR): 19.6; 95%CI: 4.6, 82.9), higher prevalence of open-angle glaucoma (p = 0.02; OR: 16.1; 95%CI: 1.51, 170), lower best-corrected visual acuity (expressed in logMAR) (=0.03; OR: 0.06; 95%CI: 0.004, 0.75) and female gender (p = 0.002). If level of education was added to the model, educational level was not significantly associated with MR (p = 0.17; OR: 0.53; 95%CI: 0.22, 1.31). If gender was dropped from the model, higher prevalence of MR was associated with lower educational level (p = 0.04; OR: 0.44; 95%CI: 0.20, 0.97)., Conclusions: Prevalence of MR in rural Central India was low (11/4561 or 0.2%), and correlated with a 16 times higher risk of open-angle glaucoma, after adjusting for axial length and gender. If gender was excluded from the analysis, higher prevalence of MR was associated with lower educational level. This latter finding distinguishes adult MR from today's school children myopia which is strongly associated with higher educational level., (© 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Retinal vein occlusions (RVOs) have been defined as retinal vascular disorders characterized by dilatation of retinal veins with retinal and subretinal hemorrhages, macular edema, and a varying degree of retinal ischemia. Retinal angiography, either as fluorescein and indocyanine green (ICG) angiography or in the form of optical coherence tomography (OCT)-based angiography, is essential for the diagnosis and assessment of the prognosis of RVOs. It allows the differentiation of diverse types of RVOs, such as perfused or nonperfused, as well as the detection of different modalities in the natural history of RVOs. OCT angiographic imaging in combination with dye angiography (fluorescein or ICG) is the most effective method to assess the amount and location of cystoid macular edema and the persistence, regression, and degree of ischemia. OCT can additionally display the presence and integrity of the outer limiting membrane and of the inner and outer segments of the photoreceptors as useful biomarkers for the prognosis and as a guide for the treatment of RVO. Due to the relatively often benign and self-limiting course of nonischemic RVOs, therapy may initially be delayed. If macular edema extends into the foveolar region and persists, intravitreal medical therapy including steroids (triamcinolone; fluocinolone or dexamethasone in slow-release devices) and/or anti-VEGF (vascular endothelial growth factor) drugs (bevacizumab, ranibizumab, aflibercept) may be intravitreally administered, avoiding the irreversibly destructive effect of laser coagulation, which previously was applied in a 'grid' pattern over the extrafoveolar leaking area. The side effects of intraocularly applied steroids in relatively young patients including cataract formation and ocular hypertension have to be considered., (© 2017 S. Karger AG, Basel.)

Objective: To assess stereoacuity in a population-based sample of children and to examine ocular and systemic parameters related to stereoacuity., Methods: Using a random cluster sampling method, four- to 18-year-old children from kindergartens, elementary schools, junior high schools and senior high schools from a rural area and an urban area in the East Chinese province of Shandong were included in the school-based cross-sectional study. All participants underwent a comprehensive eye examination including assessment of cycloplegic refraction and measurement of stereoacuity using the Titmus Stereo test., Results: Out of 6364 eligible children, 5780 (90.8%) children with a mean age of 10.1 ± 3.2 years (range: 4 to 18 years) participated. Mean (± standard deviation) stereoacuity was 50.2 ± 50.6 arc seconds. Stereoacuity improved significantly (P<0.01) from the age group of 4 years to the age group of 6 to 7 years, then showed a plateau, deteriorated (P = 0.001) for both sexes from the age group of 9 years to the age group of 12 years (P<0.001), after which it improved (P = 0.001) again in the age group of 16 years or older to the pre-puberty values. In multivariate analysis, larger angle of binocular disparity (i.e., lower stereoacuity) was significantly associated with lower best corrected visual acuity (logMAR; P<0.001), higher intereye difference in refractive error (spherical equivalent) (P<0.001), higher cylindrical refractive error (P<0.001), higher refractive error (spherical value; P<0.001), higher intereye difference in best corrected visual acuity (logMAR) (P = 0.001), higher intereye difference in axial length (P = 0.001), and rural region of habitation (P = 0.006)., Conclusions: Stereoacuity as tested with the Titmus Stereo test improved significantly from an age of 4 years to an age of 6 and 7 years, then remained constant, temporarily deteriorated for both sexes in pre-puberty and puberty, after which it improved again to pre-puberty or better values at the age of 16 years or older. Lower stereoacuity was associated with lower best corrected visual acuity and higher intereye difference in best corrected visual acuity, higher cylindrical and spherical refractive errors, higher inter-eye difference in refractive error, higher intereye difference in axial length, and rural region of habitation.

Purpose: To describe prevalence and associations of anisometropia in children., Methods: The cross-sectional school-based study included children aged 4 to 18 years., Results: The study included 6025 (94.7%) of 6364 eligible children. Mean refractive anisometropia was 0.37 ± 0.57 diopters (median: 0.25 diopters; range: 0-7.88 diopters; prevalence [≥1 diopter]: 7.0% ± 0.3%). In multivariate analysis (regression coefficient r: 0.66), higher refractive anisometropia was associated with older age (P < 0.001; β: 0.07; B: 0.01; 95% CI: 0.01-0.02), higher maternal education level (P < 0.001; β: 0.04; B: 0.02; 95% CI: 0.01-0.03), more total time spent indoors reading or writing (P = 0.001; β: 0.04; B: 0.01; 95% CI: 0.01-0.02), larger intereye difference in axial length (P < 0.001; β: 0.57; B: 1.20; 95% CI: 1.15-1.24), shorter mean axial length of both eyes (P = 0.03; β: -0.03; B: -0.02; 95% CI: -0.03 to -0.001), larger intereye difference in best corrected visual acuity (BCVA) (P < 0.001; β: 0.14; B: 1.83; 95% CI: 1.54-2.12), and lower stereoacuity (P < 0.001; β: 0.08; B: 0.31; 95% CI: 0.22-0.39). Refractive anisometropia showed a U-shaped correlation with refractive error. Higher anisomyopia was associated (r: 0.57) with older age (P = 0.001; β: 0.05; B: 0.006; 95% CI: 0.002-0.009), higher level of paternal education (P = 0.001; β: 0.01; B: 0.01; 95% CI: 0.01-0.02), more total time spent indoors reading or writing (P = 0.01; β: 0.03; B: 0.01; 95% CI: 0.00-0.01), larger intereye difference in axial length (P < 0.001; β: 0.22; B: 0.26; 95% CI: 0.23-0.29), greater myopic refractive error (P < 0.001; β: -0.46; B: -0.07; 95% CI: -0.08 to -0.07), and lower corneal astigmatism (P < 0.001; β: -0.10; B: -0.06; 95% CI: -0.08 to -0.05). In the same multivariate model, hyperopic anisometropia was not significantly associated with time spent indoors with reading (P = 0.18). Cylindrical anisometropia (mean: 0.30 ± 0.32 diopters; prevalence [≥1 diopter]: 3.7% ± 0.2%) increased with higher refractive anisometropia (P < 0.001; β: 0.16; B: 0.09; 95% CI: 0.08-0.11), greater myopic refractive error (P < 0.001; β: -0.06; B: -0.01; 95% CI: -0.01 to -0.01), higher corneal astigmatism (P < 0.001; β: -0.22; B: -0.15; 95% CI: -0.17 to -0.13), and lower mean BCVA (P < 0.001; β: 0.11; B: 0.90; 95% CI: 0.68-1.17)., Conclusions: In 4- to 18-year-old children, refractive anisometropia and anisomyopia increased with systemic parameters such as age, parental education level, and lifestyle of the children, for example, more time spent indoors reading or writing. In contrast, hyperopic anisometropia and cylindrical anisometropia were not related with lifestyle parameters.

Purpose: To examine the thickness of the macular choroid and its associations in school children aged 6 to 18 years., Methods: The school-based cross-sectional Shandong Children Eye Study included 6026 (94.7%) of 6364 eligible children fulfilling the inclusion criterion of an age from 4 to 18 years. Spectral-domain optical coherence tomography (SD-OCT) was performed for a subgroup of 972 school children aged 6+ years. All participants underwent ocular examinations, including measurement of visual acuity, cycloplegic refractometry, biometry, and SD-OCT (enhanced depth imaging mode) for measurement of choroidal thickness., Results: The study included 972 children (501 girls) with a mean age of 11.3 ± 3.3 years (range, 6-18 years) and mean axial length of 24.10 ± 1.56 mm (range, 16.57-28.82 mm). Mean choroidal thickness was thicker (P < 0.001) at 500 μm temporal to the foveola (290 ± 67 μm) than in the subfoveal region (283 ± 67 μm; range, 113-507 μm) and the region 500 μm superior to the fovea (283 ± 66 μm), where it was thicker (P < 0.001) than at 500 μm inferior of the foveola (281 ± 66 μm), and it was thinnest (P < 0.001) at 500 μm nasal of the foveola (268 ± 67 μm). In multivariate analysis, thicker SFCT was (overall correlation coefficient r: 0.51) associated with shorter axial length (P < 0.001; standardized correlation coefficient β: -0.48; B: -23.7; 95% confidence interval [CI]: -27.2 to -20.3), male sex (P = 0.006; β: -0.08; B: -10.7; 95% CI: -18.3 to -3.11), and younger age (P = 0.04; β: -0.07; B: -1.46; 95% CI: -2.85 to -0.07)., Conclusions: As in adults, thicker SFCT in children and teenagers was markedly associated with shorter axial length, and to a lesser degree with male sex and older age. As in adults, increasing axial myopia in teenagers is associated with choroidal thinning and development of a leptochoroid.

Purpose: To evaluate the effect of surgical posterior scleral reinforcement in extremely myopic patients (axial length ≥30 mm) with myopic foveoschisis., Methods: The retrospective interventional case series study included patients with an axial length ≥30 mm, posterior scleral staphyloma, and myopic foveoschisis, who were treated either by posterior scleral reinforcement and 23-gauge 3-port pars plana vitrectomy (posterior scleral reinforcement group) or by vitrectomy (vitrectomy group) alone. All eyes additionally underwent cataract surgery., Results: The study included 28 patients (28 eyes) with no significant (all P > 0.05) difference between the posterior scleral reinforcement group (n = 14) and the vitrectomy group (n = 14) in age, refractive error, axial length, and preoperative best-corrected visual acuity (BCVA). In addition to posterior scleral staphyloma and foveoschisis, a macular hole, a macular hole-associated retinal detachment, and a macular detachment without macular hole were present in three eyes, five eyes, and one eye, respectively in the study group and in three eyes, three eyes, and six eyes, respectively in the control group. In the study group, BCVA was significantly better after surgery than at baseline (P = 0.005) with an improvement in BCVA in 13 eyes, whereas BCVA was unchanged in 1 eye. In the control group, BCVA at baseline and at the end of follow-up did not differ significantly (P = 0.22). Gain in BCVA was marginally significantly higher in the study group than that in the control group (improvement by 0.69 ± 0.76 logMAR vs. 0.19 ± 0.54 logMAR; P = 0.05). The number of eyes with any improvement in BCVA (13 [93%] eyes vs. 11 [79%] eyes; P = 0.289) did not differ between both groups; an improvement in BCVA by more than 2 lines (10 [71%] eyes vs. 3 [21%] eyes; P = 0.009) was significantly higher in the study group than that in the control group. Anatomical success (defined as closure of macular holes and collapse of the foveoschisis) was achieved earlier in the study group (3.7 ± 3.2 months vs. 6.2 ± 3.0 months; P = 0.04)., Conclusion: Posterior scleral reinforcement in association with vitrectomy, as compared with vitrectomy alone, was associated with a higher improvement in visual acuity in extremely myopic eyes with foveoschisis.

Background: The aim of this study was to determine whether pretreatment spectral-domain optical coherence tomographic (SD-OCT) features are associated with visual prognosis after treatment for idiopathic subfoveal choroidal neovascularization (ISCNV) with intravitreal ranibizumab., Methods: We retrospectively evaluated SD-OCT images of eyes with ISCNV undergoing treatment with intravitreal ranibizumab with a mean follow-up of 7 months., Results: This study included 22 patients (22 eyes) with a mean age of 32.7 ± 8.1 years. In univariate analysis, better final visual acuity expressed in logMAR units was significantly associated with a lower amount of pretreatment ellipsoid zone defects (p = 0.03; standardized correlation coefficient β = 0.46) and a lower amount of pretreatment external limiting membrane (ELM) damage (p = 0.007; β = 0.56). All other SD-OCT parameters were not significantly associated with final visual acuity. A higher improvement in visual acuity was marginally significantly associated with larger pretreatment ellipsoid zone defects (p = 0.049; β = -0.43)., Conclusions: The integrity of the outer retinal layers at baseline, in particular of the ELM, is of importance in predicting the final visual outcome in patients undergoing intravitreal medical therapy for ISCNV., (© 2015 S. Karger AG, Basel.)

Purpose: To examine the association between best corrected visual acuity (BCVA) and subfoveal choroidal thickness., Design: Population-based study., Methods: The Beijing Eye Study 2011 included 3468 subjects with ages of 50+ years. The participants underwent an ophthalmologic examination including spectral-domain optical coherence tomography with enhanced depth imaging for measurement of choroidal thickness. BCVA was measured as logarithm of the minimal angle of resolution., Results: Of the 3468 participants, choroidal measurements were available for 3233 (93.2%) subjects. In multivariate analysis, better BCVA was significantly associated with thicker subfoveal choroid (P < 0.001) in general and a subfoveal choroid thicker than 30 μm (P < 0.001) in particular, after adjusting for younger age (P < 0.001), higher level of education (P < 0.001), taller body stature (P < 0.001), higher body mass index (P = 0.005), absence of glaucoma (P = 0.001), absence of diabetic retinopathy (P < 0.001), absence of late-stage age-related macular degeneration (P < 0.001), and axial length shorter than 26.0 mm (P < 0.001) (correlation coefficient r:0.56). If eyes with glaucoma, diabetic retinopathy, late-stage age-related macular degeneration or myopic retinopathy were excluded, better BCVA was still significantly associated with thicker subfoveal choroid (P < 0.001) and subfoveal choroid thicker than 30 μm (P < 0.001) in multivariate analysis. In a reverse manner, thicker subfoveal choroid was associated with better BCVA (P < 0.001) after adjusting for younger age (P < 0.001), male gender (P < 0.001), longer axial length (P < 0.001), and higher corneal curvature radius (P < 0.001)., Conclusions: Better visual acuity is strongly associated with thicker subfoveal choroid independent of additional factors, such as age, axial length, education level, and major ocular diseases., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: To assess the target refractive error after cataract surgery to achieve best uncorrected visual acuity for both distance vision and reading vision., Methods: The study included patients consecutively undergoing routine phacoemulsification with clear corneal incisions and implantation of a foldable monofocal intraocular lens (IOL). Uncorrected distance visual acuity (UCDVA), best-corrected distance visual acuity (BCDVA), uncorrected near visual acuity (UCNVA,) and best-corrected near visual acuity were measured at 93 ± 47 days (minimum 4 weeks) after surgery. Inclusion criteria were a postoperative cylindrical refractive error ≤1.5 D and an unremarkable postoperative status., Results: The study included 493 eyes of 493 patients with a mean age of 74.2 ± 8.7 years and mean axial length 23.4 ± 1.1 mm. The UCDVA significantly (p<0.001) increased with decreasing myopic refractive error (spherical equivalent) towards emmetropia and then significantly (p<0.001) decreased with increasing hyperopic refractive error. The UCNVA significantly (p<0.001) decreased with decreasing myopic and increasing hyperopic refractive error. The ascending UCDVA line and the descending UCNVA line intersected in the refractive error range (spherical equivalent) of -1.00 D to -1.50 D. For patients with a BCDVA of ≥20/25, the lines of UCDVA and UCNVA intersected at a UCDVA range between 20/40 (logMAR 0.30; -1.5 D) and 20/32 (logMAR 0.26; -1.0 D) and at a UCNVA range between Jaeger 3 (logMAR 0.26) and Jaeger 4 (logMAR 0.32)., Conclusions: For routine unilateral cataract surgery with implantation of monofocal IOLs, target refractive error to achieve best uncorrected distance and near vision was in the range of -1.00 D to -1.50 D (spherical equivalent).

Purpose: To examine the prevalence of refractive errors and prevalence and causes of vision loss among preschool and school children in East China., Methods: Using a random cluster sampling in a cross-sectional school-based study design, children with an age of 4-18 years were selected from kindergartens, primary schools, and junior and senior high schools in the rural Guanxian County and the city of Weihai. All children underwent a complete ocular examination including measurement of uncorrected (UCVA) and best corrected visual acuity (BCVA) and auto-refractometry under cycloplegia. Myopia was defined as refractive error of ≤-0.5 diopters (D), high myopia as ≤ -6.0D, and amblyopia as BCVA ≤ 20/32 without any obvious reason for vision reduction and with strabismus or refractive errors as potential reasons., Results: Out of 6364 eligible children, 6026 (94.7%) children participated. Prevalence of myopia (overall: 36.9 ± 0.6%;95% confidence interval (CI):36.0,38.0) increased (P<0.001) from 1.7 ± 1.2% (95%CI:0.0,4.0) in the 4-years olds to 84.6 ± 3.2% (95%CI:78.0,91.0) in 17-years olds. Myopia was associated with older age (OR:1.56;95%CI:1.52,1.60;P<0.001), female gender (OR:1.22;95%CI:1.08,1.39;P = 0.002) and urban region (OR:2.88;95%CI:2.53,3.29;P<0.001). Prevalence of high myopia (2.0 ± 0.2%) increased from 0.7 ± 0.3% (95%CI:0.1,1.3) in 10-years olds to 13.9 ± 3.0 (95%CI:7.8,19.9) in 17-years olds. It was associated with older age (OR:1.50;95%CI:1.41,1.60;P<0.001) and urban region (OR:3.11;95%CI:2.08,4.66);P<0.001). Astigmatism (≥ 0.75D) (36.3 ± 0.6%;95%CI:35.0,38.0) was associated with older age (P<0.001;OR:1.06;95%CI:1.04,1.09), more myopic refractive error (P<0.001;OR:0.94;95%CI:0.91,0.97) and urban region (P<0.001;OR:1.47;95%CI:1.31,1.64). BCVA was ≤ 20/40 in the better eye in 19 (0.32%) children. UCVA ≤ 20/40 in at least one eye was found in 2046 (34.05%) children, with undercorrected refractive error as cause in 1975 (32.9%) children. Amblyopia (BCVA ≤ 20/32) was detected in 44 (0.7%) children (11 children with bilateral amblyopia)., Conclusions: In coastal East China, about 14% of the 17-years olds were highly myopic, and 80% were myopic. Prevalence of myopia increased with older age, female gender and urban region. About 0.7% of pre-school children and school children were amblyopic.

Purpose: To evaluate changes in cup/disc (C/D) diameter ratios and parapapillary atrophy in patients with non-arteritic anterior ischemic optic neuropathy (NA-AION), using morphometric methods., Methods: The clinical non-interventional study included 157 patients with unilateral or bilateral NA-AION. Optic disc photographs taken from both eyes at the end of follow-up were morphometrically examined., Results: Follow-up was 86.3±70.3 months. Horizontal and vertical disc diameters (P = 0.30;P = 0.61, respectively), horizontal and vertical C/D ratios (P = 0.47;P = 0.19,resp.), and size of alpha zone and beta zone of parapapillary atrophy (P = 0.27;P = 0.32,resp.) did not differ significantly between affected eyes and contralateral normal eyes in patients with unilateral NA-AION. Similarly, horizontal and vertical disc diameters, horizontal and vertical C/D ratios, and size of alpha zone and beta zone did not vary significantly (all P>0.05) between the unaffected eyes of patients with unilateral NA-AION and the eyes of patients with bilateral NA-AION. Optic disc diameters, C/D ratios, size of alpha zone or beta zone of parapapillary atrophy were not significantly associated with final visual outcome in the eyes affected with NA-AION (all P>0.20) nor with the difference in final visual acuity between affected eyes and unaffected eyes in patients with unilateral NA-AION (all P>0.25)., Conclusions: NA-AION did not affect C/D ratios nor alpha zone and beta zone of parapapillary atrophy. Optic disc size was not related to the final visual acuity outcome in NA-AION.

Purpose: To determine the prevalence of cataract surgery and the postoperative visual outcomes in rural central India., Setting: Villages in rural central India., Design: Cohort study., Methods: The population-based Central India Eye and Medical Study examined the prevalence of surgical pseudophakia/aphakia, the postoperative visual acuity, and the reasons for decreased postoperative vision in subjects aged 30+ in rural central India. Visual impairment was defined as (1) presenting visual acuity worse than 6/18 or (2) corrected distance visual acuity (CDVA) worse than 6/18., Results: Of the 9392 eyes (99.7%) of 4711 subjects with available data on the lens status, 318 eyes (3.4%) (234 patients, 129 women) had had cataract surgery (5.0% ± 0.3%). Cataract surgery was significantly associated with age (P<.001), female sex (P = .008), shorter axial length (P<.001), and diabetes mellitus (P<.001). The prevalence of postoperative presenting visual impairment was 63% (201/318 eyes) and of postoperative CDVA impairment, 36% (117/318 eyes). The major cause of the former was incorrect intraocular lens (IOL) power (42%); the major causes of the latter were posterior capsule opacification (24%), surgical complications (21%), age-related macular degeneration (10.3%), other macular disorders (4.3%), corneal opacities (3.4%), and glaucoma (2.0%). Surgical complications were significantly more common in the aphakic group than in the pseudophakic group (46.4% versus 2.0%; P<.001)., Conclusions: Approximately 5% of the central India population aged 30 years or older had had cataract surgery. Postoperative visual impairment was present in 2 of 3 eyes. The major reasons were incorrect IOL power and surgical complications. Improved IOL power calculations and improved surgical techniques may markedly improve postoperative outcome., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to evaluate whether baseline visual acuity and baseline anatomy of the macula influence visual outcome in patients receiving intravitreal bevacizumab as treatment of exudative age-related macular degeneration (AMD) in clinical practice., Methods: This clinical case series study included 319 patients (406 eyes) who consecutively received intravitreal injections of bevacizumab for treatment of exudative AMD. The intervals between injections were 6 weeks and postinjection examinations were performed at 4 weeks after injection. Mean follow-up was 3.6 months., Results: After 3 injections of bevacizumab, best-corrected visual acuity (BCVA) significantly (P<0.01) improved in eyes with a baseline BCVA of less than 0.2 (group 1; 138 eyes; -0.10±0.43 LogMAR) and in eyes with a baseline BCVA ≥0.2 and <0.4 (group 2; 117 eyes; -0.06±0.24 LogMAR), but BCVA deteriorated in eyes with a baseline BCVA of ≥0.4 (group 3; 151 eyes; 0.09±0.32 LogMAR). Correspondingly, regression analysis revealed that improvement in BCVA after 3 intravitreal bevacizumab injections was significantly (P=0.001) associated with a low baseline BCVA. After the first injection of bevacizumab, changes in optical coherent tomography measurements of the macula (height of subretinal fluid, macular tissue thickness) were statistically significant for group 1 (P=0.03, P=0.03, respectively) and group 2 (P=0.01, P=0.02, respectively), but not for group 3 (P=0.85, P=0.22, respectively)., Conclusions: In clinical practice, patients with exudative AMD and a baseline BCVA of <0.2 have a better prognosis for an increase in BCVA after intravitreal bevacizumab injections than patients with a higher baseline BCVA.

Purpose: To investigate the normal distribution of corneal refractive power (CRP) and its associations with other ocular and systemic parameters in the Central Indian population., Design: Population-based study., Participants: The Central India Eye and Medical Study is a population-based study performed in a rural region of Central India. The study comprised 4711 subjects aged 30+ years., Methods: A detailed ophthalmic and medical examination was performed. Horizontal and vertical CRP were measured using a non-automatic keratometer., Main Outcome Measures: Corneal refractive power., Results: After excluding pseudophakic or aphakic eyes, keratometric measurements were available on 9024 eyes of 4617 study participants (98.0%) with a mean age of 49.1±13.2 years (range, 30-100 years) and a mean refractive error of -0.20±1.52 diopters (D). Mean horizontal CRP was 44.60±1.68 D (mean ± standard deviation; range, 36.5-52.0 D), and vertical CRP was 44.62±1.74 D (range, 37.75-52.0 D) with no significant difference between both parameters (P=0.27). In multivariate analysis, CRP was significantly (P < 0.001) associated with the systemic parameters of increasing age (P < 0.001), lower level of education (P=0.02), and lower body height (P < 0.001), and with the ocular parameters of thinner central corneal thickness (P < 0.001), deeper anterior chamber (P < 0.001), shorter axial length (P < 0.001), and myopic refractive error (P < 0.001). The results remained unchanged if eyes with CRP ≥48 D were excluded., Conclusions: Horizontal CRP increased with higher age, lower level of education, lower body height, thinner central cornea, deeper anterior chamber, shorter axial length, and myopic refractive error. The association with age may be of importance for refractive surgery. The association of a steeper cornea with a shorter body stature and a shorter axial length parallels an association between shorter body length and shorter axial length without association with refractive error. The association among steeper cornea, shorter body length, and lower educational level complements the association between shorter body length and lower educational level. The correlation between steeper cornea and deeper anterior chamber may be explained geometrically., (Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess side differences in patients undergoing bilateral intravitreal bevacizumab injections as treatment of exudative age-related macular degeneration (AMD)., Methods: The clinical interventional case series study included 48 patients (96 eyes) who consecutively and bilaterally received 3 intravitreal bevacizumab injections. The mean age was 76.5±7.5 years (range: 59-88 years). Follow-up was 6 months. Main outcome parameters were best-corrected visual acuity (BCVA) and measurements by optic coherence tomography. The eyes of the same patient were assigned to a study group 1 for the eye with the higher visual acuity at baseline, and study group 2 for the contralateral eye with the lower visual acuity at baseline., Results: The increase in BCVA was significantly (P=0.02) greater in group 2 (0.07±0.25 logarithm of the minimum angle of resolution, LogMAR) than in group 1 (0.05±0.29 LogMAR). The height of a detached retinal pigment epithelium, the height of subretinal fluid, and the tissue thickness of the macula decreased significantly (P<0.05) in group 2 during follow-up, whereas these parameters did not markedly change in the eyes of group 1 (P=0.96, P=0.38, and P=0.07, respectively). The reduction in the height of a detached retinal pigment epithelium and in the height of subretinal fluid was significantly more pronounced in group 2 than in group 1 (P=0.03, P=0.04, respectively)., Conclusions: After an initial set of 3 bilateral bevacizumab injections, patients with bilateral exudative AMD have a higher likelihood for an improvement in vision in the worse-seeing eye at baseline than in the better-seeing eye.

Visual acuity is a major parameter for quality of vision and quality of life. Information on visual acuity and its associated factors in rural societies almost untouched by any industrialization is mostly non-available. It was, therefore, the purpose of our study to determine the distribution of visual acuity and its associated factors in a rural population not marked influenced by modern lifestyle. The population-based Central India Eye and Medical Study included 4711 subjects (aged 30+ years), who underwent a detailed ophthalmologic examination including visual acuity measurement. Visual acuity measurements were available for 4706 subjects with a mean age of 49.5±13.4 years (range: 30-100 years). BCVA decreased significantly (P<0.001) from the moderately hyperopic group (0.08±0.15 logMAR) to the emmetropic group (0.16±0.52 logMAR), the moderately myopic group (0.28±0.33 logMAR), the highly hyperopic group (0.66±0.62 logMAR) and finally the highly myopic group (1.32±0.92 logMAR). In multivariate analysis, BCVA was significantly associated with the systemic parameters of lower age (P<0.001), higher level of education (P<0.001), higher body stature (P<0.001) and higher body mass index (P<0.001), and with the ophthalmic parameters of more hyperopic refractive error (spherical equivalent) (P<0.001), shorter axial length (P<0.001), lower degree of nuclear cataract (P<0.001), and lower intraocular pressure (P = 0.006). The results suggest that in the rural population of Central India, major determinants of visual acuity were socioeconomic background, body stature and body mass index, age, refractive error, cataract and intraocular pressure.

Purpose: To determine the prevalence of cataract surgery and the postoperative visual outcome in the adult Chinese population living in rural and urban regions of Greater Beijing., Design: Population-based study., Participants: The Beijing Eye Study 2006 included 3251 subjects (73.3%) (aged 45+ years) of 4439 subjects who participated in the 2001 survey and returned for reexamination., Methods: The prevalence of surgical pseudophakia/aphakia was assessed, and postoperative visual acuity and reasons for decreased postoperative vision were examined. Visual impairment was defined by a presenting visual acuity (PVA) <6/18 or a best-corrected visual acuity (BCVA) <6/18., Main Outcome Measures: Prevalence of cataract surgery, lens status, and causes of visual impairment., Results: Of the 3215 (98.9% of 3251) subjects for whom data on the lens status were available, 92 (41 male, 133 eyes) had undergone cataract surgery in 1 or both eyes (prevalence rate, 2.86%; 95% confidence interval [CI], 2.28-3.44). In multivariate analysis, this rate was statistically associated with higher age (P<0.001), presence of angle-closure glaucoma (P = 0.02), and higher level of hemorrhagic retinopathy (P<0.001). The prevalence of postoperative visual impairment was 27/133 (20.3%), as defined by a PVA <6/18, and 14/133 or 10.5%, as defined by a BCVA <6/18. Aphakia (odds ratio [OR], 6.71; P = 0.02) and rural residence (OR, 4.05; P = 0.01) were significantly associated with postoperative visual impairment. The most common causes of postoperative visual impairment were uncorrected refractive error followed by hemorrhagic retinopathy and posterior capsule opacification. By comparing 2001 with 2006, the rate of cataract surgery increased, and the rate of postoperative visual impairment decreased significantly (P = 0.049)., Conclusions: In the adult population of Greater Beijing, approximately 3% of the population aged 45+ years underwent cataract surgery, the prevalence of which was associated with age, angle-closure glaucoma, and hemorrhagic retinopathy. One of 10 subjects who underwent cataract surgery had a BCVA visual of less than 6/18, and 1 of 5 subjects had a PVA of less than 6/18. Low postoperative visual acuity was associated with rural region, undercorrection of refractive error, and hemorrhagic retinopathy.

Purpose: To examine an association between the subfoveal neovascular membrane type and visual acuity change after intravitreal bevacizumab injection for exudative age-related macular degeneration (AMD)., Methods: We carried out a clinical, retrospective, interventional case-series study including 66 consecutive patients (67 eyes) with exudative AMD who received an intravitreal injection of 1.5 mg bevacizumab. Study subgroups included the occult type without or with minimally classic subfoveal neovascularization (n = 28 eyes, 42%), predominantly or purely classic subfoveal neovascularization (n = 22 eyes, 33%), and eyes with retinal pigment epithelium detachment (n = 17 eyes, 25%). Follow-up was >or= 2 months., Results: The maximal visual acuity (VA) gain (mean +/- standard deviation - 0.07 +/- 0.30 logMAR, 0.5 +/- 2.9 Snellen lines; p = 0.87), and VA gain at 1 month (p = 0.10), 2 months (p = 0.77) and 3 months (p = 0.35) after the injection did not vary significantly between the three study subgroups. Correspondingly, a multivariate analysis did not reveal a statistically significant (p = 0.57) influence of subfoveal lesion type on gain in VA., Conclusions: Visual improvement after intravitreal bevacizumab does not differ markedly between various types of subfoveal neovascularization in AMD.

Objective: To evaluate factors associated with high myopia (defined as a myopic refractive error exceeding -8 diopters) in a population-based study., Design: Population-based prevalence study., Participants: The Beijing Eye Study included 4439 participants from among 5324 individuals from a rural area and an urban region of Greater Beijing, > or =40 years old and invited to participate (response rate, 83.4%)., Methods: Interview and detailed ophthalmic examination., Main Outcome Measures: Refractive error, microvascular retinal abnormalities, optic disc morphometry, amount of cataract, and age-related macular changes., Results: Fundus photographs and data for refractive error were available for 4319 participants (97.3%; 8484 eyes). In binary logistic regression analysis, prevalence of high myopia was significantly associated with low best-corrected visual acuity (P<0.001; 95% confidence interval [CI], 0.15-0.40), large optic disc size (P<0.001; 95% CI, 1.64-2.25), large size of beta zone (P = 0.31; 95% CI, 1.45-1.75) and alpha zone of peripapillary atrophy (P<0.001; 95% CI, 1.20-1.58), and lower macular drusen count (P = 0.020; 95% CI, 0.81-0.98). The highly myopic group had a smaller mean size of macular drusen (P = 0.03; 95% CI, 0.02-0.26) and a smaller area covered by drusen (P = 0.01; 95% CI, 0.03-0.22). In the highly myopic group, the predominant drusen type was significantly (P = 0.01; 95% CI, 0.05-0.41) more often the hard distinct drusen type than the soft drusen type, and visual field defects were significantly more common (P<0.001; odds ratio [OR], 24.0; 95% CI, 13.9-41.4) and larger (P<0.001; 95% CI, -1.67 to -1.13). The frequencies of early macular degeneration (P = 0.03; OR, 3.0; 95% CI, 1.21-7.51) and late macular degeneration (P<0.001; OR, 6.33) were significantly lower in the highly myopic group than in the non-highly myopic group. High myopia was not significantly associated with gender (P = 0.18; 95% CI, 0.76-1.05), focal arteriolar thinning (P>0.35), arteriolar sheathing (P>0.45), arteriovenous crossing abnormalities (P>0.20), self-reported diagnosis of diabetes mellitus (P = 0.54; OR, 1.36; 95% CI, 0.48-3.80), or arterial hypertension (P = 0.34; OR, 0.66; 95% CI, 0.32-1.34)., Conclusions: In the adult Chinese population, high myopia is associated with a lower number, smaller, size and less advanced type of macular drusen, a larger optic nerve head, and decreased best-corrected visual acuity. The risk of early and late macular degeneration was lower for highly myopic participants than for non-highly myopic participants.

Objective: The aim of this study was to compare the visual acuity change after an intravitreal high-dose injection of triamcinolone acetonide (TA) in various types of exudative age-related macular degeneration (AMD)., Participants: The interventional comparative case series study included 142 patients (146 eyes) with progressive exudative AMD differentiated into the occult type (n = 78; 53.4%), minimal classic type (n = 45; 30.8%), predominantly classic type (n = 17; 11.6%), and the purely classic type (n = 6; 4.1%). Mean follow-up was 9.7 +/- 7.0 months (3-35.7 months)., Methods: Single intravitreal injection of approximately 20 mg of TA., Outcome Measures: Visual acuity, intraocular pressure (IOP)., Results: Gain in visual acuity measured at 1 month (P = 0.20), 2 months (P = 0.43), and at 3 months (P = 0.38) after the intravitreal injection of triamcinolone and maximal gain in visual acuity during the whole follow-up (P = 0.81) did not vary significantly between the 4 study groups. Correspondingly, the size of a retinal pigment epithelium detachment was not significantly associated with the change in visual acuity at 1 month (P = 0.62), 2 months (P = 0.24), 3 months (P = 0.96), or the maximal gain in visual acuity during follow-up (P = 0.93). The amount of rise in IOP, compared with the baseline value (6.5 +/- 7.4 mmHg), was statistically not associated with the type of subfoveal membrane (P = 0.20; 95% confidence interval: -0.52, 2.45)., Conclusions: The change in visual acuity and the rise in IOP in patients with exudative AMD receiving an intravitreal triamcinolone monotherapy is statistically independent of the type of subfoveal membrane, including the size of a retinal epithelium detachment.

Objective: To evaluate which factors influence maximum gain in best-corrected visual acuity after intravitreal injection of triamcinolone acetonide as treatment for diffuse diabetic macular edema., Methods: This prospective clinical interventional study included 53 eyes with diffuse diabetic macular edema receiving an intravitreal injection of about 20 mg of triamcinolone. The mean +/- SD follow-up was 10.2 +/- 7.6 months., Results: In a multiple linear regression analysis, maximum gain in best-corrected visual acuity after the intravitreal injection of triamcinolone was significantly (P < .001) and negatively correlated with an increased degree of macular ischemia and a higher preoperative visual acuity. Improvement in best-corrected visual acuity was significantly and positively correlated with increased degree of macular edema (P = .001). Change in best-corrected visual acuity after the intravitreal triamcinolone injection was statistically independent (P > .15) of age, sex, pseudophakia, and macula grid laser treatment before inclusion into the study. The results were comparable for gain in visual acuity at 6 months after the injection., Conclusion: Pronounced macular edema may have a positive impact, and marked macular ischemia and a high preoperative best-corrected visual acuity may have a negative impact, on an increase in best-corrected visual acuity after intravitreal triamcinolone injection in patients with diabetic macular edema.

Purpose: To report on visual outcome after intravitreal injection of triamcinolone acetonide for exudative age-related macular degeneration., Design: Interventional comparative non-randomized clinical trial., Setting: Institutional., Patients: Twenty consecutive patients with bilateral exudative age-related macular degeneration with minimally classic or occult subfoveal neovascularisation., Interventions: Unilateral intravitreal injection of about 20 mg triamcinolone acetonide into the eye (study group) more severely affected or showing more pronounced progression of the disease. Mean follow-up was 13.5 +/- 4.1 months., Main Outcome Measures: Visual acuity., Results: In the study group, visual acuity increased significantly (P < 0.001) from 0.96 +/- 0.32 logMar to a mean maximum of 0.76 +/- 0.30 logMar during follow-up. An increase in best visual acuity during follow-up was found in 18 (90%) eyes. In 11 (55%) eyes and 7 (35%) eyes, respectively, best visual acuity increased by at least two Snellen lines and three Snellen lines, respectively. In the control group, visual acuity at baseline and the highest visual acuity measurements during follow-up did not vary significantly (P = 0.90). Comparing study group and control group, visual acuity gain was significantly (P = 0.003) higher in the study group. Correspondingly, the number of eyes with an increase in visual acuity (P = 0.002) and with an increase in visual acuity higher > or = 3 lines compared to a loss of > or = 3 lines was significantly (P = 0.027) higher in the study group., Conclusions: Intravitreal triamcinolone acetonide may temporarily increase visual acuity in eyes with exudative age-related macular degeneration.

Purpose: To evaluate visual outcome after allogenic penetrating keratoplasty., Methods: The clinical non-randomized retrospective comparative interventional study included 245 patients undergoing allogenic penetrating keratoplasty for keratoconus ( n=77), herpetic corneal scars ( n=29), non-herpetic corneal scars ( n=46), Fuchs endothelial dystrophy ( n=24), and pseudophakic/aphakic bullous keratopathy ( n=69). All patients were consecutively operated on by the same surgeon. The duration of follow-up had to exceed 1 year., Results: Increase in visual acuity and the best-corrected postoperative visual acuity were significantly ( P<0.01) highest for the patients with keratoconus (visual acuity increase from 0.16 to 0.69), followed by those with herpetic corneal scars (from 0.18 to 0.58), Fuchs corneal endothelial dystrophy (from 0.13 to 0.48), non-herpetic corneal scars (from 0.13 to 0.36), and finally patients with pseudophakic/aphakic bullous keratopathy (from 0.05 to 0.28). The increase in visual acuity expressed in lines did not vary significantly ( P>0.05) among the study groups. Visual acuity increased significantly after suture removal, with no significant ( P>0.20) difference between the study groups. Visual acuity was significantly ( P<0.001) and positively correlated with the diameter of the corneal graft. Multiple linear regression analysis revealed that graft size, keratometric astigmatism and reason for keratoplasty were the major factors significantly ( P<0.05) influencing postoperative visual acuity., Conclusions: The main predictive factors for visual outcome after allogenic penetrating keratoplasty are reason for keratoplasty and graft size. Postoperative visual acuity is significantly the highest in keratoconus and significantly the lowest in pseudophakic/aphakic bullous keratopathy. Expressed in lines, increase in visual acuity does not differ significantly among groups of patients with different reasons for keratoplasty.

To explore the prevalence and causes of loss of visual acuity and visual field in highly myopic eyes. Population-based study. 4439 subjects of the Beijing Eye Study underwent ophthalmological and systemic examinations including frequency doubling technology perimetry. High myopia was defined by a refractive error of ≤–6 diopters (D) or axial length >26.0 mm. Prevalence of vision impairment causes. 212 highly myopic eyes from 154 participants were included with a mean age of 56.2 ± 9.6 years, a mean refractive error of –9.87 ± 3.70 D and a mean axial length of 27.2 ± 1.3 mm. We observed moderate/severe vision impairment (MSVI) in 40 eyes (18.9%; 95% confidence interval [CI], 13.6–24.2) and blindness in 10 eyes (4.7%; 95% CI, 1.8–7.6). Primary causes for MSVI and blindness were myopic macular degeneration (MMD) (29/50; 58%), age-related macular degeneration (1/50; 2%), and branch macular retinal vein occlusion (1/50; 2%). Secondary causes were MMD (4/50; 8%) and optic nerve atrophy (14/50, 28%), further differentiated into non-glaucomatous optic atrophy (NGOA) (9/50; 18%) and glaucomatous optic atrophy (GOA) (5/50; 10%). Prevalence of MMD as vision impairment cause increased significantly from 1/61 (1.6%) in the refractive error group of –6.00 to ≥–7.00 D, to 16/25 (64%) in the group of <–15.0 D. Higher MMD prevalence correlated with higher myopic refractive error (P < 0.001) and increased likelihood of concomitant optic neuropathy (P < 0.001). Similarly, prevalence of optic neuropathy as vision impairment cause increased from 0/61 (0%) in the refractive error group of –6.00 D to ≥–7.00 D, to 9/25 (36%) in the group of <–15.0 D. Higher optic neuropathy prevalence correlated with more myopic refraction (P < 0.001) and older age (P = 0.02). In this population-based recruited cohort of highly myopic patients, optic neuropathy accounted for vision impairment in 9.0% eyes, which was lower than the prevalence of MMD as vision impairment cause (18.9%). Notably, optic neuropathy became a significant contributor to vision impairment in more advanced high myopia, reaching 36% in the group with refractive error of <–15.0 D. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

To assess prevalence of mild vision impairment (MVI; best corrected visual acuity (BCVA) < 6/12 to 6/18 in the better eye), moderate-to-severe vision impairment (MSVI; BCVA < 6/18 but ≥ 3/60) and blindness (BCVA < 3/60) in a local population in Russia, we conducted the population-based Ural Eye and Medical Study. Out of 7,328 eligible individuals aged 40 + years, 5,899 (80.5%) individuals participated. MVI was present in 184 (3.1%; 95% confidence interval (CI) 2.7, 3.6) individuals, MSVI in 182 (3.1%; 95% CI 2.7, 3.5) individuals, and 11 individuals (0.19%; 95% CI 0.008, 0.30) were blind. Causes for MSVI were cataract (n = 109; 59.9%), late stage of age-related macular degeneration (n = 14; 7.7%; geographic atrophy and neovascular AMD in 7 (3.8%) individuals) each), myopic maculopathy (n = 11; 6.0%), glaucoma (n = 9; 4.9%), non-glaucomatous optic nerve damage (n = 5; 2.7%), and diabetic retinopathy (n = 4; 2.2%). Causes for blindness were cataract (n = 3; 27.3%), myopic maculopathy (n = 2; 18.2%), retinal dystrophies (n = 2; 18.2%), glaucoma (n = 1; 9.1%), and corneal scars (n = 1; 9.1%). Higher prevalence of MSVI/blindness was associated with age (P < 0.001; odds ratio (OR)1.10; 95% CI 1.08, 1.12), male gender (P < 0.001; OR 2.32; 95% CI 1.47, 3.66), educational level (P < 0.001; OR 0.83; 95% CI 0.76,0.92), manual grip force (P < 0.001; OR 0.94; 95% CI 0.92, 0.96), diabetes prevalence (P = 0.006; OR 1.67; 95% CI 1.08, 2.56) and axial length (P < 0.001; OR 1.43; 95% CI 1.26,1.62). In this population from Bashkortostan/Russia, prevalence of MVI, MSVI and blindness was 3.1%, 3.1% and 0.19%, respectively. Cataract was the most frequent cause of reversible vision impairment, while AMD, myopic maculopathy and glaucoma were the most common reasons for irreversible vision impairment. [ABSTRACT FROM AUTHOR]

Purpose: To assess the normal distribution of axial length and its associations in a population of Russia. Methods: The population-based Ural Eye and Medical Study included 5,899 (80.5%) individuals out of 7328 eligible individuals aged 40+ years. The participants underwent an ocular and systemic examination. Axial length was measured sonographically (Ultra-compact A/B/P ultrasound system, Quantel Medical, Cournon d'Auvergne, France). Results: Biometric data were available for 5707 (96.7%) individuals with a mean age of 58.8±10.6 years (range:40–94 years; 25%, 50%, 75% quartile: 51.0, 58.0, 66.0 years, respectively). Mean axial length was 23.30±1.10 mm (range: 19.02–32.87mm; 95% confidence interval (CI): 21.36–25.89; 25%, 50%, 75% quartile: 22.65mm, 23.23mm, 23.88mm, resp.). Prevalences of moderate myopia (axial length:24.5-<26.5mm) and high myopia (axial length >26.5mm) were 555/5707 (8.7%;95%CI:9.0,10.5) and 78/5707 (1.4%;95%CI:1.1,1.7), respectively. Longer axial length (mean:23.30±1.10mm) was associated (correlation coefficient r2:0.70) with older age (P<0.001;standardized regression coefficient beta:0.14), taller body height (P<0.001;beta:0.07), higher level of education (P<0.001;beta:0.04), higher intraocular pressure (P<0.001;beta:0.03), more myopic spherical refractive error (P<0.001;beta:-0.55), lower corneal refractive power (P<0.001;beta:-0.44), deeper anterior chamber depth (P<0.001;beta:0.20), wider anterior chamber angle (P<0.001;beta:0.05), thinner peripapillary retinal nerve fiber layer thickness (P<0.001;beta:-0.04), higher degree of macular fundus tessellation (P<0.001;beta:0.08), lower prevalence of epiretinal membranes (P = 0.01;beta-0.02) and pseudoexfoliation (P = 0.007;beta:-0.02) and higher prevalence of myopic maculopathy (P<0.001;beta:0.08). In that model, prevalence of age-related macular degeneration (any type: P = 0.84; early type: P = 0.46), diabetic retinopathy (P = 0.16), and region of habitation (P = 0.27) were not significantly associated with axial length. Conclusions: Mean axial length in this typically multi-ethnic Russian study population was comparable with values from populations in Singapore and Beijing. In contrast to previous studies, axial length was not significantly related with the prevalences of age-related macular degeneration and diabetic retinopathy or region of habitation. [ABSTRACT FROM AUTHOR]

The 56th World Health Assembly passed a resolution in 2003 to eliminate avoidable blindness and urged member states to develop a national Vision 2020 plan.[1] In Australia, this led to the establishment of the National Eye Health Framework that would work in combination with non-government organizations and the private sector to achieve these goals.[2] As we move into 2020, we should ponder the question as to the progress towards this objective. Associated risk factors were older age (OR 3.59), habitation in outer regional areas (OR 1.78) and lack of an eye examination in the previous 2 years (OR 1.5) for the Indigenous group. 6 Keel S, Foreman J, Xie J, Taylor HR, Dirani M. Prevalence and associations of presenting near-vision impairment in the Australian national eye health survey. [Extracted from the article]

Purpose: Since there is a scarcity on population-based health information available for Russia, we conducted this project to assess the prevalence of major ocular and systemic disorders and their associated risk factors. Methods: A population-based cross-sectional study (Ural Eye and Medical Study (UEMS)) was performed in Bashkortostan 1300 km east of Moscow. The sampling frame consisted of all inhabitants aged over 40 years and living in an urban study area in the capital city Ufa and a rural region at 65 km outside of Ufa. The target sample size was 2500 individuals for the urban region and 2500 persons for the rural region. The study participants underwent a detailed interview, a detailed ophthalmologic examination including biometry and optical coherence tomography, and clinical examination including assessment of electrocardiography, hearing test, blood sampling, spirometry, and hand grip dynamometry. Results: After a first study period, the study population included 4254 individuals with a mean age of 60.3 ± 11.1 years (range: 40-94 years), mean body weight of 74.8 ± 14.4 kg (range: 31-170 kg), body height of 163.6 ± 8.9 cm (range: 112-196), body mass index of 28.0 ± 5.1 kg/m2 (range: 13.96-60.96 kg/m2), mean systolic blood pressure of 133.7 ± 21.0 mmHg (range: 84-232 mmHg), and mean diastolic blood pressure of 81.2 ± 10.6 mmHg (range: 40-134 mmHg). Mean refractive error was −0.21 ± 1.94 D and mean intraocular pressure was 13.6 ± 3.9 mmHg. Conclusions: The UEMS provides population-based normative data for a Russian region on the quantitative traits such as axial length, quality of life and lifestyle including smoking and alcohol consumption, and prevalence and risk factors of ocular and systemic diseases such as diabetes mellitus, arterial hypertension, chronic obstructive pulmonary disease, and depression. [ABSTRACT FROM AUTHOR]

Purpose: To assess prevalence and associated factors of myopia and high myopia in schoolchildren in Greater Beijing. Methods: The school-based, cross-sectional Greater Beijing School Children Myopia study was carried out in the year 2016 in 54 schools randomly selected from 15 districts in Beijing. Non-cycloplegic auto-refractometry of the right eyes was performed. Results: The study included 35,745 (99.4%) out of 35,968 eligible pupils with a mean age of 12.6±3.4 years (range 6–18 years). Prevalence of myopia defined as myopic refractive error of ≥-0.50 diopters (D),≥-1D,≥-6D,≥-8D and ≥-10D was 70.9%(95% confidence intervals (CI):70.5,71.4), 60.9% (95%CI:60.4,61.4), 8.6%(95%CI:8.4,8.9), 2.2%(95%CI:2.0,2.4), and 0.3% (95%CI:0.3,0.4), respectively. The frequency of high myopia (≥-6D, ≥-8D, ≥-10D) increased from 1.5% (95%CI:1.0,2.0), 0.4% (95%CI:0.1,0.6) and 0.1% (95%CI:0.00,0.02), respectively in 10-year-olds to 19.4% (95%CI:17.3,21.6), 5.2% (95%CI:4.0,6.4) and 0.9% (95%CI:0.4,1.5), respectively, in 18-year-olds. Mean refractive error in the 18-year-olds was -3.74±2.56D (median:-3.63D;range:-19.6D to + 6.25D). Higher prevalence of high myopia (≥-6D and ≥-8D) was correlated (all P<0.001) with older age (OR:1.18, and 1.15, respectively), female gender (OR: 1.44 and 1.40, respectively), higher body mass index (OR: 1.02 and 1.03, respectively), taller body height (OR: 1.03 and 1.02, respectively), urban region of habitation (OR: 1.26 and 1.33, respectively) and higher school type (OR:1.57 and 2.22, respectively). Prevalence of severe high myopia (≥-10D) was associated only with older age (P<0.001; OR: 1.44; 95%CI: 1.31, 1.59) but not with any education-related parameter such as higher school type (P = 0.48), urban region of habitation (P = 0.07) or female gender (P = 0.37). Conclusion: In this most recent survey, prevalence of high myopia (≥-6D:19.4%;≥-8D:5.2%;≥-10D:0.9%) in 18-year-old school children was higher than in previous surveys from mainland China. In contrast to minor high myopia and moderate high myopia (defined as myopic refractive error of <-10D), severe high myopia (myopic refractive error ≥-10D) was not strongly correlated with educational parameters. [ABSTRACT FROM AUTHOR]