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Sedation with chloral hydrate or anesthesia using propofol allow ocular examination and testing in young children, but these drugs may affect electrophysiologic recordings. We compared the flash and pattern ERGs and VEPs recorded with each drug in a cohort of young children enrolled in a prospective study of optic nerve hypoplasia (ONH) syndrome. ERGs and VEPs to light-adapted, standard, full-field flashes, to standard and steady-state pattern-reversal (PR) were recorded with cycloplegia in 9 participants. Age range at the first session, with chloral hydrate was 8–23 mo; at the second session with propofol it was 20–29 mo. Examiners masked to the drug and clinical conditions measured the waveforms for longitudinal, paired comparisons between the sessions. Flash ERG amplitudes did not differ between sessions; peak times were longer at the second session (propofol) by clinically insignificant amounts ( 10 mo between sessions (n = 5, 10 eyes) but not for those with a shorter inter-test interval ( 0.05, n = 4). Magnitudes of the steady-state PERGs did not differ between tests but the waveforms had earlier peaks at the second test with propofol. Flash VEP waveforms were present in 10/18 eyes and showed 72% agreement for recordability between sessions. Standard pattern VEPs were recordable in only a few eyes in this cohort with ONH. Light-adapted flash ERG waveforms were generally similar with chloral hydrate and with propofol. Larger PERGs with later peaks, found in the second session (propofol) could reflect maturation of the PERG generators, as the differences found were associated with a greater age difference between the sessions, but we do not rule out that small differences in the waveforms may be drug-related. There are insufficient VEP data from these children with ONH to identify drug-related or maturational effects on VEPs.

To compare the differences between cycloplegic and noncycloplegic refraction as well as associated factors in grade one students of primary schools, and explore the effectiveness of noncycloplegic refraction for refractive error screening.Cross-sectional study.A school-based study of 1856 students was conducted in Lhasa, Tibetan Plateau, China. Cycloplegia was achieved with two drops of 1% cyclopentolate and 1 drop of Mydrin P at a 5-min interval. Autorefraction was performed under both cycloplegic and noncycloplegic conditions. Bland-Altman analysis, receiver operating characteristic curve analysis, univariate and multiple linear regression models were used for analysis.Of the 1856 children enrolled, 1830 (98.60%) completed all procedures. The average age was 6.83 ± 0.46 years. 965 (52.73%) children were boys and 1737 (94.92%) were Tibetan. Overall, there was a significant difference between cycloplegic and noncycloplegic SE of 0.90 ± 0.76D (P 0.001). However, the intra-class coefficient correlation (ICC) for cylinder between these two methods was high (ICC = 0.941, 95% CI, 0.935-0.946). Larger differences between cycloplegic and noncycloplegic SE were associated with hyperopic RE and higher cylindrical value (P 0.001). The prevalence of myopia, emmetropia and hyperopia with and without cycloplegia was (3.93% vs 14.59%), (9.95% vs 45.8%) and (86.21% vs 39.56%), respectively. Myopia, emmetropia and hyperopia based on noncycloplegic refraction was defined as SE ≤ - 0.625D, - 0.625 SE ≤ 0D, and SE 0D, respectively.Lack of cycloplegia leads to underestimation of hyperopia, with overestimation of myopia and emmetropia. Larger hyperopic refraction exhibited greater difference between cycloplegic and noncycloplegic refraction.

Purpose To evaluate refraction and its development in young adults born prematurely, screened for retinopathy of prematurity, and to compare with individuals of the same age born at term. Materials and methods The participants were 59 preterms, with a birthweight of ≤ 1500 g, and 43 term-born controls, all born during 1988-1990. The refraction was measured in cycloplegia, and the spherical equivalent (SE) was calculated. The axial length (AL), anterior chamber depth and corneal radius (CR) were measured, and the AL/CR ratio was calculated. Results The mean SE was -0.5 dioptres (D) (SD 2.5) in right eyes (REs) and -0.4 D (SD 2.3) in left eyes (LEs) of preterms, and -0.2 D (SD 1.5) in REs and -0.2 D (SD 1.5) in LEs of controls. The distribution of refraction was wider in the preterm group compared to the control group. In the preterm group, 12% had a SE ≥ 1.5 D, but none of the controls. Ten preterms, but none of the controls, had anisometropia ≥ 1.0 D. The prevalence of astigmatism ≥ 1.0 D was higher in preterms than controls. The SE decreased around 1 D in both preterms and controls from 10 to 25 years of age. The AL and CR were shorter in the preterms; however, the AL/CR ratio was similar in both groups. Within the preterm group, cryotherapy was correlated with astigmatism, but not with SE and anisometropia at this age. Conclusion Prematurely born individuals had higher prevalence of refractive errors in young adulthood compared to term-born controls.

PURPOSE: To present a case where following Implantable Collamer Lens (ICL) implantation the patient developed toxic anterior segment syndrome (TASS) with a subsequent pupillary block as a consequence of the occlusion of the AquaPORT (STAAR Surgical) flow hole. METHODS: Case report and literature review. RESULTS: A V4c toric ICL (STAAR Surgical) was implanted in the left eye of a 32-year-old woman. After 1 week, the lens was 15° off axis and uneventful lens alignment correction was performed. At postoperative day 1, an intraocular pressure (IOP) of 11 mm Hg and mild corneal edema were observed. At postoperative day 7, there was an uncorrected distance visual acuity of 20/800, an IOP of 44 mm Hg, diffuse corneal edema, and fibrin strands in the anterior chamber. TASS was diagnosed and topical steroids, cycloplegia, antiglaucoma drops, and oral acetazolamide were prescribed. At postoperative day 9, dispersed endothelial pigment with a fixed mid-dilated pupil were identified. Anterior segment optical coherence tomography showed strands of fibrin blocking the central ICL hole and angle closure. Pupillary block related to the fibrin occluding the AquaPORT hole consecutive to TASS was diagnosed. The patient underwent ICL removal, but had a persistent atonic, hyporeflexive pupil as a complication. CONCLUSIONS: This case demonstrates that an AquaPORT hole may not be enough to prevent pupillary block in cases with postoperative intraocular inflammation, causing severe postoperative complications such as Urrets-Zavalia syndrome. Clinicians should consider this diagnosis in cases with corneal edema in the early postoperative period following AquaPORT ICL insertion. [ J Refract Surg . 2020;36(12):856–859.]

Background: Treatment of amblyopia in esotropic subjects with accommodative component currently consists of optical correction and subsequent occlusion, or penalisation, of the dominant eye. This treatment obtains a good outcome in visual acuity but poor outcomes in binocular vision. An intervention protocol that could improve the outcome of conventional treatment is presented. Methods: A retrospective study in subjects with amblyopia associated with both fully accommodative and partially accommodative esotropia is presented. Subjects were refracted under cycloplegia and treated with occlusion (passive therapy). Subjects who did not achieve orthotropia through optical correction (partially accommodative esotropia) performed an active therapy (full‐time prismatic correction and subsequent fusional vergence therapy or surgery in larger angles > 12 prism dioptres). After treatment, the subjects were examined by a masked optometrist in an external ophthalmology clinic. Results: Twenty‐six subjects (12 males and 14 females) aged from six to 13 years (median 8.50; interquartile range [IQR] 3) were included. Median age of detection was three years (IQR 1). All the subjects were hyperopic. In the baseline, median best‐corrected visual acuity of the amblyopic eye was 0.40 logMAR (IQR 0.30) and 0.00 logMAR (IQR 0.01) in the dominant eye. After the treatment, the median best‐corrected visual acuity in the amblyopic eye was 0.06 logMAR (IQR 0.08). These differences were statistically significant (p

Background: Discrepancies have been reported between the results of objective refraction obtained with autorefraction (AR), retinoscopy, and the correction which is accepted by patients on subjective refraction. Aims: To assess the refractive status of school age children using retinoscopy and autorefraction, and estimate the accuracy of each in acceptance of subjective correction. Study Settings & Design: It was a prospective cohert study. Materials and Methods: School children of 6-15 years were enrolled for the study, after obtaining informed consent from the parent/guardian and assent from the children. 140 eyes of 70 children were evaluated in this study. Cycloplegia achieved using Cyclopentolate 1% eye drops and was examined by both retinoscopy and autorefraction. Subjective refraction was done and the relative accuracy of both methods with respect to subjective correction was noted. Statistical Analysis: The results were compared and statistical analysis was carried out using Chi-square test with p0.05. Results: The spherical power estimated by retinoscopy, was accepted subjectively by 89.3% eyes, while 35% eyes accepted the spherical refractive power estimated by autorefraction. The cylindrical power, estimated by retinoscopy, was accepted by 49.2% eyes, while, 72.8% eyes accepted AR values. Estimation of axis of cylinder on retinoscopy were accepted by 55.7% eyes, while those of autorefraction by 75.7% eyes. The diagnostic accuracy of retinoscopy and autorefraction were comparable, but higher agreement was found with retinoscopy for spherical power component, while autorefraction was slightly better for cylindrical refractive error. Conclusion: Conventional retinoscopy is still the most accurate objective method to estimate the refractive status in children and can be considered a reliable starting point for subjective refraction, however, autorefraction has comparable accuracy and can be a valuable aid to prescribe cylindrical correction. Keywords: Autor

Purpose: To compare the changes in higher order aberrations (HOA’s) for photopic and mesopic pupil diameters in children undergoing orthokeratology treatment (OK) or combined 0.01% atropine with orthokeratology treatment (AOK), and their association with axial elongation. Methods: Children aged 6 to

Purpose: To evaluate the efficacy and tolerability of cyclopentolate 1% administered as a spray in pediatric patients between 3 and 6 years old. Methods: In this prospective, randomized, parallel group study, healthy volunteers were randomly assigned to receive cyclopentolate 1% as a single drop or a single puff into closed eyes. Results: There were 61 patients included in the study; 31 received cyclopentolate 1% as drops and 30 received cyclopentolate 1% as spray. The mean age at presentation was 4.5 ± 1.07 years (range: 3 to 6 years) and 4.2 ± 1.06 years (range: 3 to 6 years) in the drops and spray groups, respectively. The distress level was significantly lower at the time of receiving cyclopentolate as a spray ( P < .0001), with the exception of patients aged 6 years. There were no significant differences in pupil diameter between the two groups ( P = .51), whereas 5 of 30 patients (16.6%) with dark irises who received cyclopentolate spray did not have adequate cycloplegia to allow for accurate refraction. Conclusions: Cycloplegia achieved with cyclopentolate 1% administered as a spray may be an option in uncooperative children because it is less distressing compared to cyclopentolate 1% drops. However, physicians should be aware that cycloplegia obtained is only partially effective in children with dark irises. [ J Pediatr Ophthalmol Strabismus . 2020;57(5):301–304.]

BACKGROUND: To investigate the effect of cycloplegia on the ocular biometry and intraocular lens (IOL) power in different age groups. METHODS: This cross-sectional study enrolled 240 right eyes of 240 healthy volunteers. Three groups were formed (range to years; group 1: 50–60, group 2: 30–40 and group 3: 10–20, respectively). We measured keratometry, central corneal thickness (CCT), white-to-white (WtW) distance, anterior chamber depth (ACD), and axial lentgh (AL) both before and after cycloplegia. The IOL powers were calculated using Sanders–Retzlaff–Kraff/theoretical (SRK/T), Holladay 1 and Haigis formulas. AL-Scan (Nidek Co., Gamagori, Japan) was used for all measurements. RESULTS: There was a significant increased in keratometry, CCT, ACD, AL, and Holladay 1 after cycloplegia (p 0.05). Keratometry, SRK/T, Haigis, and Holladay 1 significantly decreased; ACD and WtW significantly increased postcycloplegia (p 0.05). Significant increased in ACD, CCT, WtW, and AL, significant decreased in SRK/T and Haigis were observed postcycloplegia (p 0.05). CONCLUSIONS: This study demonstrated there is significant difference in many ocular parameters and IOL power formulas before and after cycloplegia. Especially, ACD showed significant changes in all age groups. Therefore, to avoid refractive prediction errors the IOL power calculation formulas using the ACD should be considered.

Purpose: This study was conducted to assess the prevalence of refractive error among secondary school students, as well as their intention to use prescription glasses regularly.Methods: This was a cross-sectional school-based study with a qualitative component. A total of 359 secondary students aged 11-22years, were selected by multistage sampling method from seven schools in Ogijo community, Ogun state, Nigeria. Of the 359 students, 353(98.3%) were examined. The examination included Visual acuity measurement, ocular motility tests, retinoscopy & autorefraction under cycloplegia, and anterior & posterior segment examination. The data collected were analysed using the statistical package for social sciences (SPSS).Results: The prevalence of refractive error was 11.6%, and of the 41 participants who had refractive error, 65.9% were females while 34.1% were males. Myopia was at 5.1%, while hyperopia and astigmatism were 3.7% and 2.8% respectively. Participants had adequate information (`x =16.08 SD±2.29) regarding refractive error and the use of prescription glasses, but revealed a lack of motivation towards prescription glasses use (`x15.8 SD±4.2). Overall, participants expressed good intention to regular prescription glasses use (`x =12.89 SD±3.8).Conclusion: Refractive error among secondary students of Ogijo community, Ogun state, Nigeria is relatively high. The students expressed good intention to use prescription glasses regularly if given, but on certain conditions. A comprehensive school health program that incorporates school eye health promotion should be practiced effectively to address the misconceptions regarding the use of prescription glasses among the teachers, parents and students. Keywords: Refractive errors, Adolescents, School health, community health, Health promotion.

Purpose To determine the current scope of practice with regards to cycloplegic examinations, specifically in the pediatric population. Methods A comprehensive literature review was conducted using PubMed, ScienceDirect, Elsevier, and Google Scholar databases using keywords such as "cyclopentolate"; "tropicamide"; "pediatric"; "cycloplegia"; "atropine"; and "cycloplegic" from inception to October 2019. Results Atropine has the strongest cycloplegic effect and is recommended for cases of large accommodative esotropia. Because of the undesired side effects and risks from atropine, cyclopentolate has been found to offer a very effective cycloplegia even for moderate to high hyperopia and has become the standard of care for traditional pediatric cycloplegic exams. Tropicamide has also been shown to offer adequate cycloplegia with less toxicity and side effects. Of all agents, tropicamide presents the least side effects and toxicity, whereas atropine presents the greatest. Cyclopentolate is a very safe cycloplegic agent that has risk of toxicity which increases with higher doses and concentrations. Conclusion The American Optometric Association's current pediatric cycloplegic guidelines have proven both safe and effective, as they recommend a conservative approach of using cyclopentolate 0.5% in infants and cyclopentolate 1% in those older than one-year old to avoid undesired side effects. Topical ophthalmic drops and spray instillation have both proved equally efficacious and therefore each have their place within a clinical setting. Using Cycolmydril under six months old and cyclopentolate 1% over 6 months old as recommended by the AAO, also provides a safe and effective guideline for cycloplegic examinations within the pediatric population.

Background Cycloplegics have been reported to induce changes in the lens thickness. However, the studies of correlation between cycloplegia and the lens position are limited. This study aims to investigate changes in crystalline lens rise (CLR) and other anterior segment parameters after inducing cycloplegia with tropicamide. Methods In this consecutive case study, 39 children (20 boys and 19 girls; mean age, 9.51 ± 1.75 years, mean spherical equivalence [SE], − 1.9 ± 1.5 D) with low-to moderate myopia were examined using CASIA 2 both before and after 30 min of administering 5-cycles (each 5 min apart) of 0.5% tropicamide. Measurements included CLR, crystalline lens thickness (CLT), mean radius of curvature of the anterior/posterior surface of the lens (Rf_ave/Rb_ave), anterior chamber depth (ACD), anterior chamber width (ACW), and central corneal thickness (CCT). Correlations of CLT and CLR with ACD, SE, and age were assessed respectively. Results CLT and CLR decreased significantly after cycloplegia (p p p = 0.008, p p r = 0.565, p r = − 0.430, p = 0.006; r = − 0.342, p = 0.035, respectively). Conclusions The crystalline lens appeared thinner and moved backward after cycloplegia. ACD increased mainly due to the backward movement of the crystalline lens. These results aid in elucidating the impact of crystalline lens changes during the process of accommodation.

Purpose We analyzed changes in the crystalline lens during accommodation and the effects of cycloplegics by swept-source anterior-segment optical coherence tomography (AS-OCT). Materials and methods Twenty healthy volunteers (7 males and 13 females, aged 22-34 years), with no history of eye disease except for refractive errors, were recruited. Biometric parameters, including anterior chamber depth (ACD), lens thickness (LT), and anterior and posterior curvature of the lens (ACL and PCL), were measured using AS-OCT (CASIA2). The measurements were performed with or without an accommodative demand of 5.0 diopters (D). The same tests were repeated following the topical administration of 1% cyclopentolate or a compounding agent comprising 0.5% tropicamide and 0.5% phenylephrine. Results The AS-OCT system was capable of simultaneous visualization of all optical components of the anterior segment in a single frame. ACD, LAC, and LPC decreased and LT increased significantly during 5.0 D accommodative stimulation in both eyes. Both cyclopentolate and tropicamide/phenylephrine eyedrops led to deeper ACD, thinner LT, and flatter LAC. There were no significant differences in all lens parameters despite having 5.0 D accommodative stimulation in both eyes with cycloplegia. Conclusion Our results suggest that both tropicamide/phenylephrine and cyclopentolate eyedrops have enough cycloplegic effects in young adults.

Purpose. Analysis of refractive errors’ frequency in children with retinoblastoma.Patients and Methods. A retrospective study included 57 children with retinoblastoma (31 male and 26 female) who received treatment in 2013–2017. The criteria for patient selection was the presence of mono- or bilateral retinoblastoma, as well as autorefractometry of both eyes before treatment. In all cases, the study was performed with cycloplegia. The parameters studied included gender, age at the time of the initial examination, visual acuity, spherical and cylindrical component of refraction, the axis of the cylinder.Results. Bilateral retinoblastoma was determined in 34 children (59.6 %), the average age of the patients was 18.0 ± 2.6 months. Monolateral retinoblastoma was detected in 23 patients (40.4 %), the average age at the time of check-up was 26.2 ± 3.1 months. In total, anisometropia of more than 2.0 diopters was detected in 14 patients (24.6 %), of which with monolateral RB in 6 patients (26.1 %) and in bilateral patients in 8 (23.5 %). In 26 cases (45.6 %) anisometropia was determined from 1.0 to 2.0 diopters, of which 41.1 % (n = 14) with bilateral lesion and 52.1 % (n = 12) with monolateral. The frequency of hyperopia over 3.0 diopters in the total cohort was 25.2 %, myopia 3.3 %. Significant differences (p = 0.025) were obtained by comparing the frequency of astigmatism determination of more than 1.0 D (39.6 % in the total cohort versus 13.0 % for healthy eyes). When analyzing the frequency of ametropia depending on age, a trend was observed (0.05 < p < 0.1) to reduce the frequency of hypermetropia and increase the frequency of astigmatism. Additionally, an analysis of the astigmatism’s frequency depending on the tumor localization was made. Patients with central or paracentral localization of the tumor lesion amounted to 69.4 % (n = 25), and from the peripheral — 30.6 % (n = 11) (p = 0.002).Conclusions. In this paper, we analyzed the frequency and nature of refractive errors in children with monolateral and bilateral retinoblastoma. The identified risk factors may affect the development of refractive amblyopia in children with retinoblastoma in more adulthood, which requires the development of an individual approach to the correction of refractive disorders taking into account the localization of tumor foci, the nature of the lesion and the individual characteristics of patients.

Objectives: To investigate the effect of cycloplegia on anterior segment structures in keratoconus and forme fruste keratoconus patients using corneal topography.Materials and Methods: In this study, 40 patients with keratoconus (group 1), 40 patients with forme fruste keratoconus (group 2), and 40 healthy subjects (group 3) were evaluated prospectively. Flat keratometry (K) value (K1), steep K value (K2), mean K value (Kmean), maximum K value (Kmax), corneal astigmatism value, anterior chamber depth (ACD), symmetry index front, symmetry index back, thinnest corneal thickness, central corneal thickness and corneal volume were measured using Sirius topography before and after cycloplegia. Results were compared with one way ANOVA test.Results: The mean age of the participants was 24.4 +/- 6.2 years for group 1, 26.3 +/- 4.3 years for group 2 and 26.5 +/- 6.1 years for group 3. There was no difference between the groups with respect to mean age and gender (p>0.05). Mean K1 value was 45.54 +/- 2.43 diopters (D) before cycloplegia and 45.46 +/- 2.48 D after cycloplegia for group 1(p=0.044). K1 value didn't change significantly after cycloplegia for group 2 and 3 (p=0.275, p=0.371). There was no significant difference in K2 and Kmean values after cycloplegia for all groups (p>0.05). Kmax value decreased significantly after cycloplegia in group 1 (p=0.001), but the difference was not significant for group 2 and 3 (p=0.087, p=0.241). ACD increased significantly after cycloplegia in all groups (p=0.001).Conclusion: Cycloplegia causes corneal flattening only in manifest keratoconus patients, leading to an increase in ACD in all groups. Amaç: Sikloplejinin keratokonus ve forme fruste keratokonuslu olgularda ön segment yapıları üzerine etkisini kornea topografisi ile değerlendirmektir. Gereç ve Yöntem: Çalışma kapsamında 40 keratokonus (grup 1), 40 forme fruste keratokonus (grup 2) ve 40 sağlıklı olgunun (grup 3) birer gözü prospektif olarak değerlendirildi. Siklopleji öncesi ve sonrasında Sirius topografi cihazı ile düz keratometri (K) değeri (K1), dik K değeri (K2), ortalama K değeri (Kort), maksimum K değeri (Kmaks), korneal astigmatizma değeri, ön kamara derinliği (ÖKD), ön simetri indeksi, arka simetri indeksi, en ince korneal kalınlık, merkezi kornea kalınlığı ve kornea volümü değerleri ölçüldü. Sonuçlartek yönlü varyans analizi testi ile karşılaştırıldı. Bulgular: Yaş ortalaması grup 1’de 24,4±6,2 yıl; grup 2’de 26,3±4,3 yıl; grup 3’te 26,5±6,1 yıl idi. Gruplar arasında yaş ve cinsiyet açısından anlamlı bir fark yoktu (p>0,05). Grup 1’de siklopleji öncesi ortalama K1 değeri 45,54±2,43 diyoptri (D) iken siklopleji sonrasında 45,46±2,48 D idi (p=0,044). Grup 2 ve 3’te siklopleji sonrasında K1 değerinde anlamlı bir değişiklik bulunmadı (p=0,275, p=0,371 sırasıyla). Her üç grupta da siklopleji sonrasında K2 ve Kort değerlerinde anlamlı bir değişim izlenmedi (p>0,05). Kmaks değerlerinde siklopleji sonrasında grup 1’de anlamlı azalma olurken (p=0,001), grup 2 ve grup 3’te anlamlı değişiklik izlenmedi (p=0,087, p=0,241 sırasıyla). Üç grupta da siklopleji sonrasında ÖKD’de istatistiksel anlamlı artış izlendi (p=0,001). Sonuç: Siklopleji sadece belirgin keratokonus hastalarında korneada düzleşmeye neden olurken, tüm gruplarda ÖKD’de artışa yol açmaktadır.

PurposeWe evaluated the noninferiority of 10.4 μl of eye drops eluted with a commercially available eye drop adapter, the Nanodropper (Nanodropper, Inc), on pupillary dilation and cycloplegia in children compared with the standard of care (SOC), 50 μl of eye drops.DesignProspective randomized trial.ParticipantsPediatric patients scheduled for routine pupillary dilation at the University of California, San Francisco, at the Pediatric Ophthalmology Clinic were enrolled. Each participant provided 1 eye for the intervention group (Nanodropper) and 1 eye for the control group (SOC).MethodsParticipants were randomized to receive small-volume dilating drops in 1 eye (Nanodropper) and SOC dilating drops in the other eye. Dilation was performed using 1 drop each of 1% cyclopentolate, 1% tropicamide, and 2.5% phenylephrine. Refraction and pupillometry were obtained before and 30 minutes after dilation. A noninferiority analysis was performed to assess change from before to after dilation in spherical equivalent and in pupil constriction percentage and maximum pupil diameter after dilation.Main outcome measuresSpherical equivalent, maximum pupil diameter, and pupil constriction percentage.ResultsOne hundred eyes of 50 patients were included, with a mean ± standard deviation age of 9 ± 3 years. After controlling for baseline measurements, the spherical equivalent after dilation was 0.05 diopter (D) more (95% confidence interval [CI], -0.28 to 0.37 D) in the Nanodropper arm, which did not achieve noninferiority. Maximum pupil diameter after dilation was lower in the Nanodropper group (mean, -0.01 mm; 95% CI, -0.20 to -0.03), which did achieve noninferiority. Constriction percentage after dilation was 0.57 percentage points more (95% CI, -1.38 to 2.51 percentage points) in the Nanodropper group, which did not achieve noninferiority.ConclusionsAdministration of eye drops using a small-volume adapter demonstrated similar efficacy to SOC in a pediatric population. Strict noninferiority was met only for pupillary dilation and not for cycloplegia or constriction percentage; however, the small differences in the effect of the Nanodropper versus SOC on all primary outcomes were not clinically significant. We conclude that small-volume eye drops have the potential to decrease unnecessary medical waste and medication toxicity while maintaining therapeutic effect.Financial disclosure(s)Proprietary or commercial disclosure may be found after the references.

To investigate the relationship between myopia progression and axial length (AL) elongation in orthokeratology (ortho-k) patients.This study investigated 184 patients (baseline age 9.0 ± 1.6 years), who underwent overnight ortho-k treatment for 12 to 72 months, and stopped lens wear for 1 to 2 months. Refractive sphere and cylinder after cycloplegia, corneal curvatures along both meridians, and AL were compared before the commencement and after discontinuation of ortho-k treatment. The effects of AL change, baseline AL, corneal curvature change, baseline age, and duration of ortho-k treatment on the change in spherical equivalent refractive error (SER) were analysed.Myopia significantly progressed and AL increased following 32.8 ± 13.0 months of ortho-k lens wear and 1 to 2 months washout period, as compared to baseline (all P 0.001). Corneal curvature along the flat meridian (FK) became significantly flatter (P 0.001) and corneal curvature along the steep meridian (SK) became steeper (P = 0.036). In the first stepwise multiple linear regression model (RThe change in SER was significantly correlated to the change in AL, change in SK, baseline AL, baseline age, and the duration of treatment among children undergoing ortho-k therapy. The ratio of axial elongation to myopia progression was approximately 1:1.6 between the ages of 6 to 14 years. A simplified equation was derived for clinical use to estimate myopia progression from repeated AL measurement in ortho-k patients.

Purpose: To establish whether clinical factors were correlated with deviation control in intermittent exotropia. Methods: This retrospective study included 54 patients with intermittent exotropia. The patient's sex, family history, age at first admission, best corrected visual acuity, refractive errors after cycloplegia, angles of ocular deviation at near and distance, and near, distance, and total deviation control were evaluated. Ocular deviation controls were determined according to the Mayo Clinic's office-based scale. Correlation analysis was performed between the deviation control and the determined clinical factors. Results: Spearman correlation analyses revealed a mild correlation between age with total exotropia control score and age with the control of near exotropia control score ( r = 0.320, P = .018 and r = 0.339, P = .012, respectively). The angle of deviation at near showed a significant moderate correlation between total exotropia control score and near exotropia control score ( r = 0.523, P < .001 and r = 0.780, P < .001, respectively). The deviation angle at distance showed a mild correlation with distance exotropia control score and total exotropia control score ( r = 0.423, P = .001 and r = 0.288, P = .034, respectively). The angle of deviation at distance showed a mild correlation with the angle of deviation at near ( r = 0.359, P = .008). The deviation angle at distance was established as an independent factor for predicting total exotropia score ( P = .037, P = .015, respectively). Conclusions: The high deviation angle correlates positively with poor deviation control. The distance deviation angle is an independent predictor of total deviation control for the first time in the literature. [ J Pediatr Ophthalmol Strabismus . 2022;59(1):53–59.]

An 82-year-old man with severe primary open-angle glaucoma on maximal medical therapy underwent an ab externo closed conjunctival Xen45 device insertion with mitomycin C. The surgery was uncomplicated, with a first postoperative day intraocular pressure of 4 mm Hg and visual acuity of 20/40 OD. Ten days later, the patient presented with an intraocular pressure of 5 mm Hg and a visual acuity of counting fingers at 5 feet. Examination showed Seidel negative bleb, shallow anterior chamber, and large nonappositional choroidal detachments. Medical therapy with steroids and cycloplegia was initiated. One week later, the serous choroidal detachments became appositional, and Xen explantation and surgical drainage of the choroidal detachment was performed. Postoperatively, the vision improved to 20/60. Significant choroidal detachments can occur after XEN45 implantation requiring surgical intervention.

Purpose: Purpose of this study is to evaluate the measuring consistency of central refraction between multispectral refraction topography (MRT) and autorefractometry.Methods: This was a descriptive cross-sectional study including subjects in Sun Yat-sen Memorial Hospital from September 1, 2020, to December 31, 2020, ages 20 to 35 years with a best corrected visual acuity of 20/20 or better. All patients underwent cycloplegia, and the refractive status was estimated with autorefractometer, experienced optometrist and MRT. We analyzed the central refraction of the autorefractometer and MRT. The repeatability and reproducibility of values measured using both devices were evaluated using intraclass correlation coefficients (ICCs).Results: A total of 145 subjects ages 20 to 35 (290 eyes) were enrolled. The mean central refraction of the autorefractometer was −4.69 ± 2.64 diopters (D) (range −9.50 to +4.75 D), while the mean central refraction of MRT was −4.49 ± 2.61 diopters (D) (range −8.79 to +5.02 D). Pearson correlation analysis revealed a high correlation between the two devices. The intraclass correlation coefficient (ICC) also showed high agreement. The intrarater and interrater ICC values of central refraction were more than 0.90 in both devices and conditions. At the same time, the mean central refraction of experienced optometrist was −4.74 ± 2.66 diopters (D) (range −9.50 to +4.75D). The intra-class correlation coefficient of central refraction measured by MRT and subjective refraction was 0.939.Conclusions: Results revealed that autorefractometry, experienced optometrist and MRT show high agreement in measuring central refraction. MRT could provide a potential objective method to assess peripheral refraction.

Introduction: Refractive errors are apparently more prevalent among the high educational group and have become a huge economic and social burden.1 Materials and Methods: The study was conducted at Era’s Lucknow Medical College and Hospital and included 420 medical students of consecutive 4ys (2013-2016). Refractive error was assessed under cycloplegia using Snellen’s visual acquity drum and streak retinoscope. The students were categorized according to their refractive error and the prevalence was calculated. Results: Of 420 students 54% had refractive error. Of these 77.7% had myopia, 8.4% had hypermetropia and 1.7% had astigmatism. Myopes were further divided into mild moderate & severe. It was found that 62.8% had mild, 35.4% had moderate and 13.7% had severe myopia. Conclusion: The commonest refractive error among medical students is myopia of varying grades. Keywords: Medical students, Myopia, Refractive error.

Purpose Many myopia control interventions are designed to induce myopic relative peripheral refraction. However, myopes tend to show asymmetries in their sensitivity to defocus, seeing better with hypermetropic rather than myopic defocus. This study aims to determine the influence of chromatic aberrations (CA) and higher-order monochromatic aberrations (HOA) in the peripheral asymmetry to defocus. Methods Peripheral (20° nasal visual field) low-contrast (10%) resolution acuity of nine subjects (four myopes, four emmetropes, one hypermetrope) was evaluated under induced myopic and hypermetropic defocus between ±5 D, under four conditions: (a) Peripheral Best Sphere and Cylinder (BSC) correction in white light; (b) Peripheral BSC correction + CA elimination (green light); (c) Peripheral BSC correction + HOA correction in white light; and (d) Peripheral BSC correction + CA elimination + HOA correction. No cycloplegia was used, and all measurements were repeated three times. Results The slopes of the peripheral acuity as a function of positive and negative defocus differed, especially when the natural HOA and CA were present. This asymmetry was quantified as the average of the absolute sum of positive and negative defocus slopes for all subjects (AVS). The AVS was 0.081 and 0.063 logMAR/D for white and green light respectively, when the ocular HOA were present. With adaptive optics correction for HOA, the asymmetry reduced to 0.021 logMAR/D for white and 0.031 logMAR/D for green light, mainly because the sensitivity to hypermetropic defocus increased when HOA were corrected. Conclusion The asymmetry was only slightly affected by the elimination of the CA of the eye, whereas adaptive optics correction for HOA reduced the asymmetry. The HOA mainly affected the sensitivity to hypermetropic defocus.

Purpose: We performed this study to determine the association between serum 25-hydroxyvitamin D [25(OH) D] level and myopia in adults. Methods: A total of 25,199 subjects aged ≥20 years were included from the National Health and Nutrition Examination Survey 2008–2012. Blood 25(OH)D levels were evaluated from blood samples. Refractive error was measured without cycloplegia. Myopia and high myopia were defined as ≥-0.50 diopters (D) and ≥-6.0 D, respectively. Other covariates such as education, physical activity, and economic status were obtained from interviews. Results: Linear regression analysis showed that as 25(OH) D level increased by 1 ng/mL, myopic refractive error significantly decreased by 0.01 D (P < 0.001) after adjusting for potential confounders including sex, age, height, education level, economic status, physical activity, and sunlight exposure time. The odds ratios for myopia was 0.75 (95% Confidence interval [CI]; 0.67–0.84, P < 0.001) in the highest 25(OH) D quintile compared to the lowest quintile. The odds ratios for high myopia was 0.63 (95% CI; 0.47–0.85, P < 0.001) in the highest 25(OH)D quintile compared to the lowest quintile. Conclusion: Serum 25(OH)D level was inversely associated with myopia in Korean adults.

Childhood blindness causes significant social and economic burden. Even though pediatric eye care has gained priority under Vision 2020, it continues to come under the purview of tertiary care centers due to lack of knowhow and facilities at primary and secondary level. Currently, India does not have standard guidelines on pediatric eye examination, refraction, and amblyopia management and therefore these are being managed inadequately or inappropriately. In view of this, an expert group of pediatric ophthalmologists from across the country met under the aegis of All India Ophthalmological Society, and deliberated to reach a consensus on the correct method of pediatric eye examination, treating refractive error in children and managing amblyopia. The purpose of the consensus statement was to enable all ophthalmologists to have a broad set of guidelines, which can form the basic framework for managing common pediatric eye conditions, in most ophthalmic setups. The consensus statement is divided into three broad categories: Pediatric eye examination, pediatric refraction, and amblyopia management. The pediatric eye exam subsection discusses the recommended clinical history, which should be taken and the essential components of an ophthalmic examination including pediatric vision assessment. Additionally, it discusses the role of special tests and investigations such as imaging and electrophysiology. The section on pediatric refraction emphasizes the correct use of cycloplegia and prescribing glasses in the Indian context. The final section on amblyopia management presents the various options of treating amblyopia and provides standard guidelines for the use of occlusion therapy and its weaning over time.

Contains fulltext : 220613.pdf (Publisher’s version ) (Open Access) PURPOSE: Children with Down syndrome (DS) more often have strabismus, refractive errors, accommodative lags and reduced visual acuity (VA) than typically developing children. In this study, we compare the effects of bifocal glasses with those of unifocal glasses in children with DS. Changes in angle of strabismus, accommodation and refractive error were analysed in this paper. METHODS: In a multicentre randomized controlled trial, 119 children with DS, aged 2-16, were randomly allocated for bifocal or unifocal glasses (with full correction of refractive error in cycloplegia). The 15 centres, all in the Netherlands, followed the participants for 1 year. Changes in refractive error, accommodative accuracy, strabismus, binocularity and stereopsis were compared across 4 subsequent visits. RESULTS: Refractive errors and accommodative errors showed no significant change throughout the course of our study in either intervention group. The manifest angle of strabismus, however, reduced significantly in the bifocal group. This improvement was observed shortly after the children received their new correction (~6 weeks) (linear regression: t = 3.652, p

The use of contact lenses (CLs) in children and adoles¬cents is a topical subject that attracted even more atten¬tion during recent years due to the improvement of ma¬terials and types of CLs. According to research, more than 2 million children and adolescents use soft CLs in the USA alone. This results from both broad medical indications for the prescription of CLs and social reasons. The age at which contact lenses can be recommended for children is also an important subject that is being under debate. While some ophthalmologists believe that children can be introduced to soft contact lenses from the age of 12 years old, others think that the minimum age should be 14 years old. Some doctors, however, are against using contact lenses in children. Optometrists, not having the right to conduct cycloplegia, prefer to prescribe contact lenses to adolescents over 14 years old. On the other hand, the selection of CLs for children and adolescents does not depend on age, but on the indications for their application.

Purpose: To evaluate the changes in the accommodative response and in the corneal and internal spherical aberration during three months of wear of orthokeratology lenses from the baseline. Methods: Fifty children aged 8 to 17 were recruited for a prospective study and were fitted with orthokeratology lenses. Refraction without cycloplegia, high and low uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), accommodation lag, horizontal near phoria without correction, corneal topography, corneal and total wavefront aberration were performed at baseline, 1 day, 1 week, 1 month and 3 months. Data were analysed by Student t-test for related samples, repeated measures ANOVA test and Pearson Correlation test. Results: The spherical equivalent (SE) before and after three months was -3.33 ± 1.60 D and -0.30±0.46 D, respectively. Accommodation lag was 0.53±0.38 D and 0.20±0.33 D at baseline and at three months, respectively. A moderate correlation between lag at the baseline and its change between baseline and the 3-month visit was found (P0.05) Conclusion: The negative SA of the lens increases during OK treatment compensated for the increase of the anterior corneal surface positive SA, in addition to increasing the accommodative response.

SIGNIFICANCE Increasing prevalence of refractive error requires assessment of ametropia as a screening tool in children. If cycloplegia is not an option, knowledge about the increase in uncertainty for wavefront-based autorefraction is needed. The cycloplegic agent as the principal variant presents cross-reference and allows for extraction of the influence of accommodation. PURPOSE The purpose of this study was to determine the repeatability, agreement, and propensity to accommodate of cycloplegic (ARc) and noncycloplegic (ARnc) wavefront-based autorefraction (ZEISS i.Profiler plus; Carl Zeiss Vision, Aalen, Germany) in children aged 2 to 15 years. METHODS In a clinical setting, three consecutive measurements were feasible for 145 eyes (OD) under both conditions. Data are described by spherical equivalent (M), horizontal or vertical astigmatic component (J0), and oblique astigmatic component (J45). In the case of M, the most positive value of the three measurements was chosen, whereas the mean was applied for astigmatic components. RESULTS Regarding agreement, differences for ARc minus ARnc were statistically significant: for M, 0.55 (0.55 D; mean [SD]; P < .001), that is, more hyperopic in cycloplegia; for J0, -0.03 (0.11 D; P = .002); and for J45, -0.03 D (SD, 0.09 D; P < .001). Regarding repeatability, astigmatic components showed excellent repeatability: SD < 0.11 D (ARnc) and SD < 0.09 D (ARc). The repeatability of M was SD = 0.57 D with a 95% interval of 1.49 D (ARnc). Under cycloplegia, this decreased to SD = 0.17 D (ARc) with a 95% interval of 0.50 D. The mean propensity to accommodate was 0.44 D from repeated measurements; in cycloplegia, this was reduced to 0.19 D. CONCLUSIONS Wavefront-based refraction measurement results are highly repeatable and precise for astigmatic components. Noncycloplegic measurements of M show a systematic bias of 0.55 D. Cycloplegia reduces the propensity to accommodate by a factor of 2.4; for noncycloplegic repeated measurements, accommodation is controlled to a total interval of 1.49 D (95%). Without cycloplegia, results improve drastically when measurements are repeated.

The relationship between the optical properties of the eye in the periphery and myopia development is still under debate. To further clarify this issue, we provide here baseline data of two-dimensional peripheral optics results in a group of emmetropic Chinese children. Peripheral aberrations were measured under cycloplegia by using an open-view Hartmann-Shack wavefront sensor (VPR, Voptica SL, Spain). This instrument allows to measure fast in the horizontal visual field from temporal 30° to nasal 30° every 1°. Two-dimensional (2D) maps were retrieved from a series of horizonal scans taken every 4° from 20° superior to 16° inferior covering a visual field of 60 × 36°. A relatively homogeneous pattern of the 2D relative peripheral refraction was found across all these emmetropic subjects. Using cluster analysis followed by manual visual refinement, the 2D maps were identified to fit into four categories. More than 70% of the subjects showed a nearly flat horizontal refraction with a slightly myopic shift in the superior retina. Peripheral astigmatism was quite constant across subjects and similar to that expected theoretically. Peripheral aberrations were also similar to those in the fovea for a large retinal area. These baseline data would offer an important reference to compare with the future evolution with time, as well as with other refractive or age groups of subjects, to better understand the role of peripheral optical properties in myopia development.

Purpose To report complications after serial anterior chamber (AC) paracentesis for sustained elevation of intraocular pressure after intravitreal injection. Methods A retrospective interventional case series of five patients who had received AC paracentesis after intravitreal injection. Results Five patients presented with either decreased vision or increased pain after intravitreal injection with planned AC paracentesis. Of the five patients, three patients presented with profound hypotony due to persistent wound leak from the AC paracentesis site. Of these three, one resolved with pressure patch and cycloplegia. The other two patients required further intervention with either polyethylene glycol hydrogel or nylon suture for wound closure. The fourth patient presented with IOL optic prolapse into the AC that resolved with dilation. The fifth patient presented with vitreous prolapse through the AC paracentesis wound and was treated with YAG vitreolysis. Conclusion A single AC paracentesis has been shown to demonstrate a favorable safety profile. Serial AC paracenteses may degrade the integrity of the peripheral cornea in patients with sustained elevation of intraocular pressure after repeated intravitreal injections.

Objective Accurate estimation of hyperopia and astigmatism is challenging in delayed children. Conventional skiascopy holds rows of increasing power ± lenses vertically in front of one eye. The school bus accommodation-relaxing skiascopy (SBA-RS) design holds child-friendly, lenses +1 to +10D horizontally so that a higher power fogs the nontested eye-relaxing accommodation without cycloplegia. Methods Design: Evaluation of diagnostic test. Subjects: Patients undergoing comprehensive eye examination in a pediatric ophthalmology practice. Cycloplegic (cyclopentolate 1%) retinoscopy was compared to dry SBA-RS and Retinomax (Righton, Japan) during pediatric eye examinations. Outcome measures: correlations, Chi-square and receiver operating characteristic (ROC) curve. Results Of 470 patients with a median age 6 years, 238 were under the age of 60 months and 110 had developmental delays. For those with cycloplegic spherical equivalent hyperopia over 0.7 D, median (90% CI) value for retinoscopy was +2.63 D (+0.75, +6.88), for SBA-RS was +2.50 D (+0.50, +6.75) and less for 184 with Retinomax +1.88 D (-1.56, +6.13) but similar despite delays. Astigmatic cylinder SBA-RS +1.50 D (+0.25, +4.00) lagged retinoscopy +1.75 D (+0.75,+4.50) but Retinomax was greater +2.00 D (+0.25, +4.64). Cycloplegic refractive components such as spherical equivalent, cylinder, and J0 and J45 power vectors correlated highly and were near unity with SBA-RS and Retinomax with the latter deviating greater. SBA-RS screened for amblyopia risk factors up to 92% sensitive and 94% specific. Conclusion Accommodation-relaxing horizontal skiascopy very precisely estimates astigmatism power and axis and only lags cycloplegic refraction by about 0.15D in hyperopic patients fairly independent of neurodevelopmental delay. This technique can quickly estimate refraction even in delayed patients potentially reducing some need for cycloplegia. Clinical trials registry NCT03668067.

Purpose. We aimed to evaluate the distribution and determinants of peripapillary retinal nerve fiber layer (pRNFL) thickness and its associations with general sleep quality in Chinese school students. Methods. 1063 grade 7 students aged 13 to 14 years with pRNFL thickness data from a school-based study on grade 7 students in Southwestern China participated in the study. The pRNFL thickness was measured on the optical coherence tomography images of a circular scan centered on the optic disc. Refractive error was measured after cycloplegia using an autorefractor and biometric parameters including axial length (AL) were measured by an IOLMaster. Participants’ sleep quality was measured by the Children’s Sleep Habits Questionnaire (CSHQ). Results. The mean pRNFL thickness was 106.8 ± 10.7 μm among the 1063 participants. There was an increasing trend of spherical equivalent and a decreasing trend of AL with RNFL thickness. In multivariate analysis, each diopter of spherical equivalent increase was associated with 0.64 μm increase in pRNFL thickness. Girls had an increased mean pRNFL thickness compared with boys with a mean difference of 1.65 μm. Per 10 μm increase in pRNFL thickness was significantly associated with a 0.5 reduction in CSHQ score (better sleep quality). Conclusions. More myopic refractive error was the major ocular determinant of decreased pRNFL thickness. In addition, students with thinner pRNFL tended to have a worse sleep quality.