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Orthokeratology (OK) lens is commonly used to control myopia progression of children. Understanding the relationship between relative peripheral refraction (RPR) and the growth rate of axial length (AL) may assist in explaining myopic progression. The aim of this work is to investigate the RPR in myopic children wearing OK lenses, and to evaluate its relationship with the growth rate of AL. RPRs of 31 children wearing OK lenses and 31 children wearing single-vision glasses were measured with multispectral refraction topography (MRT). MRT shows the total RPR (TRPR), RPR in the superior area (RPR-S), RPR in the inferior area (RPR-I), RPR in the temporal area (RPR-T) and RPR in the nasal area (RPR-N), respectively. It also shows RPR in the visual field of 15° (RPR-15), 30° (RPR-30) and 45° (RPR-45), respectively. RPRs in the visual field from 15° to 30°, 30° to 45° and 15° to 45° are recorded as RPR-(30–15), RPR-(45–30) and RPR-(45–15), respectively. According to the growth rate of AL, children wearing OK lenses were further divided into slow and fast growth groups. TRPR, RPR-I, RPR-T, RPR-N, RPR-15, RPR-30, RPR-45, RPR-(30–15), RPR-(45–30), and RPR-(45–15) of children in the OK lens group were significantly smaller than in the control group (all P < 0.05). TRPR, RPR-N, RPR-15, RPR-30, RPR-45, RPR-(30–15), and RPR-(45–15) of the slow growth group were significantly smaller than in the fast growth group (all P < 0.05). The growth rate of AL were positively correlated with TRPR (R = 0.383, P = 0.040), RPR-N (R = 0.395, P = 0.034), RPR-30 (R = 0.408, P = 0.028), RPR-45 (R = 0.377, P = 0.044), RPR-(30–15) (R = 0.390, P = 0.036). RPRs of children show relative myopic defocus after wearing OK lenses. Furthermore, the growth rate of AL is smaller with more negative RPR. [ABSTRACT FROM AUTHOR]

Purpose: The increasing prevalence of myopia is a global public health issue. Because of the complexity of myopia pathogenesis, current control methods for myopia have great limitations. The aim of this study was to explore the effect of photobiomodulation (PBM) on human sclera fibroblasts (HSFs) under hypoxia, in the hope of providing new ideas for myopia prevention and control. Methods: Hypoxic cell model was established at 0, 6, 12, and 24 h time points to simulate myopia microenvironment and explore the optimal time point. Control, hypoxia, hypoxia plus light, and normal plus light cell models were set up for the experiments, and cells were incubated for 24 or 48 h after PBM (660 nm, 5 J/cm2), followed by evaluation of hypoxia-inducible factor 1α (HIF-1α) and collagen I a1 (COL1A1) proteins using Western blotting and immunofluorescence, and photo damage was detected by CCK-8, scratch test, and flow cytometry assays. We also used transfection technology to further elucidate the regulatory mechanism. Results: The change of target proteins is most obvious when hypoxia lasts for 24 h (p < 0.01). PBM at 660 nm increased extracellular collagen content (p < 0.001) and downregulated expression of HIF-1α (p < 0.05). This treatment did not affect the migration and proliferation of cells (p > 0.05), and effectively inhibited apoptosis under hypoxia (p < 0.0001). After overexpression of HIF-1α, the effect of PBM was attenuated (p > 0.05). Conclusions: Photobiomodulation at 660 nm promotes collagen synthesis via downregulation of HIF-1α expression without photodamage. [ABSTRACT FROM AUTHOR]

On the cornea, daily epithelial resurfacing is a critical process to prevent the loss of normal function, ocular morbidity, corneal structure, and vision loss. There are several components to wound healing, including cellular attachment, migration, and growth. To develop a treatment for corneal epithelial healing, we studied the effect of substance P (SP) on corneal epithelial cell migration using a cell culture system of either transformed human corneal epithelial cells (SV-40), or rabbit corneal epithelial cells (SIRC). We investigated the effect of SP with insulin and insulin-like growth factor-I (IGF-1). We found that SP is synergistic with insulin and IGF-1 on the stimulation of transformed human corneal epithelial migration in a cell culture system, as well as in rabbit SIRC cells. The addition of either SP, insulin, or IGF-1 alone did not greatly affect epithelial migration, while the combination of SP and insulin or SP and IGF-1 markedly stimulated epithelial migration in a dose-dependent manner. The synergistic effects of SP with insulin and SP with IGF-1 were inhibited by the addition of the SP-specific inhibitor (CP96345). However, the effect of insulin and IGF-1 alone were not inhibited by the NK-1-specific inhibitor (CP96345). Our results are consistent with the need for the involvement of the neuropeptide SP in corneal epithelial wound healing of diabetic corneas where nerve-ending dropout occurs. Additionally, almost identical results were obtained with human and rabbit corneal epithelial cells. These results suggest that the maintenance of the normal integrity of the corneal epithelium might be regulated by both humoral and neural factors. [ABSTRACT FROM AUTHOR]

Introduction: Myopia prevalence among adolescents is increasing annually. While orthokeratology (OK) is effective for controlling myopia progression, it may also be detrimental. We investigated tear film parameters [including tear mucin 5AC (MUC5AC) concentration] in children and adolescents with myopia treated with spectacles or OK compared with those with emmetropia. Methods: This prospective case–control study enrolled children (aged 8–12 years; 29 and 39 with myopia treated with OK and spectacles, respectively, and 25 with emmetropia) and adolescents (aged 13–18 years; 38 and 30 with myopia treated with OK and spectacles, respectively, and 18 with emmetropia). We recorded the ocular surface disease index (OSDI), visual analog scale (VAS) score, tear meniscus height (TMH), noninvasive tear breakup time (NIBUT), meibomian gland score (meiboscore), ocular redness score, and tear MUC5AC concentration in the emmetropia, spectacle (after 12 months of spectacle wearing), and OK (baseline, and after 1-, 3-, 6-, and 12-month use) groups. We observed changes from baseline to 12 months in the OK group and compared parameters among the spectacle, 12-month OK, and emmetropia groups. Results: The 12-month OK group differed significantly from the spectacle and emmetropia groups in most indicators among children and adolescents (P < 0.05). Differences were not noticeable between the spectacle and emmetropia groups (only PVAS < 0.05 among the children). In the OK group, the 12-month NIBUT was significantly decreased (P < 0.05) in both age groups; the upper meiboscore was increased at 6 and 12 months (both P < 0.05) among children; ocular redness scores were higher at 12 months than at baseline (P = 0.007), 1 month (P < 0.001), and 3 months (P = 0.007) among children; and the MUC5AC concentration was decreased at 6 and 12 months among adolescents, but only at 12 months among children (all P < 0.05). Conclusions: Long-term OK can negatively influence the tear film in children and adolescents. Moreover, changes are masked by spectacle wearing. Trial Registration: This trial is registered with "ChiCTR2100049384." [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of 0.01% atropine alone and in combination with orthokeratology for myopia control using a meta-analysis. Methods: PubMed, Cochrane Library, and EMBASE were searched. We included eligible randomized controlled trials (RCTs), non-RCTs, and retrospective cohort studies, published up to August 1, 2022. We calculated the weighted mean difference (WMD) and 95% confidence interval (CI) for all outcomes and plotted them in forest plots. Results: Fourteen studies were included; 4 and 11 in the 0.01% atropine monotherapy and atropine-orthokeratology (AOK) groups, respectively. Compared with orthokeratology (OK) alone, 0.01% atropine alone had similar effects on slowing the axial elongation (WMD: −0.00 mm; 95% CI: −0.05–0.04, p<0.31), while AOK significantly lowered axial growth. Moreover, the baseline myopic degree and duration of treatment were influential for the change in axial elongation (WMD: −0.12 mm; 95% CI: −0.17–−0.07, p = 0.00001 and WMD: −0.11 mm; 95% CI: −0.15–−0.108, p<0.00001, respectively). Additionally, the AOK may reduce the change rate of the spherical equivalent refraction and the accommodation amplitude (WMD: −0.13 D; 95% CI: 0.07–0.19, p<0.001 and WMD: −1.08 mm; 95% CI: −1.73–−0.43, p<0.0001, respectively), and cause a slight increase in the diameter of the pupil (WMD: 0.56 mm; 95% CI: 0.43–0.70, p = 0.007). No significant differences in the uncorrected distant visual acuity, best corrected visual acuity, intraocular pressure, tear film break-up time, lipid layer thickness, and corneal endothelial cell density were found between the OK and AOK groups. Conclusion: In slowing the axial elongation, 0.01% atropine alone and OK alone have similar effects, while AOK is more effective than OK alone in slowing down the axial elongation. Furthermore, the baseline degree of myopia and treatment duration may affect changes in axial elongation. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the short‐term effects of peripheral gradient high‐addition multifocal soft contact lenses (MFSCLs) and orthokeratology (Ortho‐K lenses) on visual performance in myopic children. Methods: Thirty myopic children participated in this prospective study. Each participant wore different sets of lenses in the following sequence: single‐vision spectacles (SVSPs) as a control, MFSCLs and Ortho‐K lenses. Ocular aberrations, topography, high‐contrast visual acuity (HCVA), low‐contrast visual acuity (LCVA) and accommodation of the right eye were measured with each type of correction on a different day. Results: Compared with SVSPs, high‐addition MFSCLs and Ortho‐K lenses significantly increased all items of aberrations (all p < 0.05) except trefoil (p = 0.17). MFSCLs induced less coma, root mean square of the third‐order aberration (RMS3) and higher order aberrations than Ortho‐K lenses (all p < 0.05). No significant difference in HCVA was found across the three correction types (F = 1.19, p = 0.39). In terms of LCVA, MFSCLs performed significantly poorer than SVSPs (difference, 0.16 logMAR; p = 0.001) and slightly worse than Ortho‐K lenses (difference, 0.08 logMAR; p = 0.35). No significant difference in decentration was found between the two types of contact lenses, and no associations were observed between decentration and visual acuity at both high‐ and low‐contrast levels (all p > 0.05). For MFSCLs, decentration was positively related to coma (r = 0.43, p = 0.02) and RMS3 (r = 0.44, p = 0.02), which was not the case for Ortho‐K lenses. Accommodative facility was worse with MFSCLs than Ortho‐K lenses (p = 0.001). Conclusion: Multifocal soft contact lenses differed from Ortho‐K lenses in aberration profile and LCVA, although decentration was similar. Decentration <1 mm had minimal influence on both HCVA and LCVA for either type of correction, but significantly increased third‐order aberrations for MFSCLs, but not Ortho‐K lenses. [ABSTRACT FROM AUTHOR]

Background: To examine the 12-month clinical and refractive outcomes of PRK performed with a UV all-solid-state laser. Methods: The study included healthy patients with myopia and/or compound myopic astigmatism enrolled for refractive surgery and treated with PRK using a 210 nm wavelength, 2 kHz repetition rate, UV all-solid-state laser (LaserSoft, Katana Technologies GmbH, Kleinmachnow, Germany). All subjects were examined at baseline and after 1, 3, 6, and 12 months after the treatment with a slit lamp, refraction, visual acuity assessment (logMAR chart), tonometry, ophthalmoscopy, and corneal tomography with a Scheimpflug camera. The outcome measures considered were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, central corneal thickness, and transparency. The efficacy, safety, predictability, and stability were determined. Results: The study included 34 eyes of 19 patients. The mean UDVA changed from 1.20 ± 0.43 to −0.05 ± 0.10 logMAR at 12 months, and the mean CDVA changed from −0.03 ± 0.06 to −0.06 ± 0.09 logMAR, respectively. The mean spherical equivalent (SE) changed from −4.90 ± 2.12 D to −0.01 ± 0.40 D and was within ±0.50 D of the intended correction in 91% of eyes and within ±1.00 D in 97% of eyes at 12 months. No eyes lost lines of visual acuity, and 64% of eyes gained one or more lines. Conclusions: PRK with the 210 nm wavelength, 2 kHz repetition rate, all-solid-state laser LaserSoft system proved to have good visual, refractive, and clinical outcomes after the follow-up at 12 months. The emerging gas-free, solid-state technology might be considered a valid alternative for the gas operating lasers for corneal refractive surgery. [ABSTRACT FROM AUTHOR]

To investigate the role of lipid mediator, resolvin D1 (RvD1), in corneal inflammation. The anti-inflammatory effect of RvD1 on stimulated human corneal epithelial cells (HCECs) was assessed. C57BL/6 mice corneas were abraded and treated with RvD1 after stimulation with Staphylococcus aureus. Cytokine levels in the corneas, cervical drainage lymph nodes (DLNs), and spleens were measured. Anterior segment photography and optical coherence tomography quantified the changes in corneal thickness and haziness. Neutrophil infiltration in the cornea was examined by haematoxylin and eosin (H&E) staining and immunohistochemistry. RvD1 significantly inhibited cytokine production in HCECs and mouse corneas, cervical DLNs, and spleens while stimulating interleukin-10 (IL-10) production. Corneal opacity development, thickening, and neutrophil infiltration significantly reduced in response to RvD1 stimulation in the S. aureus-infected mice corneas. RvD1 inhibited S. aureus-induced corneal inflammation. These results potentiate RvD1 as an anti-inflammatory therapy for patients with corneal inflammation induced by bacterial keratitis. [ABSTRACT FROM AUTHOR]

Abstract Introduction There is a high prevalence of intermittent exotropia and exophoria in myopic populations, and orthokeratology is one of the effective interventions to control myopia progression in children. However, it is still obscure whether intermittent exotropia and exophoria children could wear orthokeratology without experiencing aggravated lens decentration. Methods This was a multi-center, prospective cohort study. A total of 123 myopic participants aged 8–14 years were recruited, where conditions of deviation included intermittent exotropia, exophoria, and orthophoria. Uncorrected visual acuity and corneal topography data were obtained at baseline and after 1 month of wearing orthokeratology lens. Lens decentration was analyzed in a MATLAB program. Magnitude of deviation and refractive errors were evaluated prior to orthokeratology treatment. Fisher’s exact test, ANOVA test, and univariate and multivariate linear regression models were established to evaluate the role of magnitude of deviation in lens decentration. Results There was no significant difference in magnitude and direction of lens decentration among three groups (magnitude: F = 1.25, P = 0.289; direction: Fisher = 9.91, P = 0.078). According to scale division of decentration, 1 (2.6%) intermittent exotropia subject, 2 (3.8%) exophoria subjects, and 1 (3.0%) orthophoria subject experienced severe decentration (Fisher = 1.10, P = 0.947). Inferotemporal decentration was most common among all subjects (intermittent exotropia 50.0%, exophoria 76.9%, orthophoria 72.7%). Univariate and multivariate linear regression analyses revealed that magnitude of deviation was not an independent risk factor for lens decentration [β = −0.00, 95% confidence interval (CI) −0.01–0.00, P = 0.180], while surface asymmetry index (SAI) (β = 0.21, 95% CI 0.02–0.40, P = 0.028) and surface regularity index (SRI) (β = −0.39, 95% CI −0.66 to −0.13, P = 0.004) had significant correlation with polar decentration. Conclusion Patients with intermittent exotropia and exophoria exhibit non-aggravated lens decentration after orthokeratology application. Thus, lens decentration is not the concern for orthokeratology prescription.

Background: Myopia is labeled as one of the most common eye disorders, one of the most effective methods of its treatment being orthokeratological treatment. Anisometropic amblyopia continues to be treated by optical correction applied separately or in combination with occlusion or other therapies. Material and methods: The study included 32 patients (64 eyes), who were divided by 8 patients (16 eyes) into 4 groups (2 primary and 2 control), depending on the presence or absence of amblyopia and the degree of myopia, small and medium). Subjects in the baseline group underwent combined treatment between orthokeratology and physiotherapy. Results: The combined treatment resulted in the decrease of myopia according to the spheroequivalent by 60% in patients with amblyopia and mild myopia and from 90% in those without amblyopia. The values of the antero-posterior axis had a similar dynamic (p 0.05). Corrected visual acuity depending on the degree of amblyopia increased by 50% in cases with mild amblyopia and 150% in cases with moderate amblyopia (p < 0.001). The absolute volume of accommodation increased by 70% in patients with mild amblyopia and by 300% in patients with moderate amblyopia (p

AIM: To observe changes in fundus microcirculation of myopic adolescents after wearing orthokeratology by applying optical coherence tomography angiography(OCTA).METHODS: Prospective study. A total of 40 cases(40 eyes)of adolescents with low to moderate myopia who chose orthokeratology to correct visual acuity at our hospital from April 2021 to June 2022 were collected. The uncorrected distant visual acuity and axial length were evaluated at 1, 3 and 6mo before and after wearing orthokeratology, respectively. Furthermore, the changes in superficial vessel density(SVD), deep vessel density(DVD), central retinal thickness(CRT), foveal avascular zone area(FAZ-A), foveal avascular zone perimeter(FAZ-P), retinal nerve fiber layer(RNFL)thickness and radial peripapillary capillaries density(RPCD)were observed by applying OCTA.RESULTS: The uncorrected distant visual acuity was significantly improved at 1, 3 and 6mo after wearing orthokeratology(P0.05). Moreover, there were significant differences in both SVD of fovea quadrant and DVD of fovea and lower quadrant(P0.05).CONCLUSION: Wearing orthokeratology can significantly improve visual acuity and increase local retinal vessel density in the macula in adolescents with low to moderate myopia.

AIM: To investigate changes of choroidal thickness (ChT) in children with myopia and the effect of current myopia control interventions on ChT. METHODS: Major literature databases were searched for studies relevant to myopia in children. All studies used swept-source optical coherence tomography (SS-OCT) or enhanced depth imaging optical coherence tomography (EDI-OCT) to measure the ChT value. The weighted mean difference (WMD) and 95% confidence interval (CI) were pooled to evaluate ChT in myopia children. RESULTS: A total of 11 eligible articles, including 1693 myopic and 1132 non-myopic eyes, were included in the first Meta-analysis. The sub-foveal choroidal thickness (SFCT; WMD=-40.06, 95%CI, -59.36 to -20.75, P

Abstract Background To investigate ocular biological characteristics for myopic children with axial length (AL) reduction during orthokeratology (Ortho-K) treatment and provide clinical clues for better myopia control effects. Methods Changes in ocular parameters and treatment zone (TZ) in 75 subjects who completed one-year Ortho-K treatment were retrospectively reviewed. The subjects were divided into two groups according to one-year AL change: the AL reduction group (n = 37) and the AL elongation group (n = 38). Univariate and multivariate regression analyses were performed to determine the association between TZ, ocular parameters, and AL change. Results There was no significant difference in baseline between the two groups (all P > 0.05). After one year of Ortho-K treatment, compared with those in the AL elongation group, children in the AL reduction group had a decreased anterior chamber depth (ACD) (P

The aim was to evaluate the safety, efficacy, and visual performance of an orthokeratology lens with an increased compression factor (ICF) of 1.25 D in a 3-month follow-up. Thirty-six myopic patients (5 males and 31 females; 24.2 ± 5.8 years) were fitted with Alexa AR (Tiedra Farmacéutica S.L., Madrid, Spain) contact lenses (CLs) and twenty participants finished the follow-up. Visual acuity (VA), subjective refraction, primary spherical and primary coma aberrations, keratometry, central pachymetry, and ocular surface evaluation were performed at baseline and after 1 night, 1 week, 1 month, and 3 months of CL wear. The differences among visits were analyzed using a repeated-measures analysis of variance or the Friedman test. The spherical equivalent decreased (p ≤ 0.005), and the uncorrected VA improved (p < 0.001) until the first week. Corneal and ocular aberrations showed a significant increase (p ≤ 0.02). A significant decrease (p < 0.001) was found for keratometry values. No significant changes were observed in either central pachymetry or ocular surface parameters among study visits. In conclusion, an orthokeratology CL with an ICF of 1.25 D provides good safety, efficacy, and visual performance in a 3-month follow-up. Seven days of orthokeratology wear are enough to achieve the full myopic compensation, resulting in satisfactory VA.

Myopia has significantly risen in East and Southeast Asia, and the pathological outcomes of this condition, such as myopic maculopathy and optic neuropathy linked to high myopia, have emerged as leading causes of irreversible vision loss. Addressing this issue requires strategies to reduce myopia prevalence and prevent progression to high myopia. Encouraging outdoor activities for schoolchildren and reducing near-work and screen time can effectively prevent myopia development, offering a safe intervention that promotes healthier habits. Several clinical approaches can be employed to decelerate myopia progression, such as administering low-dose atropine eye drops (0.05%), utilizing orthokeratology lenses, implementing soft contact lenses equipped with myopia control features, and incorporating spectacle lenses with aspherical lenslets. When choosing an appropriate strategy, factors such as age, ethnicity, and the rate of myopia progression should be considered. However, some treatments may encounter obstacles such as adverse side effects, high costs, complex procedures, or limited effectiveness. Presently, low-dose atropine (0.05%), soft contact lenses with myopia control features, and orthokeratology lenses appear as promising options for managing myopia. The measures mentioned above are not necessarily mutually exclusive, and researchers are increasingly exploring their combined effects. By advocating for a personalized approach based on individual risk factors and the unique needs of each child, this review aims to contribute to the development of targeted and effective myopia prevention strategies, thereby minimizing the impact of myopia and its related complications among school-aged children in affected regions.

PurposeThis aim of this study was to evaluate the effect of 3% Diquafosol Ophthalmic Solution (DQS) on children with dry eye from wearing overnight orthokeratology (OrthoK) lenses.MethodsMyopic children aged 8–18 years with dry eye syndrome were enrolled in this prospective observational study, and they were grouped according to their OrthoK treatment history for at least 1 year. All participants received DQS 4 times per day for 1 month. The following indicators were measured at baseline 1 month after treatment: the Dry Eye Questionnaire-5 (DEQ-5), non-invasive tear meniscus height (TMH), non-invasive tear film break-up time (first and average, NIBUT-F and NIBUT-A), meibomian gland score (MG score), conjunctival hyperemia redness score (R-scan), and blink pattern analysis.ResultsA total of 104 participants (189 eyes) including 40 OrthoK wearers (72 eyes) and 64 Orthok candidates (117 eyes) completed the study. Of all, after DQS treatment for 1 month, DEQ-5 scores reduced from 5.54 ± 3.25 to 3.85 ± 2.98 (t = −3.36, p = 0.00). TMH increased from 0.20 ± 0.05 mm to 0.21 ± 0.05 mm (t = 2.59, p = 0.01), NIBUT-F and NIBUT-A were prolonged from 6.67 ± 4.71 s to 10.32 ± 6.19 s and from 8.86 ± 5.25 s to 13.30 ± 6.03 s (all p = 0.00), respectively. R-scan decreased from 0.69 ± 0.28 to 0.50 ± 0.25 (t = −9.01, p = 0.00). Upper MG scores decreased from 1.04 ± 0.32 to 0.97 ± 0.36 (t = −2.14, p = 0.03). Lower MG scores, partial blink rate, partial blinks, and total blinks did not change significantly. Both break-up time (BUT) and R-scan improved significantly after DQS treatment for 1 month (all p = 0.00) in OrthoK candidates and OrthoK wearers. Among the OrthoK wearers, TMH and dry eye symptoms increased significantly (all p = 0.00) but did not increase in OrthoK candidates (p > 0.05). There were no adverse events related to DQS.ConclusionDiquafosol Ophthalmic Solution was effective for children wearing overnight orthokeratology in relieving dry eye symptoms and improving ocular surface parameters, which may help improve children's OrthoK wearing tolerance and compliance.

Background: Home confinement during the epidemic has a significant impact on the lifestyle and behavior of school-aged children, who have exhibited an increase in the prevalence and development of myopia. Our research will look at if home confinement will affect school-aged children on myopia control with orthokeratology. Method: Data on axial length was gathered from school-aged children who had received OK lenses treatment. The entire data was separated into subgroups based on gender, age, and initial refraction, and the AL changes for each period were calculated using the formula defined in our study. Finally, the acquired data will be examined using various statistical approaches, and the ideas of slow, moderate, and rapid myopia progression will be applied to our study. Result: A total of 258 study subjects met the requirements to be included in the study. We discovered that the percentage of rapid myopia growth increased during the epidemic. In addition, the AL changes before and during the epidemic were found to be statistically significant in 171 subjects in the overall data. (P = 0.041) In the high age group, the AL changes before and during the epidemic、(P = 0.033) before and after the epidemic (P = 0.023) were found to be statistically significant. The AL changes before and during the epidemic (P = 0.035) were shown to be statistically significant in the moderate myopia group. Finally, we did not find statistically significant results for other groups. Conclusion: We cannot conclude that home confinement did have a negative impact on myopia control with orthokeratology in school-aged children. But we found there was an increase in the percentage of patients with OK treatment that had fast myopia progression during the confinement. We also observed that older children with higher initial refraction were more likely to be affected by home confinement. [ABSTRACT FROM AUTHOR]

Introduction: There is a high prevalence of intermittent exotropia and exophoria in myopic populations, and orthokeratology is one of the effective interventions to control myopia progression in children. However, it is still obscure whether intermittent exotropia and exophoria children could wear orthokeratology without experiencing aggravated lens decentration. Methods: This was a multi-center, prospective cohort study. A total of 123 myopic participants aged 8–14 years were recruited, where conditions of deviation included intermittent exotropia, exophoria, and orthophoria. Uncorrected visual acuity and corneal topography data were obtained at baseline and after 1 month of wearing orthokeratology lens. Lens decentration was analyzed in a MATLAB program. Magnitude of deviation and refractive errors were evaluated prior to orthokeratology treatment. Fisher's exact test, ANOVA test, and univariate and multivariate linear regression models were established to evaluate the role of magnitude of deviation in lens decentration. Results: There was no significant difference in magnitude and direction of lens decentration among three groups (magnitude: F = 1.25, P = 0.289; direction: Fisher = 9.91, P = 0.078). According to scale division of decentration, 1 (2.6%) intermittent exotropia subject, 2 (3.8%) exophoria subjects, and 1 (3.0%) orthophoria subject experienced severe decentration (Fisher = 1.10, P = 0.947). Inferotemporal decentration was most common among all subjects (intermittent exotropia 50.0%, exophoria 76.9%, orthophoria 72.7%). Univariate and multivariate linear regression analyses revealed that magnitude of deviation was not an independent risk factor for lens decentration [β = −0.00, 95% confidence interval (CI) −0.01–0.00, P = 0.180], while surface asymmetry index (SAI) (β = 0.21, 95% CI 0.02–0.40, P = 0.028) and surface regularity index (SRI) (β = −0.39, 95% CI −0.66 to −0.13, P = 0.004) had significant correlation with polar decentration. Conclusion: Patients with intermittent exotropia and exophoria exhibit non-aggravated lens decentration after orthokeratology application. Thus, lens decentration is not the concern for orthokeratology prescription. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of different eye using behaviors on the control of axial length growth in patients using orthokeratology (Ortho-K) lens in combination with low concentration atropine. Methods This study was a cohort study. A total of 85 children and adolescents aged 5-13 years (170 eyes) who wore Ortho-K lens and used low-concentration atropine in the Optometry Center of Peking University People’s Hospital from October 2018 to July 2021 were enrolled, and collected information on different eye using behaviors within one year. According to the average daily near work hours, online classes hours, electronic product usage hours, and single longest eye-using hours, the near work hours ≥7 hours/day; online classes hours ≥1.5 hours/day; electronic product usage hours ≥1.5 hours/day; single longest eye-using hours ≥2 hours/day were classified as poor eye using behavior. To evaluate the cumulative effect of multiple eye using behaviors, we counted the number of negative eye using behaviors for each participant, with a range of 0 to 4, and further divided them into ≥2 poor eye using behaviors and ≤1 poor eye using behavior. Linear regression model was used to evaluate the association between eye using behavior and axial length growth, and other factors such as age, sex, parental myopia, and baseline axial length were considered. Results The changes of axial length of both eyes were similar in different eye using behaviors. Taking left eye axial length change as an example, among the 4 types of eye using behaviors, patients with good eye using behavior had slower axial length growth. Especially those with <1.5 hours/day showed a relative decrease in axial length growth of 0.071mm (β=-0.071, P=0.034) in the 3rd month compared to those with single longest eye-using time≥1.5 hours/day. Patients with a synthetical eye using of ≤1 poor eye using behavior had a relative decrease in axial length growth of 0.184mm (β=-0.184, P=0.025) after 1 year. Conclusions Good eye using behaviors could have a positive impact on patients using Ortho-K lens in combination with low concentration atropine to control the progression of myopia. The single longest eye-using hours had the greatest impact on axial length control, and the cumulative effect of multiple eye using behaviors was stronger than that of a single behavior. Therefore, it is important to maintain healthy eye habits in addition to using Ortho-K lens combined with low concentration atropine to control myopia progression. [ABSTRACT FROM AUTHOR]

Objective To compare effects of high-addition multifocal soft contact lens (MFSCL) and orthokeratology (Ortho-K) on accommodation in myopic children. Methods Thirty myopic children participated in this study. Each subject was corrected with three different corrections in the following order: single-vision soft contact lens (SVSCL), high-addition multifocal soft contact lens (MFSCL), and Ortho-K lens. Corneal topography, 3 D and 6 D accommodative responses and accommodative micro-fluctuation of the right eye were measured under different corrections. Results The accommodative response produced by MFSCL with high additional power was less than that of SVSCL at the stimulus of 3 D and 6 D (3 D, F=5.94, P<0.01; 6 D, F=4.81, P<0.05), but was close to that of the Ortho-K lens (P>0.05). MFSCL induced higher accommodative micro-fluctuation than that of Ortho-K lens and SVSCL at the stimulus of 3 D and 6 D (3 D, F=7.51, P<0.01; 6 D, F=4.81, P<0.05), while there was no significant difference in the accommodative micro-fluctuation between Ortho-K lens and SVSCL (P>0.05). Conclusions This peripheral high-addition MFSCL caused similar accommodative response, and higher accommodative micro-fluctuation compared with the Ortho-K lens, which might provide useful reference for the mechanism study of myopia control. [ABSTRACT FROM AUTHOR]

Objective To develop an automatic and objective quantification algorithm based on corneal topography to evaluate the orthokeratology (Ortho-K) lens fitting. Methods K-means algorithm was used to analyze the defocus ring of corneal topography and fit the most suitable ellipse on the defocusing region of corneal topography combining with weighted least squares method. The decentration distance was defined as the distance between the pupil center and the center of ellipse. Corneal topography images from 200 eyes (100 patients) were used to evaluate the accuracy and repeatability of the algorithm. Results The decentration distance was calculated using this automatic algorithm. One hundred and fourteen eyes (57%) had mild decentration, 75 eyes (37.5%) had moderate decentration and 11 eyes (5.5%) had severe decentration after wearing Ortho-K lenses. Compared with manual evaluation, the automatic algorithm showed higher accuracy and better repeatability. Conclusions Using K-means combining with weighted least squares algorithm, an objective and accurate algorithm was developed to evaluate Ortho-K fitting and could be used as an useful quantitative analysis tool for future clinical practice and research. [ABSTRACT FROM AUTHOR]

Several factors influence axial length in children with myopia treated using overnight orthokeratology. To identify these factors, this retrospective study collected axial length and corneal aberration data on 78 eyes before and 1-year after orthokeratology. Patients were divided according to axial elongation (cut-off, 0.25 mm/year). Baseline characteristics included age, sex, spherical equivalent refraction, pupil diameter, axial length, and orthokeratology lens type. Corneal shape effects were compared through tangential difference maps. Group differences in higher-order aberrations of a 4 mm zone were compared at baseline and 1-year following therapy. Binary logistic regression analysis was conducted to identify the variables determined for axial elongation. Significant differences between both groups included the initial age of wearing orthokeratology lenses, type of orthokeratology lens, size of central flattening area, corneal total surface C12 (1-year), corneal total surface C8 (1-year), corneal total surface spherical aberration (SA) (1-year root mean square [RMS] values), change in total corneal surface C12, and change in front and total corneal surface SA (RMS values). The age when wearing an orthokeratology lens was the most important factor influencing axial length in children with orthokeratology-treated myopia, followed by lens type and change in the C12 of the total corneal surface. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the relative efficacy of peripheral defocus contact lenses (PDCLs) and orthokeratology (OK) in a real‐world clinical population, and compare these results with previous randomised controlled clinical trials. Methods: Records from a university practice were reviewed to identify children who were treated with OK or PDCLs. The analysed sample contained 273 visits from 77 patients. Annualised rates of axial length (AL) progression were calculated and used as the response variable in both linear mixed‐effects (LME) and nonlinear regression models. Results: On average, children were 10.7 years of age at baseline (p = 0.14 between treatments), and most patients were female. More Asian children wore OK lenses compared with PDCLs (p < 0.01). At baseline, children had ~3.00 D of myopia and 0.75 D of astigmatism in both treatment groups (p > 0.20 between treatments). LME regression models using only baseline covariates showed no evidence that the annualised change in AL differed between treatments, with or without the inclusion of age, race, sex, baseline AL or spherical equivalent refractive error. Across all possible subsets of models, age at baseline was the best predictor of annualised AL change. There was no statistical difference between parameters of an exponential decay model fitted within treatment using follow‐up age as a time‐varying predictor, indicating that the rate of annualised change in AL was similar for OK and PDCL. Conclusions: Retrospective analysis of real‐world clinical data found no difference in annualised AL growth between PDCL and OK. Importantly, the AL progression from this clinical setting is consistent with that reported in randomised clinical trials. Therefore, continued research of real‐world performance is warranted to understand the safety and efficacy of modern myopia control treatments in the broader population. [ABSTRACT FROM AUTHOR]

Myopia control efficacy and long-term safety of the Breath-O-Correct orthokeratology (OK) lens was evaluated in a 2-year randomized, single vision (SV) spectacle lens-controlled, single-blind clinical trial combining clinical and tear proteomics data. A total of 71 children (43 OK, 9.8 ± 1.3 years; 28 SV, 9.5 ± 1.4 years) completed the 2-year study. Axial length (AL), cycloplegic refraction, clinical safety parameters (best-corrected visual acuity, central cornea thickness, corneal endothelial health, ocular surface disease index), and quantitative tear proteomics were evaluated by masked examiners. Mean 2-year-normalized AL elongations in the OK and SV groups differed significantly (p = 0.03) and were 0.37 ± 0.37 mm and 0.60 ± 0.41 mm, respectively. OK-mediated myopia control efficacy was 37.1%. No significant difference was found in clinical safety parameters of both groups (p > 0.10), except for a thinner central corneal thickness in the OK group (p = 0.01). Proteomics revealed modest OK lens-mediated effects on immune response proteins, including an increased abundance of haptoglobin at 6 and 12 months and a decreased abundance of two proteins (neutrophil defensin 3 and histone 4) at 6 months. The changes were further validated using a high-resolution multiple-reaction monitoring (MRMHR) mass spectrometry. In summary, the Breath-O-Correct OK lens significantly reduced AL elongation in schoolchildren without adverse clinical effects or subclinical inflammatory responses. [ABSTRACT FROM AUTHOR]

To develop and validate an ideal nomogram and an online calculator for predicting rapid myopia progression risk in children managed with orthokeratology (ortho-k). Data of children undergoing ortho-k treatment at Shanghai Children's Hospitals between January 2018 and April 2021 were retrospectively assessed. Potential predictors were screened using univariable analyses and a bidirectional stepwise procedure based on Akaike's information criterion. The final model was constructed using multivariable logistic regression and validated using an internal validation cohort. A nomogram and an online calculator were used to present the final model. In this retrospective study with 1051 eyes of 560 myopia patients, the training cohort included 735 eyes, and the validation cohort included 316 eyes. Among 11 potential predictors of rapid myopia progression considered, the following four variables identified as independent predictive factors were included in the nomogram: age (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.61–0.79), baseline spherical equivalent (OR, 1.53; 95% CI, 1.31–1.79), pupil diameter (OR, 0.56; 95% CI, 0.32–0.97), and horizontal visible iris diameter (OR, 0.57; 95% CI, 0.33–0.97). The mean concordance statistics for the training and validation cohorts were 0.705 (95% CI 0.664–0.747) and 0.707 (95% CI 0.639–0.774), respectively. The online calculator is publicly available (). This study developed a simple-to-use nomogram and online calculator that predicted rapid myopia progression risk in children treated with ortho-k, who will likely benefit from early intervention and improved surveillance. [ABSTRACT FROM AUTHOR]

Background: To compare risk of diabetic retinopathy (DR) between patients taking sodium-glucose cotransporter-2 inhibitors (SGLT2is) and those taking glucagon-like peptide-1 receptor agonists (GLP1-RAs) in routine care. Methods: This retrospective cohort study emulating a target trial included patient data from the multi-institutional Chang Gung Research Database in Taiwan. Totally, 33,021 patients with type 2 diabetes mellitus using SGLT2is and GLP1-RAs between 2016 and 2019 were identified. 3,249 patients were excluded due to missing demographics, age <40 years, prior use of any study drug, a diagnosis of retinal disorders, a history of receiving vitreoretinal procedure, no baseline glycosylated hemoglobin, or no follow-up data. Baseline characteristics were balanced using inverse probability of treatment weighting with propensity scores. DR diagnoses and vitreoretinal interventions served as the primary outcomes. Occurrence of proliferative DR and DR receiving vitreoretinal interventions were regarded as vision-threatening DR. Results: There were 21,491 SGLT2i and 1,887 GLP1-RA users included for the analysis. Patients receiving SGLT2is and GLP-1 RAs exhibited comparable rate of any DR (subdistribution hazard ratio [SHR], 0.90; 95% confidence interval [CI], 0.79 to 1.03), whereas the rate of proliferative DR (SHR, 0.53; 95% CI, 0.42 to 0.68) was significantly lower in the SGLT2i group. Also, SGLT2i users showed significantly reduced risk of composite surgical outcome (SHR, 0.58; 95% CI, 0.48 to 0.70). Conclusion: Compared to those taking GLP1-RAs, patients receiving SGLT2is had a lower risk of proliferative DR and vitreoretinal interventions, although the rate of any DR was comparable between the SGLT2i and GLP1-RA groups. Thus, SGLT2is may be associated with a lower risk of vision-threatening DR but not DR development. [ABSTRACT FROM AUTHOR]

Purpose: To assess changes in optical quality and visual function in children after 3 months of wearing orthokeratology (OK) lenses. Methods: A total of 25 myopic children aged 8-12 years were recruited and completed the follow-up study. Optical quality, visual function and corneal morphology were assessed at baseline and at follow-ups 1 and 3 months after wearing OK lenses. Optical quality parameters mainly included the modulation transfer function (MTF) cutoff, objective scattering index (OSI), Strehl ratio (SR) and the predicted visual acuities (PVAs). Visual function was assessed by visual acuity, monocular contrast sensitivity function (CSF) across five spatial frequencies and the area under the log contrast sensitivity function (AULCSF) that was also computed as an index for overall CSF. Results: The MTF cutoff and SR values both increased after 1 month of wearing the OK lenses (baseline vs. 1 month: PMTF = 0.008 and PSR = 0.049); this improvement plateaued after 3 months of lens wear (1 month vs. 3 months: PMTF = 0.626, PSR = 0.428). The corneal morphology also showed the similar change trend. The OSI showed the opposite change trend (baseline vs. 1 month: POSI < 0.001; 1 month vs. 3 months: POSI = 0.720). The mean CSF at 1.5 cpd decreased significantly after 1 month of wearing the lenses (baseline vs. 1 month: p = 0.001) and recovered after 3 months of lens wear (baseline vs. 3 months: p = 0.076). CSF at spatial frequencies of 3, 6, 12 and 18 cpd as well as the AULCSF did not significantly differ between any two timepoints (all Ps > 0.05). Conclusion: After 3 months of wearing OK lenses, the subjects exhibited a decrease in optical quality, similar to corneal morphology, whereas their visual function remained largely unchanged. Thus, the optical quality was more susceptible to OK lenses than visual function in children. The initial month of OK treatment of children is a key period to be paid close attention to deterioration of optical quality and visual function. [ABSTRACT FROM AUTHOR]

Background: Autophagy is an important process that maintains the quality of intracellular proteins and organelles. There is extensive evidence that autophagy has an important role in the lens. Human lens epithelial cells (HLECs) play a key role in the internal homeostasis of the lens. HLEC subtypes have been identified, but autophagy-prominent cell clusters among HLECs have not been characterized. Purpose: To explore the existence of autophagy-prominent cell clusters in HLECs. Methods: Three donated lenses (HLECs from two whole lenses and HLECs from one lens without the anterior central 6-mm zone) were used for single-cell RNA sequencing (scRNA-seq). AUCell and AddModuleScore analysis were used to identify potential autophagy-prominent cell clusters. Transmission electron microscopy (TEM) was used to confirm the results. Results: High-quality transcripts from 18,120 cells were acquired by scRNA-seq of the two intact lenses. Unsupervised clustering classified the cells into four clusters. AUCell and AddModuleScore analysis revealed cluster 1 is autophagy-prominent. scRNA-seq analysis of HLECs from the lens capsule lacking the central zone confirmed the cluster 1 HLECs was located in the central capsule zone. The TEM result showed that greater autophagy activity was observed in the HLECs in central capsule zone, which further supported the above conclusions based on scRNA-seq analysis that autophagy was prominent in the central zone where the cluster 1 HLECs located. Conclusions: We identified an autophagy-prominent cell cluster among HLECs and revealed that it was localized in the central zone of the lens capsule. Our findings will aid investigations of autophagy in HLECs and provide insights to guide related research. [ABSTRACT FROM AUTHOR]

Background: Orthokeratology lenses, which are worn overnight, are recommended for reducing myopia progression. They lie on the cornea and can influence the ocular surface by temporarily reshaping the corneal surface through a reverse geometry design. This study investigated the effect of overnight orthokeratology lenses on tear film stability and meibomian gland status in children aged 8–15 years. Methods: This prospective, self-controlled study included 33 children with monocular myopia who were prescribed orthokeratology lenses for at least one year. The experimental group (ortho-k group) comprised 33 myopic eyes. The control group comprised the emmetropic eyes of the same participants. Tear film stability and meibomian gland status were measured using a Keratograph 5M (Oculus, Wetzlar, Germany). Paired t-tests and Wilcoxon signed-rank tests were used to compare the data between the two groups. Results: At the one-year visit, the non-invasive first tear film break-up time (NIBUTf) values were 6.15 ± 2.56 s and 6.18 ± 2.61 s in the experimental and control groups, respectively. The lower tear meniscus height was 18.74 ± 0.05 μm and 18.65 ± 0.04 μm in these groups, respectively. No significant difference was observed in loss of meibomian glands or non-invasive average tear film break-up time between the experimental and control groups using Wilcoxon signed-rank tests. Conclusions: The stability of the tear film and meibomian gland status were not significantly affected by wearing orthokeratology lenses overnight, indicating that continuous use of orthokeratology lenses for 12 months has a minimal effect on the ocular surface. This finding can help guide the clinical management of tear film quality with respect to the use of orthokeratology contact lenses. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this case series was to examine the association between unaided binocular visual acuity for near vision and pupil change after the instillation of a special topical formulation for presbyopia treatment. Methods: This was a case series consisting of consecutive participants with presbyopia aged 40–70 years who were tested for visual acuity and pupil diameter before and 2 h after instillation of a formulation of pilocarpine and phenylephrine drops (FOV Tears) for presbyopia. Participants underwent subjective refraction, photopic and scotopic pupil diameter measurement and unaided monocular and binocular visual acuity testing by logMAR for distance and near vision both pre- and post-instillation of eye drops. Results: The study enrolled 363 subjects (n = 176 women, 48%) with a mean (± standard deviation) age of 50.4 ± 5.8 years. Mean spherical equivalent (SE) changed significantly (− 0.17 Diopters) after instillation of the FOV Tears formulation (p < 0.001). Post-instillation of eye drops, the scotopic pupil diameter decreased by 0.97 ± 0.98 mm, and the near visual acuity by logMAR improved significantly by nearly two lines (p < 0.01). In the linear regression analyses, age (p < 0.001) and SE pre-drop instillation (p < 0.001) were associated with unaided binocular visual acuity. The changes in photopic pupil diameter and the scotopic pupil diameter were not associated with unaided binocular visual acuity. Conclusions: The use of the pilocarpine and phenylephrine formulation (FOV Tears) improved binocular visual acuity for near vision in presbyopic patients, and the effect was independent of pupil change. [ABSTRACT FROM AUTHOR]

Abstract Purpose To investigate the efficacy of myopia control by comparing the orthokeratology (Ortho-K) treated eyes and the emmetropic contralateral eyes in unilateral myopic children, and to identify the inter-individual influence factors. Method In this retrospective study, 1566 medical records of children wearing Ortho-K lens were reviewed, and 62 children who received monocular Ortho-K lens for more than 1 year were analyzed. The change in axial length (AL) of the Ortho-K eyes and the emmetropic contralateral eyes was recorded. To evaluate the absolute and relative efficacy of myopia control, the intra-bilateral absolute reduction in AL growth (ibARAL) and the intra-bilateral relative reduction in AL growth (ibRRAL) were calculated as main outcomes. Association of the AL elongation, ibARAL and ibRRAL with age, sex and ocular parameters was analyzed by correlation analysis and generalized estimating equation (GEE) analysis. Result The average initial wearing age was 10.76 ± 1.45 (ranged 8.5 to 15.8). The average baseline SER was − 2.15 ± 1.03 (ranged − 5.25 to -1.00) D in the Ortho-K eyes and − 0.01 ± 0.40 (ranged − 0.75 to 0.75) D in the contralateral eyes. At the 1-year follow-up, the average increased AL was significantly less in the Ortho-K eyes (0.07 ± 0.18 mm) than in the fellow eyes (0.48 ± 0.24 mm) (p

Background/Purpose: Orthokeratology (Ortho-K), atropine eye drops and combined atropine with Ortho-K are proven to be effective ways to prevent myopic progression in many studies, but there is scarce evidence regarding the comparative efficacy of different dosages of atropine,Ortho-K, and combined atropine with Ortho-K for childhood myopia. Methods: We performed a network meta-analysis (NMA) to assess the relative efficacy of the aforementioned interventions for myopic progression; moreover, we calculated the surface under cumulative ranking area (SUCRA) to determine the relative ranking of treatments. Results: We identified 19 randomized controlled trials (3435 patients). NMA revealed that 0.01%–1% atropine, Ortho-K, and 0.01% atropine combined with Ortho-K inhibited axial elongation (AL) over one year. For refractive change, SUCRA analysis revealed that the hierarchy was high-dose (0.5%–1%), moderate-dose (0.1%–0.25%), and low-dose (0.01%–0.05%) atropine. Regarding AL, SUCRA analysis revealed the following hierarchy: Ortho-K combined with 0.01% atropine, high-dose atropine, moderate-dose atropine, Ortho-K, and low-dose atropine. Conclusion: In conclusion, we found that atropine (0.01%–1%), Ortho-K, and 0.01% atropine combined with Ortho-K could significantly slow down myopia progression. The atropine efficacy followed a dose-related pattern; moreover, Ortho-K and low-dose atropine showed similar efficacy. There was a synergistic effect of using 0.01% atropine combined with Ortho-K, and it showed comparable efficacy to that of high-dose atropine.

Abstract Background: To evaluate the additive effects of orthokeratology (OK) lenses and 0.01% atropine on slowing axial elongation in myopic children. Methods: A prospective, randomized, double-blinded, placebo-controlled trial was conducted over a 12-month period. Sixty children aged 8 to 12 years with spherical equivalent refraction from − 1.00 to -4.00 D who had been wearing OK lenses successfully for 2 months (as baseline) were randomly assigned in a 1:1 ratio to combination group (combination of OK lens and 0.01% atropine eye drops) and control group (combination of OK lens and placebo). The primary outcome was change in axial length, along with secondary outcomes including change in pupil diameter (PD) and accommodative amplitude (AMP) at 12 months (measured at 4-month intervals). Results: After 12 months, the overall axial elongation was 0.10 ± 0.14 mm and 0.20 ± 0.15 mm (p = 0.01) in the combination and control groups, respectively. The change in axial length in the two groups showed significant differences only in the first four months (median [Q1, Q3] (95% CI), -0.01 mm [-0.07, 0.05] (-0.06, 0.04) vs. 0.04 mm [0.00, 0.10] (0.02, 0.09); p = 0.04), but no difference thereafter. Multivariate linear regression analysis showed that the axial elongation was significantly slower in the combination group than in the control group (standard β = -0.10, p = 0.02). PD significantly increased by 0.45 mm [0.20, 0.68] at the 4th month visit (p 0.05). Conclusion: The combination therapy was more effective than the OK lens alone in slowing axial elongation after 12 months of treatment, and mainly in the first 4 months. Trial registration: The First Affiliated Hospital of Zhengzhou University, ChiCTR2000033904. Registered 16/06/2020, http://www.chictr.org.cn/login.aspx?referurl=%2flistbycreater.aspx

Abstract Background To assess the correlation between ocular residual astigmatism and anterior corneal astigmatism in children with low and moderate myopia. Methods Refractive astigmatism was determined by subjective manifest refraction. Anterior corneal astigmatism was determined by IOL Master. Thibos vector analysis was used to calculate ocular residual astigmatism. Correlation analysis was used to assess the relationship between the amounts of ocular residual astigmatism and anterior corneal astigmatism. The relationship between the vectors of ocular residual astigmatism and anterior corneal astigmatism was evaluated by a physical method. Results The study analysed 241 right eyes of 241 children aged 8 to 18 years old. In this study, the median magnitude of ocular residual astigmatism was 1.02 D, with an interquartile range was of 0.58 D. Against-the-rule ocular residual astigmatism was seen in 232 eyes (96.3%). There was a significant and moderate correlation between ocular residual astigmatism and anterior corneal astigmatism (r = 0.50, P

Abstract Background To observe alterations of fundus microcirculation and retinal thickness in adolescent myopic patients with astigmatism after toric and spherical orthokeratology using optical coherence tomography angiography (OCTA), to explore the effects of orthokeratology on the retinal thickness and choroidal blood flow. Methods A total of 48 patients were enrolled and divided into two group (toric orthokeratology (T) group and spherical orthokeratology (S) group) according to the type of lens design. OCTA was used to measure the superficial and deep retinal vessel densities at the macular region, radial peripapillary capillary (RPC) density, foveal avascular zone (FAZ) area, and choriocapillaris (ChC) perfusion area before and after orthokeratology for 3 months. The data were statistically analyzed by SPSS 19.0 software. Results Compared with before orthokeratology, the superficial vessel density in the fovea and parafovea in the T group significantly increased, and the deep vessel density in the whole area and fovea were significantly elevated after 3 months (P

AIM:To observe the changes of choroidal thickness(CT)and axial length(AL)in adolescents with myopic anisometropia before and after orthokeratology(OK lenses)treatment.METHODS: In this retrospective case-control study, 71 myopic participants who insisted on using OK lenses more than 6mo at night from June 2020 to September 2021 in Second People's Hospital of Shenzhen were enrolled. They were divided into three groups, including group A consisted of 31 myopic participants with non-anisometropic myopia with binocular lenses(A1 group: the right eyes, A2 group: the left eyes), group B consisted of 18 bilateral myopic anisometropes(B1 group: the eyes with high degree, B2: the eyes with low degree)and group C consisted of 22 unilateral myopic anisometropes(C1: the eyes with high degree, C2: the eyes with low degree). The length of axis, the CT values of subfoveal(SF)and the superior(S0.5, S1.0, S1.5), inferior(I0.5, I1.0, I1.5), temporal(T0.5, T1.0, T1.5)and nasal(N0.5, N1.0, N1.5)at 0.5, 1.0 and 1.5mm from the fovea before and after wearing lenses at 6mo were measured.RESULTS: After wearing lenses at 6mo, CT of all sites in group A1 was all thickening compared with that before wearing lenses(all P0.05). Among them, the CT at SF, S0.5, S1.0, S1.5, I0.5, I1.0, I1.5, N0.5, N1.0 and N1.5 was thinner than before wearing lenses, but it was not statistically significant. There were differences in all sites of CT in group C1 compared with that before and after wearing lenses(all P0.05).CONCLUSION: For adolescents with myopic anisometropia patients after long-term wearing OK lenses have CT thickening in high degree eyes, but no thickening in low-degree eyes, and even thinning. At the same time, wearing OK lenses can slow axis elongation and reduce interocular anisometropia difference in axis, which is an effective clinical method to control the development of anisometropia.

AIM:To discuss the efficacy and safety of orthokeratology with reducing back optic zone diameter(5mm-BOZD)compared with conventional back optic zone diameter(6mm-BOZD)in the treatment of adolescent myopia.METHODS: A prospective randomized controlled trial was performed. There were 100 cases with 100 eyes of adolescent myopia(all right eye data were taken)selected from April 2016 to January 2019, the spherical degree was -1.00--5.00D. Then they were randomly divided into the two groups. The experimental group wore 5mm-BOZD orthokeratology, and the control group wore 6mm-BOZD orthokeratology. Their axis length(AL), spherical equivalent(SE), relative peripheral refraction(RPR), best corrected visual acuity(BCVA), uncorrected near visual acuity(NVA), Efron grading was applied to record the anterior segment of the eyes, corneal hysteresis(CH), corneal resistance factor(CRF), corneal-compensated intraocular pressure(IOPcc), average noninvasive Keratograph tear breakup time(NIKBUTav)and higher order aberration(RMSh) were compared between the two groups during the 1a treatment period.RESULTS: After 1a of treatment, the AL in experimental group increased 0.05±0.05mm,while it increased 0.15±0.05mm(t=-8.949, P0.05).CONCLUSION:Reducing back optic zone diameter orthokeratology can correct adolescent myopia safely and more effectively during the observation period.

AIM: To explore the photopic pupil size behavior in myopic children undergoing overnight orthokeratology (ortho-k) over 1-year period and its effects on the axial elongation. METHODS: A total of 202 Chinese myopic children were enrolled in this prospective clinical trial. Ninety-five subjects in ortho-k group and eighty-eight subjects in spectacle group completed the 1-year study. Axial length (AL) was measured before enrollment and every 6mo after the start of ortho-k. The photopic pupil diameter (PPD) was determined using the Pentacam AXL and measured in an examination room with lighting of 300-310 Lx. Stepwise multiple linear regression analysis was used to identify variables contribution to axial elongation. RESULTS: Compared with spectacle group, the average 1-year axial elongation was significantly slower in the ortho-k group (0.25±0.27 vs 0.44±0.23 mm, P0.05, Bonferroni correction). The 4.81 mm PPD may be a possible cutoff point in the ortho-k group. Subjects with PPD below or equal to 4.81 mm tended to have smaller axial elongation compared to subjects with PPD above 4.81 mm after 1-year period (t=-3.09, P=0.003). In ortho-k group, univariate analyses indicated that those with older age, greater degree of myopia, longer AL, smaller baseline PPD (PPDbaseline) experienced a smaller change in AL. In multivariate analyses, older age, greater AL and smaller PPDbaseline were associated with smaller increases in AL. In spectacle group, PPD tended to be stable (P>0.05, Bonferroni correction) and did not affect axial growth. CONCLUSION: PPDs experience significantly decreases at 1-month and 3-month ortho-k treatment. Children with smaller PPD tend to experience slower axial elongation and may benefit more from ortho-k.

Abstract Background The goal of this study was to reproduce a three-dimensional representation of corneal defocus characteristics after orthokeratology (Ortho-K) treatment via an indicator defined as the weighted Zernike defocus coefficient of the treatment zone (C weighted defocus ). This could be used to predict the effectiveness of Ortho-K treatment quantitatively in a timely manner after the one-month visit. Methods Seventy myopic children with axial length (AL) elongation after Ortho-K treatment (group A) and 63 myopic children with AL shortening after Ortho-K treatment (group B) were included in this one-year retrospective study. The proposed indicator was calculated by a customized MATLAB program. Multivariate binomial logistic regression and multivariate linear regression analyses were used to explore the association between AL change and the C weighted defocus , age, sex, and other ocular biometric parameters. Results The 12-month AL change, age, pupil diameter, and vertical decentration of the Ortho-K lens were significantly different between the two groups. Multivariate logistic regression analysis showed that a larger C weighted defocus (≥ 0.35 D/mm2) (OR: 0.224; 95% CI: 0.078–0.646; P = 0.006) was correlated with the emergence of AL shortening after orthokeratology treatment. A multivariate linear regression model showed that a greater C weighted defocus was associated with slower 12-month AL elongation (β = − 0.51, P = 0.001). Conclusions The C weighted defocus is an effective predictive indicator of myopia control, and a larger C weighted defocus may lead to slower elongation of AL. This meaningful indicator may help in the evaluation and adjustment of Ortho-K lens parameters in a timely manner and minimize the cost of clinical trial and error.

It is predicted that emergency responses to critical incidents will increase over the next few decades, as society faces unique and dynamic challenges (e.g., pandemics, migrant crises, and terrorism). As such, it is necessary to breakdown, identify, and evaluate the unique barriers associated with decision-making in the context of critical incident responses. The aim of the current study was to synthesize the bibliographic characteristics of the research on decision making and present a holistic narrative analysis of the multi-layered factors. Additionally, the systematic synthesis of evidence facilitated a critical appraisal of the quality and distribution of evidence across macro-, meso-, and micro- levels. Results suggested that research was moderately heterogeneous, as evidence captured diverse narrative factors. However, micro-centric characteristics (e.g., cognitive-related factors) were not well represented. Instead, research primarily focused toward intermediate meso-level characteristics, capturing factors such as "interoperability" and "organization policy and procedure" as critical challenges to decision-making. Six key narratives were also identified and discussed. Both the quality appraisal and narrative findings suggested that research should seek opportunities to experimentally assess, evaluate and validate decision-making. Whilst this has previously appeared ethically and practically problematic, advances in technology, research and analysis have allowed high-fidelity simulation experimentation to recreate critical incidents. [ABSTRACT FROM AUTHOR]

The development of EGFR small-molecule inhibitors has provided significant benefit for the affected patient population. Unfortunately, current inhibitors are no curative therapy, and their development has been driven by on-target mutations that interfere with binding and thus inhibitory activity. Genomic studies have revealed that, in addition to these on-target mutations, there are also multiple off-target mechanisms of EGFR inhibitor resistance and novel therapeutics that can overcome these challenges are sought. Resistance to competitive 1st-generation and covalent 2nd- and 3rd-generation EGFR inhibitors is overall more complex than initially thought, and novel 4th-generation allosteric inhibitors are expected to suffer from a similar fate. Additional nongenetic mechanisms of resistance are significant and can include up to 50% of the escape pathways. These potential targets have gained recent interest and are usually not part of cancer panels that look for alterations in resistant patient specimen. We discuss the duality between genetic and nongenetic EGFR inhibitor drug resistance and summarize current team medicine approaches, wherein clinical developments, hand in hand with drug development research, drive potential opportunities for combination therapy. [ABSTRACT FROM AUTHOR]

Corneal myofibroblasts play a crucial role in the process of corneal scarring. Potassium has been documented to reduce skin scar tissue formation. Herein, we investigated the ability of potassium to prevent corneal fibrosis in cell culture and in vivo. Corneal fibroblasts (CFs) were isolated from the corneal limbus and treated with TGF-β1 to transform into corneal myofibroblasts. Corneal myofibroblast markers were detected by quantitative real-time PCR, Western blot, and immunofluorescence. The contractive functions of corneal myofibroblast were evaluated by the scratch assay and the collagen gel contraction assay. RNA sequencing in corneal fibroblasts was performed to explore the mechanisms underlying hyperosmolar potassium treatment. GO and KEGG analysis were performed to explore the underlying mechanism by hyperosmolar potassium treatment. The ATP detection assay assessed the level of cell metabolism. KCl eye drops four times per day were administered to mice models of corneal injury to evaluate the ability to prevent corneal scar formation. Corneal opacity area was evaluated by Image J software. Treatment with hyperosmolar potassium could suppress corneal myofibroblast transformation and collagen I synthesis induced by TGF-β1 in cell culture. Hyperosmolar potassium could inhibit wound healing and gel contraction in CFs. RNA sequencing results suggested that genes involved in the metabolic pathway were downregulated after KCl treatment. ATP levels were significantly decreased in the KCl group compared with the control group. Hyperosmolar potassium could prevent corneal myofibroblast transformation after corneal injury and corneal scar formation in mice. Potassium can suppress corneal myofibroblast transformation and collagen I protein synthesis. Moreover, given that KCl eye drops can prevent corneal scar formation, it has been suggested to have huge prospects as a novel treatment approach during clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: The coronavirus disease 2019 (COVID-19) pandemic profoundly impacts lifestyle habits and myopia control in children worldwide. This study investigated the changes in eyecare habits, orthokeratology compliance, axial length, and time interval of follow-up visits during home confinement in the COVID-19 pandemic in Taiwan. Methods: This investigation was part of a prospective study undertaken to evaluate the effectiveness of a mobile application. A semi-structured telephone interview was conducted with parents retrospectively to document eyecare habits and myopia control during the COVID-19 home confinement. Results: Thirty-three children with myopia participated in the follow-up of orthokeratology lenses for 2 years. The children's time viewing digital devices such as tablets and televisions significantly increased during the COVID-19 pandemic (P < 0.05). An analysis using McNemar's test found that the proportional growth of axial length <0.2 mm in 2021 was significantly higher than that in 2020 (77.42% vs. 58.06%, P < 0.05). In the multivariate logistic regression analysis, onset <10 years of age (P = 0.001) and parents with high myopia (P < 0.001) were independent risk factors for the growth of axial length ≥0.2 mm in 2021. Conclusion: The suspension of face-to-face classes and after-school tutorials benefited myopic axial elongation in children during COVID-19 home confinement. The use of digital devices and staying indoors may not be the exclusive reasons for myopia progression. Educating parents about the influence of extra learning classes after school on myopia progression would be prudent. [ABSTRACT FROM AUTHOR]

Purpose: To investigate changes in peripheral and relative peripheral refraction (RPR) during orthokeratology lens (OKL) use in children, and predictors for myopia progression in a randomized controlled trial. Methods: Refraction and axial length (AL) were measured at baseline, 6, 12, and 18 months for children aged 6–12 years, with myopia of 0.5 to 4.75 dioptres (D) spherical component randomized to either OKL or single‐vision spectacles (SVS) at baseline. Cycloplegic spherical equivalent refractive error (SEQ) was measured on‐axis and eccentric at 10°, 20°, and 30° during nasal and temporal gaze in the horizontal plane with Shin‐Nippon Nvision‐K 5001. RPR was computed as SEQ(eccentricity) minus SEQ(on axis). AL was measured with Lenstar LS900. Results: Twenty‐one and 28 subjects from the OKL and SVS groups, respectively were available for analysis. OKL wear induced significant myopic RPR at all eccentricities (p ≤ 0.004) whereas peripheral refraction only changed in two out of six eccentric measuring points. Baseline peripheral refraction SEQ at all eccentricities, baseline on‐axis SEQ, and baseline RPR at 30° nasal eccentricity were positively correlated to treatment efficacy defined as change in AL. Conclusion: We found no correlations between change in RPR and treatment efficacy defined as change in AL. Interestingly, our results suggest that the central emmetropisation that occurs during OKL‐use accounts for most of the optical changes and to a lesser extent the mid‐peripheral plus‐zone of the lens. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the effect of orthokeratology treatment with DRL lenses on the control of myopia progression compared with single vision glasses users (monofocal glasses). It was also possible to analyze the clinical efficacy of orthokeratology treatment with DRL lenses for myopia correction in children and adolescents in a 2 year retrospective, multicenter study, performed in eight different ophthalmology centers in France. A total of 360 data records of children and adolescents with myopia between −0.50 D and −7.00 D at baseline visit, who completed treatment and had a centered outcome, were selected for the study from a database of 1271. The final sample included subjects undergoing orthokeratology treatment with DRL lenses (n = 211 eyes) and spectacle wearers (n = 149 eyes). After one year of treatment, the data analysis shows that the DRL lens has a refractive myopia progression control rate of 78.5% compared with the spectacle wearers (DRL M change = −0.10 ± 0.25 D, p < 0.001 Wilcoxon test and Glasses M change = −0.44 ± 0.38 D, p < 0.001 Wilcoxon test). Similar results were found after 2 years of treatment (80% with 310 eyes). This study showed the clinical efficacy of orthokeratology DRL lenses compared to monofocal spectacle wearers in controlling myopia progression in children and adolescents in a 2 year retrospective study. [ABSTRACT FROM AUTHOR]

Background and Objectives: Ocular alkaline burn is a clinical emergency that can cause permanent vision loss due to limbal stem cell deficiency and corneal neovascularization (CNV). Although the basic pathogenetic mechanisms are considered to be acute oxidative stress and corneal neovascularization triggered by inflammation, the underlying intracellular mechanisms have not been clearly elucidated. The aim of this study was to investigate the role of endoplasmic reticulum (ER) stress on inflammation and neovascularization, and the effect of the ER stress inhibitor salubrinal (SLB), as a novel treatment in a corneal alkaline burn model in rats. Methods: Chemical burns were created by cautery for 4 s using a rod coated with 75% silver nitrate and 25% potassium nitrate in the corneal center for the corneal neovascularization (CNV) model. Twenty-eight Wistar albino rats were divided into four groups: SHAM, CNV, CNV + SLB, and CNV + bevacizumab (BVC). After the CNV model was applied to the right eye, a single subconjunctival dose (0.05 mL) of 1 mg/kg salubrinal was injected into both eyes in the CNV + SLB group. A total of 1.25 mg/mL of subconjunctival BVC was administered to the CNV + BVC group. Fourteen days after experimental modeling and drug administration, half of the globes were placed in liquid nitrogen and stored at −20 °C until biochemical analysis. The remaining tissues were collected and fixed in 10% buffered formalin for histopathological and immunohistochemical analysis. Three qualitative agents from three different pathways were chosen: TNFR for inflammation, endothelial nitric oxide synthase (e-NOS) for vascular endothelial growth factor (VEGF)-mediated vascular permeability, and caspase-3 for cellular apoptosis. Results: Significantly lower caspase-3 and eNOS levels were detected in the CNV + SLB and CNV + BVC groups than in the CNV group. Additionally, histopathological evaluation revealed a significant decrease in neovascularization, inflammatory cell infiltration, and fibroblast activity in the CNV + SLB and CNV + BVC groups. The endoplasmic reticulum stress inhibitor, salubrinal, administered to the treatment group, attenuated apoptosis (caspase-3) and inflammation (e-NOS). In the control group (left eyes of the SLB group), salubrinal did not have a toxic effect on the healthy corneas. Conclusion: The ER stress pathway plays an important role in angiogenesis after alkaline corneal burns, and treatment with SLB modulates this pathway, reducing caspase-3 and eNOS levels. Further studies are needed to understand the molecular mechanisms altered by SLB-mediated therapy. The fact that more than one mechanism plays a role in the pathogenesis of CNV may require the use of more than one molecule in treatment. SLB has the potential to affect multiple steps in CNV pathogenesis, both in terms of reducing ER stress and regulating cellular homeostasis by inhibiting the core event of integrated stress response (ISR). Therefore, it can be used as a new treatment option and as a strengthening agent for existing treatments. Although blockade of intracellular organelle stress pathways has shown promising results in experimental studies, more in-depth research is needed before it can be used in routine practice. To the best of our knowledge, this study is the first to report the role of ER stress in corneal injury. [ABSTRACT FROM AUTHOR]

Understanding the impact of home confinement on axial length in myopic children undergoing orthokeratology (OK) treatment facilitates the management of myopia control during coronavirus disease 2019 (COVID-19) lockdown. The outbreak of COVID-19 and the corresponding home confinement measures have brought a considerable challenge to myopia control. The study aimed to investigate the influence of home quarantine on axial length in myopic children with OK treatment. Axial length measurements during and before COVID-19 home confinement were retrospectively collected from the myopic children treated with OK, and the children were prospectively followed up after finishing the quarantine. The monthly axial length growth before, during and after confinement was calculated and compared in the full dataset and subgroups stratified by age. Influencing factors for monthly axial length growth during confinement were analysed. Ninety-two myopic children with OK treatment were enrolled in this study. In the full dataset, covariates adjusted (gender, time interval, baseline axial length and age) monthly axial length growth during confinement was not significantly different from that before (P = 0.213) or after the home confinement (P = 1.000). Multiple linear regression showed that the monthly axial length growth during confinement was negatively correlated with age (P = 0.002). Subgroup analysis based on age demonstrated that the adjusted monthly axial length growth was not significantly different among three periods (P > 0.05) for younger children. For children older than 12-year-old, the adjusted monthly axial length growth during home confinement was significantly slower than before the confinement (P = 0.011), but not the monthly axial length growth after the confinement (P = 1.000). COVID-19 home confinement does not increase the myopic axial length elongation in children with OK treatment. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the correlation between the baseline axial length (AL) and axial elongation in myopes undergoing orthokeratology (ortho‐k). Methods: This was a retrospective study. During the 1‐year follow‐up, 1176 children (aged 8–14 years) were included and divided into an ortho‐k group (n = 588) and a single‐vision spectacle group (n = 588). The ortho‐k group participants (8–11 years of age) who completed the 3‐year follow‐up (n = 150) were further divided into three subgroups stratified by their baseline AL: subgroup 1 (AL < 24.5 mm), subgroup 2 (24.5 ≤ AL < 26 mm) and subgroup 3 (AL ≥ 26 mm). AL was measured at baseline and during the annual visit. Results: The ortho‐k group exhibited slower 1‐year axial elongation (39% reduction) than the spectacle group. The 1‐year axial elongation was negatively correlated with initial age in both groups. A negative association between 1‐year axial elongation and baseline AL was observed in the ortho‐k group but not in the spectacle group. However, this relationship only existed in ortho‐k participants 8–11 years of age. For the younger ortho‐k participants who completed the 3‐year follow‐up, the annual axial elongation was significantly higher in subgroup 1 for the first and second years but not in the third year compared with subgroups 2 and 3. Conclusion: Axial elongation was negatively correlated with baseline AL in the ortho‐k group. Children aged 8–11 years with longer baseline AL (≥24.5 mm) demonstrated slower annual axial elongation during the first 2 years of ortho‐k treatment, which may provide insight into establishing individual guidelines for controlling myopia using ortho‐k in children with different baseline characteristics. [ABSTRACT FROM AUTHOR]