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Background: Conjunctival ultraviolet autofluorescence (CUVAF) has been used as a biomarker of time spent outdoors. Smaller CUVAF area is associated with myopia in southern hemisphere cohorts. Further research is required to determine if this association is replicated in northern latitudes and whether average CUVAF intensity is a valuable metric. This prospective study explored the association between myopia, CUVAF (area and intensity) and additional indicators of sun exposure (vitamin D 3 and self-reported sun exposure preferences) across seasons at a location of 55° north., Methods: Young adults (age 18-20) provided blood samples biannually (March/April and September/October) over an 18-month period (four phases) for the assessment of 25-hydroxyvitamin D (25(OH)D 3 ) concentrations (liquid chromatography-tandem mass spectrometry). CUVAF (total area, average intensity) and self-reported sun exposure preferences were recorded at each phase. Axial length and corneal radius were measured. Refractive error was measured by autorefractor and spherical equivalent refraction used to classify participants into refractive groups: myopic (spherical equivalent refraction ≤ -0.50 DS) or non-myopic., Results: Fifty-four participants (24 myopes, 30 non-myopes) participated. CUVAF area was negatively associated with the presence of myopia (odds ratio = 0.94, 95 per cent confidence interval = 0.90-0.98, p = 0.002). Myopes = 4.5 mm 2 (interquartile range [IQR] 0.95-6.4 mm 2 ), non-myopes = 7.0 mm 2 (IQR = 2.0-10.7 mm 2 ). No significant association was found between CUVAF intensity and refractive group (p = 0.17). There was no significant association between sun exposure preferences or serum concentration of 25(OH)D 3 and refractive status (all p ≥ 0.21). CUVAF measures were not associated with ocular biometry measures (all p ≥ 0.084). CUVAF area was unaffected by season (all p ≥ 0.45) and variations in CUVAF area over the study period did not exceed the repeatability of the measurement technique., Conclusion: Myopia was associated with smaller areas of CUVAF indicative of less cumulative ultraviolet-B exposure. These findings suggest that CUVAF measures are a useful, non-invasive biomarker of the time spent outdoors in adults in northern hemisphere populations., (© 2018 Optometry Australia.)

Purpose: To investigate potential risk factors for the progression of myopia., Methods: Prospective study. Myopic progression was evaluated by cycloplegic autorefraction and axial length (AL) every 6 months in children 6 to 15 years old. Univariate analysis and multiple logistic regression were applied., Results: Around 82 children with median age of 10.3±2.3 years. Myopia progressed by -0.816±0.6 D over 18 months. Increased myopic spherical equivalent refraction (SER) was correlated with increase in AL (P<0.001). Univariate analysis found SER to be significantly associated with: age, especially between 6 and 9.4 years old (P=0.001), parental myopia (P=0.028), and less time spent outdoors (P=0.009). There was a significantly greater increase in SER during months with the least daylight hours (P<0.001)., Conclusion: Outdoor activities and daylight have a protective effect against increased AL and progression of myopia. Younger children with significant myopia should be monitored closely, especially those around 6 years old with myopic parents., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Purpose: To determine if drug-induced peroxisome proliferator-activated receptor α (PPARα) signal pathway modulation affects refractive development and myopia in guinea pigs., Methods: Pigmented guinea pigs were randomly divided into normal vision (unoccluded) and form deprivation myopia (FDM) groups. Each group received daily peribulbar injections of either a vehicle or (1) PPARα agonist, GW7647, clofibrate, or bezafibrate or (2) PPARα antagonist, GW6471, for 4 weeks. Baseline and posttreatment refraction and ocular biometric parameters were measured. Immunofluorescent staining of PPARα and two of its downstream readouts, cytosolic malic enzyme 1 (ME1) and apolipoproteinA II (apoA-II), was undertaken in selected scleral sections. Western blot analysis determined collagen type I expression levels., Results: GW6471 induced a myopic shift in unoccluded eyes, but had no effect on form-deprived eyes. Conversely, GW7647 inhibited FDM progression without altering unoccluded eyes. Bezafibrate and clofibrate had effects on refraction similar to those of GW7647 in unoccluded and form-deprived eyes. GW6471 downregulated collagen type I expression in unoccluded eyes whereas bezafibrate inhibited collagen type I decreases in form-deprived eyes. GW6471 also reduced the density of ME1- and apoA-II-stained cells in unoccluded eyes whereas bezafibrate increased apoA-II-positive cell numbers in form-deprived eyes., Conclusions: As GW7647 and GW6471 had opposing effects on myopia development, PPARα signaling modulation may be involved in this condition in guinea pigs. Fibrates are potential candidates for treating myopia since they reduced both FDM and the associated axial elongation. Bezafibrate also inhibited form deprivation-induced decreases in scleral collagen type I expression and the density of apoA-II expressing cells.

Purpose: To assess the peripheral refraction induced by Fractal Contact Lenses (FCLs) in myopic eyes by means of a two-dimensional Relative Peripheral Refractive Error (RPRE) map., Materials and Methods: This study involved 26 myopic subjects ranging from -0.50 D to -7.00 D. FCLs prototypes were custom-manufactured and characterized. Corneal topographies were taken in order to assess correlations between corneal asphericity and lens decentration. Two-dimensional RPREs were measured with an open-field autorefractor at 67 points, covering the central 60 × 30 degrees of the visual field. The bidimensional RPRE vector components: M, J 0 and J 45 of the difference between the values obtained with and without the FCLs in the eye were obtained. Additionally, the FCL-induced peripheral refraction in tangential and sagittal planes was computed along the horizontal meridian., Results: Induced by the FCLs, significant differences for all vector components were found in the peripheral retina. FCLs were decentered a mean of 0.7 ± 0.19 mm to the temporal cornea. The two-dimensional RPRE maps manifested the FCLs decentration. In particular, M varied asymmetrically between nasal and temporal retina after fitting the FCLs with a significant increment of the myopic shift beyond 10º (p < 0.05). No correlations were found between the amount of lens decentration and the asphericity of the cornea along temporal and nasal sides. However, significant correlations were found between the corneal asphericity and vector components of the RPRE in naked eyes. FCLs produced an increasing myopic shift in tangential and sagittal power errors along the horizontal meridian., Conclusions: As predicted by ray-tracing simulations, FCLs fitted in myopic eyes produce a myopic shift of the RPRE. The two-dimensional RPRE maps show information about the lens performance that is hidden in the conventional one-dimensional meridional representations.

Retinal arachidonic acid (ARA) levels in form-deprived eyes decline in guinea pigs. As prostaglandin F2α (PGF2α) is an ARA metabolite and endogenous agonist of prostaglandin F receptor (FP), we have been suggested that down-regulation of PGF2α-FP receptor signalling pathway contributes to myopia onset. To test this hypothesis, this study determines whether: (i) retinal PGF2α levels decline during the development of form deprivation myopia (FDM) in guinea pigs; (ii) FP receptor agonism and antagonism alter emmetropization and myopia development. Pigmented guinea pigs were randomly assigned to normal vision and form-deprived groups. Ultraperformance liquid chromatography coupled with a mass spectrometer (UPLC-MS) measured retinal PGF2α levels 2 weeks after form deprivation (FD). The selective FP agonist, latanoprost acid (LAT) and its corresponding antagonist, AL8810, were peribulbarly injected into each group. An eccentric infrared photorefractor (EIR) monitored refraction. A-scan ultrasonography measured axial elongation (AL) and vitreous chamber depth (VCD). Tonometry measured the intraocular pressure (IOP). Retinal PGF2α levels declined in form-deprived eyes compared to those in normal eyes. Neither LAT nor AL8810 affected IOP with or without FD. On the other hand, after 4 weeks of daily 0.5 μg AL8810 treatment, a myopia of -1.99 ± 0.34 dioptre (D) developed, but LAT had no effect on emmetropization in a normal visual environment. Nevertheless, daily 30 μg LAT treatment for 4 weeks inhibited FDM development by 41% (vehicle control: -8.39 ± 0.45 D; LAT: -4.95 ± 0.39 D; two-way anova with repeated measures, p < 0.05). Down-regulation of PGF2α-FP receptor signalling pathway may contribute to myopia onset as retinal PGF2α declined in myopic eyes and antagonism of FP receptor by AL8810 induced a myopic shift in normal vision environment. Meanwhile, up-regulation of this pathway by LAT inhibited FDM development. However, the mechanism underlying LAT-induced FDM inhibition needs further clarification. This uncertainty exists because its inhibition of FDM suggests that LAT strengthens the scleral framework which reduces axial elongation. On the other hand, its IOP-lowering effect is attributed to thinning and weakening the scleral framework in glaucoma treatment., (© 2018 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).)

Background: In this retrospective observational case series study, the aim was to evaluate the long-term safety, efficacy, stability and predictability of posterior chamber phakic intraocular lens (pIOL) implantation to correct myopia and myopic astigmatism associated with keratoconus., Methods: Uncorrected distance visual acuity (UDVA), best spectacle-corrected distance visual acuity (BSCDVA), refraction and adverse effects were evaluated in 23 keratoconic eyes of 13 patients after five years with Visian ICMV4 pIOL (STAAR Surgical)., Results: The mean pre-operative spherical equivalent and cylinder changed from -5.35 ± 2.82 D and -3.14 ± 1.58 D to -0.78 ± 1.31 D and -1.56 ± 1.53 D, respectively, five years post-operatively. Before the surgery the mean Snellen decimal BSCDVA was 0.60 ± 0.20. The mean UDVA and BSCDVA changed to 0.74 ± 0.22 and 0.88 ± 0.16, respectively. A total of 82.5 per cent of eyes achieved 6/12 or better UDVA post-operatively. The mean safety and efficacy indices were respectively, 1.47 ± 0.32 and 1.24 ± 0.34. No eye lost a line of visual acuity and 19 eyes gained one or more lines. An endothelial cell loss of 7.88 per cent occurred. No significant changes were seen in intraocular pressure, steep, flat and mean keratometry. The crystalline lens was clear., Conclusion: The clinical outcomes of the current study demonstrate the safety, efficacy and predictability of the implantable collamer lens (toric and non-toric) in the correction of myopia and myopic astigmatism associated with keratoconus. The patients' refractions achieved early stability and remained stable during the course of the study., (© 2018 Optometry Australia.)

Purpose: To determine the best method to minimize postoperative hyperopia and achieve mild myopia in patients requiring low-powered (<6.00 D) MN60MA intraocular lenses (IOLs)., Methods: This retrospective non-comparative case series consists of 32 eyes (20 patients). Postoperative spherical equivalent (SE) refractions were compared using four methods: standard formulas with varying target refractions (Haigis -1.00 D, Hoffer Q -1.75 D, Holladay 1 -1.50 D and SRK/T -1.00 and -1.25 D), axial length adjustment methods for standard formulas targeted for both plano and -0.50 D, Barrett Universal II formula and the Haigis formula using separate constants for plus and minus IOLs (Haigis +/-). SE (mean, standard deviation, median, range), median absolute error (MedAE), prediction errors, percentage SE less than 0.25 D and greater than -1.00 D, percentage SE within ±0.50 and ±1.00 D of the targeted refraction were calculated., Results: All methods and formulas gave acceptable mean SE refractions ranging from -0.04 to -0.68 D. The Barrett Universal II, Haigis +/-, standard Haigis formula targeted for -1.00 D and the Holladay 1 formula targeted for -1.50 D met stricter criteria of final SE between 0.25 and -1.00 D in 94-100% of eyes and MedAE between 0.37 and 0.51 D. Other methods had more myopic or hyperopic outliers., Conclusions: For these eyes with high myopia, the Barrett Universal II, Haigis +/-, standard Haigis targeted for -1.00 D and the standard Holladay 1 targeted for -1.50 D formulas produce the best results exceeding established benchmark criteria and minimizing hyperopic surprises.

This paper examines whether only children have poor vision by exploiting the quasinatural experiment generated by the Chinese One-Child Policy. The results suggest that being an only child increases the incidence of myopia by 9.1 percentage points. We further investigate the mechanisms through which being an only child affects the myopia and find that only children, as the only hope in a household, receive higher expectations in terms of academic performance and future educational attainment and pressure to succeed in life from parents, which contribute to the increased myopia. We also find that the school quality of only children is significantly higher than that of non-only children. This study provides new insights into an important health consequence of One-Child Policy in China., (Copyright © 2018 John Wiley & Sons, Ltd.)

Myopia occurs in more than 50% of the population in many industrialized countries and is expected to increase; complications associated with axial elongation from myopia are the sixth leading cause of blindness. Thus, understanding its etiology, epidemiology, and the results of various treatment regiments may modify current care and result in a reduction in morbidity from progressive myopia. This rapid increase cannot be explained by genetics alone. Current animal and human research demonstrates that myopia development is a result of the interplay between genetic and the environmental factors. The prevalence of myopia is higher in individuals whose both parents are myopic, suggesting that genetic factors are clearly involved in myopia development. At the same time, population studies suggest that development of myopia is associated with education and the amount time spent doing near work; hence, activities increase the exposure to optical blur. Recently, there has been an increase in efforts to slow the progression of myopia because of its relationship to the development of serious pathological conditions such as macular degeneration, retinal detachments, glaucoma, and cataracts. We reviewed meta-analysis and other of current treatments that include: atropine, progressive addition spectacle lenses, orthokeratology, and multifocal contact lenses.

Purpose: To determine ocular refraction, corneal thickness, corneal radius, corneal power, corneal astigmatism and intraocular pressure in patients before and immediately after repeated hyperbaric oxygen (HBO2) exposures twice a week during six weeks of HBO2 therapy., Methods: 23 patients received HBO2 therapy at 2.4 ATA for 90 minutes daily in monoplace chambers for six weeks, five days a week. The Topcon TRK-1P instrument was installed next to the hyperbaric chambers to record the ocular measurements., Results: A gross myopic shift developed at -0.95 ± 0.54 D (P ⟨ 0.001) in the right eye and -0.95 ± 0.53 D (P ⟨ 0.001) in the left eye during the six weeks of treatment. Myopic shift reversion, corneal thinning and reduced intraocular pressure appeared as immediate effects after a single HBO2 exposure, but resolved before the patients attended for the next measurement visit., Conclusions: Ocular variables were influenced by both cumulative and transient short-term effects during the HBO2 therapy. The short-term effects showed that the point of time for performing the ocular measurements after HBO2 exposure might influence the result and must be considered before making relevant comparisons among studies., Competing Interests: The authors of this paper declare no conflicts of interest exist with this submission., (Copyright© Undersea and Hyperbaric Medical Society.)

Case Report: The case concerns a 16 year-old boy with a history of high myopia and unilateral congenital cataract, tall stature for age, facial dysmorphism, hypermobile metacarpal-phalangeal joints, as well as behavioural problems. The mother had a history of recurrent pregnancy loss. Chromosomal analysis of the peripheral blood lymphocytes reported 47,XYY., Discussion: Patients with sex chromosome aneuploidy 47,XYY have higher risk of congenital malformations, although ophthalmological anomalies are unusual. Evaluation of patients with tall stature and behavioural problems should include a chromosomal analysis in order to determine the aetiology., (Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose: To determine the long-term effect of scleral encircling on the progression of myopia., Design: Retrospective clinical cohort study., Methods: Setting: Single-center academic hospital (Severance Hospital)., Study Population: The study included 76 eyes of 38 patients (mean age 37.21 ± 15.76) who had undergone retinal detachment surgery with scleral encircling. Observational Procedures: Axial length was measured preoperatively, at 6 months after surgery, and at the most recent visit. Patients were followed up for at least 12 months., Main Outcome Measure: The changes of axial length per month between operated eyes and contralateral eyes (control group)., Results: The operated group showed more rapid changes in axial length from 6 months after surgery to the time of the last follow-up than did the control group (0.020 ± 0.033 mm/month vs 0.002 ± 0.002 mm/month, P = .002; mean follow-up, 26.05 ± 11.39 months). Similar trends were observed during the entire follow-up period (0.065 ± 0.062 mm/month vs 0.008 ± 0.020 mm/month, P < .001). Subgroup analysis showed that both the myopic and highly myopic group showed no significant difference of change in rate of axial length during the first 6 postoperative months (P = .267), from 6 months after surgery to the final assessment point (P = .144), or over the entire observation period (P = .507)., Conclusions: Encircling the sclera may accelerate progression of myopia by significantly increasing axial length. The degree of myopia itself does not contribute to a significant difference in the increased axial length., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: To generate percentile curves of axial length (AL) for European children, which can be used to estimate the risk of myopia in adulthood., Methods: A total of 12 386 participants from the population-based studies Generation R (Dutch children measured at both 6 and 9 years of age; N = 6934), the Avon Longitudinal Study of Parents and Children (ALSPAC) (British children 15 years of age; N = 2495) and the Rotterdam Study III (RS-III) (Dutch adults 57 years of age; N = 2957) contributed to this study. Axial length (AL) and corneal curvature data were available for all participants; objective cycloplegic refractive error was available only for the Dutch participants. We calculated a percentile score for each Dutch child at 6 and 9 years of age., Results: Mean (SD) AL was 22.36 (0.75) mm at 6 years, 23.10 (0.84) mm at 9 years, 23.41 (0.86) mm at 15 years and 23.67 (1.26) at adulthood. Axial length (AL) differences after the age of 15 occurred only in the upper 50%, with the highest difference within the 95th percentile and above. A total of 354 children showed accelerated axial growth and increased by more than 10 percentiles from age 6 to 9 years; 162 of these children (45.8%) were myopic at 9 years of age, compared to 4.8% (85/1781) for the children whose AL did not increase by more than 10 percentiles., Conclusion: This study provides normative values for AL that can be used to monitor eye growth in European children. These results can help clinicians detect excessive eye growth at an early age, thereby facilitating decision-making with respect to interventions for preventing and/or controlling myopia., (© 2017 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: Despite extensive research, mechanisms regulating postnatal eye growth and those responsible for ametropias are poorly understood. With the marked recent increases in myopia prevalence, robust and biologically-based clinical therapies to normalize refractive development in childhood are needed. Here, we review classic and contemporary literature about how circadian biology might provide clues to develop a framework to improve the understanding of myopia etiology, and possibly lead to rational approaches to ameliorate refractive errors developing in children., Recent Findings: Increasing evidence implicates diurnal and circadian rhythms in eye growth and refractive error development. In both humans and animals, ocular length and other anatomical and physiological features of the eye undergo diurnal oscillations. Systemically, such rhythms are primarily generated by the 'master clock' in the surpachiasmatic nucleus, which receives input from the intrinsically photosensitive retinal ganglion cells (ipRGCs) through the activation of the photopigment melanopsin. The retina also has an endogenous circadian clock. In laboratory animals developing experimental myopia, oscillations of ocular parameters are perturbed. Retinal signaling is now believed to influence refractive development; dopamine, an important neurotransmitter found in the retina, not only entrains intrinsic retinal rhythms to the light:dark cycle, but it also modulates refractive development. Circadian clocks comprise a transcription/translation feedback control mechanism utilizing so-called clock genes that have now been associated with experimental ametropias. Contemporary clinical research is also reviving ideas first proposed in the nineteenth century that light exposures might impact refraction in children. As a result, properties of ambient lighting are being investigated in refractive development. In other areas of medical science, circadian dysregulation is now thought to impact many non-ocular disorders, likely because the patterns of modern artificial lighting exert adverse physiological effects on circadian pacemakers. How, or if, such modern light exposures and circadian dysregulation contribute to refractive development is not known., Summary: The premise of this review is that circadian biology could be a productive area worthy of increased investigation, which might lead to the improved understanding of refractive development and improved therapeutic interventions., (© 2018 The Authors Ophthalmic & Physiological Optics © 2018 The College of Optometrists.)

After birth, remnants of pupillary membrane which constitute the vascular supply to the crystalline lens can persist. These are contiguous to the iris collarette causing possible deprivation amblyopia by obstructing the pupillary area. We here report the case of a 4-year-old child, born to consanguineous parents, presenting with bilateral persistent pupillary membrane associated with high myopia. Clinical examination showed bilateral remnants of pupillary membrane, intact iris sphincter and diffuse chorioretinal atrophy in the fundus of eye . Visual acuity was difficult to assess. On the other hand, refraction test showed high myopia RE -10.75 (-3.25, 29°) LE -10 (-0.75, 180°). Treatment of bilateral persistent pupillary membrane is based on mydriatic agents, surgical excision or laser destruction. We opted for the use of mydriatic agents with total optical correction and amblyopia treatment.

Unilateral cyclitis leading to myopia is a rare and clinical relevant entity. In clinical settings, pseudomyopia is generally encountered in the form of accommodative spasm, which is always bilateral. Cyclitis due to inflammation, on the other hand, can cause pseudomyopia unilaterally and it is a very rare presentation. A young male with acute anterior uveitis, presented with acute episode of unilateral myopia. When patient was examined on first visit, there were no cells in anterior chamber; so he was started on cycloplegic eye drops, but his condition didn't improve. Examination on subsequent visit revealed cellular reaction in anterior chamber and narrowing of anterior chamber angles on anterior segment optical coherence tomography (OCT). Treatment for uveitis was started and patient's visual acuity and refractive error improved. Pseudomyopia is a known complication of several drugs and certain medical conditions. The possible mechanism is supraciliary exudation causing relaxation of zonular fibers and increased convexity of the crystalline lens. Myopia in the setting of a mild cellular reaction can easily be missed and has not been reported yet to the best of authors' literature search.

PurposeTo study the varied clinical presentations of patients with spherophakia, their management using surgical methods, and the clinical outcomes.Patients and methodsA prospective interventional study of 13 patients of spherophakia who presented to us from January 2014 and were followed up over the course of their treatment, and the data were documented for analysis.ResultsIn all, 26 eyes of 13 patients were reviewed and the median age of presentation was 12±12.05 years. All patients had a bilateral presentation with 22 eyes having lenticular myopia with a mean refractive error of -11.5±12.945 DS. Ten eyes presented with glaucoma of which six had raised intraocular pressure (IOP) >21 mm Hg. A total of 23 eyes underwent lens extraction for dislocation/subluxation. Lens extraction helped lower overall IOP. Refractive rehabilitation was done with ACIOL, posterior chamber intraocular lens (PCIOL) with capsular tension ring, and scleral-fixated intraocular lens (SFIOL) in respective cases with ACIOLs being the most commonly used option.ConclusionsSpherophakia is a rare condition, which exhibits a varying degree of lenticular myopia, glaucoma, and subluxation of the crystalline lens. Lensectomy with proper rehabilitation using ACIOL, PCIOL, or SFIOL is a method of managing subluxation and unacceptable myopia. Lensectomy may also be a viable option of controlling glaucoma alongside medications and glaucoma surgery for the management of glaucoma in such cases.

Purpose: To evaluate and correlate anthropometric, biometric, and refractive error changes in thalassemia major (TM)., Methods: One hundred children with TM and another hundred healthy controls were recruited. Height, weight, body mass index (BMI), and occipitofrontal circumference (OFC) were the anthropometric parameters recorded. Full ophthalmologic examination was performed, including best-corrected visual acuity, cycloplegic refraction, slit-lamp examination, Goldmann applanation tonometry, indirect ophthalmoscopy, keratometry (K readings), and ocular biometry., Results: Compared to controls, children with TM were shorter and lighter, with a smaller BMI (p<0.001); however, no significant difference existed in OFC. Regarding ocular biometric data, patients with thalassemia had steeper mean K readings (p = 0.03), shorter axial length (AXL) (p = 0.005), shorter vitreous chamber depth (p<0.001), and thicker crystalline lens (p<0.001) than controls. Patients with thalassemia had a significant myopic shift (p = 0.003). Multiple regression analyses only showed a significant correlation between corneal astigmatism and both weight and height (β = -0.05 and p = 0.03 and β = 0.06 and p = 0.04, respectively). Spherical equivalent was significantly correlated to K readings, lens thickness, and anterior chamber depth (p<0.0001 for all parameters)., Conclusions: Compared to controls, children with TM have significant retardation in general and ocular growth (smaller BMI and shorter AXL). Ocular growth changes probably resulted in compensatory biometric changes (steeper corneas and thicker lenses) to reach emmetropization, with an exaggerated response and subsequent myopic shift. However, growth retardation is not directly related to ocular growth changes, myopic shift, or variations in biometric parameters.

Purpose: To evaluate the clinical outcomes of cataract surgery using novel diffractive trifocal intraocular lenses (IOLs) in Koreans., Methods: This was a retrospective, consecutive, interventional study of cataract surgery using POD FineVision IOL implantation. Complete ophthalmologic examinations were performed preoperatively and postoperatively. Defocus curves were assessed over a range of +1.5 to -4.0 diopters in 0.5-diopter steps at one month postoperatively. Uncorrected distant visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity, corrected distant visual acuity, distant-corrected intermediate visual acuity, and distant-corrected near visual acuity were assessed one month postoperatively, and manifest refraction was performed during every visit., Results: The study analyzed 31 eyes in 20 patients. There were statistically significant improvements in uncorrected distance visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity, corrected distance visual acuity, distance-corrected intermediate visual acuity, and distance-corrected near visual acuity (p < 0.001). The final postoperative refractive outcomes showed statistically significant myopic shifts compared to the target refraction based on SRK/T, SRK-II, Haigis, and Hoffer Q formulas (p < 0.001)., Conclusions: POD FineVision IOLs provide stable visual restoration with improvements of near and intermediate vision in presbyopic eyes. POD FineVision IOLs show myopic shift in a Korean population; therefore, surgeons should be cautious when selecting IOL power in such patients., Competing Interests: No potential conflict of interest relevant to this article was reported., (© 2018 The Korean Ophthalmological Society)

Despite the global pandemic of myopia, the precise molecular mechanism of the onset of myopia remains largely unknown. This is partially because of the lack of efficient murine myopic models that allow genetic manipulation at low cost. Here we report a highly practical and reproducible lens-induced myopia model by specially designed frames and lenses for mice. A lens power dependent myopic induction in mice was shown until minus 30 diopter lenses. The phenotype was significantly stronger than form-deprivation myopia. We presented the protocol for precise evaluations of the state of myopia, including refraction, corneal curvature and axial length using up-to-date devices. We also found that myopic mouse eyes showed decreased visual acuity on optokinetic response examination. Finally, we confirmed the anti-myopic effect of 1% atropine using this model, which showed its potential in drug screening. The strong phenotype, stable evaluation and the potential for gene manipulation utilizing the presented method in mice will accelerate the translational research of myopia.

Myopia is a highly prevalent eye disease. There is limited information suggesting a relationship between myopia and inflammation. We found children with allergic conjunctivitis (AC) had the highest adjusted odds ratio (1.75, 95% confidence interval [CI], 1.72-1.77) for myopia among the four allergic diseases. A cohort study was conducted and confirmed that children with AC had a higher incidence and subsequent risk of myopia (hazard ratio 2.35, 95%CI 2.29-2.40) compared to those without AC. Lower refractive error and longer axial length were observed in an AC animal model. Myopia progression was enhanced by tumor necrosis factor (TNF)-α or interleukin (IL)-6 administration, two cytokines secreted by mast cell degranulation. The TNF-α or IL-6 weakened the tight junction formed by corneal epithelial (CEP) cells and inflammatory cytokines across the layer of CEP cells, which increased the levels of TNF-α, IL-6, and IL-8 secreted by retinal pigment epithelial cells. The expression levels of TNF-α, IL-6, IL-8, monocyte chemoattractant protein-1, and nuclear factor kappa B were up-regulated in eyes with AC, whereas IL-10 and the inhibitor of kappa B were down-regulated. In conclusion, the experimental findings in mice corroborate the epidemiological data showing that allergic inflammation influences the development of myopia., (Copyright © 2018. Published by Elsevier B.V.)

Purpose: High myopia (≤-6 D) usually has its onset before 10 years of age and can lead to blinding complications later in life. We examined whether differences in myopia prevalences in socioeconomic risk groups could be explained by differences in lifestyle factors., Methods: A total of 5711 six-year-old children participating in the prospective population-based birth cohort study Generation R underwent a stepwise ophthalmic examination, which included visual acuity and objective cycloplegic refraction to identify children with myopia (≤-0.5D). Daily activities, ethnicity, factors representing family socioeconomic status and housing were ascertained by questionnaire. Risk assessments of myopia and mediation analyses were performed using logistic regression; attenuation of risks was calculated by bootstrapping., Results: Prevalence of myopia was 2.4% (n=137). Myopic children spent more time indoors and less outdoors than non-myopic children (p<0.01), had lower vitamin D (p=0.01), had a higher body mass index and participated less in sports (p=0.03). Children of non-European descent (OR 2.60; 95% CI 1.84 to 3.68), low maternal education (OR 2.27; 95% CI 1.57 to 3.28) and low family income (OR 2.62; 95% CI 1.8 to 3.74) were more often myopic. Lifestyle factors explained the majority of the increased risk for ethnicity (82%; 95% CI 55 to 120), maternal education (69%; 95% CI 45 to 109) and family socioeconomic status (71%; 95% CI 46 to 104)., Conclusion: This study found environmental factors to be strong risk factors for myopia already at the age of 6 years. The myopia prevalence differences in socioeconomic groups were greatly determined by differences in distribution of these environmental risk factors, highlighting the importance of lifestyle adjustments in young children developing myopia., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Purpose: The purpose of this study was to evaluate the myopic shift over a period of 2 years following implantation of intraocular lens (IOL) in children less than 2 years of age with axial length less than 22 mm., Method: A retrospective analysis of records of children below 2 years of age with axial length less than 22 mm who had undergone cataract surgery with primary IOL implantation over a period of 7 years was undertaken. Mean myopic shift was analyzed at 6 months, in first year, second year and end of 2 years following surgery., Results: Total 40 eyes of 23 children were included (mean age 13.55±7.38 months); with mean myopic shift at end of 2 years -2.35±2.15. Myopic shift in eyes with undercorrection in range of 3-4 D (group-I) and 5-7 D (group-II) was compared using Mann-Whitney test. Mean myopic shift at end of 2 years was -2.93±2.55 in group-I and -1.88±1.77 in group-II (p value not significant). There was no significant difference in myopic shift between two groups at 6 months and 1 year; a borderline significant difference was found in second year (p= 0.04)., Conclusion: In our study amount of myopic shift in first two years in children with axial length less than 22 mm is below the expected normal. There was not much significant difference in the myopic shift over a period of 2 years in eyes, which were undercorrected by 3-4 D against those with 5-7 D. Thus aiming for less residual hyperopia by less undercorrection did not increase myopic shift. Thus high-level hyperopic glasses in the early years could be avoided and help in prevention of amblyopia after paediatric cataract surgery., (© NEPjOPH.)

Objective: Introduction: Number of children with myopia increased 3-fold while those with spasm of accommodation followed a suit by 5-fold increase over last decade to some extend due to computerization. These tidings necessitate the development and implementation of primordial prevention programs. The aim was to evaluate the changes in risk of spasm of accommodation in pupils due to implementation of prevention program., Patients and Methods: Materials and methods: Data collection was based on dynamic panel of pupils padding by first-formers over 2012-2015 and tracing up to 2017, sample size is 1115. Program was administered randomly at the entrance point to 594 pupils. We used 3 models to analyze the impact of program and possible confounders on spans to spasm development, i.e. base log-logistic survival model (1), survival fraction model (2), and survival fraction frailty model (3)., Results: Results: Program effect was significant by all models, the highest by model 3 with median effect of .-2,4340, i.e. with annual risk decrease of 0,72%. Fraction of non-sensitives was next to zero. Data rebutted group segregation by innate propensity to spasm development., Conclusion: Conclusions: Program effect proved to be significant by all models. The most validated estimation was by survival fraction frailty model (3). Incorporating frailty squared attenuation of regression effects by selection bias. Frailties followed clean cut unimodal distribution, it allowance improved model information value significantly. The starting point of program participation is of significance too, each consecutive lag decreased program effect.

There is an epidemic of myopia in East and Southeast Asia, with the prevalence of myopia in young adults around 80-90%, and an accompanying high prevalence of high myopia in young adults (10-20%). This may foreshadow an increase in low vision and blindness due to pathological myopia. These two epidemics are linked, since the increasingly early onset of myopia, combined with high progression rates, naturally generates an epidemic of high myopia, with high prevalences of "acquired" high myopia appearing around the age of 11-13. The major risk factors identified are intensive education, and limited time outdoors. The localization of the epidemic appears to be due to the high educational pressures and limited time outdoors in the region, rather than to genetically elevated sensitivity to these factors. Causality has been demonstrated in the case of time outdoors through randomized clinical trials in which increased time outdoors in schools has prevented the onset of myopia. In the case of educational pressures, evidence of causality comes from the high prevalence of myopia and high myopia in Jewish boys attending Orthodox schools in Israel compared to their sisters attending religious schools, and boys and girls attending secular schools. Combining increased time outdoors in schools, to slow the onset of myopia, with clinical methods for slowing myopic progression, should lead to the control of this epidemic, which would otherwise pose a major health challenge. Reforms to the organization of school systems to reduce intense early competition for accelerated learning pathways may also be important., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The purpose of this survey was to determine the association of parents' attitudes and behaviors toward children's visual care with myopia risk in school-aged children.A total of 894 parents of school-aged children were investigated in primary and middle schools in the central and noncentral urban area in Wuhan through stratified cluster random sampling on July, 2015. We analyzed the association by the generalized linear mixed model.The results indicated that children with parents' high expectations of 1.5 or higher on their vision exhibited a decreased risk of myopia compared with 1.0 and 0.5 or lower (OR = 0.49, 95%CI = 0.36-0.67). Children whose parents only paid attention to their vision in junior and senior school and in primary school had an increased myopia risk than that in preschool (OR = 2.12, 95%CI = 1.01-4.45, and OR = 3.11, 95%CI = 1.28-7.58, respectively). Children whose parents ensured for their sufficient sleep had a decreased myopia risk (OR = 0.45, 95%CI = 0.24-0.85). Compared with children whose parents who never adjusted electronic devices' parameters, the odds ratio of sometimes was 0.49 (95%CI = 0.31-0.79), often 0.53 (95%CI = 0.33-0.85), and always 0.44 (95%CI = 0.26-0.75), respectively.Parents' attitudes and behaviors toward children's visual care are significantly associated with the myopia risk in school-aged children. Consequently, efforts should be made to educate parents on how they protect children's vision and reduce their risk of myopia., (Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: The near work and outdoor activity are the most important environmental risk factors for myopia. However, data from Chinese rural children are relatively rare and remain controversial. Therefore, the purpose of this study was to evaluate the relationship of both near work and outdoor activities with refractive error in rural children in China., Methods: In this cross-sectional study, 572 (65.1%) of 878 children (6-18 years of age) were included from the Handan Offspring Myopia Study (HOMS). Information from the parents on these children, as well as the parent's non-cycloplegic refraction, were obtained from the database of the Handan Eye Study conducted in the years 2006-2007. A comprehensive vision examination, including cycloplegic refraction, and a related questionnaire, were assessed on all children., Results: The overall time spent on near work and outdoor activity in the children was 4.8 ± 1.6 and 2.9 ± 1.4 h per day, respectively. Myopic children spent more time on near work (5.0 ± 1.7 h vs.4.7 ± 1.6 h, p = 0.049), while no significant difference was found in outdoor activity hours (2.8 ± 1.3 h vs. 3.0 ± 1.4 h, p = 0.38), as compared to non-myopic children. In the multiple logistic analysis, in general, no association between near work and myopia was found after adjusting for the children's age, gender, parental refractive error, parental educational level, and daily outdoor activity hours [odds ratio (OR), 95% confidence interval (CI): 1.10, 0.94-1.27]. However, a weak protective effect of the outdoor activity on myopia was found (OR, 95% CI: 0.82, 0.70-0.96), after adjusting for similar confounders., Conclusions: In general, no association between near work and myopia was found, except for the high near work subgroup with moderate outdoor activity levels. A weak protective effect of outdoor activity on myopia in Chinese rural children was observed.

In the face of an "epidemic" increase in myopia over the last decades and myopia prevalence predicted to reach 2.5 billion people by the end of this decade, there is an urgent need to develop effective and safe therapeutic interventions to slow down this "myopia booming" and prevent myopia-related complications and vision loss. Dopamine (DA) is an important neurotransmitter in the retina and mediates diverse functions including retina development, visual signaling, and refractive development. Inspired by the convergence of epidemiological and animal studies in support of the inverse relationship between outdoor activity and risk of developing myopia and by the close biological relationship between light exposure and dopamine release/signaling, we felt it is timely and important to critically review the role of DA in myopia development. This review will revisit several key points of evidence for and against DA mediating light control of myopia: 1) the causal role of extracellular retinal DA levels, 2) the mechanism and action of dopamine D1 and D2 receptors and 3) the roles of cellular/circuit retinal pathways. We examine the experiments that show causation by altering DA, DA receptors and visual pathways using pharmacological, transgenic, or visual environment approaches. Furthermore, we critically evaluate the safety issues of a DA-based treatment strategy and some approaches to address these issues. The review identifies the key questions and challenges in translating basic knowledge on DA signaling and myopia from animal studies into effective pharmacological treatments for myopia in children., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

On a global scale, myopia is one of the most common causes of visual impairment. Given the increasing prevalence of myopia, it is vital to understand the pathogenesis and to identify potential interventions. Some studies have described physical activity as a potential correlation for myopia. The objective of this study was to make a systematic review regarding the correlation between physical activity and myopia. A total of 263 papers were identified in a systematic database search of PubMed/Medline and Embase. Five steps of screening removed studies of a low evidence quality and animal studies. Studies included had refractive error and physical activity (as measured by questionnaires, accelerometers and cycle ergometers) as separate, well-defined outcomes. Nine studies (six cross-sectional, two cohorts and one case-control study) with a total of 17 634 subjects were included. Six studies demonstrated a reverse association between physical activity and myopia. Three studies supported this, but also attributed the results to time spent outdoors and not physical activity per se. One cross-sectional study found no relation. We could not identify trends among the papers regarding the type of studies, population sizes, ethnicity or age of study subjects. A consistent relationship between more physical activity and less myopia was observed. No evidence of physical activity as an independent risk factor for myopia was seen. Evidence suggests that time outdoors remain the most important factor. Future studies should include objective measurements of physical activity to determine a potential independent effect. Distinction between physical activity and outdoor exposure remains important., (© 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Marfan syndrome (MFS) is an inherited and systemic disorder. It has been reported that mutations in the fibrillin‑1 gene (FBN1) account for ~90% of autosomal dominant cases of MFS. This study was conducted to screen mutations of FBN1 in a Chinese family with autosomal dominant MFS; four individuals including two patients with MFS were recruited. The family members underwent complete physical, cardiovascular and ophthalmologic examinations. Genomic DNA samples were collected from the family along with 383 unrelated healthy subjects. FBN1 coding regions were amplified by polymerase chain reaction and analyzed by direct sequencing. SIFT and PolyPhen‑2 were used to predict the possible structural and functional alterations of the protein. A novel heterozygous mutation c.1708 T>G (p.C570G) in exon 14 was identified, which led to a substitution of cysteine by glycine at codon 570 (p.C570G). The mutation was identified as being associated with the MFS phenotype in the affected members of this family. However, the unaffected family members and the 383 normal controls lacked the mutation. Multiple sequence alignment of the human FBN1 protein revealed that this novel mutation occurred within a highly conserved region of the FBN1 protein across different species and may induce structural alterations in this functional domain. The spectrum of MFS‑associated mutations in the FBN1 gene has been enriched from this study; this may improve understanding of the molecular pathogenesis and clinical diagnosis of MFS.

Cases Reports: The cases are presented of three women of 22, 36 and 55 years old with bilateral myopic retinochoroidosis. They had unilateral decreased visual acuity, normal bilateral tonometry, and biomicroscopy. Funduscopy showed bilateral and unilateral myopic maculopathy, and Optical Coherence Tomography (OCT) showed a dome shaped macula with neurosensory detachment. Treatment was started with spironolactone and an improvement by OCT was shown in all cases., Discussion: The etiopathogenic mechanism of the dome shaped macula is discussed. OCT demonstrated to be the fundamental test in the follow-up of this condition. After the evidence shown, initial treatment with spironolactone is suggested., (Copyright © 2016 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To classify dome shaped macula cases by their bulge height (BH). To analyse the characteristics associated with the groups formed by this classification., Methods: Observational, descriptive and cross-sectional study on 15 selected eyes with dome shaped macula and high myopia. Using Caillaux method and optical coherence tomography images, 3groups were determined by their BH: low (50-350 μ), medium (351-650 μ), and high (>650 μ), and a study of visual acuity, axial length, presence of subfoveal serous detachment, and images by fluorescein angiography and optic coherence tomography, as main variables. The confidence interval was 95%., Results: By using the chi-squared test, the study showed that a BH higher than 400 μ was associated with lower visual acuity, presence of subfoveal serous detachment, and greater atrophy of the retinal pigment epithelium measured by disc diameters (P<.05)., Conclusions: The medium and high BH showed a positive correlation with the presence of foveal serous detachment and a lower visual acuity., (Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose: It is unknown which retinal cells are involved in the retina-to-sclera signaling cascade causing myopia. As inherited retinal dystrophies (IRD) are characterized by dysfunction of a single retinal cell type and have a high risk of refractive errors, a study investigating the affected cell type, causal gene, and refractive error in IRDs may provide insight herein., Design: Case-control study., Methods: Study Population: Total of 302 patients with IRD from 2 ophthalmogenetic centers in the Netherlands. Reference Population: Population-based Rotterdam Study-III and Erasmus Rucphen Family Study (N = 5550). Distributions and mean spherical equivalent (SE) were calculated for main affected cell type and causal gene; and risks of myopia and hyperopia were evaluated using logistic regression., Results: Bipolar cell-related dystrophies were associated with the highest risk of SE high myopia 239.7; odds ratio (OR) mild hyperopia 263.2, both P < .0001; SE -6.86 diopters (D) (standard deviation [SD] 6.38), followed by cone-dominated dystrophies (OR high myopia 19.5, P < .0001; OR high hyperopia 10.7, P = .033; SE -3.10 D [SD 4.49]); rod dominated dystrophies (OR high myopia 10.1, P < .0001; OR high hyperopia 9.7, P = .001; SE -2.27 D [SD 4.65]), and retinal pigment epithelium (RPE)-related dystrophies (OR low myopia 2.7; P = .001; OR high hyperopia 5.8; P = .025; SE -0.10 D [SD 3.09]). Mutations in RPGR (SE -7.63 D [SD 3.31]) and CACNA1F (SE -5.33 D [SD 3.10]) coincided with the highest degree of myopia and in CABP4 (SE 4.81 D [SD 0.35]) with the highest degree of hyperopia., Conclusions: Refractive errors, in particular myopia, are common in IRD. The bipolar synapse and the inner and outer segments of the photoreceptor may serve as critical sites for myopia development., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: It is well known that the dopaminergic signaling pathway plays a pivotal role in the control of axial elongation. Much research has shown that retinal dopamine (DA) is decreased in experimental myopia, but the exact alteration in DA quantity underlying the myopia model induced by flickering light (FL) has not yet been fully elucidated. Therefore, in this study, we first attempted to prove the feasibility of the myopia model induced by FL and then to determine whether and how DA and its receptors changed in myopia induced by FL., Methods: Forty-five 2-week-old guinea pigs were randomly divided into three groups, as follows: the control group, form-deprivation myopia (FDM) group, and FL-induced myopia (FLM) group. Animals in the control and FDM groups were raised under normal illumination, and the right eyes of the FDM group were covered with semitransparent hemispherical plastic shells serving as eye diffusers. Guinea pigs in the FLM group were raised under illumination with a duty cycle of 50% at a flash rate of 0.5 Hz. The refraction, axial length (AL), and corneal radius of curvature (CRC) were measured using streak retinoscopy, A-scan ultrasonography, and keratometry, respectively, before and after 2, 4, 6, and 8 weeks of treatment. The contents of DA, 3,4-dihydroxyphenylacetic acid (DOPAC), and homovanillic acid (HVA) in the retina, vitreous body, and RPE were measured at the end of the 8-week experiment using high-performance liquid chromatography (HPLC). The numbers of retinal D1 DA receptor (D1DR) and D2 DA receptor (D2DR) were evaluated via immunohistofluorescence and western blot assay., Results: The refraction of the FLM group became more myopic throughout the experimental period, which was mainly indicated by decreased refraction and a longer AL compared with the control group (p<0.05). The contents of DA, DOPAC, and HVA in the retina, vitreous body, and RPE of the FLM group were significantly increased, but decreased in the FDM group, compared with those of the control group (both p<0.05). Like form-deprived eyes, the expressions of retinal D1DR and D2DR in FL eyes were significantly upregulated compared with controls (p<0.05)., Conclusions: Myopia can be induced by 0.5-Hz FL in guinea pigs at puberty. Contrary to FDM, dopaminergic neuron activity and DA release were significantly elevated in FLM. Like in FDM, the expressions of D1DR and D2DR were upregulated in FLM. Thus, the results of our study may further demonstrate that the DA system is associated with the development of myopia.

Background: To study biometric and structural ocular manifestations of Marfan syndrome (MFS)., Methods: Observational, retrospective, comparative cohort study in a tertiary referral center on 285 MFS patients and 267 controls. Structural and biometric ocular characteristic were compared., Results: MFS eyes were longer (axial length 24.25 ± 1.74 mm versus 23.89 ± 1.31 mm, p < 0.001) and had a flatter cornea than control eyes (mean keratometry 41.78 ± 1.80 diopters (D) versus 43.05 ± 1.51 D, p < 0.001). Corneal astigmatism was greater and the central cornea was thinner in MFS eyes (530.14 ± 41.31 μm versus 547.02 ± 39.18 μm, p < 0.001). MFS eyes were more myopic than control eyes (spherical equivalent -2.16 ± 3.75 D versus -1.17 ± 2.58 D, p < 0.001). Visual acuity was reduced (0.13 ± 0.25 logMAR versus 0.05 ± 0.18 logMAR, p < 0.001) and intraocular pressure was lower in MFS eyes (14.6 ± 3.4 mmHg versus 15.1 ± 3.2 mmHg, p = 0.01). Iris transillumination defects (ITD) were significantly more common in MFS eyes (odds ratio for MFS in the presence of ITD, 3.7). Ectopia lentis (EL) was only present in MFS eyes (33.4%). History of retinal detachment was significantly more common in MFS eyes. Glaucoma was equally common in both groups., Conclusions: ITD and EL are most characteristic findings in MFS. ITD and corneal curvature should be studied as diagnostic criteria for MFS. Visual acuity is reduced in MFS. MFS patients need regular eye exams to identify serious ocular complications.

Purpose: To compare surgically induced astigmatism (SIA) and refractive outcomes between two operation methods for late in-the-bag IOL dislocation., Methods: In this prospective, randomized, parallel-group clinical trial, 104 patients (eyes) were assigned to IOL repositioning by scleral suturing 1.5- to 2-mm posterior to limbus (n = 54) or IOL exchange with a retropupillar iris-claw IOL using a 5.5-mm scleral pocket incision (n = 50). The SIA was determined by vector analysis through conversion of corneal cylinders to Cartesian coordinates, and is presented as magnitude in diopters @ direction in degrees (D @ °). Follow-up was 6 months., Results: The SIA was 0.24 D @ 8° for IOL repositioning and 0.65 D @ 171° for IOL exchange, which was a nonsignificant group difference (X coordinate: P = 0.08; Y coordinate: P = 0.16). Mean SIA magnitude was 0.60 ± 0.50 D and 1.12 ± 0.85 D, respectively (P < 0.001). Mean postoperative spherical equivalent was -1.6 ± 1.6 D after IOL repositioning and -0.5 ± 1.0 D after IOL exchange (P < 0.001). For IOL repositioning, this represented a mean myopic shift of -0.7 ± 1.1 D compared with before the IOL dislocation (P < 0.001). For IOL exchange, it was within ±1 D of target refraction in 83% of the patients., Conclusions: Surgically induced astigmatism was modest in both operation groups, albeit with a tendency of being more pronounced for IOL exchange. Repositioning surgery led to a myopic shift, whereas exchange surgery provided good refractive predictability.

Purpose: The purpose of this study is to compare the refractive error outcomes in the eyes of premature babies with retinopathy of prematurity (ROP) who underwent laser plus lens-sparing vitrectomy (LSV) in one eye and laser alone in the fellow eye., Methods: This is a retrospective study. Fourteen babies with Stage 4A of ROP or worse who underwent laser plus LSV in one eye (Group 1) and laser alone in the fellow eye (Group 2) were followed at 2 months, 6 months, 1 year, one and a half year, and 2 years. The main outcome variable studied was cycloplegic refraction at the baseline and follow-up visits. The change in spherical and cylindrical power at each visit was compared in Groups 1 and 2. The changes in spherical equivalent in subgroups were analyzed., Results: Mean gestational age at birth was 29.43 ± 2.10 weeks (range 26-32 weeks). Mean chronological age at the time of surgery was 4.11 ± 3.00 months (range 2-10 months). Mean postmenstrual age was 45.86 ± 12.13 weeks (range 39-75 weeks). Mean birth weight was 1340.71 ± 361.59 g (range 860-1980 g). All the babies in both groups had progressive myopia till 2 years follow-up; laser group had less myopia than LSV group till 1 year, thereafter, there was no difference in median till 2-year follow-up. The mean ± standard deviation of spherical equivalent in LSV versus laser group was: -4.36 ± 5.52 versus -3.21 ± 4.59 at 2 months; -5.09 ± 5.82 versus -4.04 ± 4.68 at 6 months; -7.14 ± 5.36 versus -5.36 ± 5.09 at 1 year; and -7.47 ± 1.38 versus -6.41 ± 1.91 at 2 years. Spherical equivalent difference across the visits did not differ significantly between Groups 1 and Group 2 in children whose birth weight was <1500 g (P = 0.247) and those who had more than 1500 g (P = 0.748), in those with gestational age between 20 and 30 weeks (P = 0.215) compared to those> 30 weeks (P = 0.602)., Conclusion: No difference in the progression of myopia was noted in eyes that underwent additional LSV following laser photocoagulation in one eye and laser alone in the fellow eye.

Purpose: Indian children belong to a diverse socioeconomic strata with retinopathy of prematurity (ROP) developing in mature, higher birth weight babies as well. The purpose of our study is to analyze the long-term status of refractive errors and its relationship with ocular biometry in children with ROP who were laser treated at a tertiary center in North India., Methods: Cross sectional study. Children (<16 years) enrolled from January 2014 to December 2014 with a history of laser treatment for ROP and examined for refractive and biometric status., Results: Thirty-six children presenting to us at the mean age of 7.37 ± 3.07 years (6-15 years) were included. Mean spherical equivalent (SE) was -4.05 D ± 5.10. 75% were myopic, with high astigmatism in 31%. Higher lens thickness (P = 0.03) and higher SE (P = 0.002) at 1 year postnatal age were predictors of larger SE. 79.4% achieved a favorable functional outcome (visual acuity ≥20/40). 5.88% achieved unsatisfactory outcome (<20/200) despite having a favorable structural outcome., Conclusion: There are a substantial number of children who develop myopia and high astigmatism while undergoing laser treatment for ROP. We found myopia in our cohort to be lenticular and greater axial length contributing to the development of high myopia. An initial large refractive error predicts the future development of myopia in these children. Nearly 6% of patients with good structural outcome have unexplained subnormal vision. Our threshold for prescribing glasses in these children should be low.

Purpose: To assess Visian Implantable Collamer Lens (ICL) (STAAR Surgical, Monrovia, CA) implantation in the ciliary sulcus to correct pseudophakic ametropia in patients who are not candidates for a keratorefractive procedure., Methods: The authors performed a prospective non-comparative case series study of 18 patients (age: 48 to 61 years) with refractive surprise after phacoemulsification. Patients underwent implantation of a piggyback collagen copolymer lens: V4C design in 16 myopic eyes and V4B design in 2 hyperopic eyes. The position and vault of the ICLs were documented at all control visits clinically and with Pentacam (Oculus Optikgeräte, Wetzlar, Germany). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), intraocular pressure (IOP), and endothelial cell count were recorded at baseline and 1 week and 1, 6, 12, and 18 months postoperatively., Results: The MRSE improved from -3.08 ± 2.37 diopters (D) preoperatively to -0.44 ± -0.23 D postoperatively, corrected with a mean ICL power of -3.20 ± 2.90 D. The mean UDVA improved from 1.03 ± 0.12 logMAR preoperatively to 0.05 ± 0.06 logMAR postoperatively (P = .00), whereas CDVA improved from 0.47 ± 0.03 logMAR preoperatively to -0.006 ± 0.02 logMAR (P = .001) postoperatively. None of the cases developed interlenticular opacification throughout the 18-month follow-up. The mean ICL vault measured by Scheimpflug tomography was 451.27 ± 178.5 µm. Acute IOP elevation with anterior uveitis developed in 2 eyes and was controlled by topical steroids and a beta-blocker., Conclusions: Sulcus implantation of the secondary ICL to correct pseudophakic refractive error was safe, predictable, and well tolerated in all studied eyes. [J Refract Surg. 2017;33(8):532-537.]., (Copyright 2017, SLACK Incorporated.)

Purpose: To report the prevalence of anisometropia at age 5 years after unilateral intraocular lens (IOL) implantation in infants., Design: Prospective randomized clinical trial., Methods: Fifty-seven infants in the Infant Aphakia Treatment Study (IATS) with a unilateral cataract were randomized to IOL implantation with an initial targeted postoperative refractive error of either +8 diopters (D) (infants 28 to <48 days of age) or +6 D (infants 48-210 days of age). Anisometropia was calculated at age 5 years. Six patients were excluded from the analyses., Results: Median age at cataract surgery was 2.2 months (interquartile range [IQR], 1.2, 3.5 months). The mean age at the age 5 years follow-up visit was 5.0 ± 0.1 years (range, 4.9-5.4 years). The median refractive error at the age 5 years visit of the treated eyes was -2.25 D (IQR -5.13, +0.88 D) and of the fellow eyes +1.50 D (IQR +0.88, +2.25). Median anisometropia was -3.50 D (IQR -8.25, -0.88 D); range -19.63 to +2.75 D. Patients with glaucoma in the treated eye (n = 9) had greater anisometropia (glaucoma, median -8.25 D; IQR -11.38, -5.25 D vs no glaucoma median -2.75; IQR -6.38, -0.75 D; P = .005)., Conclusions: The majority of pseudophakic eyes had significant anisometropia at age 5 years. Anisometropia was greater in patients that developed glaucoma. Variability in eye growth and myopic shift continue to make refractive outcomes challenging for IOL implantation during infancy., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Macular hole-associated retinal detachment in high myopia is described as a final stage in progression of myopic traction maculopathy (MTM). 1â€"3 Shimada et al 4 described the progressive stages of MTM from macular retinoschisis to serous retinal detachment in high myopia. Stage 4 MTM is characterised as disappearance of retinoschisis with progression to retinal detachment due to macular hole formation. It is hypothesised that vitreoschisis and abnormal vitreo-retinal interface create the premacular tangential traction. 5 6 Intraoperative triamcinolone acetonide is used to visualise the residual posterior vitreous cortex (PVC). We hereby describe the utility of microscope-integrated optical coherence tomography (MIOCT) in assisting complete removal of PVC and internal limiting membrane (ILM) peeling with multilayered inverted ILM flap in the treatment of myopic macular hole retinal detachment. MIOCT helped identify vitreoschisis and confirm the position of ILM flaps over the macular hole intraoperatively., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

PurposeTo investigate the association between urinary cotinine levels as an objective biological marker for exposure to nicotine and refractive status.Patients and methodsThis cross-sectional study analyzed data from the Korea National Health and Nutrition Examination Survey between 2008 and 2011. A total of 1139 Korean adolescents aged 12-18 years were enrolled. Urinary cotinine concentrations and other potential risk factors for myopia were examined. Correlation analyses and multivariate regression analysis were performed to investigate the association between urinary cotinine level and refractive error.ResultsSpherical equivalent correlated significantly with urinary cotinine concentration (r=0.104, P=0.011). Lower urinary cotinine level was associated with a trend toward more myopic refractive errors (P for trend=0.003). After adjusting for age, sex, area of residence, physical activity, serum 25-hydroxyvitamin D level, parental income level, and receipt of basic livelihood security, subjects with a low urinary cotinine level had a significantly increased risk of myopia <-0.5 D (odds ratio (OR) 1.95, 95% confidence interval (CI) 1.18-3.21), <-3.0 D (OR 2.03, 95% CI 1.29-3.2), and <-6.0 D (OR 2.2, 95% CI, 1.15-4.23) when compared with subjects with a high urinary cotinine level. As urinary cotinine level decreased, the risks of myopia <-0.5 D, <-3.0 D, and <-6.0 D increased significantly (P for trend <0.05).ConclusionA trend toward less myopic refractive error was observed among Korean adolescents with higher urinary cotinine levels. This result provides the epidemiologic evidence implying nicotine as a potential modulator related with refractive development. Further studies with full consideration for myopia-associated risk factors are required to yield clear answers on the direct effect of smoking to the refractive status.

Experimental studies in animals, as well as observational and intervention studies in humans, seem to support the premise that the development of juvenile myopia is promoted by a combination of the effect of genetic and environmental factors, with a complex interaction between them. The very rapid increase in myopia rates in some parts of the world, such as Southeast Asia, supports a significant environmental effect. Several lines of evidence suggest that humans might respond to various external factors, such as increased activity in near vision, increased educational pressure, decreased exposure to sunlight outdoors, dietary changes (including increased intake of carbohydrates), as well as low light levels indoors. All these factors could be associated with a higher prevalence of myopia., (Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose To determine the population prevalence and risk factors of myopia in children and adolescents in Germany. Methods The prevalence of myopia in Germany was computed using data from the 2003-2006 German Health Interview and Examination Survey for Children and Adolescents (N=17 640, 49% girls). Status of myopia was derived from parental questionnaire responses for myopia and the use of spectacles. Potential risk factors were identified using directed acyclic graphs and evaluated using multivariable logistic regression analysis. Results The population prevalence of myopia in the age group 3-17 years was estimated at 13.3% (95%-confidential interval 12.6-14.0%). In the age group 3-10 years, myopia was positively associated with age (per 2 years: OR=1.78 [1.59; 2.00]) and negatively associated with male gender (OR=0.73 [0.57; 0.95]), but neither with leisure-time activities nor with media use. In the age group 11-17 years, attending a High School was positively associated with myopia (OR=1.69 [1.32; 2.16]), while regular physical activity (OR=0.67 [0.53; 0.84]) was negatively associated. Media use was not associated. Conclusions In Germany, myopia is one of the most frequent chronic medical conditions among children and adolescents. Girls, adolescents, and pupils attending a Gymnasium are at higher risk of developing myopia while being physically active may be protective., Competing Interests: Interessenkonflikt: Die Autoren erklären hiermit, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Retinal metabolic changes have been suggested to be associated with myopia development. However, little is known about either their identity or time dependent behavior during this sight compromising process. To address these questions, gas chromatography time-of-flight mass spectrometry (GC-TOF/MS) was applied to compare guinea pig retinal metabolite levels in form deprivation (FD) eyes at 3 days and 2 weeks post FD with normal control (NC) eyes. Orthogonal partial least squares (OPLS) models discriminated between time dependent retinal metabolic profiles in the presence and absence of FD. Myopia severity was associated with more metabolic pattern differences in the FD than in the NC eyes. After 3 days of FD, 11 metabolite levels changed and after 2 weeks the number of differences increased to 16. Five metabolites continuously decreased during two weeks of FD. Two-way ANOVA of the changes identified by OPLS indicates that 15 out of the 22 metabolites differences were significant. Taken together, these results suggest that myopia progression is associated with an inverse relationship between increases in glucose accumulation and lipid level decreases in form-deprived guinea pig eyes. Such changes indicate that metabolomic studies are an informative approach to identify time dependent retinal metabolic alterations associated with this disease.

Purpose: To report the myopic shift at 5 years of age after cataract surgery with intraocular lens (IOL) implantation for infants enrolled in the Infant Aphakia Treatment Study (IATS)., Methods: Refractions were performed at 1 month and every 3 months postoperatively until age 4 years and then at ages 4.25, 4.5, and 5 years. The change in refraction over time was estimated by linear mixed model analysis., Results: Intraocular lens implantation was completed in 56 eyes; 43 were analyzed (median age, 2.4 months; range, 1.0-6.8 months). Exclusions included 11 patients with glaucoma, 1 patient with Stickler syndrome, and 1 patient with an IOL exchange at 8 months postoperatively. The mean rate of change in a myopic direction from 1 month after cataract surgery to age 1.5 years was 0.35 diopters (D)/month (95% confidence interval [CI], 0.29-0.40 D/month); after age 1.5 years, the mean rate of change in a myopic direction was 0.97 D/year (95% CI, 0.66-1.28 D/year). The mean refractive change was 8.97 D (95% CI, 7.25-10.68 D) at age 5 years for children 1 month of age at surgery and 7.22 D (95% CI, 5.54-8.91 D) for children 6 months of age at surgery. The mean refractive error at age 5 years was -2.53 D (95% CI, -4.05 to -1.02)., Conclusions: After IOL implantation during infancy, the rate of myopic shift occurs most rapidly during the first 1.5 years of life. Myopic shift varies substantially among patients. If the goal is emmetropia at age 5 years, then the immediate postoperative hypermetropic targets should be +10.5 D at 4 to 6 weeks and +8.50 D from 7 weeks to 6 months. However, even using these targets, it is likely that many children will require additional refractive correction given the high variability of refractive outcomes., (Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To characterize angioid streaks (AS) with en face optical coherence tomography (OCT)., Methods: Case report of a patient with myopia presenting with choroidal neovascularization secondary to AS. Swept-source en face OCT ability to image the streaks was compared with spectral-domain and swept-source B-scans as well as color and red-free pictures. A 48-year-old man with myopia presented with sudden central visual loss. Choroidal neovascularization secondary to AS was diagnosed and intraocular anti-vascular endothelial growth factor given with clinical and OCT features improvement., Results: Angioid streaks were visualized as less dark than the overlying retinal and the underlying choroidal vasculature. En face OCT located the changes at the level of Bruch membrane. An AS was found to be interrupted by the choroidal neovascularization, what was not captured by other modalities., Conclusion: En face OCT allows to assess the extent of changes in Bruch membrane and their spatial relationship to choroidal neovascularization.