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Myopia is a global public issue with a dramatically increasing incidence. Myopia is currently characterized by its earlier onset, quick development in preschool (0–5 years old), and continued progression particularly during the coronavirus-19 epidemic phase. It has been established that myopia experienced during childhood earlier resulted in vision impairment. In order to intervene in myopia development and offer a novel tool for earlier detection, the review attempts to identify known environmental and genetic risk factors for juvenile myopia (6–18 years old). Medline, Embase, and Web of Science databases were thoroughly searched for articles on myopia that had been published within the previous 10 years. The searches were carried out separately by two experts. The study's inclusion criteria were met by 28 articles. All studies that examined the link between risk factors and myopia were recruited. Parental myopia, near work, time spent outdoors, and a high level of education are all significant risk factors for juvenile myopia. It is clear that there is a strong environmental connection, especially in high myopia; nevertheless, more research is needed to identify any potential links between myopia and screen use. Myopia's genesis and mechanism are ambiguous and unclear. Further genetic studies could aid in examining genes to comprehend the development of myopia. [ABSTRACT FROM AUTHOR]

There is a need to better elucidate demographic and behavioural factors that are contributing to the rising prevalence of myopia. Doing so will aid in developing evidence-based recommendations for behavioural modifications to prevent onset and slow progression of myopia in children. The contributions of environmental and behavioural factors in myopia remain unclear. The goal of this work was to provide a standardised survey to better understand risk factors for myopia. Development of the survey was carried out in 4 phases. In phase 1, three methods (direct, lay terms, and indirect) of parental reporting for the presence of myopia in their child were investigated through a questionnaire (N = 109) to determine sensitivity and specificity. The best method determined from phase 1 was used in phase 2, where questions regarding demographics, ocular history, and visual behaviour were compiled and refined. In phase 3, the survey was administered to focus groups of parents (N = 9). In phase 4, a scoring system was developed. The highest sensitivity for parental reporting for myopia of their child was the indirect method (0.84), and the lowest sensitivity was the direct method (0.41). The highest specificity was the direct method (0.86), once excluding the 'do not know' responses, and the lowest specificity was the indirect method (0.53). The direct method yielded a 53.2% 'do not know' response rate, 50.5% for the lay method, and 1.8% for the indirect method. Time to complete the survey was 10:09 ± 2:45 minutes. This study provides a comprehensive and up-to-date myopia risk factor survey that can be utilised by researchers and clinicians. Parents found the survey to be easy to understand and relatively quick to answer, and the scoring system allows quantification of behaviours across different categories using provided equations. [ABSTRACT FROM AUTHOR]

Optical approaches to modulating near work may be beneficial in arresting the progression of myopia To explore whether a long-distance optical image workbench (LOIW) can replace traditional near-distance reading and has beneficial influences on accommodation and choroidal parameters. This self-control study included two sessions. In session 1, an open-field autorefractor measured sustained accommodative response and pupil diameter when participants viewed virtual images from 3.42 m away through LOIW with + 0.50 D over-correction lenses (3.42 m/+0.50 D), LOIW with full-correction lenses (3.42 m/FC), or the visual target at a given distance of 0.33 m with + 0.50 D over-correction lenses (0.33 m/+0.50 D), with full-correction lenses (0.33 m/FC). In session 2, swept-source optical coherence tomography angiography assessed subfoveal choroidal thickness (SFChT), choroidal volume (CV), and choriocapillaris flow void percentage (FV%) at baseline and before and after reading via LOIW with + 0.50 D over-correction lenses (Far/+0.50 D) or in habitual near distance with full-correction (Near/FC) for a sustained 30-min period. Thirty-five myopic (mean spherical equivalent refraction: −1.11 ± 0.78 D) children (median [range] age: 8.36 [8–10] years) were analysed. Children viewing virtual images in 3.42 m/+0.50 D exhibited mild-degree accommodative leads (−0.54 ± 0.17 D), much smaller pupil diameter (3.39 ± 0.63 mm) and microfluctuations (0.13 ± 0.04 D); accommodative lags (0.88 ± 0.04 D), larger pupil diameter (5.05 ± 0.75 mm) and microfluctuations (0.88 ± 0.16 D) were observed in 0.33 m/+0.50 D, and the microfluctuations were unstable (F = 2.185, p = 0.038). Compared with baseline data, SFChT, CV, and FV% changed by 13.40 ± 4.71 μm, 0.26 ± 0.21 mm3, and − 0.14%±3.66% in Far/+0.50 D, respectively, while changes under Near/FC were − 10.19 ± 7.48 μm, −0.15 ± 0.22 mm3 and 1.95%±2.92%, respectively. All changes differed significantly between these two conditions (all p < 0.001). The long-distance working mode may exert beneficial effects on accommodative and choroidal parameters in myopic children compared with traditional near work. [ABSTRACT FROM AUTHOR]

SIGNIFICANCE: Myopia holds significant public health concern given its social, ocular disease and economic burdens. Although environmental factors are primarily to blame for the rapid rise in prevalence, key risk factors remain unresolved. PURPOSE: The aim of this study was to objectively characterize, using a wearable technology, the temporal indoor and outdoor behavioral patterns and associated environmental lighting characteristics of young myopic and nonmyopic University students. METHODS: Participants were recruited to continuously wear an Actiwatch for 3 weeks, during either or both academic and non-academic periods. The device allows continuous recording of activity and incident light. Recorded illuminance levels were used as a proxy for outdoors (>1,000 lux), with the dynamics (interval frequency and duration) of indoor and outdoor activities, as well as lighting characteristics derived. In addition, participant input regarding near work was obtained daily. Participants were classified by both myopia and axial length status (based on collected refractive error and biometry data) for the purpose of data analysis. RESULT: A total of 55 students, aged 18 to 25 years of age, participated. Overall, the dosing of indoor and outdoor activities was similar across participants, regardless of myopia status, during the academic period. Nonetheless, an apparent difference in the timing of outdoor activities was noted with myopes going outdoors later in the day, particularly during the weekend (p = 0.03). While a trend was observed between increased lighting levels experienced outdoors and shorter axial lengths, there was no significant relationship with myopia status. Noteworthy, participants generally significantly overestimated time spent outdoors, compared to Actiwatch-derived estimates of the same. CONCLUSION: While the findings from this cohort of young adult students did not reveal substantial myopia-related differences in behavior, the power of a more objective and dynamic approach to quantifying behavior cannot be understated, providing argument for general adoption of wearable technologies in future clinical myopia studies.

Abstract Background Near work is generally considered as a risk factor for myopia onset and progression. This study aimed to investigate the choroidal responses to a brief-period of near work in children and young adults. Methods Thirty myopic medical students (aged 18–28 years) and 30 myopic children (aged 8–12 years) participated in this study. The submacular total choroidal area (TCA), luminal area (LA), stromal area (SA), choroidal vascularity index (CVI) and choriocapillaris flow deficit (CcFD), as well as subfoveal choroidal thickness (SFCT) were measured with swept-source optical coherence tomography/optical coherence tomography angiography (SS-OCT/OCTA) before and immediately after 20 min, 40 min, 60 min of near work at a distance of 33 cm. Results In adults, 20 min of near work induced a significant reduction in SFCT (− 5.1 ± 6.5 μm), LA [(− 19.2 ± 18.6) × 103 μm2], SA [(− 8.2 ± 12.6) × 103 μm2] and TCA [(− 27.4 ± 24.9) × 103 μm2] (all P

AIM: To analyze the clinical characteristics of acute acquired concomitant esotropia(AACE)in patients among different age groups.METHODS: Retrospective analysis of clinical data. A total of 112 non-Swan type AACE patients who underwent surgery at Peking University People's Hospital from January 2015 to December 2022 were retrospectively analyzed. Clinical data were collected and the characteristics were compared, including gender, age, diopter, duration of disease, daily time spent on near work, angles of deviation before and after surgery, stereopsis, etc. According to age, patients were divided into three groups: 45 years old group(23 cases). The clinical characteristics of patients were compared in each group.RESULTS: A total of 112 patients were included in the study, comprising 56 males and 56 females, with a median age of 29.50(19.25, 41.75)years old. Among them, 97 patients had myopia(86.6%). There were 93 patients(83.0%)who spent more than 8 h on near work. The age group 45 years old(both P45 years old, the median near angle of deviation after surgery was -4.50(-7.50, 0)PD, and the median distant angle of deviation after surgery was 4.50(0, 9.50)PD, which were smaller than those in other two groups(all P45 years old had the hiughest surgical success rate(100%). The preoperative stereopsis was better in age group >45 years old than the group 45 years old was better than age group

Background: Childhood myopia represents a global concern with increasing prevalence in recent decades. Lifestyle factors significantly impact myopia. Aim: To evaluate lifestyle factors in myopic children from a metropolitan area in Europe. Methods: This was a descriptive study including myopic subjects aged 4–18 years. Patient demographic and clinical data were collected, including cycloplegic refraction in spherical equivalent refraction (SER) and axial length (AL). In addition, a questionnaire on lifestyle factors was conducted between September 2022 and April 2023. Results: A total of 321 myopic children were included, aged 10.72 ± 3.05 years, of whom 51.4% were boys, with SER −2.25 ± 1.9 D and AL 24.54 ± 0.98 mm. The mean age of myopia onset was 7.69 ± 3.05 years. A total of 59.8% had family history of myopia. Those children who had <2 h/day of screen time (on weekdays) presented SER −2 ± 1.91 D, compared to those who had >2 h/day, SER: −2.50 ±1.88 D (p = 0.009). Children who spent <2 h/day doing near work after school were less myopic compared to those who spent >2 h/day (SER: −1.75 ± 1.83 vs. SER: −2.75 ± 1.82, respectively, p = 0.03). However, no significant association was observed between SER and AL and time spent outdoors nor between SER and AL and academic performance (p > 0.05). Conclusions: Screen time and near-work time appear to be lifestyle factors related to myopia. [ABSTRACT FROM AUTHOR]

Background: The incidence of myopia is increasing at an alarming rate. Investigating the causes of myopia gives us a better understanding of it. This gives us better odds of preventing the occurrence and retarding the condition's progression. The study used a method called stratified sampling to select 100 individuals who were near-sighted. They belonged to the age of 17-30 years old and pursued medicine in the district of Kanchipuram. The role of risk factors was assessed through a questionnaire. Result: The percentage of subjects with low, medium, and high myopia was 77, 18, and 5, respectively. The role of heredity, diet, academic performance, time spent doing near work, and outdoor work was indeed found to play significant roles in the development and progression of myopia. Conclusion: The incidence of myopia is constantly increasing, especially in Asian countries. To prevent myopia and its complications, we need to take significant steps to reduce the risk factors that can be changed.

Background: The COVID-19 pandemic introduced barriers to in-person learning, challenging teachers worldwide to modify their classroom activities. These changes in daily visual behavior could have long-term implications for children's eye health. Methods: Teachers (n=52) were asked to describe the platforms used for teaching, estimate the time children spent in various activities during the school day, and describe their perceptions of how children's vision may be affected by pandemic-related classroom changes. Results: During the pandemic, classroom time spent in group work decreased, while individual work increased (both p<0.005). The use of printed material decreased, whereas computer, phone, and tablet use for academic purposes increased (all p<0.005). Most teachers believed that pandemicrelated classroom changes contributed to increased amounts of near work and eye fatigue in their students. Conclusions: The adoption of digital devices for learning may have a lasting impact on eye health. Guidelines for the use of digital devices in schools should be based on evidence-based studies and prompt educators to balance teaching modalities. Given previously reported associations between visual activity with conditions such as myopia and computer vision syndrome, eye care professionals should be prepared to monitor for potential post-pandemic ocular issues in children. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the incidence rate and risk factors for anisometropia among young schoolchildren. Methods: A population‐based cohort study, the Myopia Investigation Study in Taipei, was conducted in primary schools in Taipei City. Children were recruited for biannual comprehensive eye examinations over 2 years. Cycloplegic autorefraction and slit lamp examinations were performed biannually. Data on demographic information, parental history, lifestyle and near‐work activities were collected using parent‐administered questionnaires at the first and final visits. Anisometropia was defined as ≥1 D difference in the spherical equivalent (SE) refractive error. Results: A total of 7035 8‐year‐old children completed the 2‐year follow‐up evaluations. The average annual incidence of anisometropia was 3.8%. Multivariable logistic regression analysis revealed that baseline SE (odds ratio [OR]: 0.87 95% CI: 0.80–0.95) and female sex (OR: 1.24, 95% confidence interval [CI]: 1.02–1.50) were significantly associated with incident anisometropia. Among lifestyle risk factors, spending <1 h per day in after‐school outdoor activities on weekdays (OR: 1.38, 95% CI: 1.08–1.76) and performing near work at a distance <30 cm (OR: 1.33, 95% CI: 1.08–1.64) were significantly associated with an increased risk of incident anisometropia. In the multiple linear regression analysis, the inter‐eye difference in SE increased significantly in children performing near work at distances <30 cm (adjusted β = 0.03; p = 0.02). Conclusions: This study indicated the annual incidence of anisometropia in Taiwanese schoolchildren. Less time spent outdoors and shorter eye‐to‐object distances during near work increased the risk of incident anisometropia. [ABSTRACT FROM AUTHOR]

BACKGROUND: The ultra-Orthodox Jewish community has a unique lifestyle including minimal outdoor activity and intense, prolonged nearby work, beginning at a very young age. Their prevalence of myopia is extremely high. This paper provides a unique insight into the attitudes of this community towards myopia. METHODS: Ultra-Orthodox Jewish parents of children who came to the pediatric ophthalmology clinic in one tertiary care and two community centers in ultra-Orthodox-oriented cities were given a questionnaire. Demographic information, along with myopia prevalence in the family, was gathered. In addition, their attitudes and common knowledge regarding myopia were investigated. RESULTS: 161 questioners were collected, mostly completed by mothers (n = 110, 68%). The average number of children per family was 6 (range 1-16). In 148 families (92%) at least one of the parents has myopia. The average parent refraction was - 4.5 diopters (range - 0.5 to 15 diopters). Out of 935 children, 410 (44%) wore glasses. Twelve parents (7%) believe that myopia is a disease and 94 (58%) reported that they are concerned because their child wears glasses. Twenty-four (15%) believe that glasses are a sign of a high education level. Regarding treating myopia progression, 144 (89%) think that myopia progression should be treated, but only 36 (22%) are aware of the available treatments for it. CONCLUSION: This study examines an insular community with a very high incidence of myopia. In this community most parents think that myopia progression should be treated but most of them are unaware of the currently available treatments.

This research aimed to determine the effects of near work on macular choroidal blood flow and thickness in young adults. A total of 109 participants (19–28 years old) were recruited from Capital Medical University in China. The participants spent 40 min reading a book text at a distance of 33 cm. Swept-source optical coherence tomography/optical coherence tomography angiography (SS-OCT/OCTA) was performed to measure the changes in choriocapillaris perfusion area (CCPA) and choroidal thickness (ChT) after 40 min of near work. The SS-OCT/OCTA data covered an area of 6 mm × 6 mm, which centered on the fovea. The baseline ChT and CCPA before near work were negatively correlated with AL, while positively correlated with the magnitude of spherical equivalent (p <.001). Total CCPA decreased significantly by 6 mm × 6 mm macular area after near work compared to that before near work (24.26 ± 1.96 vs. 24.63 ± 1.61 mm2, p<.001). The macular ChT was lower after 40 min of reading than that before 40 min of reading, but no significant difference was observed (302.25 ± 77.69 vs. 304.92 ± 79.73 μm, p =.078). The extent of choroidal thinning was significantly positively correlated with the magnitude of CCPA reduction (p <.001). The decline in CCPA after near work was significantly positively correlated with axial length (AL; p <.001). This study demonstrated that near work significantly decreased CCPA. The extent of CCPA reduction after near work was associated with higher severity of myopia and choroidal thinning. The baseline CCPA and ChT decreased gradually with AL. [ABSTRACT FROM AUTHOR]

Due to the myopia prevalence increase worldwide, this study aims to establish the most relevant risk factors associated with its development and progression. A review search was carried out using PubMed, Web of Science, and Scopus databases to identify the main myopia risk factors. The inclusion criteria for the articles were those related to the topic, carried out in subjects from 5 to 30 years, published between January 2000 and May 2023, in English, and with the full text available. Myopia etiology has proven to be associated with both genetic and environmental factors as well as with gene–environment interaction. The risk of developing myopia increases in children with myopic parents (one parent ×2 times, two parents ×5 times). Regarding environmental factors, education is the main risk factor correlated with myopia prevalence increase. Further, several studies found that shorter distance (<30 cm) and longer time spent (>30 min) for near work increase the risk of myopia. Meanwhile, increased outdoor activity (>40 min/day) has been shown to be a key factor in reducing myopia incidence. In conclusion, the interventional strategy suggested so far to reduce myopia incidence is an increase in time outdoors and a reduction in the time spent performing near-work tasks. [ABSTRACT FROM AUTHOR]

Abstract Background Nutritional status influences the growth and development of the eyes. However, there are few studies on the association between diet, especially whole grains (WG) consumption, and myopia. The study aimed to evaluate the association between WG intake and myopia prevalence among primary school-age children in China. Methods This cross-sectional epidemiological study conducted between November 2019 and December 2019 included 586 children, aged 6–12 years, attending primary school in Binhai district, Tianjin, China. Ophthalmologic examinations and optometric cycloplegic refraction measurements were conducted. Information was collected on known risks and protective factors for myopia and the consumption of WGs, vegetables, and fruits. This association between the probability of myopia and the proportion of WG consumption (WG proportion was calculated as the mean intake from WG sources divided by total grain intake), adjusted for protective and risk factors, was analysed using crude and multivariable logistic regression. Results Among the study participants, 226/586 (38.57%) children had myopia in at least one eye. WG intake was inversely correlated with the prevalence of myopia. Furthermore, in the multivariate analysis, WG intake of > 50% was identified as a protective factor against myopia after subsequent adjustment for children’s age, sex, parental myopia, near-work activity, screen time, reading and writing habits, visual fatigue, outdoor time, and classroom light environment (all P 50%) was an independent protective factor against myopia. Modifying the form of grains consumed (whole versus refined) could be one of the targets of future public health measures.

Abstract Background To investigate environmental and social risk factors for myopia in children and adolescents in Germany. Methods 1437 children aged between 3 and 18 inclusive were examined as part of the LIFE Child study based in Leipzig, Germany. Information about leisure time activities and social status was ascertained by parents and children in a questionnaire. Refractive status was attained by measuring noncycloplegic autorefraction. Myopia was defined as spherical equivalent (SE) ≤ − 0.75 D. Risk factors were identified using multiple logistic regression analysis. Results In multiple logistic regression analysis, myopia was significantly associated with less frequent outdoor activity (“once a week” vs. “twice a week or more”: odds ratio (OR) 4.35, 95% confidence interval (CI) 1.89–9.98, p 3 h vs. < 1 h: OR 3.71, CI 1.43–9.61, p 0.05). Children with a lower SES were involved in longer periods of outdoor and near work activities but on fewer occasions over the course of the week, although this connection was not significant. Conclusion Myopia is associated with environmental factors. The present findings suggest that daily exposure to sunlight and a restriction of long-duration near work activities might protect against pathological eye growth. Prevention strategies should be implemented for children at all ages.

SignificanceMyopia holds significant public health concern given its social, ocular disease and economic burdens. Although environmental factors are primarily to blame for the rapid rise in prevalence, key risk factors remain unresolved.PurposeThe aim of this study was to objectively characterize, using a wearable technology, the temporal indoor and outdoor behavioral patterns and associated environmental lighting characteristics of young myopic and nonmyopic University students.MethodsParticipants were recruited to continuously wear an Actiwatch for 3 weeks, during either or both academic and non-academic periods. The device allows continuous recording of activity and incident light. Recorded illuminance levels were used as a proxy for outdoors (>1,000 lux), with the dynamics (interval frequency and duration) of indoor and outdoor activities, as well as lighting characteristics derived. In addition, participant input regarding near work was obtained daily. Participants were classified by both myopia and axial length status (based on collected refractive error and biometry data) for the purpose of data analysis.ResultA total of 55 students, aged 18 to 25 years of age, participated. Overall, the dosing of indoor and outdoor activities was similar across participants, regardless of myopia status, during the academic period. Nonetheless, an apparent difference in the timing of outdoor activities was noted with myopes going outdoors later in the day, particularly during the weekend (p = 0.03). While a trend was observed between increased lighting levels experienced outdoors and shorter axial lengths, there was no significant relationship with myopia status. Noteworthy, participants generally significantly overestimated time spent outdoors, compared to Actiwatch-derived estimates of the same.ConclusionWhile the findings from this cohort of young adult students did not reveal substantial myopia-related differences in behavior, the power of a more objective and dynamic approach to quantifying behavior cannot be understated, providing argument for general adoption of wearable technologies in future clinical myopia studies.

Introduction: Despite the known associations between near work and myopia, and retinal image quality and eye growth, accommodation‐induced changes in higher order aberrations (HOA's) and retinal image quality in children with different refractive errors are poorly understood. Methods: Ocular HOA's were measured using a Hartmann‐Shack wavefront sensor (COAS‐HD, Wavefront Sciences) in 18 myopic and 18 age‐ and sex‐matched non‐myopic children during short‐term accommodation tasks (four demands of 0, 3, 6 and 9 D) presented using a Badal optometer. Eighth order Zernike polynomials were fitted across a 2.3 mm pupil diameter to determine refractive power vectors (M, J180 and J45) and the accommodation error, and a 4 mm pupil was used for HOA analyses. Retinal image quality was examined using the visual Strehl ratio based on the optical transfer function (VSOTF) for third to eighth radial orders only. Results: Most refractive error group differences were observed for the 6 and 9 D demands. Myopic children underwent greater changes in with‐the‐rule astigmatism (J180), higher order and third order RMS values, primary vertical (C3−1) and horizontal coma (C31), and several other individual Zernike coefficients compared with non‐myopic children (all refractive error group by demand interaction p‐values of ≤0.02). Non‐myopic children exhibited a greater negative shift in primary (C40) and positive shift in secondary spherical aberration (C60) (both refractive error group by demand interaction p‐values of ≤0.002). The VSOTF degraded for the 6 and 9 D demands in both groups, but the myopic children underwent a greater mean (SE) reduction from 0 D of −0.274 (0.048) for the 9 D demand, compared with −0.131 (0.052) for the non‐myopic children (p = 0.001). Conclusion: These results may have implications for the association between near work, accommodation and myopia development, particularly related to the use of short working distances during near tasks. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate eye use behavior in myopic and non-myopic children objectively using Clouclip M2 device and subjectively using questionnaire and compare the results. The study also aimed to assess the relationships between ocular biometric parameters and refractive status.MethodsClouclip M2 was used in monitoring eye use behavior and visual environment in children aged 9–11 years. The participants were monitored for 7 days. On the eighth day, data stored in the device were collected, relevant eye examination were conducted and survey questionnaire was administered. The paired sample t-test was used to compare the eye use behavior obtained objectively and subjectively. The relationships between ocular biometric parameters and refractive status were assessed using the Pearson's Correlation analysis.ResultsSpherical equivalent refraction was significantly correlated with axial length, axial length to corneal radius, anterior chamber depth, lens thickness, and corneal radius (P

To determine the fixation disparity and refractive error of first-year optometry students to ascertain any relationship between them and also identify any association between fixation disparity and visual symptoms at near. It was an analytical cross-sectional study involving 85 participants aged 17 to 27 years (18.60 ± 1.37), 41% of whom were males. Subjective refraction was done at 3 m and fixation disparity was measured with and without spectacle correction using the Wesson Fixation Disparity Card. All analysis was set within a 95% confidence interval with a p -value ≤ 0.05 considered statistically significant. Refractive error ranged from 0.25 SEQ (spherical equivalent) to 5.50 SEQ. Mean fixation disparity ranged from 2.9 ± 2.6 to 3.9 ± 2.8 min arc. There was no statistically significant correlation between refractive error and fixation disparity without correction (r = −0.180, p = 0.098) and with correction (r = 0.155, p = 0.157). For fixation disparity in the ortho and exo direction, mean fixation disparity with correction of participants who experienced headaches during or after reading (5.1 ± 2.6 min arc) was significantly higher (p = 0.032) than participants who did not (2.0 ± 2.6 min arc). Myopia is common among first-year optometry students. Refractive error has no significant effect on fixation disparity. Headache is significantly associated with exo fixation disparity at near. [ABSTRACT FROM AUTHOR]

Background: Childhood myopia represents a global concern with increasing prevalence in recent decades. Lifestyle factors significantly impact myopia. Aim: To evaluate lifestyle factors in myopic children from a metropolitan area in Europe. Methods: This was a descriptive study including myopic subjects aged 4–18 years. Patient demographic and clinical data were collected, including cycloplegic refraction in spherical equivalent refraction (SER) and axial length (AL). In addition, a questionnaire on lifestyle factors was conducted between September 2022 and April 2023. Results: A total of 321 myopic children were included, aged 10.72 ± 3.05 years, of whom 51.4% were boys, with SER −2.25 ± 1.9 D and AL 24.54 ± 0.98 mm. The mean age of myopia onset was 7.69 ± 3.05 years. A total of 59.8% had family history of myopia. Those children who had 2 h/day, SER: −2.50 ±1.88 D (p = 0.009). Children who spent 2 h/day (SER: −1.75 ± 1.83 vs. SER: −2.75 ± 1.82, respectively, p = 0.03). However, no significant association was observed between SER and AL and time spent outdoors nor between SER and AL and academic performance (p > 0.05). Conclusions: Screen time and near-work time appear to be lifestyle factors related to myopia.

Background: Nutritional status influences the growth and development of the eyes. However, there are few studies on the association between diet, especially whole grains (WG) consumption, and myopia. The study aimed to evaluate the association between WG intake and myopia prevalence among primary school-age children in China. Methods: This cross-sectional epidemiological study conducted between November 2019 and December 2019 included 586 children, aged 6–12 years, attending primary school in Binhai district, Tianjin, China. Ophthalmologic examinations and optometric cycloplegic refraction measurements were conducted. Information was collected on known risks and protective factors for myopia and the consumption of WGs, vegetables, and fruits. This association between the probability of myopia and the proportion of WG consumption (WG proportion was calculated as the mean intake from WG sources divided by total grain intake), adjusted for protective and risk factors, was analysed using crude and multivariable logistic regression. Results: Among the study participants, 226/586 (38.57%) children had myopia in at least one eye. WG intake was inversely correlated with the prevalence of myopia. Furthermore, in the multivariate analysis, WG intake of > 50% was identified as a protective factor against myopia after subsequent adjustment for children's age, sex, parental myopia, near-work activity, screen time, reading and writing habits, visual fatigue, outdoor time, and classroom light environment (all P < 0.05). Conclusion: WG intake (> 50%) was an independent protective factor against myopia. Modifying the form of grains consumed (whole versus refined) could be one of the targets of future public health measures. [ABSTRACT FROM AUTHOR]

Background: To investigate environmental and social risk factors for myopia in children and adolescents in Germany.Methods: 1437 children aged between 3 and 18 inclusive were examined as part of the LIFE Child study based in Leipzig, Germany. Information about leisure time activities and social status was ascertained by parents and children in a questionnaire. Refractive status was attained by measuring noncycloplegic autorefraction. Myopia was defined as spherical equivalent (SE) ≤ - 0.75 D. Risk factors were identified using multiple logistic regression analysis.Results: In multiple logistic regression analysis, myopia was significantly associated with less frequent outdoor activity ("once a week" vs. "twice a week or more": odds ratio (OR) 4.35, 95% confidence interval (CI) 1.89-9.98, p<0.01) and longer near work sessions (1-2 h vs. < 1 h: OR 1.83, CI 1.10-3.04, p=0.02; > 3 h vs. < 1 h: OR 3.71, CI 1.43-9.61, p<0.01) after adjustment for age, sex and socioeconomic status (SES). Duration of outdoor activity, near work frequency and SES showed no significant association with myopia (p > 0.05). Children with a lower SES were involved in longer periods of outdoor and near work activities but on fewer occasions over the course of the week, although this connection was not significant.Conclusion: Myopia is associated with environmental factors. The present findings suggest that daily exposure to sunlight and a restriction of long-duration near work activities might protect against pathological eye growth. Prevention strategies should be implemented for children at all ages. [ABSTRACT FROM AUTHOR]

Myopia has reached epidemic levels in recent years. Stopping the development and progression of myopia is critical, as high myopia is a major cause of blindness worldwide. This overview aims at finding the association of time spent outdoors (TSO), near work (NW), and physical activity (PA) with the incidence, prevalence, and progression of myopia in children. Literature search was conducted in PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, ProQuest, and Web of Science databases. Systematic reviews (SR) and meta-analyses (MA) on the TSO, NW, and PA in relation to myopia were reviewed. Methodological nature of qualified studies were evaluated utilizing the Risk of Bias in Systematic Review tool. We identified four SRs out of which three had MA, which included 62 unique studies, involving >1,00,000 children. This overview found a protective trend toward TSO with a pooled odds ratio (OR) of 0.982 (95% confidence interval (CI) 0.979–0.985, I2 = 93.5%, P < 0.001) per extra hour of TSO every week. A pooled OR 1.14 (95% CI 1.08–1.20) suggested NW to be related to risk of myopia. However, studies associating myopia with NW activities are not necessarily a causality as the effect of myopia might force children to indoor confinement with more NW and less TSO. PA presented no effect on myopia. Though the strength of evidence is less because of high heterogeneity and lack of clinical trials with clear definition, increased TSO and reduced NW are protective against myopia development among nonmyopes.

Objectives: Decreased static pupil size due to accommodation is a common clinical finding; however, changes in pupillary dynamic responses after near-work activities such as reading a book and using a smartphone are not well understood. Methods: The present study was performed on 76 right eyes of 76 volunteers (mean age: 20.95±2.34 years) who had ocular near activity more than 4 h per day. The participants were divided into two groups based on the dominant activity, reading a book (Group 1) or using a smartphone (Group 2). Evaluation of dynamic and static parameters of the pupil was performed before and after 1 h of continuous routine eye activity in both groups and compared. Results: Near work reduced pupil diameter (PD) in all static components (p<0.001) and the amount of change in the min PD (p=0.039) and mesopic PD (p=0.043) were different between two groups and were higher in Group 1 (both, p<0.05). Dynamic elements showed a decrease in initial diameter, amplitude and velocity of contraction and dilation, and an increase in other components so that the changes after using smartphone were significant in all dynamic parameters (all, p<0.05), but reading the book only made a significant difference in the initial diameter, amplitude, and velocity of contraction and duration of dilation (all, p<0.05); the changes were only different in the initial diameter between the two studied groups, which was higher in Group 1 (p=0.047). Conclusion: The present study showed that reading a book and using smartphone cause changes in the pupil components, which were decreasing in diameter components and velocity of changes and increasing in latency of changes; the type of ocular work may affect the changes. [ABSTRACT FROM AUTHOR]

Objective assessment of near viewing behaviours performed in a laboratory setting showed that children demonstrate differing viewing distances and angles based on the type of task. Findings will contribute to our understanding of how near work influences myopia. Evidence suggests that near working distance and viewing breaks are associated with myopia. The purpose of this study was to use an objective, continuously measuring range finding device to examine these viewing behaviours in children. Viewing distance, number of breaks, and head and eye angles were assessed in 16 non-myopic and 19 myopic children (ages 13.38 ± 4.14 years) using the Clouclip, an objective rangefinder, during five 15-minute near tasks, including (a) passive reading and (b) active writing on printed material, (c) passive viewing and (d) active engagement on an iPad, and (e) active engagement on a cell phone. Height and Harmon distance were measured. Viewing behaviours were analysed by task, refractive error group, and gender. Mean viewing distances significantly differed by task (P < 0.001) and were highly correlated with children's Harmon distance and height for all near tasks (P < 0.05), except for the active printed task (P > 0.05). Viewing distances did not differ by gender or refractive error group. During each task, mean number of viewing breaks was 2.6 ± 4.1 and did not vary between task (P = 0.92) or refractive error group (P = 0.65). Head declination and total viewing angle varied by type of near task (P < 0.001 for both). Children demonstrated differing viewing distances and viewing angles based on the type of near task they were performing. Viewing behaviours did not vary between myopic and non-myopic children. Findings will contribute to a better understanding of how near viewing behaviours can be quantified objectively and relationships with myopia. [ABSTRACT FROM AUTHOR]

BackgroundWe conducted this study to investigate the prevalence of myopia among school students in Ningbo and to explore the associations between reading and writing postures and myopia.MethodsA population-based and cross-sectional study was conducted, and 3,256 school students aged 8–19 years were recruited. Each enrolled subject was assessed for uncorrected distance visual acuity (UDVA) using a standard logarithmic visual acuity E-chart and a non-cycloplegic autorefraction examination. Self-administered questionnaires were used to investigate myopia-related reading and writing postures and behavioral habits among school students.ResultsThe prevalence of myopia among primary school, middle school, and high school students was 61.49, 81.43, and 89.72%, respectively. Regarding the associations between reading and writing postures and myopia, we identified that a reading distance >33 cm is a protective factor for myopia in female students [odds ratio (OR) = 0.31, 95% confidence interval (CI) = 0.15–0.64], in both primary school (OR = 0.55, 95% CI = 0.30–0.99) and middle school (OR = 0.37, 95% CI = 0.15–0.90).ConclusionsA reading distance >33 cm can be used as an additional measure to prevent and control myopia. Proper postural measures for reading and writing may have educational and public health benefits.

After decades of investigation, the role of near work in myopia remains unresolved, with some studies reporting no relationship and others finding the opposite. This systematic review is intended to summarize classic and recent literature investigating near work and the onset and progression of myopia, potential mechanisms and pertinent clinical recommendations. The impact of electronic device use is considered. PubMed and Medline were used to find peer‐reviewed cross‐sectional and longitudinal studies related to near work and myopia from 1980 to July 2020 using the PRISMA checklist. Studies were chosen using the Joanna Briggs Institute checklist, with a focus on studies with a sample size greater than 50. Studies were independently evaluated; conclusions were drawn per these evaluations. Numerous cross‐sectional studies found increased odds ratio of myopia with increased near work. While early longitudinal studies failed to find this relationship, more recent longitudinal studies have found a relationship between myopia and near work. Rather than daily duration of near work, interest has increased regarding absolute working distance and duration of continuous near viewing. Several reports have found that shorter working distances (<30 cm) and continuous near‐work activity (>30 min) are risk factors for myopia onset and progression. Novel objective continuously measuring rangefinding devices have been developed to better address these questions. The literature is conflicting, likely due to the subjective and variable nature in which near work has been quantified and a paucity of longitudinal studies. We conclude that more precise objective measures of near viewing behaviour are necessary to make definitive conclusions regarding the relationship between myopia and near work. Focus should shift to utilizing objective and continuously measuring instruments to quantify near‐work behaviours in children, followed longitudinally, to understand the complex factors related to near work. A better understanding of the roles of absolute working distance, temporal properties, viewing breaks and electronic device use on myopia development and progression will aid in the development of evidence‐based clinical recommendations for behavioural modifications to prevent and slow myopia. [ABSTRACT FROM AUTHOR]

Purpose: To examine the association between near work, screen time including TV and outdoor time with myopia in children from the Sunflower Myopia Asian Eye Epidemiology Consortium (AEEC). Methods: We analysed AEEC cross‐sectional data (12 241 children) on risk factors (near work, screen time including TV and outdoor time) and myopia of six population‐based studies (China, Hong Kong and Singapore). Cycloplegic refraction and axial length (AL) measurements were included. Risk factors were determined using questionnaires. Data were pooled from each study, and multivariable regression analysis was performed to evaluate the associations between risks factors and myopia, spherical equivalent (SE) and AL. Results: Among the included children, 52.1% were boys, 98.1% were Chinese and 69.7% lived in urban areas. Mean±standard deviation (SD) for age was 8.8 ± 2.9 years, for SE was −0.14 ± 1.8 D and for AL was 23.3 ± 1.1 mm. Myopia prevalence was 30.6%. In multivariate analysis, more reading and writing (OR = 1.17; 95% CI, 1.11–1.24), more total near work (OR = 1.05; 95% CI, 1.02–1.09) and less outdoor time (OR = 0.82, 95% CI, 0.75–0.88) were associated with myopia (p's < 0.05). These factors were similarly associated with SE and AL (p's < 0.05), except for total near work and AL (p = 0.15). Screen time including TV was not significantly associated with myopia (p = 0.49), SE (p = 0.49) or AL (p = 0.83). Conclusion: In this study, increased reading and writing and decreased outdoor time were associated with myopia. Screen time may be a surrogate factor of near work or outdoor time, but further research is needed to assess its role as an independent risk factor for myopia. [ABSTRACT FROM AUTHOR]

Abstract Background The ultra-Orthodox Jewish community has a unique lifestyle including minimal outdoor activity and intense, prolonged nearby work, beginning at a very young age. Their prevalence of myopia is extremely high. This paper provides a unique insight into the attitudes of this community towards myopia. Methods Ultra-Orthodox Jewish parents of children who came to the pediatric ophthalmology clinic in one tertiary care and two community centers in ultra-Orthodox-oriented cities were given a questionnaire. Demographic information, along with myopia prevalence in the family, was gathered. In addition, their attitudes and common knowledge regarding myopia were investigated. Results 161 questioners were collected, mostly completed by mothers (n = 110, 68%). The average number of children per family was 6 (range 1–16). In 148 families (92%) at least one of the parents has myopia. The average parent refraction was − 4.5 diopters (range − 0.5 to 15 diopters). Out of 935 children, 410 (44%) wore glasses. Twelve parents (7%) believe that myopia is a disease and 94 (58%) reported that they are concerned because their child wears glasses. Twenty-four (15%) believe that glasses are a sign of a high education level. Regarding treating myopia progression, 144 (89%) think that myopia progression should be treated, but only 36 (22%) are aware of the available treatments for it. Conclusion This study examines an insular community with a very high incidence of myopia. In this community most parents think that myopia progression should be treated but most of them are unaware of the currently available treatments.

Purpose: To study the prevalence and risk factors of myopia with data from a questionnaire study conducted in 1983 among Finnish school children. Methods: School children (n = 4 961) from the 1st, 5th and 8th grades of school (7‐, 11‐ and 15‐year‐olds) in Central Finland were screened for vision followed by a questionnaire, which was returned by 4 352 (87.7%) participants. Myopia was categorized based on the questionnaire. Items concerned daily time spent on near work and outdoor activities, excluding time spent at school, watching TV and parental myopia and the associations of myopia with these factors were studied. Results: The prevalence of myopia was 3%, 15% and 27% among the 7‐, 11‐ and 15‐year‐olds, and if daily near work at home was ≤1 hr, myopia prevalence was 0.5%, 3.3% and 17.6%, respectively. The adjusted risk of myopia for each daily near work hour was OR 1.476 (95% confidence interval 1.099–1.984, p = 0.010), OR 1.346 (1.170–1.584, p < 0.001) and OR 1.206 (1.076–1.352, p = 0.001), in the 3 age groups, respectively. The adjusted risk of myopia for each daily hour spent outdoors was OR 0.764 (0.648–0.900, p = 0.001) in the 11‐year‐olds and OR (0.840, 0.743–0.950, p = 0.005) in the 15‐year‐olds. Outdoors time prevented myopia at different levels of near work, although less at the highest levels, and near work increased risk of myopia with the level of outdoors time. If the ratio between near work and outdoors time was ≤0. 5 or >1.5, the prevalence of myopia was 1.4% versus 5.6%, 6.3% versus 24.7% and 15.9% versus 36.9%, among the 7‐, 11‐ and 15‐year‐olds, respectively. The higher prevalence of myopia among the 11‐ and 15‐year‐old girls than boys was explained by more near work and less outdoor time among the girls. Having two myopic parents roughly doubled the risk of myopia compared to if one myopic parent in the 11‐ and 15‐year‐olds. Conclusions: Myopic parents, greater near work time, less outdoors time, a higher near work/outdoors ratio, and being a girl increased the risk of myopia. Myopia was rare in the 7‐ and 11‐year‐olds if daily near work at home did not exceed one hour or if the near work/outdoors ratio was not higher than 0.5. Outdoors time was associated with the prevalence of myopia at all levels of near work, although the association was weaker at the highest level. [ABSTRACT FROM AUTHOR]

I review the key findings and our current knowledge of the cause of myopia, making the connections among the reliable observations on myopia development and theory to arrive at a summary of what we know about myopia, the proposed prevailing theory, and applicable action. Myopia is reaching epidemic proportions. It is estimated that half of the world's population will be myopic by 2050 unless new strategies to fight myopia are developed. Our high-level mathematical description of myopia is translated into clinical applications involving effective treatment and prevention. A regulating mechanism controlling the refraction of the eye is intimately related to myopia. The approach at hand is to review our knowledge about emmetropization, connecting myopia and emmetropization feedback theory to unveil the cause of myopia. Many observations discussed here test the validity of feedback theory positively. The cause of human myopia fits perfectly with the idea that emmetropization, in particular its feedback theory implementation, is the controlling mechanism behind myopia. They include near work, atropine, lenses, defocus, and outdoor versus indoor activities. The key findings in myopia research point the same way: myopia is the result of corrective lenses interfering with emmetropization. We have enough knowledge to answer the question of whether myopia can be reversed or prevented. There is no need to have mathematical skills to apply theory to real cases. It is enough to know the predictions of the feedback theory of emmetropization. [ABSTRACT FROM AUTHOR]

Myopia has reached epidemic levels in recent years. Stopping the development and progression of myopia is critical, as high myopia is a major cause of blindness worldwide. This overview aims at finding the association of time spent outdoors (TSO), near work (NW), and physical activity (PA) with the incidence, prevalence, and progression of myopia in children. Literature search was conducted in PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, ProQuest, and Web of Science databases. Systematic reviews (SR) and meta-analyses (MA) on the TSO, NW, and PA in relation to myopia were reviewed. Methodological nature of qualified studies were evaluated utilizing the Risk of Bias in Systematic Review tool. We identified four SRs out of which three had MA, which included 62 unique studies, involving >1,00,000 children. This overview found a protective trend toward TSO with a pooled odds ratio (OR) of 0.982 (95% confidence interval (CI) 0.979-0.985, I2 = 93.5%, P < 0.001) per extra hour of TSO every week. A pooled OR 1.14 (95% CI 1.08-1.20) suggested NW to be related to risk of myopia. However, studies associating myopia with NW activities are not necessarily a causality as the effect of myopia might force children to indoor confinement with more NW and less TSO. PA presented no effect on myopia. Though the strength of evidence is less because of high heterogeneity and lack of clinical trials with clear definition, increased TSO and reduced NW are protective against myopia development among nonmyopes. [ABSTRACT FROM AUTHOR]

"AIM: To assess the influence of near work, time outdoor and parental myopia on the prevalence of myopia in school children in Aba, Nigeria. METHODS: Primary and secondary school children aged between 8 and 15y were randomly recruited from 12 schools in Aba. Information on family history, near work and outdoor activity was obtained using myopia risk factor questionnaire. Cycloplegic refraction was performed using autorefraction technique. Myopia was defined as spherical equivalent refraction (SER) ≤-0.50 D in the poorer eye. Data were analysed for 1197 (male: 538 and female: 659) children with full relevant data. RESULTS: Risk of developing myopia was positively associated with parental myopia [odds ratio (OR): 6.80; 95%CI, 2.76-16.74; P

Background: Refractive errors are the most frequent form of impaired vision and the second most manageable cause of blindness in the world. Surprisingly, uncorrected refractive errors are accounting for 20% of blindness cases as well as 50% of vision loss cases worldwide. During the year 2000, the international prevalence of myopia and high myopia was calculated to be 22.9 percent and 2.7 percent, correspondingly. Purpose: The purpose of this study was to evaluate the different patterns of refractive error among near workers. Methodology: Cross-sectional study was done on 248 participants through a convenient sampling method from the private sector hospitals. Data was collected during 3-4 months from March 2022 to May 2022 by a modified adapted questionnaire to evaluate the pattern of refractive errors among near workers in Lahore. Results: All the participant's profession was associated with near work. 42.3.% of responders reported myopia,10.9% hyperopia, 14.9% simple myopic astigmatism, 2.4% simple hyperopic astigmatism,7.3% compound hyperopic astigmatism, and 5.6% with mixed astigmatism. Conclusion: Near work is strongly associated with the refractive errors most commonly myopia progression and aggravation but unfortunately, there is little research work done in Pakistan on the relationship between near work and refractive errors further studies needed to be done on this topic. [ABSTRACT FROM AUTHOR]

Purpose: To validate a novel wearable device that can measure both viewing distance and light exposure, Clouclip, and compare questionnaire estimates regarding near‐work and outdoor time with the objective measures obtained using Clouclip. Methods: Fifteen Clouclips were selected to measure different distances and levels of illuminance. With each Clouclip, five measurements at different distances and light intensities were measured and recorded. Eighty participants wore Clouclips for a week and completed an activity questionnaire afterwards. Results: The intra‐ and inter‐Clouclip coefficients were 1.00 and 0.99 for measuring distance and 1.00 and 1.00 for illuminance, respectively. Within the measurement limit, the maximum relative error was 2.07% for distance and 2.23% for illuminance. Assuming that <30 cm was the typical distance for near‐work activities and >1000 Lux was the typical cut‐off for outdoor environments, the questionnaire showed a trend of overestimation for both. The greatest overestimation of near‐work occurred during the school period [Questionnaire: 4.73 hr (4.73, 5.07) versus Clouclip: 2.16 hr (1.74, 2.78); p < 0.01]. The greatest overestimation of outdoor activity also occurred during the school period [Questionnaire: 1.60 hr (1.33, 1.85) versus Clouclip: 1.21 hr (0.96, 1.50); p < 0.01]. Based on Clouclip, the total time spent outdoors was estimated to be 1.55 hr on school days, of which 0.34 hr occurred after school. For weekend days, however, the duration was only 0.17 hr. Conclusions: Clouclip had excellent precision and accuracy. Although the agreement between the questionnaire and Clouclip was relatively poor, they were able to complement each other to provide a more logical and feasible assessment of exposure to near‐work and outdoor activity. Indoor‐oriented lifestyles were found to predominate in Chinese children. [ABSTRACT FROM AUTHOR]

Changes in higher order aberrations (HOA's) and retinal image quality during accommodation have not previously been examined in children. This study measured ocular HOA's in ninety non-myopic, school-aged children during short-term accommodation tasks at 0, 3, 6, and 9 D demands presented via a Badal optometer mounted to a Hartmann-Shack wavefront aberrometer (COAS-HD, Wavefront Sciences). Eighty-four participants who exhibited active accommodation were included in the analyses. An eighth order Zernike polynomial was fit across a 2.3 mm, 4 mm, and natural pupil diameter to evaluate changes in refractive power vectors (M, J180, and J45), accommodation errors (lags and leads), HOA root mean square (RMS) variables, individual Zernike coefficients, and the visual Strehl ratio based on the optical transfer function (VSOTF). All HOA RMS variables changed significantly with accommodation, with the greatest change observed for the 9 D demand. Of the individual Zernike coefficients, primary (C40) and secondary spherical aberration (C60) exhibited the greatest magnitude of change, becoming negative and positive with increasing accommodation, respectively. The VSOTF changed significantly with greater accommodation for both the 4 mm and natural pupil size, becoming significantly worse for the 9 D demand. HOA's increase and retinal image quality decreases significantly during higher levels of accommodation in children, similar to adults. These findings provide a greater understanding of the optical properties of children's eyes and insights into possible mechanisms for the association between accommodation, near work, and refractive error development. [ABSTRACT FROM AUTHOR]

Purpose: To compare real‐world measures of illumination obtained with the Actiwatch‐2 and Clouclip‐M2 with 'gold standard' photometry measures and to evaluate the ability of Actiwatch‐2 to correctly identify photometer‐defined conditions: scotopic (≤0.01 lux), mesopic (0.02–3 lux), indoor photopic (>3–1,000 lux) and outdoor photopic (>1,000 lux); and Clouclip to correctly identify photometer‐defined conditions within its operating range (>1 lux). Inter‐device reliability of Clouclip for illumination and viewing distance measures was also investigated. Methods: A Hagner‐S2 photometer was used as reference. Measures of illumination were obtained from a range of real‐world conditions. To investigate inter‐device reliability, five Clouclips were simultaneously exposed to varied light conditions and object distances. Results: Strong correlations existed between illumination measured with the photometer and both Actiwatch‐2 (ρ = 0.99, p < 0.0001) and Clouclip (ρ = 0.99, p < 0.0001). However, both devices underestimated illumination compared to the photometer; disparity increased with increasing illumination and was greater for Actiwatch‐2 than Clouclip measures. Actiwatch‐2 successfully categorised illumination level (scotopic, mesopic, indoor and outdoor photopic) in 71.2% of cases. Clouclip successfully categorised illumination levels as scotopic/mesopic (≤3 lux) and indoor and outdoor photopic in 100% of cases. Mean differences and limits of agreement (LOA) were 430.92 ± 1,828.74 and 79.35 ± 407.33 lux, between the photometer and Actiwatch‐2 and photometer and Clouclip, respectively. The Intra‐class Correlation Coefficients for illumination and viewing distance measured with five Clouclips were 0.85 and 0.96, respectively. Conclusion: These data illustrate that different Clouclip devices produce comparable measures of viewing distance and illumination in real‐world settings. Both Actiwatch‐2 and Clouclip underestimate illumination in the field compared to gold standard photometer measures. The disparity increases at higher levels of illumination and the discrepancy was greater for Actiwatch‐2 measures. For researchers interested in categorising light exposure, Clouclip classifies illumination levels >2 lux more accurately than Actiwatch‐2 but cannot discriminate between scotopic and low mesopic light. [ABSTRACT FROM AUTHOR]

Abstract Background To evaluate the prevalence and risk factors associated with myopia and high myopia in children in South Korea. Methods A total of 983 children 5–18 years of age who participated in the Korean National Health and Nutrition Examination Survey 2016–2017 (KNHANES VII), a nationwide population-based cross-sectional study, were evaluated. Myopia and high myopia were defined as a spherical equivalent (SE) ≤ − 0.5 diopters (D) and SE ≤ --6.0 D. The association between refractive errors and potential risk factors for myopia was analyzed. Results The prevalence of myopia and high myopia was 65.4 and 6.9%, respectively. Older age and parental myopia were significantly associated with both myopia and high myopia, while higher body mass index (BMI) was associated with high myopia only. Although the proportion of subjects who spent more time on near work activities (≥4 h/day) was sequentially increased with increased refractive error, this tendency was not statistically significant by multivariable logistic regression. Conclusions Korean children had a high prevalence of myopia and high myopia. In this age group, the risk of myopia increased with aging and parental myopia. Higher BMI may be associated with high myopia.

Abstract Background School children are considered a high-risk group for visual impairment because uncorrected refractive errors and problems such as amblyopia can seriously affect their learning abilities and their physical and mental development. There are many studies reporting the prevalence of refractive errors among school children of different ethnic groups in Malaysia, however, studies concerning the prevalence of refractive errors among indigenous or Orang Asli children are very limited. Therefore, the objective of this study was to determine the prevalence and causes of visual impairment among Orang Asli children. Methods One hundred ten Orang Asli children aged 7 to 12 years old in Negeri Sembilan, Malaysia were selected. 51% of these children were boys while the remainders were girls. They underwent visual acuity test, cover test, Hirschberg’s test, ocular external assessment and ophthalmoscopy. Children who failed the vision screening were then referred for further eye examination. Results Of these 110 Orang Asli children, 46 failed the vision screening and subsequently 45 of them were confirmed to have visual problems (40.9% of the total subjects). The main cause of visual impairment in this study was refractive error (34.5% of the total subjects) where the main refractive error found was hyperopia (28.2%) followed by amblyopia (2.7%), strabismus (1.8%) and ocular abnormalities (1.8%). Conclusion Hence, vision screening and a comprehensive eye examination is very important and needs to be done on all Orang Asli children so that any visual problems can be detect at an early stage to avoid the development of learning difficulties among these already disadvantaged children.

Bayan A Alsaif,1 Mohanna Y Aljindan,2 Hanan M Alrammah,1 Malak O Almulla,1 Saad S Alshahrani3 1College of Medicine, King Fahad Hospital of the University, Imam Abdulrahamn Bin Fasial University, Khobar, Saudi Arabia; 2Department of Ophthalmology, King Fahad Hospital of the University, Imam Abdulrahman Bin Fasial University, Khobar, Saudi Arabia; 3Epidemiology Department, King Fahd Specialist Hospital, Dammam, Saudi Arabia Objectives: To determine the prevalence of refractive errors among freshman students of Imam Abdulrahman Bin Faisal University (IAU), and to examine the relationship of near-work activities and outdoor activities with refractive errors. Methods: A cross-sectional study of 338 freshman students of IAU (162 males, 176 females) was carried out. Students were selected using a simple random sampling technique. Eye examination was done including non-cycloplegic autorefraction for determining the refractive error status. Myopia was defined as spherical equivalent refraction (SER) ≤-0.75 diopters (D), and it was further divided into low myopia (SER from -0.75 D to -2.99 D), moderate myopia (SER from -3.00 to -5.99 D), and high myopia (SER ≤-6.00 D). Hyperopia was defined as SER ≥1.00 D and emmetropia as having an SER value between that of low myopia and hyperopia. SER was calculated as sphere + 1/2 cylinder. A questionnaire detailed on activities was completed by participants. Results: Myopia was found in 47.9% of the students (95% CI 42.7%–53.3%). The most prevalent type of myopia was low myopia (66.7%; 95% CI 59.1%–73.5%). Hyperopia and emmetropia were found in 6.5% (95% CI 4.3%–9.7%) and 45.6% (95% CI 40.3%–50.9%) of the students, respectively. Parental myopia was significantly associated with the myopic status of the students (P=0.007, Fisher’s exact test). About 6% of myopic students had a history of myopia in both parents. In addition, both parents had a history of myopia in 1.9% of emmetropic students, whereas such an association was absent in the hyperopic students. Refractive error type in both genders was not significantly predicted by the activity type. Conclusion: Although the different types of activities did not predict the types of refractive errors, the high prevalence of myopia among the college students at this age requires further studies to explore more about the clinical characteristics and risk factors of the disease. Keywords: near-work, outdoor activity, college students, axial length, keratometry, anterior chamber depth, myopia, biometry

Purpose: To compare 3‐year myopic progression between Finnish and Singaporean children. Methods: Myopic progression was compared between 9‐year‐old (mean age 9.7 ± 0.4 years, n = 92) and 11‐year‐old (mean age 11.7 ± 0.4 years, n = 144) Finnish (Finnish RCT) children and Singaporean children matched by age and refraction (SCORMMatched, n = 403) and 7‐ to 8‐year‐old Singaporean children matched only by refraction (SCORM Young, n = 186). Spherical equivalent (SE) was between −0.50 and −3.00 D. Refraction with cycloplegia was controlled annually for 3 years. Information on parental myopia, mother's education, time spent on near‐work and outdoor time was gathered by parental questionnaire. Results: Three‐year myopic progression was −2.08 ± 0.96 D and −1.30 ± 0.69 D in the Finnish RCT and Singaporean SCORM Matched 9‐year‐olds, respectively, and −1.34 ± 0.78 D, and −0.52 ± 0.44 D in the 11‐year‐olds, respectively (p < 0.001 between all groups). Myopic progression was fastest (−2.69 ± 0.89 D) in the SCORM 7‐year‐olds and similar between the SCORM Matched 9‐year‐olds and Finnish RCT 11‐year‐olds (p = 0.55). The Finnish RCT and SCORM Matched children showed significant differences in both daily near‐work time (1.8 ± 1.0 versus 3.4 ± 1.9 hours per day, p < 0.001) and outdoor time (2.6 ± 0.9 versus 0.5 ± 0.4 hours per day, p < 0.001). These differences did not, however, explain the differences in myopic progression between the groups. More time spent outdoors was associated with less myopic progression in the Finnish RCT (r = 0.17, p = 0.009) group only. In the whole materials, greater myopic progression was associated with younger age at baseline (p < 0.001), younger age was associated with mother's higher education (p < 0.001), and mothers higher education was associated with myopia in both parents (p < 0.001). Conclusion: Age at baseline was the most significant factor associated with myopic progression. However, at the same age and with the same initial refraction, the Finnish and Singaporean children showed different myopic progression. This result remains unexplained. Thus, age of myopia onset should be considered when comparing myopic progression between different samples and conducting treatment trials. Parental myopia may be a weak indicator of heredity of myopia. [ABSTRACT FROM AUTHOR]

Background: Myopia is a good model for understanding the interaction between genetics and environmental stimuli. Here we dissect the biological processes affecting myopia progression. Methods: Human Genetic Analyses: (1) gene set analysis (GSA) of new genome wide association study (GWAS) data for 593 individuals with high myopia (refraction ≤ -6 diopters [D]); (2) over-representation analysis (ORA) of 196 genes with de novo mutations, identified by whole genome sequencing of 45 high-myopia trio families, and (3) ORA of 284 previously reported myopia risk genes. Contributions of the enriched signaling pathways in mediating the genetic and environmental interactions during myopia development were investigated in vivo and in vitro. Results: All three genetic analyses showed significant enrichment of four KEGG signaling pathways, including amphetamine addiction, extracellular matrix (ECM) receptor interaction, neuroactive ligand-receptor interaction, and regulation of actin cytoskeleton pathways. In individuals with extremely high myopia (refraction ≤ -10 D), the GSA of GWAS data revealed significant enrichment of the HIF-1α signaling pathway. Using human scleral fibroblasts, silencing the key nodal genes within protein-protein interaction networks for the enriched pathways antagonized the hypoxia-induced increase in myofibroblast transdifferentiation. In mice, scleral HIF-1α downregulation led to hyperopia, whereas upregulation resulted in myopia. In human subjects, near work, a risk factor for myopia, significantly decreased choroidal blood perfusion, which might cause scleral hypoxia. Interpretation: Our study implicated the HIF-1α signaling pathway in promoting human myopia through mediating interactions between genetic and environmental factors. Funding: National Natural Science Foundation of China grants; Natural Science Foundation of Zhejiang Province.

AIM: To analyze the vision distribution and its related risk factors of two teenager aviation schools in Western China. METHODS: The study was a cross-sectional survey. A total of 233 participants were randomly selected from two teenager aviation schools in Western China in November and December of 2017, which were all qualified through the standard of physical examination by Air Force. Distance visual acuity of students was checked and questionnaires about influencing factors of vision were filled voluntarily. Mann-Whitney U rank-sum test and chi-square test were applied for single factor analysis, and Multiple factor Logistic regression analysis was used for the main influence factors of the vision difference. RESULTS: The proportion of students with less than 0.8 eyesight in school B of Grade 2 and Grade 3 were 18.6% and 45.9%, which was significantly higher than that of 2.6% and 20% of school A. The well-vision distribution in school B of Grade 2 and Grade 3 were lower than that of school A(PPPP=0.032). Multiple factor Logistic regression analysis showed that reading and writing time was a risk factor for vision loss(OR=1.109, P=0.010)and outdoor activity time was a protective factor(OR=0.986, P=0.001). Mothers' education background, father's educational background, parents' myopia, primary school enrollment age, class time and electronic product using time were not the main factors affecting the vision. CONCLUSION: More reading and writing time and less outdoor activity time are the main factors for loss of vision, the key point of school myopia prevention needs to coordinate the time between reading, writing and outdoor activity.

Purpose: To validate the Clouclip, a continuously measuring objective rangefinder, and examine viewing behaviours during various near tasks in non‐myopic and myopic adults. Methods: In experiment 1, five Clouclip devices were utilised. An infrared camera was used to visualise and measure infrared beam size and angle. Repeatability for distance tracking was assessed from 5 to 120 cm in 5 cm increments. Accuracy of distance tracking was investigated for paper and iPad targets, spatial integration was calculated, effects of target tilt were determined and light measurements were compared to a lux meter. In experiment 2, viewing behaviour was assessed in 41 subjects (21 non‐myopic, 20 myopic) during four 15‐min near tasks; (1) passive reading of printed material, (2) active writing on printed material, (3) passive viewing on an electronic device and (4) active engagement on an electronic device. Working distance was compared between tasks and refractive error groups. Results: Clouclip distance tracking showed good repeatability, with a mean difference of 0.34 cm and limits of agreement of ±2.0 cm. Clouclip‐measured and actual distances were highly correlated for paper and electronic targets from 5 to 120 cm, with mean differences and limits of agreement of 3.96 ± 13.78 cm and 4.48 ± 8.92 cm, respectively; variability increased for distances >100 cm. Tracking ability increased with larger target sizes; tracking was accurate when the target occupied 1.5%–20.3% of tracking beam area, depending on distance and with target tilt up to ±60 degrees. Clouclip‐ and lux meter‐measured ambient illumination were highly correlated for a wide range of intensities (r = 0.96, p < 0.001), but with greater variability for intensities >20 000 lux. The Clouclip infrared beam was measured to have a diameter of 25.6 ± 2.2° and a downward angle of 10.3 ± 0.5°. For subject testing, viewing distance was significantly closer for active and passive printed tasks (29.5 ± 6.7 cm and 33.2 ± 8.8 cm, respectively) than for active and passive electronic tasks (35.4 ± 8.0 cm and 40.8 ± 10.4 cm, respectively), with no differences between refractive error groups (p = 0.88). Conclusions: The Clouclip performed well in measuring near and intermediate distances and could distinguish between indoor (<1000 lux) and outdoor (>1000 lux) illumination. A closer working distance was observed for printed tasks compared to those on an iPad, with no difference in viewing distance between non‐myopic and myopic adults. [ABSTRACT FROM AUTHOR]

PURPOSE: Refractive error (RE) is one of the most common ocular disorders among children worldwide. This study aimed to investigate the prevalence of RE and possible risk factors among school children in Riyadh. METHODS: This is a cross-sectional study using data collected at various schools. To achieve the aim of the study, we selected a random sample of 850 school children aged 6-15 years. The examination was based on the RESC protocol and included full visual assessment. Furthermore, a questionnaire was sent to the parents of the participants to ascertain information about lifestyle factors. We constructed a logistic regression model to evaluate the predictors of RE. RESULTS: Close to a third of the children had a RE. Of those identified as having the condition, 60% did not wear glasses (newly diagnosed). Nearly all the children (95.4%) in our sample reported using electronic devices, according to parents. No association was found between using electronic devices and having a RE (P = 0.26). Doing outdoor activities was associated with 52% lower odds of a RE (odds ratio = 1.52). CONCLUSION: We found a higher prevalence of uncorrected RE than previously reported in other Saudi studies. About 60% of children who had RE were not wearing glasses, highlighting the need for a standardized school screening program for early detection and management. Outdoor activities were associated with a lower likelihood of having a RE. These findings might support initiatives to encourage outdoor activities among school children. [ABSTRACT FROM AUTHOR]

Purpose: Near work has been linked with myopia development; however, the underlying mechanism remains unclear. Small increases in axial length during accommodation have previously been reported in adults, and therefore, this study aimed to examine if accommodation‐induced changes in ocular biometry also occur in school‐aged children. Methods: A range of ocular biometric measurements were captured during brief accommodation tasks at four demands (0, 3, 6, and 9 D), in a group of 87 non‐myopic, school‐aged children using a Badal optometer mounted to a non‐contact optical biometer (Zeiss IOLMaster 700, https://www.zeiss.com/meditec/int/product‐portfolio/optical‐biometers/iolmaster‐700.html). Reliable biometry measurements and active accommodation were observed for 76 participants who were included in the analysis. The average central corneal thickness (CCT), anterior chamber depth (ACD), crystalline lens thickness (LT), anterior segment length (ASL), vitreous chamber depth (VCD), and axial length (AL) were determined for each accommodation demand. Raw measurements of AL and VCD were corrected to account for the effect of LT changes during accommodation. Results: On average, AL increased with increasing levels of accommodation (p = 0.005). The mean (SEM, standard error of the mean) AL increase from 0 D to the 3, 6, and 9 D demands was 4 (1), 8 (1), and 15 (2) µm, respectively. All other biometric parameters, except CCT, changed significantly during accommodation. LT and ASL increased, and ACD and VCD decreased significantly with increasing accommodation (all p ≤ 0.02). A longer baseline AL was associated with greater levels of accommodation‐induced axial elongation at the 9 D demand (p < 0.0001). Conclusions: AL increased significantly during accommodation in children, consistent with previous findings in adults up to a 6 D demand. AL continued to increase for higher levels of accommodation (9 D demand), which children may experience during near tasks. These findings provide further insights into potential mechanisms linking near work, axial elongation, and myopia development. However, no myopic children participated in this experiment; therefore, further research is required. [ABSTRACT FROM AUTHOR]

Purpose: To quantify the defocus characteristics in the near‐work environment at home and investigate the relationship with subsequent myopia progression. Methods: Fifty subjects (aged 7–12 years) were recruited and followed for 1 year. The home near‐work environment (writing desk) was measured at a baseline home‐visit using the Kinect‐for‐Windows to capture a 3‐dimensional image. The depth values of the image were then converted into scene defocus with respect to the subject's viewpoint. The defocus characteristics were quantified as the dioptric volume (the total amount of net defocus, or DV) and standard deviation of the defocus values (SDD). Information on home size, time spent outdoors, and in front of a desk were also obtained. Univariate correlation, and multivariate regression were used to assess the association between myopia progression, defocus characteristics, and other co‐variates. Results: The baseline spherical equivalent refraction (M) and refraction change over 1 year (∆M) were − 1.51 ± 2.02 D and − 0.56 ± 0.45 D respectively. DV was not significantly correlated with ∆M (Spearman's ρ = −0.25, p = 0.08), while SDD was negatively correlated to ∆M (Spearman's ρ = −0.42, p = 0.003). Although SDD was not a significant predictor in multivariate analysis, the regional DV at 15°–20° eccentricity was significant (p = 0.001). Home size (F2,50 = 7.01, p = 0.002) and time spent outdoors (Independent t = −2.13, p = 0.04) were also associated with ∆M, but not time spent in front of desk (Independent t = 0.78, p = 0.44). Conclusion: The defocus profile in the home environment within the para‐central field of view is associated with childhood refractive error development. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare two wearable sensors to each other and to a questionnaire in an adult population. For one week, participants aged 29.2 ± 5.5 years (n = 25) simultaneously wore a Clouclip, a spectacle-mounted device that records viewing distance and illuminance, and an Actiwatch, a wrist-worn device that measures illuminance and activity. Participants maintained a daily log of activities and completed an activity questionnaire. Objective measures of time outdoors, near (10–< 60 cm) and intermediate (60–100 cm) viewing, and sleep duration were assessed with respect to the daily log and questionnaire. Findings showed that time outdoors per day from the questionnaire (3.2 ± 0.3 h) was significantly greater than the Clouclip (0.9 ± 0.8 h) and Actiwatch (0.7 ± 0.1 h, p < 0.001 for both). Illuminance from the Actiwatch was systematically lower than the Clouclip. Daily near viewing duration was similar between the questionnaire (5.7 ± 0.6 h) and Clouclip (6.1 ± 0.4 h, p = 0.76), while duration of intermediate viewing was significantly different between methods (p < 0.001). In conclusion, self-reported time outdoors and viewing behaviors were different than objective measures. The Actiwatch and Clouclip are valuable tools for studying temporal patterns of behavioral factors such as near work, light exposure, and sleep.