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BACKGROUND: Plusoptix photoscreeners are capable of measuring refractive errors of children from 1 meter distance, without cyloplegia. We aimed to compare refractive data obtained from the newest version of Plusoptix (model 12) with cycloplegic autorefraction. METHODS: We examined 111 consecutive children aged 3-7 years first by Plusoptix A12C under manifest condition and subsequently for cycloplegic refraction by Topcon KR-1 tabletop autorefractometer. Sphere, spherical equivalent, cylinder and axis of astigmatism measured by the two methods were analyzed to determine correlation, agreement and differences. RESULTS: Binocular examination of 111 children aged 4.86±1.27 years revealed good agreement between refractive data obtained by Plusoptix and cycloautorefraction, according to Bland-Altman plots. Significant (p < 0.001) and strong correlation was found between all refractive measurements (Pearsons r value of 0.707 for sphere, 0.756 for pherical equivalent, and 0.863 for cylinder). Plusoptix mean sphere, spherical equivalent and cylinder were 1.22, 0.56, and -1.32 D, respectively. Corresponding values for cycloautorefraction were 1.63, 1.00, and -1.26 D. The difference between axis of cylinder measured by the two methods was < 10° in 144 eyes (64.9%). CONCLUSIONS: Considering the significant agreement and correlation between Plusoptix photoscreener and cycloplegic autorefraction, the need for cycloplegic drops in refractive examination of children may be obviated. The mean difference between cylinder measurements are considerably trivial (0.06 D), but sphere is approximately 0.4 D underestimated by Plusoptix compared to cycloautorefraction, on average.

IntroductionThe purpose of this study is to assess the prevalence of comprehensive eye examinations in multiethnic preschool children, including children with visually significant eye conditions, and identify factors associated with comprehensive eye examinations.MethodsA sample of 9,197 African American, Hispanic, Asian American, and non-Hispanic White children aged 6-72 months was recruited for the Multi-Ethnic Pediatric Eye Disease Study from 2003 to 2011. Logistic regression performed in 2022 identified independent factors associated with parent-reported history of comprehensive eye examinations. The proportion of children with previous comprehensive eye examinations and the proportion with undetected amblyopia or strabismus were measured.ResultsThe prevalence of comprehensive eye examinations was 6.3% overall and 38.3%, 24.8%, 19.1%, 15.1%, and 9.8% among children with strabismus, amblyopia, significant anisometropia, hyperopia, and astigmatism, respectively. Children without prior comprehensive eye examinations were more likely to have undetected amblyopia or strabismus than those with comprehensive eye examination history (ps

AbstractPurposeMethodsResultsConclusionsAffecting one-third of the population worldwide and increasing, the sight-threatening condition myopia is causing a significant socio-economic burden. To better understand its etiology, recent studies investigated the role of ocular and systemic rhythms, yet results are conflicting. Here we profiled 24-h variations of axial length of the eye and salivary melatonin concentration in young adults with and without myopia and explored the potential impacts of bedtime on these rhythms.A total of 25 healthy young adults (age 25.0 ± 4.8 years, 13 females) completed this study, including 13 myopes (mean spherical equivalent refractive error −2.93 ± 1.46 diopters) and 12 non-myopes (0.14 ± 0.42 diopters). Saliva sample collection and axial length measurements were repeated for seven times over 24 h starting from 8 am. Information on sleep and chronotype was collected at first visit with the Pittsburgh Sleep Quality Index and the Morningness-Eveningness Questionnaire.Significant diurnal rhythms of axial length and salivary melatonin concentration were identified in both refractive groups (both p < 0.001), with no myopia-related rhythm difference (interaction of measurement time-point × myopia, p = 0.9). Late bedtime was associated with altered rhythms (p = 0.009) and smaller diurnal change (p = 0.01) in axial length. Elevated melatonin levels were observed in myopes (p = 0.006) and in late sleepers (p = 0.017).These findings suggest that sleep/wake cycles may be involved in the regulation of axial length rhythms. Further research is needed to determine if there exists a causal relationship between the two. [ABSTRACT FROM AUTHOR]

Clinical relevance: Knowing the agreement and interobserver variability of the 2WIN-S photorefractometer with cycloplegic retinoscopy and prism cover test is important for judging the clinical usefulness of the device. Background: This study aims to determine an agreement and interobserver reliability between 2WIN-S photorefractometer and cycloplegic retinoscopy for estimating refractive errors and between 2WIN-S and prism cover test for measuring horizontal ocular deviation in children. Methods: Two groups of 129 and 64 participants (range, 5 to 16 years) were recruited for the agreement and interobserver reliability studies, respectively. Non-cycloplegic 2WIN-S refraction was compared with cycloplegic retinoscopy for low and moderate myopia and hyperopia. Similarly, corneal reflex-function (CR-function) of 2WIN-S was compared with prism cover test for horizontal ocular deviation. Bland-Altman plots were used to depict agreement, and the intraclass correlation coefficient (ICC) was used for determining interobserver reliability of repeated measures. Results: The mean differences in spherical equivalent, J0 (Cartesian astigmatism) and J45 (oblique Jackson cross-cylinder) between cycloplegic retinoscopy and 2WIN-S were 1.10 (95% CI = 0.97 to 1.21, p < 0.001), −0.06 (95% CI = −0.09 to −0.03, p < 0.001) and 0.009 (95% CI = −0.01 to 0.03, p = 0.35), respectively. The overall median difference in the horizontal ocular deviation between prism cover test and 2WIN-S was −4.5 (Interquartile range = −12.0 to 4.0). For constant strabismus, this difference was insignificant (median= −2.0, interquartile range = −11.0 to 6.7, p = 0.19) between prism cover test and 2WIN-S. The ICC was high for the spherical equivalent (0.997; p < 0.001), J0 (0.932; p < 0.001) and J45 (0.901; p < 0.001), whereas it was low-to-moderate for horizontal ocular deviation (0.50; p < 0.001). Conclusion: 2WIN-S refraction was in agreement with cycloplegic retinoscopy for low and moderate myopia and hyperopia, and requires an adjustment for the consistent differences between cycloplegic retinoscopy and 2WIN-S refraction. The measurement of constant strabismus with 2WIN-S is comparable to that of prism cover test. [ABSTRACT FROM AUTHOR]

Purpose: The prevalence of myopia in Scandinavia tends to be lower than in other parts of the world. This study aimed to investigate the incidence of myopia and its predictors in Swedish children to characterise this trend. Methods: A 2‐year longitudinal study was conducted following a cohort of schoolchildren aged 8–16 years. Myopia was defined as a spherical equivalent refraction (SER) ≤ −0.50 D. The study enrolled 128 participants, 70 (55%) females with a mean age of 12.0 years (SD = 2.4). Results: The cumulative incidence of myopia during the follow‐up period was 5.5%, and the incidence rate of myopia was 3.2 cases per 100 person‐years. Participants with myopia at baseline exhibited a faster increase in refractive error during the follow‐up period. Likewise, participants with two myopic parents exhibited a more marked change towards myopia, regardless of their initial refractive error. Conclusion: In the current study, similar to prevalence, the incidence of myopia was low when compared with other parts of the world. These results lead us to formulate a new hypothesis that the normal emmetropisation process may be protected by low educational pressure practised in Sweden during early childhood. Further research is necessary to test this new hypothesis. [ABSTRACT FROM AUTHOR]

Purpose: Uncorrected refractive error is the leading cause of vision impairment globally; however, little attention has been given to equity and access to services. This study aimed to identify and prioritise: (1) strategies to address inequity of access to refractive error services and (2) population groups to target with these strategies in five sub‐regions within the Western Pacific. Methods: We invited eye care professionals to complete a two‐round online prioritisation process. In round 1, panellists nominated population groups least able to access refractive error services, and strategies to improve access. Responses were summarised and presented in round 2, where panellists ranked the groups (by extent of difficulty and size) and strategies (in terms of reach, acceptability, sustainability, feasibility and equity). Groups and strategies were scored according to their rank within each sub‐region. Results: Seventy five people from 17 countries completed both rounds (55% women). Regional differences were evident. Indigenous peoples were a priority group for improving access in Australasia and Southeast Asia, while East Asia identified refugees and Oceania identified rural/remote people. Across the five sub‐regions, reducing out‐of‐pocket costs was a commonly prioritised strategy for refraction and spectacles. Australasia prioritised improving cultural safety, East Asia prioritised strengthening school eye health programmes and Oceania and Southeast Asia prioritised outreach to rural areas. Conclusion: These results provide policy‐makers, researchers and funders with a starting point for context‐specific actions to improve access to refractive error services, particularly among underserved population groups who may be left behind in existing private sector‐dominated models of care. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion To investigate the refractive error profile and progression in infants with different stages of ROP, without ROP, and those who received laser treatment for ROP.This retrospective study included the data from 838 infants (baseline mean age 3.7 ± 5.4 months) who had premature birth. Among these, 433 infants had one of the stages of ROP and 405 had no ROP. Infants with ROP were sub‐divided into stage 1 (n = 76), stage 2 (n = 142), and stage 3 (n = 136) and aggressive posterior ROP, (APROP, n = 79). They were further categorized into those who received treatment (n = 213) and with no treatment for ROP (n = 220). Data from a subset of 117 infants was used to assess the 1‐year change in the refractive error. Myopia was defined as spherical equivalent refraction (SER) <−0.50 diopters (D). Eyes with retinal detachment were excluded.Higher percentage of myopia was found in infants with ROP (39.7%) than no‐ROP (19.8%), and it increased with severity of ROP: stage 1: 19.7%, stage 2: 33.8%, stage 3: 45.6%, and 59.5% in APROP. Percentage of myopia doubled in those who underwent treatment for ROP (54.5%) compared to no‐treatment group (25.5%). Mean (± SEM) change in SER after 1 year was significantly greater in infants with APROP −4.55 ± 1.38 D and stage 3 ROP −2.28 ± 0.57 D compared to other stages and no‐ROP.Myopia was found to be more prevalent in preterm infants in general, and more in the presence of ROP. Preterm infants without or with any form of ROP, particularly those with severe form of ROP and those who received treatment require meticulous periodic refractive error assessment. [ABSTRACT FROM AUTHOR]

Understanding the refractive profile, amblyopia prevalence, binocular status, and head position in patients with Brown syndrome help clinicians become more familiar with this syndrome. Brown syndrome is identified as an active and passive restricted elevation of the eye in adduction. There is little information on clinical features, including refractive status, amblyopia, abnormal head posture (AHP), and types of deviation in these patients. This study retrospectively evaluated records of 100 Brown syndrome patients from 2015 to 2022 at Farabi Eye Hospital, Iran. The mean age was 6.99 ± 6.33 years, including 48 (48%) males. A congenital source was found in 74 (74%) and 96 (96%) patients had unilateral involvement. The mean CDVA for the affected and non-affected eyes were 0.05 ± 0.11 and 0.03 ± 0.06 logMAR, respectively (P = 0.31). In unilateral cases, hyperopia, myopia, and emmetropia were observed in 55 (57.29%), 2 (2.08%), and 39 (40.63%) affected eyes, respectively. The most common type of deviation was pure hypotropia, which was found in 53 (53%) cases, followed by 'combined exotropia and hypotropia' observed in 26 (26%) patients. The mean angle of hypotropia and horizontal deviation in the primary position at distance was 12.10 ± 8.50 and 8 ± 13.20 prism dioptre, respectively. A V-pattern was found in 76 (76%) patients. Amblyopia was observed in 13 (21.67%) of 60 cooperative patients, and AHP was noticed in 66 (66%) patients, in which "combined chin up and contralateral face turn" was the most common type. About 75% of cases were congenital, 50% had pure hypotropia, 75% showed V-pattern, 20% had amblyopia, and AHP was observed in 67% of patients. The remarkable prevalence of amblyopia alongside the high occurrence of AHP should alert clinicians to carefully assess patients with Brown syndrome for sensory fusion and amblyopia. [ABSTRACT FROM AUTHOR]

In this study, we aimed to validate a novel light field virtual reality (LFVR) system for estimating refractive errors in the human eye. Fifty participants with an average age of 22.12 ± 2.2 years (range 20–30 years) were enrolled. The present study compared spherical equivalent (SE) and focal line measurements (F1 and F2) obtained by the LFVR system with those obtained by established methods, including closed-field and open-field autorefractors, retinoscopy, and subjective refraction. The results showed substantial agreement between the LFVR system and the traditional methods, with intraclass correlation coefficients (ICC) for SE ranging from 82.7% to 86.7% (p < 0.01), and for F1 and F2 from 80.7% to 86.4% (p < 0.01). Intra-repeatability for F1 and F2 demonstrated strong agreement, with ICC values of 88.8% and 97.5%, respectively. These findings suggest that the LFVR system holds potential as a primary tool for refractive error measurement in optical care, offering high agreement and repeatability compared to conventional methods. [ABSTRACT FROM AUTHOR]

Individuals with Down syndrome are known to have a greater prevalence of ocular conditions such as strabismus, nystagmus, elevated refractive error, poor accommodative function, elevated higher‐order optical aberrations and corneal abnormalities. Related to these conditions, individuals with Down syndrome commonly have reduced best‐corrected visual acuity at both far and near viewing distances across their lifespan. This review summarises the various optical sources of visual acuity reduction in this population and describes clinical trials that have evaluated alternative spectacle prescribing strategies to minimise these optical deficits. Although refractive corrections may still have limitations in their ability to normalise visual acuity for individuals with Down syndrome, the current literature provides evidence for eye care practitioners to consider in their prescribing practices for this population to maximise visual acuity. These considerations include accounting for the presence of elevated higher‐order aberrations when determining refractive corrections and considering bifocal lens prescriptions, even for young children with Down syndrome. [ABSTRACT FROM AUTHOR]

(1) Background: This study compares the effective lens position (ELP) and intraocular lens power (IOLP) derived from SRK/T, Hoffer Q, Holladay I, and Haigis formulas with the actual lens position (ALP) and the implanted IOLP after cataract surgery. Additionally, it aims to optimize ALP using a ray-tracing-based simulated optical model to achieve emmetropia. (2) Methods: A retrospective observational study was conducted on 43 eyes implanted with the same monofocal intraocular lens (IOL). Preoperative and postoperative biometric data were collected using the Lenstar LS900. Postoperative measurements included ALP, subjective refraction, and refraction error (RE). Optical simulations (OSLO EDU 6.6.0) were utilized to optimize ALP for emmetropia (ALPIDEAL). (3) Results: Paired t-test results between REOSLO-REOBJ (p-value = 0.660) and REOSLO-RESUB (p-value = 0.789) indicated no significant statistical differences. However, statistically significant differences were found between ALP and ALPIDEAL (p < 0.05), with a difference of −0.04 ± 0.45 mm [ranging from −1.00 to 1.20 mm]. A significant correlation was observed between ΔALP (ΔALP = ALP − ALPIDEAL) and RESUBJ. (4) Conclusions: This customized ray-tracing eye model effectively achieves refractive outcomes similar to those obtained both subjectively and objectively post-surgery. Additionally, it has enabled optical simulations to optimize the IOL position and achieve emmetropia. [ABSTRACT FROM AUTHOR]

Background: Assessing refractive errors under cycloplegia is recommended for paediatric patients; however, this may not always be feasible. In these situations, refraction has to rely on measurements made under active accommodation which may increase measurements variability and error. Therefore, evaluating the accuracy and precision of non-cycloplegic refraction and biometric measurements is clinically relevant. The Myopia Master, a novel instrument combining autorefraction and biometry, is designed for monitoring refractive error and ocular biometry in myopia management. This study assessed its repeatability and agreement for autorefraction and biometric measurements pre- and post-cycloplegia. Methods: A prospective cross-sectional study evaluated a cohort of 96 paediatric patients that underwent ophthalmologic examination. An optometrist performed two repeated measurements of autorefraction and biometry pre- and post-cycloplegia. Test-retest repeatability (TRT) was assessed as differences between consecutive measurements and agreement as differences between post- and pre-cycloplegia measurements, for spherical equivalent (SE), refractive and keratometric J0/J45 astigmatic components, mean keratometry (Km) and axial length (AL). Results: Cycloplegia significantly improved the SE repeatability (TRT, pre-cyclo: 0.65 D, post-cyclo: 0.31 D). SE measurements were more repeatable in myopes and emmetropes compared to hyperopes. Keratometry (Km) repeatability did not change with cycloplegia (TRT, pre-cyclo: 0.25 D, post-cyclo:0.27 D) and AL repeatability improved marginally (TRT, pre-cyclo: 0.14 mm, post-cyclo: 0.09 mm). Regarding pre- and post-cycloplegia agreement, SE became more positive by + 0.79 D, varying with refractive error. Myopic eyes showed a mean difference of + 0.31 D, while hyperopes differed by + 1.57 D. Mean keratometry, refractive and keratometric J0/J45 and AL showed no clinically significant differences. Conclusions: Refractive error measurements, using the Myopia Master were 2.5x less precise pre-cycloplegia than post-cycloplegia. Accuracy of pre-cycloplegic refractive error measurements was often larger than the clinically significant threshold (0.25 D) and was refractive error dependent. The higher precision compared to autorefraction measurements, pre- and post-cycloplegia agreement and refractive error independence of AL measurements emphasize the superiority of AL in refractive error monitoring. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to quantify how much of the burden of visual impairment (VI) and unmet need in Talagang, identified by Rapid Assessment of Avoidable Blindness (RAAB) survey data, has been addressed by Community Eye Health (CEH) programme efforts. Methods: A RAAB survey was carried out in November 2018, with 2,824 participants in Talagang Tehsil, Punjab, Pakistan, aged 50 and over. Census data were used to extrapolate survey data to the population. Alongside this, a CEH programme was launched, consisting of community eye screening, and onward referral to rural health centres, secondary or tertiary ophthalmological services, as required. This health intervention aimed to address the eye care needs surfaced by the initial survey. From 2018 to 2022, 30,383 people aged 50 or over were screened; 14,054 needed referral to further steps of the treatment pathway and more detailed data collection. Programme data were compared to estimates of population unmet needs. Main outcome measures were prevalence of VI, and proportion of need met by CEH Programme, by cause and level of VI. Results: Among those aged 50 and over, 51.0% had VI in at least one eye. The leading causes were cataract (46.2%) and uncorrected refractive error (URE) (25.0%). In its first four years, the programme reached an estimated 18.3% of the unmet need from cataract, and 21.1% of URE, equally in both men and women. Conclusions: Robustly collected survey and programme data can improve eye health planning, monitoring and evaluation, address inequities, and quantify the resources required for improving eye health. This study quantifies the time required to reach eye health needs at the community level. [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]

Purpose: To present a paraxial method to estimate the influence of variations in ocular biometry on changes in refractive error (S) at a population level and apply this method to literature data. Methods: Error propagation was applied to two methods of eye modelling, referred to as the simple method and the matrix method. The simple method defines S as the difference between the axial power and the whole‐eye power, while the matrix method uses more accurate ray transfer matrices. These methods were applied to literature data, containing the mean ocular biometry data from the SyntEyes model, as well as populations of premature infants with or without retinopathy, full‐term infants, school children and healthy and diabetic adults. Results: Applying these equations to 1000 SyntEyes showed that changes in axial length provided the most important contribution to the variations in refractive error (57%–64%), followed by lens power/gradient index power (16%–31%) and the anterior corneal radius of curvature (10%–13%). All other components of the eye contributed <4%. For young children, the largest contributions were made by variations in axial length, lens and corneal power for the simple method (67%, 23% and 8%, respectively) and by variations in axial length, gradient lens power and anterior corneal curvature for the matrix method (55%, 21% and 14%, respectively). During myopisation, the influence of variations in axial length increased from 54.5% to 73.4%, while changes in corneal power decreased from 9.82% to 6.32%. Similarly, for the other data sets, the largest contribution was related to axial length. Conclusions: This analysis confirms that the changes in ocular refraction were mostly associated with variations in axial length, lens and corneal power. The relative contributions of the latter two varied, depending on the particular population. [ABSTRACT FROM AUTHOR]

Background: To study the levels of vitamin D serum levels in children with vernal keratoconjuctivits (VKC) and comparing vitamin D levels in after giving vitamin D supplements between intervention and control group. Methods: The study was conducted in population between 1 to 12 years in tertiary care hospital in North India. Amongst children with VKC, full ocular examination along with Boninis clinical grading of VKC and serum vitamin D levels were assessed. Whole study group was randomly divided into two groups. Intervention group had received vitamin D powder while control group kept under observation. Results: A total of 88 children received vitamin D supplementation and 39 kept in control group. Conclusion: Our study suggests that children in intervention group showed improvement in serum vitamin D levels with the clinical improvement in VKC grading too. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluates the recent trends in ocular morbidities and vision-related practices in "out-of-school" children in urban slums of Gurugram in North India. Methods: In this observational study, a validated questionnaire was administered to 161 students from two nonformal slum schools. Sociocultural, demographic data, vision-related practices, and visual acuity with subjective refraction of the children were recorded. Results: A total of 80 boys and 81 girls (9.17 ± 2.58 years) participated in this study. About 40% of the children were from lower socioeconomic status. The visual acuity recorded for all the children, except three children, was 6/6 in both eyes. One child had a pre-phthisical eye with no light perception, following a childhood trauma, with the other eye having 6/6 vision. Two children had refractive errors (myopia and compound myopic astigmatism), with a best corrected visual acuity (BCVA) of 6/6. Thirteen children (8%) had Bitot's spots and 67 (35.4%) had allergic conjunctivitis. Eight (5%) children complained of dry eye- related symptoms like redness and watering of eyes, while 19 (11.8%) had diffuse headache. Average number of years spent in school for these children was less than 1.7 years (range: 1 month-6 years). Only 10.5% of the children gave the history of watching television more than 30 h/week. Significant association was found between the income of father and use of digital devices in children below 10 years (P = 0.003) and children playing outdoors (P = 0.001). There was a significant association noted for age and use of digital devices (P = 0.037). Conclusion: The prevalence of refractive errors in "out-of-school" children of urban slum was much less than the national average. Almost one in three children suffered from eye allergies, while 8% children had Bitot's spots. The data about the prevalence of ocular comorbidities in underserved areas like urban slums can be used to update and strategize eye health-care delivery models for out-of-school children. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the magnitude, determinants, and causes of visual impairment (VI) and blindness among people >40 years. Methods: In this cross‑sectional survey, 2,968 people >40 years from 34 clusters were examined. A cluster random sampling method with a compact segment sampling technique was used to select the study participants. Prevalence of any VI (presenting visual acuity (PVA) <6/12 in better eye), severe VI (PVA <6/60 – 3/60), and blindness (PVA <3/60 in better eye) were expressed as percentage with 95% confidence interval. Logistic regression was performed to determine the risk factors associated with blindness. A P value of less than 0.05 was considered statistically significant. Results: The mean age of the participants was 54.6 years (Standard deviation ± 11.2 years). The prevalence of mild, moderate, and severe visual impairment was 14.2% (12.95–15.49), 13.7% (12.46–14.97), and 0.7% (0.47–1.12), respectively. The prevalence of blindness was 1.3% (0.94–1.79, n = 39). The overall prevalence of VI (presenting Visual Acuity <6/12) was 12.0% (95% CI: 10.8–13.2%). The major causes of VI were cataract (78.08%), refractive error (12.07%), and optic atrophy (2.22%), and corneal opacity (2.22%) and the major cause of blindness was cataract (77.27%). Blindness was strongly associated with increasing age‑ OR 17.1 (95% CI: 4.9–59.8) for people >70 years, and OR 7.6 (95% CI: 2.2–26.5) for people aged between 60 and 69 years compared to those aged 41–50 years and people living near coastal regions (Within 50 km of coast) (OR: 3.9, 95% CI: 1.6–7.3). Conclusion: Blindness and vision impairment are of public health concern in this geographic region. Eye care services need to be augmented to address this challenge. [ABSTRACT FROM AUTHOR]

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Purpose: As per the recent World Health Organization estimates, approximately 2.2 billion people have near and distance vision impairment (VI) globally, and out of this almost 50% is avoidable. Methods: The Rapid Assessment of Avoidable Visual Impairment survey was a cross-sectional study conducted in September 2021, using cluster random sampling in 42 clusters with a cluster size of 140, giving a total of 6000 participants. Two teams comprising of trained optometrists and social workers conducted the ocular examination which included unaided, pinhole, and aided visual acuity assessments followed by examination of the anterior segment and lens. Distance visual acuity was measured using simplified tumbling “E” charts of different sizes for VA of 6/12, 6/18, and 6/60. The lens assessment was done in an un-dilated pupil with torch light by the optometrist. Results: Overall, 6520 individuals aged 6 years and above were enumerated, of whom 5440 (83.4%) were examined. The response rate for examination was better among females (93.1%) than males (73.9%), and it decreased from 93.8% in the age group 6–15 years to 77.1% in the 45+ age group. The prevalence of blindness and VI were 0.18% (95% CI: 0.06–0.29) and 4.19% (95%CI: 3.65–4.72), respectively. The major causes of VI in all age groups were uncorrected refractive error (65.4%), cataract (23.7%), cataract surgical complications (2.6%), corneal opacity (0.4%), and other posterior segment diseases (7.5%). The effective cataract surgical coverage (eCSC) was 61.8%, effective refractive error coverage (eREC) for distance vision was 59.8%, and eREC for near vision was 47.0%. Conclusion: The RAAVI methodology is suitable to measure effective coverage in the general population, both for baseline measurement and periodic monitoring. The 2030 targets for the surveyed district are 90% eCSC and 100% eREC. Such exercises need to be conducted in each district of the country to determine the baseline and target values of effective coverage.

Background: Poor vision impairs the performance of school children and has a negative impact on their future. The prevalence of blindness in school children is estimated to be 0.8/1000 in the age group of 0–15 years. Most children with an uncorrected refractive error are asymptomatic; hence, periodic visual screening and primary eye care reduce the prevalence of refractive error and ocular morbidity. Objective: To study the prevalence of ocular morbidity among school children in urban and rural areas. Methods: Cross-sectional study was conducted in two randomly selected private schools in urban area and two randomly selected government schools in rural area among school children aged 6–15 years studying in standards I–X. They were selected from each class by systematic random sampling. Detailed history and ocular examination were carried out for all children. Results: The prevalence of ocular morbidity among study participants was high (20.3%). The major cause of ocular morbidity was refractive error in 17.4% of the cases. Age group of 5–7 years, being urban school child, illiterate parents were significantly associated with ocular morbidity (P < 0.05). Gender and religion were not associated with ocular morbidity. The most common ocular morbidity was refractive error (17.4%). Color blindness (1.5%), conjunctivitis (1.3%), and stye and chalazion (1.1%) were other ocular morbidities. Conclusion: Most cases of ocular morbidity were preventable or treatable if detected early. Hence, strategies including prevention at the primary and secondary level form core of any strategies to reduce ocular morbidities in school going children.

Abstract This study explored the potential of telemedicine integration into the eye health ecosystem with an aim of scaling effective refractive error coverage in Kenya. This exploratory study was conducted telephonically and through online interviews with key opinion leaders, ophthalmologists, optometrists, ophthalmic clinical officers, optical technicians and beneficiaries of the optical technician’s services in rural areas. A telemedicine workflow was developed and validated based on the comments from the key opinion leaders using the Delphi technique. Quantitative and qualitative data were analysed using SPSS and NVivo Software respectively. All of the key opinion leaders agreed that telemedicine is relevant in the eye health ecosystem and recognition of primary vision technicians is critical for effective telemedicine integration. The reasons for the need of telemedicine integration were categorized into; good relationship, organized refractive error service delivery, convenience and availability and cost reduction. The possible factors influencing integration of telemedicine identified were categorized into cost, unwillingness, dominance, perception, lack of technical team, policies and network coverage. The limited human resources in the eye health ecosystem in developing countries cannot effectively deliver refractive error services to the growing population. Hence, integration of telemedicine and establishment of policies recognizing telemedicine are desirable to strengthen task shifting and scale effective refractive error coverage.

Abstract Background Assessing refractive errors under cycloplegia is recommended for paediatric patients; however, this may not always be feasible. In these situations, refraction has to rely on measurements made under active accommodation which may increase measurements variability and error. Therefore, evaluating the accuracy and precision of non-cycloplegic refraction and biometric measurements is clinically relevant. The Myopia Master, a novel instrument combining autorefraction and biometry, is designed for monitoring refractive error and ocular biometry in myopia management. This study assessed its repeatability and agreement for autorefraction and biometric measurements pre- and post-cycloplegia. Methods A prospective cross-sectional study evaluated a cohort of 96 paediatric patients that underwent ophthalmologic examination. An optometrist performed two repeated measurements of autorefraction and biometry pre- and post-cycloplegia. Test-retest repeatability (TRT) was assessed as differences between consecutive measurements and agreement as differences between post- and pre-cycloplegia measurements, for spherical equivalent (SE), refractive and keratometric J0/J45 astigmatic components, mean keratometry (Km) and axial length (AL). Results Cycloplegia significantly improved the SE repeatability (TRT, pre-cyclo: 0.65 D, post-cyclo: 0.31 D). SE measurements were more repeatable in myopes and emmetropes compared to hyperopes. Keratometry (Km) repeatability did not change with cycloplegia (TRT, pre-cyclo: 0.25 D, post-cyclo:0.27 D) and AL repeatability improved marginally (TRT, pre-cyclo: 0.14 mm, post-cyclo: 0.09 mm). Regarding pre- and post-cycloplegia agreement, SE became more positive by + 0.79 D, varying with refractive error. Myopic eyes showed a mean difference of + 0.31 D, while hyperopes differed by + 1.57 D. Mean keratometry, refractive and keratometric J0/J45 and AL showed no clinically significant differences. Conclusions Refractive error measurements, using the Myopia Master were 2.5x less precise pre-cycloplegia than post-cycloplegia. Accuracy of pre-cycloplegic refractive error measurements was often larger than the clinically significant threshold (0.25 D) and was refractive error dependent. The higher precision compared to autorefraction measurements, pre- and post-cycloplegia agreement and refractive error independence of AL measurements emphasize the superiority of AL in refractive error monitoring.

AIM: To evaluate the changes in corneal epithelial thickness(CET)and corneal optical density(CD)after smart pulse technology(SPT)-assisted transepithelial photorefractive keratectomy(TPRK)and analyze their correlation.METHODS: The prospective study included 60 patients(120 eyes)with myopia and myopic astigmatism who underwent SPT-TPRK in the ophthalmology department at the First Affiliated Hospital of Xinxiang Medical University between February and August 2023. Changes in CET and CD were evaluated preoperatively and at 1 wk, 1 and 3 mo postoperatively.RESULTS: A total of 14 cases(28 eyes)were lost to follow-up, and 3 patients(6 eyes)with postoperative haze were excluded from this study, resulting in a final inclusion of 43 patients(86 eyes). At 1 wk after SPT-TPRK, CET had statistically significantly thickened compared to preoperative levels(P

Background: Uncorrected refractive error is a major cause of vision impairment worldwide and its increasing prevalent necessitates effective screening and management strategies. Meanwhile, deep learning, a subset of Artificial Intelligence, has significantly advanced ophthalmological diagnostics by automating tasks that required extensive clinical expertise. Although recent studies have investigated the use of deep learning models for refractive power detection through various imaging techniques, a comprehensive systematic review on this topic is has yet be done. This review aims to summarise and evaluate the performance of ocular image-based deep learning models in predicting refractive errors. Main text: We search on three databases (PubMed, Scopus, Web of Science) up till June 2023, focusing on deep learning applications in detecting refractive error from ocular images. We included studies that had reported refractive error outcomes, regardless of publication years. We systematically extracted and evaluated the continuous outcomes (sphere, SE, cylinder) and categorical outcomes (myopia), ground truth measurements, ocular imaging modalities, deep learning models, and performance metrics, adhering to PRISMA guidelines. Nine studies were identified and categorised into three groups: retinal photo-based (n ​= ​5), OCT-based (n ​= ​1), and external ocular photo-based (n ​= ​3).For high myopia prediction, retinal photo-based models achieved AUC between 0.91 and 0.98, sensitivity levels between 85.10% and 97.80%, and specificity levels between 76.40% and 94.50%. For continuous prediction, retinal photo-based models reported MAE ranging from 0.31D to 2.19D, and R2 between 0.05 and 0.96. The OCT-based model achieved an AUC of 0.79–0.81, sensitivity of 82.30% and 87.20% and specificity of 61.70%–68.90%. For external ocular photo-based models, the AUC ranged from 0.91 to 0.99, sensitivity of 81.13%–84.00% and specificity of 74.00%–86.42%, MAE ranges from 0.07D to 0.18D and accuracy ranges from 81.60% to 96.70%. The reported papers collectively showed promising performances, in particular the retinal photo-based and external eye photo -based DL models. Conclusions: The integration of deep learning model and ocular imaging for refractive error detection appear promising. However, their real-world clinical utility in current screening workflow have yet been evaluated and would require thoughtful consideration in design and implementation.

Kelly K Bisignano, Jennyffer D Smith, Wendy W Harrison Department of Clinical Sciences College of Optometry, University of Houston, Houston, TX, USACorrespondence: Wendy W Harrison, Email wwharris@central.uh.eduPurpose: Local retinal oxygen saturation is a research technique, which has the potential as a biomarker for diabetes. However, normative data has not been established. This study examined differences in oxygen saturation around the macula and characterizes the relationship between age, race, refractive error (RE), sex, blood pressure (BP), prediabetic status and oxygen saturation.Methods: Fifty-nine subjects aged 22– 69 (38.8 ± 14.7 years) were included who were racially diverse and with equal gender distribution. None had eye disease. Oxygen saturation was taken with the Zilia Ocular in 4 locations around the macula 3.1 degrees from the fovea and they were also averaged. BP, RE, and HbA1c were noted. Regression analyses for oximetry and other factors were completed as were t-tests with multiple comparison corrections.Results: There were significant variations in oximetry measures by race, with higher pigmentation levels associated with lower oximetry values (p < 0.01). There was no relationship between oximetry and sex (p = 0.34), RE (p = 0.67), BP (systolic p = 0.61, diastolic p = 0.71) nor prediabetic status (p = 0.87). Oximetry was associated with age when controlling for race (P < 0.002). Nasal-temporal variations showed nasal oximetry to higher than temporal measures (P < 0.01).Conclusion: This study revealed race/pigmentation is an important influence on oximetry measures. Retinal location also caused variations, likely due to proximity to larger vessels nasally. No differences in sex, RE nor BP were observed to alter local oxygen saturation. However, age was correlated when considered with race. This study will inform our future work in different disease states and is an important first step in evaluating this technology.Plain Language Summary: This study evaluates a new research instrument (Zilia Ocular) which measures how much oxygen is in the very small blood vessels of the retina. Our group wanted to evaluate healthy people to find out if the measurements the instrument takes are different in different sexes, ages, races, glasses prescriptions and blood pressures. We also looked at if they were changed in people with prediabetes and if it is different in different locations on the retina. We found that the measures are different in different races and ages. The measures also change with location in the eye. The other factors did not change the measurements of oxygen saturation on this instrument. We need to know this information because we want to detect changes in the retina in diabetes in diverse patient groups; however, we need to know about normal variations to better understand and collect that data.Keywords: oximetry, oxygen saturation, prediabetes, refractive error, blood pressure

The objective of this article is to comprehensively review the effect of environmental lighting on ocular growth and refractive status in both animal and clinical studies, with an emphasis on the underlying mechanisms. This review was performed by searching research articles and reviews utilizing the terms “myopia,” “light therapy,” “axial length,” “refractive error,” and “emmetropization” in PubMed datasets. The review was finalized in December 2023. In the animal studies, high lighting brightness, illumination periods aligning with circadian rhythm, and color contrast signals including multiple wavelengths all help regulate ocular growth against myopia. Long wavelengths have been found to induce myopia in chicks, mice, fish, and guinea pigs, whereas shorter wavelengths lead to hyperopia. In contrast, red light has been observed to have a protective effect against myopia in tree shrews and rhesus monkeys. Apart from wavelength, flicker status also showed inconsistent effects on ocular growth, which could be attributed to differences in ocular refractive status, evolutionary disparities in retinal cone cells across species, and the selection of myopia induction models in experiments. In the clinical studies, current evidence suggests a control effect with red light therapy. Although the lighting conditions diverge from those in animal experiments, further reports are needed to assess the long-term effects. In conclusion, this review encompasses research related to the impact of light exposure on myopia and further explores the retinoscleral signaling pathway in refractive development. The aim is to establish a theoretical foundation for optimizing environmental factors in lighting design to address the epidemic of childhood myopia.

PURPOSE: After infantile cataract surgery, axial elongation, induces a myopic shift that cannot be fully compensated by corneal flattening and the rate is unpredictable owing to the non-linear growth of the eye. The current prospective study assesses the myopic shift and visual outcomes in children undergoing cataract surgery in infancy over a follow-up period of 5 years. MATERIALS AND METHODS: A prospective study conducted at a tertiary eye care center to evaluate the five-year myopic shift, refractive and visual outcomes in infants, who underwent surgery for congenital cataract in infancy. The visual acuity, myopic shift and biometric changes are compared between the aphakia and pseudophakia group. RESULTS: The mean best-corrected visual acuity (BCVA) recorded in logMAR at 5 years for aphakia group was 0.92±0.44 and for pseudophakia group was 0.66±0.42. (pvalue: 0.002102). The myopic shift was noted to be -5.9+/-5.16 in the aphakia group whereas it was -9.01+/- 3.11 in the pseudophakia group (P value= 0.002101) at 5 years after surgery for infantile cataract. CONCLUSION: IOL implantation in eyes of infants undergoing cataract surgery is feasible in eyes that strictly satisfy the pre-operative inclusion criteria and the visual outcomes in these eyes are better compared to aphakia group at 5 years follow up. Eyes with primary IOL implantation had a higher myopic shift compared to ones without primary IOL implantation. Eyes undergoing primary IOL implantation, need higher under correction compared to the current available formulae.

Abstract Background Functional visual impairments in children are primarily caused by amblyopia or strabismus. This study aimed to determine the prevalence and clinical profile of amblyopia and strabismus among individuals aged 3–16 years in Shanghai, China. Methods From February 2023 to February 2024, this hospital-based, cross-sectional study included data of children who visited the Ophthalmology Department of Shanghai General Hospital. Comprehensive ocular examinations included visual acuity measurement after cycloplegic refraction, slit lamp examination, cover test, and dilated fundus examination. Descriptive statistics were performed to estimate the proportion and clinical characteristics of amblyopia and strabismus. Results A total of 920 children were enrolled in our study. Among them, 223 (24.24%) children were identified as amblyopia. Unilateral amblyopia occupied 57.85%, and bilateral amblyopia occupied 42.15%. Most participants were within the age range of 5–10 years (75.97% for unilateral amblyopia, and 70.21% for bilateral amblyopia). Anisometropia was the primary cause of unilateral amblyopia (68.99%). Most amblyopic children have high hyperopia (38.76% for unilateral amblyopia, and 39.89% for bilateral amblyopia). 30 (3.26%) children were diagnosed with strabismus, and 19 (63.3%) of them were aged 5–10 years. Seven of the children had both strabismus and amblyopia. Conclusion The proportion of patients with amblyopia and strabismus was determined as 24.24% and 3.26% in our study. Anisometropia was the leading cause of unilateral amblyopia, whereas high hyperopia was a crucial refractive error in the amblyopic population. These findings shed light on further longitudinal studies targeting the age-related changes in amblyopia, strabismus and refraction errors. Therefore, efforts should be made to manage uncorrected refractive errors, amblyopia, and strabismus among children in Shanghai.

John D Hong,1 Elliot H Choi,1 Susie Suh,1 Joseph H Bui,1 Annabelle M Storch,1 Kimberly R Walker,1 Kourosh Shahraki,1 Carolina Yanez,1 Diana Torres,1 Jennifer Espinoza,1 Iliana Molina,2,&ast; Donny W Suh1,&ast; 1Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA; 2Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, CA, USA&ast;These authors contributed equally to this workCorrespondence: Donny W Suh, Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, 850 Health Sciences Road, Irvine, CA, 92697, USA, Tel +1 949 824-4122, Email donnys@hs.uci.edu Iliana Molina, Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, 9415 Campus Point Dr, San Diego, CA, 92037, USA, Tel +1 858 822-2585, Email imolina@health.ucsd.eduPurpose: Uncorrected refractive errors (REs) and amblyopia can lead to visual impairment with deleterious effects on quality of life and academic performance. Early detection and treatment by community vision care programs, such as the UCI EyeMobile for Children, can aid in addressing preventable vision loss.Methods: A total of 5074 children between the ages of 3 and 10 years were screened at 153 locations, including preschools, head start programs, and elementary schools within Orange County (OC), California (CA). Subsequently, 1024 children presented for comprehensive eye examinations. A retrospective analysis of all examined children was conducted, determining the frequency and severity of REs and amblyopia and the spectacle prescription rate by age. Propensity score matching analysis evaluated the effect of median household income on RE and amblyopia frequency.Results: Among those who failed initial screening and were subsequently examined, significant rates of REs and amblyopia were detected: myopia (24.4%), hyperopia (35.4%), astigmatism (71.8%), anisometropia (8.9%), amblyopia (7.0%), and amblyopia risk (14.4%). A majority (65.0%) of those examined received prescription spectacles from UCI EyeMobile, with around a third requiring a new or updated prescription. The frequency of REs and amblyopia and the spectacle prescription rate were uniform across OC congressional districts. Myopia and amblyopia risk was positively and negatively associated with household income, respectively.Conclusion: The UCI EyeMobile for Children serves as a vital vision care program, providing free vision screening, comprehensive eye examinations, and spectacles. A significant number of children required examination, and a high frequency of REs and amblyopia were detected in examined children, with subsequent provision of prescription spectacles to most children.Keywords: pediatrics, refractive error, amblyopia, spectacles, mobile clinic, screening

Abstract Introduction Even though the burden of uncorrected refractive error could potentially be addressed through innovative and cost-effective approaches, integration of the services into the National Health Services (NHS) is desirable. However, minimal information exists on the current situation warranting the need for evidence about the integration of refractive error service provided by optometrists into the national health services in Kenya. Methods A situation analysis of the Kenyan refractive error services provided by optometrists within the NHS was undertaken based on access to service delivery, service coverage, and human resource. A strengths, weaknesses, opportunities, and threats analysis was undertaken based on the existent evidence to identify the core factors that could potentially facilitate or hinder the integration of refractive error services provided by optometrists within the National Health Services. The proportion of optometrists to be integrated in the NHS was estimated based on the minimum ratios recommended by the World Health Organization. Results A section of tertiary and secondary healthcare facilities in Kenya have specific services to address refractive errors within the NHS with most facilities lacking such services. Treatment of refractive error occurs at the level of eye care general services. There are 11,547 health facilities offering primary care services in Kenya. However, none of them offers refractive error services and only a section of facilities offering county health referral services provides eye care services which is limited to refraction without provision of spectacles. The existing workforce comprises of ophthalmologists, optometrists and ophthalmic clinical officers, together with nurses and other general paramedical assistants. Optometrists, ophthalmologists and ophthalmic clinical officers are allowed to undertake refraction. However, optometrists majorly practices in the private sector. Centralization of eye care services in urban areas, weak referral systems, and a shortage in the workforce per population was observed. Conclusions The Kenyan NHS should advocate for primary care and reorient the current hospital-based delivery approach for refractive error services. This is attributed to the fact that provision of refractive error services at primary care remains effective and efficient and could translate to early detection of other ocular conditions. The existing human resources in the eye health ecosystem in Kenya should maximize their efforts towards addressing uncorrected refractive error and optometrists should be integrated into the NHS.

Abstract Purpose To explore the epidemiology and demographic risk factors for myopia among a clinical sample. Methods In a hospital-based retrospective study, eligible subjects were grouped into either myopia or non-myopia. Demographic data, including age, sex, occupation, area of residence, region of residence, and ethnicity, were analysed. Other clinical information analysed included the degree of myopia and intervention provided for the myopia. Results Overall, the medical records of 15807 patients were retrieved between January 2015 and December 2019, with 50.9% being males. The mean ± SD age of the patients was 42.81 ± 18.99 years. A total of 44.4% of the patients were myopic. Age, type of ethnic group, occupation, and area of residence were associated with myopia. Demographic risk factors for myopia included occupations such as professionals (OR: 2.93; 95% CI 2.44–3.52), technicians and associated workers (OR: 6.71; 95% CI 5.15–8.74), service workers (OR: 11.74; 95% CI 9.62–14.33), skilled agriculture and fishery (OR: 1.88; 95% CI 1.41–2.50), craft workers (OR: 3.41; 95% CI 2.75–4.25), armed forces (OR: 10.26; 95% CI 7.54–13.97), students (OR: 3.49; 95% CI 2.76–4.42), the unemployed (OR: 6.64; 95% CI 5.44–8.11), as well as Ewe (OR: 1.46; 95% CI 1.17–1.82) and Ga-Adangbe (OR: 1.28; 95% CI 1.05–1.54) ethnicities. Conclusion Ewe and Ga-Adangbe ethnicities, and specific occupations are risk factors for myopia.

Background and purpose: Premature birth is common worldwide and can affect the development of brain structures, such as the optic nerve. Eye diseases are very common in low birth weight children and premature children. Vision defects associated with premature birth include Retinopathy of premature babies (ROP), decreased visual acuity, strabismus, amblyopia, and various types of refractive errors. Studies have shown that the occurrence of myopia in children born prematurely is negatively correlated with gestational age and birth weight and is directly related to the severity of retinopathy of prematurity(ROP). Advances in neonatal intensive care unit services have led to a significant increase in the survival rate of premature infants and subsequent medical problems in these children. This study was designed to determine the prevalence of refractive errors in 4-6-year-old children born with a birth weight of less than 2000 grams and gestational age of less than 34 weeks and normal children admitted to the neonatal department of Bou-Ali Sina Hospital in Sari in 2016-2018. Materials and methods: This study was a cross-sectional descriptive study on 43 children aged 4-6 years who were born with a weight of less than 2000 grams and gestational age of less than 34 weeks, and 17 normal children who were admitted in the neonatal department of Bou-Ali Sina Hospital due to neonatal jaundice. The study subjects were in four groups: 12 subjects in group A (ROP cases without injection), 14 subjects in group B (ROP cases with injection), 17 subjects in group C (cases with birth weight less than 2000 grams and gestational age less than 34 weeks without ROP), and 17 normal subjects in group D. Uncorrected distance visual acuity was measured using E-chart. Dry and cyclo refraction (using cyclopentolate 1%) were measured using an autorefractometer. Finally, the fundus was examined using a biomicroscope and 90 diopter lens. Statistical analysis was performed using SPSS software, version 26. Results: of the 60 studied subjects, 46.67% were females and 53.33% were males, and there was no significant difference in the prevalence of the two sexes between the groups (P=0.146). In total, 12.1% of the studied subjects were myopie, 34.5% were emmetrope, and 53/4% were hypermetrope. Although the prevalence of hypermetropia was higher than other types of refractive errors in all groups, the prevalence of myopia was higher in those with ROP than in groups without ROP, and there was a significant difference in the prevalence of refractive errors in different groups (P=0.025). There was no significant difference between the prevalence of the different types of astigmatism in the studied groups (P=0.304) and with the rule astigmatism was the most common type among all groups. There was a significant and direct relationship between gestational age and birth weight with cyclo-equivalent sphere, which means that the lesser gestational age (P=0.356, r=0.006) and birth weight (P=0.002, r=0.387), the higher the probability of myopia. Conclusion: Considering the higher prevalence of myopia in low birth weight children, especially in children with ROP, it is necessary to formulate a regular program to screen this category of children to prevent refractive errors, especially myopia in the future.

Abstract Background This study aimed to compare the results of the Chronos binocular/monocular refraction system, that measures objective and subjective ocular refraction in one unit, to objective findings obtained from a conventional autorefractometer and a conventional subjective ocular refraction using a trial-frame in real space. Methods Twenty-eight healthy volunteers (21.2 ± 1.5 years old) were included in this study. Objective ocular refraction was measured using two tests: the Chronos binocular/monocular refraction system under binocular conditions and a conventional autorefractometer under monocular conditions. Subjective ocular refraction was measured using three tests: Chronos binocular/monocular refraction system under binocular, monocular conditions, and trial-frame in the real space under monocular conditions. The measurement distance was set to 5.0 m for each test. All ocular refractions were converted into spherical equivalents (SEs). Results The objective SE was significantly more negative with Chronos binocular/monocular refraction system under binocular condition (− 4.08 ± 2.76 D) than with the conventional autorefractometer under monocular condition (− 3.85 ± 2.66 D) (P = 0.002). Although, the subjective SE was significantly more negative with Chronos binocular/monocular refraction system under binocular condition (− 3.55 ± 2.67 D) than with the trial-frame in the real space under monocular condition (− 3.33 ± 2.75 D) (P = 0.002), Chronos binocular/monocular refraction system under monocular condition (− 3.17 ± 2.57 D) was not significantly different from that in trial-frame in real space under monocular condition (P = 0.33). Conclusion These findings suggest that the Chronos binocular/monocular refraction system, which can complete both objective and subjective ocular refraction tests in a single unit, is suitable for screening ocular refraction, although it produces slightly more myopic results. Furthermore, subjective ocular refraction testing accuracy in Chronos binocular/monocular refraction system can be equivalent to trial-frame in real-space testing by switching from binocular to monocular condition.

Abstract Purpose To evaluate the long-term clinical outcomes of femtosecond thin-flap LASIK (femto-LASIK) for correction of refractive error after penetrating keratoplasty in keratoconus-affected eyes. Setting a private ophthalmology clinic. Design Prospective interventional case series. Methods This prospective interventional case series enrolled 22 eyes of 22 patients who underwent femto-LASIK for the management of post-penetrating keratoplasty ametropia. The refractive error, uncorrected (UDVA), and corrected (CDVA) distance visual acuities and vector analysis were reported in short-term and long-term period after surgery. Results The mean age was 32.7 ± 7.5 years (range, 23 to 47 years) at the surgery time. The average time between PK and femto-LASIK was 42.5 ± 31.7 months. The average follow-up duration after femto-LASIK was 81.2 ± 18.6 months. The mean preoperative UDVA significantly improved from 0.47 ± 0.15 logMAR to 0.35 ± 0.14 logMAR at 12 months (P = 0.048) and 0.4 ± 0.17 at final follow-up exam (P = 0.007). CDVA was 0.22 ± 0.1 at baseline which improved to 0.18 ± 0.15 and 0.15 ± 0.1 logMAR at 12 and 81 months, respectively. (Ps = 0.027, 0.014). The mean cylinder before surgery was − 5.04 ± 1.4D which significantly decreased to -1.5 ± 0.8 D at 12 months postoperatively. (P

Abstract Background Plusoptix photoscreeners are capable of measuring refractive errors of children from 1 meter distance, without cyloplegia. We aimed to compare refractive data obtained from the newest version of Plusoptix (model 12) with cycloplegic autorefraction. Methods We examined 111 consecutive children aged 3-7 years first by Plusoptix A12C under manifest condition and subsequently for cycloplegic refraction by Topcon KR-1 tabletop autorefractometer. Sphere, spherical equivalent, cylinder and axis of astigmatism measured by the two methods were analyzed to determine correlation, agreement and differences. Results Binocular examination of 111 children aged 4.86±1.27 years revealed good agreement between refractive data obtained by Plusoptix and cycloautorefraction, according to Bland-Altman plots. Significant (p < 0.001) and strong correlation was found between all refractive measurements (Pearson’s r value of 0.707 for sphere, 0.756 for pherical equivalent, and 0.863 for cylinder). Plusoptix mean sphere, spherical equivalent and cylinder were 1.22, 0.56, and -1.32 D, respectively. Corresponding values for cycloautorefraction were 1.63, 1.00, and -1.26 D. The difference between axis of cylinder measured by the two methods was < 10° in 144 eyes (64.9%). Conclusions Considering the significant agreement and correlation between Plusoptix photoscreener and cycloplegic autorefraction, the need for cycloplegic drops in refractive examination of children may be obviated. The mean difference between cylinder measurements are considerably trivial (0.06 D), but sphere is approximately 0.4 D underestimated by Plusoptix compared to cycloautorefraction, on average.

Sruthi Vijendran,1,&ast; Yogish S Kamath,1,&ast; Yash Alok,2 Neetha IR Kuzhuppilly1 1Department of Ophthalmology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India; 2Department of Community Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India&ast;These authors contributed equally to this workCorrespondence: Neetha IR Kuzhuppilly, Department of Ophthalmology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India, Tel +91 98861 61979, Fax +91-820-2571934, Email neetha.kir@manipal.eduPurpose: Refractive error is a major cause of visual impairment in children and its early detection can prevent ocular morbidity such as amblyopia and strabismus. Brückner test is a comprehensive test which can be easily administered in children using a direct ophthalmoscope. We aimed to determine refractive error in children by analysis of the red reflex using modified Brückner test.Patients and Methods: This prospective observational study was conducted on 683 undilated eyes of 683 children aged four to 10 years. They were evaluated with a direct ophthalmoscope from one meter in a dimly lit room. The characteristics of the red reflex and crescent obtained were compared with photoscreener refraction value and analyzed.Results: The presence of superior crescent was associated with hypermetropia (Chi square 37.11, p < 0.001, kappa = 0.15) and inferior crescent with myopia (Chi square 157.29, p < 0.001, kappa = 0.477). Superior crescent was 98.4% sensitive in detecting hypermetropia. Hypermetropia greater than +1.5D, was associated with larger superior crescent crossing horizontal midline of pupil (Chi square = 5.29, p = 0.021).Conclusion: The modified Brückner test is useful in detection and quantification of refractive error in children. It is easy, simple, quick and can be employed in the community as a screening test to detect potentially amblyogenic refractive errors.Keywords: visual impairment, pediatric refraction, hypermetropia, myopia, Brückner test, refractive error

Background: Functional visual impairments in children are primarily caused by amblyopia or strabismus. This study aimed to determine the prevalence and clinical profile of amblyopia and strabismus among individuals aged 3–16 years in Shanghai, China. Methods: From February 2023 to February 2024, this hospital-based, cross-sectional study included data of children who visited the Ophthalmology Department of Shanghai General Hospital. Comprehensive ocular examinations included visual acuity measurement after cycloplegic refraction, slit lamp examination, cover test, and dilated fundus examination. Descriptive statistics were performed to estimate the proportion and clinical characteristics of amblyopia and strabismus. Results: A total of 920 children were enrolled in our study. Among them, 223 (24.24%) children were identified as amblyopia. Unilateral amblyopia occupied 57.85%, and bilateral amblyopia occupied 42.15%. Most participants were within the age range of 5–10 years (75.97% for unilateral amblyopia, and 70.21% for bilateral amblyopia). Anisometropia was the primary cause of unilateral amblyopia (68.99%). Most amblyopic children have high hyperopia (38.76% for unilateral amblyopia, and 39.89% for bilateral amblyopia). 30 (3.26%) children were diagnosed with strabismus, and 19 (63.3%) of them were aged 5–10 years. Seven of the children had both strabismus and amblyopia. Conclusion: The proportion of patients with amblyopia and strabismus was determined as 24.24% and 3.26% in our study. Anisometropia was the leading cause of unilateral amblyopia, whereas high hyperopia was a crucial refractive error in the amblyopic population. These findings shed light on further longitudinal studies targeting the age-related changes in amblyopia, strabismus and refraction errors. Therefore, efforts should be made to manage uncorrected refractive errors, amblyopia, and strabismus among children in Shanghai. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusionThe purpose of the study was to design a simple, handy prediction for the effect of spherical and cylindrical refractive error on the visual acuity degradation at different distances and validate this model on a clinical dataset.This study examined 70 eyes from 35 patients’ post-cataract surgery with aberration-free intraocular lenses. Biometric and corneal data were analysed, and subjective refraction and visual acuity were evaluated by two experienced optometrists. The study computed the spherical equivalent (SEQ), and defocus equivalent via vector addition (DEQ vec), as the sum of absolute values (DEQ abs). Predictive models were developed using univariate regression, with confidence intervals (BCa 95%) calculated through non-parametric bootstrapping (10,000 cycles).Various calculated equivalents included −0.44 D for spherical equivalent (SEQ), 0.70 D for defocus equivalent based on vector calculation (DEQ vec), and 0.89 D for defocus equivalent based on absolute values (DEQ abs). Uncorrected and corrected visual acuity averaged 0.07 logMAR and −0.04 logMAR, respectively. The absolute defocus equivalent (DEQ abs) exhibited the smallest confidence interval (BCa 95%) at 0.07.The defocus equivalent based on the addition of absolute values (DEQ abs) emerged as the most practical predictor for the described applications. Notably, it offers the advantage of easy calculability through a simple equation: VA loss = DEQ abs ⋅ 0.23. In 95% of cases, this predicted loss would have an accuracy of ±0.03 lines. [ABSTRACT FROM AUTHOR]

Cataracts are characterized by the crystalline lens of the eye becoming cloudy, and dry eye disease (DED) is a multifactorial disease in which the homeostasis of the tear film is lost. As the prevalence of both diseases increases with age, there is a high prevalence of DED among patients who are candidates for cataract surgery. In recent years, cataract surgery has evolved from vision restoration surgery to refractive surgery. To achieve good surgical outcomes, it is necessary to minimize postoperative refractive error in intraocular lens (IOL) power calculation, which requires accurate preoperative keratometry measurements. A stable tear film is important for the accuracy and reproducibility of keratometry measurements, and DED may have a deleterious effect. In this study, original articles that focused primarily on findings related to this topic were evaluated. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Although appropriate DED diagnoses were not presented in the articles evaluated in this review, it was confirmed that the clinical signs of DED, particularly the shortening of the tear film break-up time (TBUT), negatively impact IOL power calculations. Improvement in these clinical signs might mitigate the negative effects on these calculations. [ABSTRACT FROM AUTHOR]

To investigate the influence of lens thickness (LT) on accuracy of Kane, Hill-RBF 3.0 Barrett Universal II (BUII), Emmetropia Verifying Optical (EVO), and Pearl-DGS formulas in eyes with different axial lengths (AL). The prospective cohort study was conducted at Eye and ENT Hospital of Fudan University. Patients who had uneventful cataract surgery between March 2021 and July 2023 were recruited. Manifest refraction was conducted two-month post-surgery. Eyes were divided into 4 groups based on AL: short (<22mm), medium (22-24.5 mm), medium long (24.5-26mm) and very long (≥26mm). In each AL group, eyes were then divided into 3 subgroups based on the LT measured with IOLmaster700: thin (<4.5 mm), medium (4.5-5.0 mm), and thick (≥ 5 mm). The influence of LT on accuracy of Kane, Hill-RBF 3.0, BUII, EVO, and Pearl-DGS formulas were investigated in each AL group. A total of 327 eyes from 327 patients were analyzed, with 64, 102, 73 and 88 eyes in each AL group, respectively. In eyes with AL < 24.5 mm, myopic PE was significantly associated with greater LT using all the 5 formulas (all p < 0.05). Backward stepwise multivariate regression analyses revealed that LT was an important influencing factor for PE in all 5 formulas, particularly in eyes with AL <24.5 mm. In eyes with AL <24.5 mm and LT > 5.0 mm, PE of all 5 formulas calculated with the optional parameter LT were more myopic than those calculated without LT. Thicker LT was associated with more myopic PE among eyes with AL <24.5 mm when using all 5 formulas. Further optimization of current formulas is necessary, especially for eyes with short AL and thick LT. [ABSTRACT FROM AUTHOR]