ABSTRACT
In recent years, treatment of myopia with low-intensity 600-670 nm red light irradiation has attracted extensive attention.A one-year multi-center clinical study in China showed that red light therapy can inhibit axial elongation and the progression of myopia in myopic children.Nevertheless, the underlying mechanism and long-term safety are still to be determined.The longitudinal chromatic aberration theory could explain its effect on retarding myopia in chicks and guinea pigs.However, studies on different species had inconsistent conclusions and even contrary results in primates.The possible mechanisms of its efficacy on myopia control include the temporary increasing choroidal blood flow to mitigate scleral hypoxia, affecting the metabolic signal pathway of cones, stimulating the retina to secrete dopamine through intensive irradiation, affecting circadian rhythm, and stimulating cytochrome C oxidase to reduce oxidative stress to promote cell repair and inhibit apoptosis.In terms of safety, studies revealed the biphasic dose response in red light therapy, that is to say, no adverse event has been reported for low-intensity, low-dose and short-time red light irradiation, but it is necessary to stay alert for photoreceptor cell and retinal pigment epithelium cell damage caused by excessive irradiation.This article reviewed the research progress on the clinical effectiveness, therapeutic mechanism and safety of red light irradiation in the treatment of myopia to provide a theoretical basis for its use in clinical treatment.
ABSTRACT
Background It has been reported that orthokeratology has the effects of slowing down myopia progression and axial elongation.However,the affecting mechanism of orthokeratology wearing on ocular peripheral refraction is still not elucidated.Objective This study was to observe and compare the changes of ocular peripheral refraction and relative peripheral refraction (RPR) in low to moderate myopic eyes of children after wearing orthokeratology lens and spectacles for 6 months.Methods A randomized controlled clinical trial was carried out after approval of Ethic Committee of Beijing Tongren Hospital and informed consent of guardians of the children.One hundred myopic children aged (ll.0±1.9) years were recruited in Beijing Tongren Hospital from June 2014 to January 2015,with the diopter of-0.50 to-6.00 D.The subjects were randomized into orthokeratology group and spectacles group by the process PLAN PROC of software SAS 9.1.3,50 for each group.The subjects in the orthokeratology group wore orthokeratology lens for 6 months and those in the spectacles group wore spectacles for the same period.An infrared open-field autorefractor was employed to measure the refraction at central 0°,temporal 15°,temporal 30°,nasal 15°and nasal 30° radial lines before and after wearing lens for the assessment and comparison of the changes of peripheral refraction and RPR.Results There was no significant difference in spherical equivalent between the orthokeratology group and the spectacles group before wearing lens ([-3.35±1.31] D versus [-3.01± 1.15] D,P =0.20).The peripheral refraction values in the orthokeratology group were (-2.28 ± 1.60),(-3.28±1.41),(-3.40±1.23),(-3.38±1.12) and (-2.09±1.29)D at nasal 15°and nasal30°,central,temporal 15° and temporal 30°radial lines before wearing lens,and reduced by (0.29±1.67),(0.85±1.66),(0.92±1.76) and (0.66±1.66) D at nasal 30°,nasal 15°,central and temporal 15° after wearing lens,respectively,with significant differences at nasal 15°,central and temporal 15°(all at P＜0.05).The peripheral refraction values in the spectacles group were (-1.88±1.30),(-2.66±1.18),(-2.89±1.27) and (-1.94±1.31)D at nasal 15°,nasal 30°,temporal 15 ° and temporal 30°,radial lines before wearing lens and increased by (-0.25±0.80),(-0.43 ±0.67),(-0.32±0.64) and (-0.22±0.75)D after wearing lens,respectively,with significant differences between before and after wearing lens (all at P＜0.05).The RPR shifted from hyperopia defocus to myopia defocus before and after wearing lens in temporal 15° and 30° radial lines in the orthokeratology group,and at various radial lines in the spectacles group,the RPR showed gradually worsening of hyperopia defocus.Conclusions Long-term wearing of orthokeratology results in a hyperopia shifting in myopic children by exposing the peripheral retina towards relative myopia defocus,whereas wearing spectacles leads to a relative hyperopia defocus on retina.Thus,orthokeratology may slow down the myopia progression.
ABSTRACT
Background Preferred practice pattern (PPP) is an evidence-based documents which can be used for reference to standardize medical practice by ophthalmologists.So far it has been promoted for more than 10 years in China.However,there is no report about the popularization and application of PPP in China.Objective This study was to investigate the cognitions of ophthalmologists to PPP from the view of clinical questions.Methods A questionnaire-based study was conducted.Questionnaires were dispensed during September 17 to 21,2014 to inquiry into the cognitions of ophthalmologists to PPP in the 19th Congress of Chinese Ophthalmological Society.A selfadministered questionnaire was designed and discussed according to the article published in the past by our research group.It included personal basic information and cognitions to PPP,and the latter consisted of self-assessment and cognition scoring.The constituent ratios of aware,quite aware,unaware and fully unaware ophthalmologists were counted.The cognitions were divided into low level (0-4 scores),moderate level (5-8 scores) and high level (9-12 scores) based on the effective answer sheets.The questionnaires were filled out anonymously and incomplete questionnaires were excluded.Results Among the 300 distributed questionnaires,282 were retrieved and 209 were valid,with the effective rate 74.1％.The ophthalmologists of awareness to PPP were 46.4％ (97/209),and 53.6％ (112/209) of respondents did not know PPP very well.A positive correlation was found between the awareness to PPP and the cognition scores to clinical issues (r,=0.143,P ＜ 0.05).The cognition scores to clinical issues were significantly different among different educational backgrounds (F =12.26,P ＜ 0.05),and cognition scores were significantly reduced in the ophthalmologists with lower master degree in comparison with the ophthalmologists with doctoral degree (all at P＜0.05).The coincide ratio between cognitions of ophthalmologists to different clinical issues and suggestions in PPP were evidently different in the ophthalmologists,with the highest coincide ratio 83％ and the lowest coincide ratio 1％.Conclusions The awareness to PPP is not adequate in Chinese eye doctors,which reduces the cognition level to clinical issues.There is a poor coincide ratio between cognitions of Chinese ophthalmologists to clinical issues and suggestions in PPP.This study emphasizes the need for effective awareness programs towards clinical issues based on PPP.
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Background Randomized controlled trial (RCT) can offer high quality of evidence for the medical decisions.Consolidated standards of reporting trials (CONSORT) statement,an international criteria for RCT report,is a guideline and methodology of RCT report.However,the assessment and application of RCT according to CONSORT are dissatisfactory in China.Objective This study was to evaluate the reporting quality of ophthalmic diseases related RCTs published in SCI journals from mainland China and offer a good methodology of RCT report.Methods The RCT literature were searched on PubMed database according to Ophthalmology, Eye and all of their inferior subjective terms,and the published papers were limited in mainland China and before March,2013.Included papers were evaluated independently and checked by two searchers.The methodology and results of all retrieved papers were stratifiedly analyzed by the year of CONSORT published and revised.Results Sixty eligible RCTs were assessed,and the intervention methods were primarily surgery trials (34/60).Forty-four papers presented the comparison study of two groups with the median sample size of 76.0.Only 22％ (13/60) trial reports gave the clear identification of RCT in the title.Majority of papers described trial design,eligibility criteria for participants,detail of interventions and outcome measures.Twelve pieces of articles reported how sample size was determined,and 41 pieces referred settings and locations,but only 6 pieces recorded interim analyses and stopping guidelines.After CONSORT 2010 Statement was published,the proportion of trial reports that included details of the randomization had little improvement (RR=1.06,95％ CI:0.62-1.82).Only 42％ trial reports (25/60) offered a description about blinding method.Conclusions RCT reports related to ophthalmic diseases from mainland China in SCI journals are still flawed with certain shortcomings.Following the guidance of the CONSORT statement can improve the quality of ophthalmic diseases related RCT from mainland China.
ABSTRACT
Background Evidence-based medicine (EBM) has been widely applied to solve clinical issues internationally,however,the awareness of oculists in China still is dissatisfied,and the relevant issue survey can offer the training guidance.Objective This study was to survey the status of the cognition and practice of EBM in ophthalmologists in China and analyze the problems in their EBM practice.Methods Two hundred and thirty-three ophthalmologists were enrolled in the 18th Congress of Chinese Ophthalmological Society in August,2013.A survey about EBM was performed by self-made questionnaire,including general data from the surveyors,the way and channel of understanding EBM,the attitude toward EBM,clinical practice of EBM and influencing factors.The educational background,professional qualifications,ranked distribution of hospitals which surveyors came from,size of the citys and attribute of hospitals were stratified and analyzed.SPSS 17.0 software was used for statistical analysis.Results A total of 233 questionnaires were distributed,and 233 were regained with the response rate 100％,and 214 valid questionnaires were included,with the effective rate 91.8％.50.5％ of the respondents (104/206) knew EBM in university.The proportion of those believe EBM initially as medical students was 41.8％,and 49.1％ (102/208) were aware of EBM in recent 8 years.And 47.7％ (101/211) believed that EBM should be given priority in clinic,and 7.5％ (16/211) were indifferent to EBM.Only 3.8％ (8/211) surveyors thought EBM to be little important.The proportion of the respondents choosing ‘ know’ or ‘ moderately-know’ were 69.1％ (148/214),35.0％ (75/ 213),21.5％ (46/213) and 57.4％ (121/211) respectively in EBM,Meta analysis,Cochrane as well as Preferred Practice Patterns (PPPs) with a higher receiving degree in well-educated individuals (P =0.000,0.000,0.001,0.000).EBM was well practiced in 11.7％ (25/211) oculists,with a higher using frequency in senior ophthalmologists,and 17.8％ (89/495,frequency) oculists consulted the EBM literature to resolve problems in clinic,with a significant difference in the using frequency of EBM among the different educational background subjects (x2=13.406,P=0.037).The top three barriers which affected the application of EBM in clinical practices were lack of time and the limited energy,feeling it difficult to evaluate the evidence correctly as well as the absence of cases proving the efficacy to treat based EBM.The type of EBM evidence mostly used by respondents was medical database (36.7％),and CNKI (33.5％) and PubMed (38.4％) were the mostly used Chinese and English database,respectively.Respondents who have never searched the Chinese or English database occupied up to 7.3％ and 17.2％,respectively.Conclusions The cognition degree and applying frequency are still lower in ophthalmologists in China.The training of EBM should be strengthened in medical students.The guidance measurement should be taken to encourage eye doctors to apply EBM.