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Myopia has become a serious public health problem, but its pathogenesis is still unclear, and effective interventions are relatively scarce.It is recognized that myopia is influenced by both genetic and environmental factors, in which epigenetics may play a key role.Epigenetics refers to the changes in gene expression and function that do not involve DNA sequence variation.Mainly including DNA methylation, non-coding RNA (microRNA, long non-coding RNA and circular RNA, etc.), histone modification and mRNA modification, epigenetic modifications interact to form a complex regulatory network in the pathophysiological process of myopia.By controlling the process of scleral matrix remodeling, eye cell proliferation and retinal development, the morphological characteristics of the eye are jointly regulated, ultimately affecting the onset and development of myopia.Epigenetics has provided new targets of myopia intervention and has become a hotspot in the field.In this paper, we reviewed the current findings of myopia epigenetics to provide a reference for related research.
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The high prevalence of myopia is a global public health concern, and the risk of associated complications is becoming increasingly apprent.The International Myopia Institute (IMI) was established in 2015 to promote scientific research and clinical practice in myopia control, and IMI published the White Paper on Myopia Prevention and Control on the diagnosis, treatment, and management of myopia.In 2023, the IMI released the series three of the White Paper on Myopia Prevention and Control, which delves deeper into key issues in myopia research and management.The white paper focuses on non-pathological changes observed in axial myopia, and the role of the choroid in eye growth and myopia management.It also reviews the evidence for myopia incidence, progression and management in atypical populations, such as infants, pre-school children, and young adults.It provides recommendations and strategies for clinical practice in myopia management and summarizes important new findings in myopia research since 2019, which are summarized into the IMI 2023 Digest.This article aims to interpret the key contents of the series three of the White Paper on Myopia Prevention and Control, to help professionals involved in myopia control to stay informed about the latest evidence from international research, to optimize strategies for preventing and treating myopia-related diseases, and ultimately to promote the development of myopia research and management in China.
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Myopia has become a global public health concern with its increasing prevalence.It is the interaction result of genetic and environmental factors.Exploration of the changes of metabolites in myopia is helpful to know new clues about its pathogenic mechanism.Metabolomics focuses on the integral analysis of all small molecular metabolites (relative molecular mass <1 000) which form a biological system and it is used as an effective tool to discover potential biomarkers.Metabolomic analysis of the myopic population could discover the metabolic changes related to myopia and screen the markers with potential biological significance, which can be used in the early diagnosis and treatment of myopia.It has been found that metabolites related to oxidative stress and inflammation play an important role in the development of myopia.Abnormal energy metabolism and amino acid metabolism are associated with myopic fundus changes.In addition, classical myopia-associated metabolites such as retinoic acid, dopamine and vitamin D, other metabolites such as melatonin, cyclic adenosine monophosphate and 5-hydroxy indole acetic acid, as well as multiple metabolic pathways such as fatty acid metabolism and mitochondrial metabolism are all closely related to myopia.This article systematically reviewed metabolomics researches on myopia, providing clues for better prevention and control of myopia in the future.
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With the high incidence and early onset age of myopia, continuous attention has been paid to the prevention and control of high myopia.Interventions to control the progression of high myopia in children and adolescents at present mainly include low-dose atropine eye drops, orthokeratology, multifocal soft contact lenses and posterior scleral reinforcement.The interventions have also been applied among children with high myopia and have been proved effective in controlling the progression of myopia.Controversies over their clinical usages and safety still exist.There is a contradiction between concentration and safety of low-dose atropine eye drops, namely, higher concentration showing better efficacy is accompanied by the higher risk of adverse reactions.Meanwhile, there exist some children having poor response to atropine treatment.The long-term effect of orthokeratology lens is unclear, and how to choose the power of orthokeratology lens has not come to an agreement.The effect of multifocal soft contact lens on high myopia needs to be further verified by clinical trials with large sample size.Posterior scleral reinforcement is a surgical procedure, having a higher risk of adverse reactions and trauma than other interventions, and there is a lack of high-level evidence-based medical evidence to prove its efficacy.The promotion and application of interventions for high myopia still require the support of high-level medical evidences.From the perspectives of medicine, optics, surgery and other strategies, the recent controversies about the intervention for high myopia in children and adolescents were reviewed in this article.
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Objective:To investigate whether the presence of complement factor H( CFH) gene polymorphisms is associated with unexplained mild visual loss (UMVL) in type 2 diabetes mellitus patients. Methods:A case control study was adopted.The participants included two groups from a previous population-based epidemiology study on type 2 diabetes mellitus patients in the Beixinjing community, Shanghai: UMVL was defined by a best corrected visual acuity(BCVA)<20/25 and≥20/63 in both eyes, with no eye diseases causing visual impairment, such as corneal diseases, cataract, age-related macular degeneration, glaucoma, optic nerve atrophy, diabetic retinopathy, etc.Genomic DNA was isolated from the peripheral venous blood of all the participants and then loaded onto Fluidigm Digital Arrays.Four CFH gene single nucleotide polymorphisms (SNPs)(rs800292, rs1061170, rs529825, rs1410996, rs203674) were assessed with the SPSS 13.0 and HAPLoVIEW 4.0 software to test the statistical association of CFH polymorphisms with UMVL.The study protocol was approved by the Ethics Committee of Shanghai General Hospital, Shanghai Jiaotong University(No.2013KY023). All the procedures were conducted according to the tenets of the Declaration of Helsinki.Written informed consent was obtained from each subject prior to entering the study cohort. Results:Total of 135 residents with UMVL and 133 with normal vision(BCVA≥20/25 in both eyes) were enrolled.The UMVL group matched the control group in terms of gender, age, onset age, and duration of diabetes mellitus, hemoglobin A1c levels, and body mass index(all at P>0.05). The four SNPs(rs800292, rs1061170, rs529825, rs1410996) except rs203674 tested in the UMVL and control groups were qualified by the Hardy-Weinberg equilibrium ( P>0.05). There were no differences in SNPs and genotypes between the two groups in the four loci of the CFH gene.The P value of allele frequencies of rs529825, rs800292, rs1410996 and rs1061170 were 0.79, 0.25, 0.69 and 0.77, respectively, and the P value of genotype frequencies were 0.61, 0.69, 0.87 and 0.43, respectively. Conclusions:There is no correlation between CFH gene polymorphism and UMVL in type 2 diabetic patients.
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Ametropic visual impairment has become a public health problem in China and even in the world, especially the prevention and control of myopia development, and the Chinese government attaches great importances to the eye health of school-age children and adolescents.The establishment of visual health archives and the screening of refractive errors are important managements prevention and control.However, there has always been a lack of relevant domestic or international screening specifications, and which may result in screening implementation subject confusion, inconsistent screening indicators and boundary values, unscientific operation methods and feedback in the routine screening work in China.With the push and support of National Health Commission, a recommended national health standard Specification for Screening of Refractive Error in School-age Children and Adolescents (WS/T 663-2019) was officially issued on January 11, 2020 and will be implemented from June 1, 2020, which clarified the technical standardization for the specific requirement, methods, referral recommendation and management during screening of refractive error in school-age children and adolescents.Implementing an effective screening and prevention of ametropic visual impairment in school-age children and adolescents according to the standard is an important task and responsibility of medical and educational institutions.
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Background Researches showed that elevatory blood glucose level results in long-term damage of cells and tissue,or metabolic memory phenomenon,and manipulation of hyperglycemic memory is a good approach in the prevention of diabetic complications.However,its mechanism is not clear.It is speculated that the pathogenesis of diabetic retinopathy (DR) in diabetic patients may be associated to related mechanisms.Uncoupling proteins (UCPs) can decrease the production of reactive oxygen species (ROS),which may be related to DR.Objective This study was to explore the association between DR and the single nucleotide polymorphisms (SNPs) of UCP genes in Chinese Han population with type 2 diabetes.Methods A cross-sectional study was performed.This study was approved by Ethic Committee of Affiliated First Hospital of Shanghai Jiao Tong University and complied with Declaration of Helsinki,and written informed consent was obtained from each subject prior to any medical examination.One thousand eight hundreds and seventy-five patients with type 2 diabetes mellitus were enrolled in Xinjing district of Shanghai city by cluster sampling from November 2014 to January 2015.The demographic and medical baseline characteristics,ocular examination and laboratory tests were obtained and periphery blood of 2 ml was collected for extraction of DNA.Eight tag SNPs of UCP1,three tag SNPs of UCP2,and seven tag SNPs of UCP3 were selected as marker locus for the detection of genotype by Sequenom Mass ARRAY.Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry platform were used for genotyping.Hardy-Weinberg equilibrium (HWE) analysis,allele and genotype frequencies,haplotype analysis,and association tests for DR and SNPs were performed by SAS and SHEsis software.Results A total of 530 DR patients were checked out from 1 875 subjects with type 2 diabetes mellitus,with the detection rate of 28.27％.rs660339 locn of UCP2 gene and rs1626521,rs668514 locus of UCP3 gene appeared to have low detectable rates,and the secondary allele base frequency of rs632862 in UCP2 gene was ＜0.01 and rs15763 of UCP3 gene was unmatched with HWE,therefore,these locus analysis was not included.In 13 SNPs locus included in the analysis,only 2 SNPs of UCP1 gene were related to DR.Compared with the non-diabetic retinopathy (NDR) patients,the G allele frequency of rs10011540 was increased (P =0.03,OR =1.31,95 ％ confidence interval[CI] =1.03-1.67,and T allele frequency of rs3811787 was decreased (P=0.04,OR=0.86,95％ CI=0.75-0.99) in DR patients.Genotyping detection showed that the C/C and A/A frequencies of rs3811790 in UCP1 gene were significantly more and C/A frequency was less in DR patients than those in NDR patients (all at P＜0.01).The logistic regression analysis indicated an association of SNPs of rs10011540 and rs3811787 with DR independent from glucose and disease duration.Conclusions The SNPs of rs10011540 and rs3811787 locus in UCP1 gene are associated with DR in Chinese type 2 diabetes patients.
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Thinning and atrophy of sclerotic tissues play an important role in the development of high myopia. High myopic eyes had the thickest sclera at the posterior pole and the thinnest sclera at the equator. Most clinical studies found that scleral thickness was negatively correlative with the axial length. Patients complicated with posterior staphyloma had even thinner sclera, and its height was negatively related with the scleral thickness. At present, the main measurement methods for scleral thickness of high myopic eyes include histological measurement, enhanced depth imaging optical coherence tomography (OCT), and swept-source OCT. Following the development of OCT technique, it gradually becomes feasible to carry out studies on sclera thickness in mildly and moderately myopic populations, which is helpful to illuminate the mechanism of action of sclera on the onset and progression of high myopia.
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Background Measurement of corneal thickness is important for the early diagnosis and treatment of some eye disorders,including corneal diseases and refractive errors.However,the corneal parameters from schoolage population are rarely reported.Objective The aim of this survey was to characterize the central corneal thickness (CCT),minimum corneal thickness (MCT) and paracentral corneal thickness in healthy Chinese schoolage population.Methods A cross-sectional study was designed in this study.Children aged 7 to 15 years with the diopter of-3.00 D to +3.00 D were recruited from two primary schools in Baoshan district in Shanghai based on random cluster sampling under the approval of Shanghai First People's Hospital and informed consent of child custodian.Routine examinations were firstly performed to determine the healthy participants.CCT (within 2 mm range away the corneal vertex),MCT and paracentral corneal thicknesses (2 to 5 mm zone away the cornea vertex in superior,inferior,nasal and temporal quadrants) were then measured by RTVue Fourier optical coherence tomography (OCT) for the comparison between both eyes and different gender.The subjects were grouped into the 7-9,10-12 and 13-15 years groups,and the correlations between age and CCT,MCT and paracental corneal thicknesses were analyzed.The coordinate position of the thinnest cornea was determined.Results A total of 147 children were enrolled in the study.The mean CCT value of the right eyes was (537.77±29.33) μm,and that of the left eyes was (539.22±29.16) μm,showing a significant difference between them (t =-3.21,P =0.00).The paracentral corneal thicknesses of the right and left eyes were (565.52±30.11) μm and (568.42±31.07) pm in the superior quadrant,and those in the temporal quadrant were (549.01 ±30.46) μm and (547.24±30.23) μm,with significant differences between them (t =-2.47,P =0.01 ; t =2.12,P =0.04).No significant difference was found in the CCT,MCT,paracentral corneal thicknesses from various quadrants (all at P＞0.05).In addition,no considerably correlation was seen between age and CCT,MCT and paracentral corneal thickness (all at P＞0.05).The thinnest cornea area was located in the inferotemporal region in 40.82％ right eyes and 57.82％ left eyes.The distance of thinnest cornea area away corneal vertex was (0.62±0.33)mm in the right eyes and (0.91±0.63)mm in the left eyes,with a significant difference between them (t =-5.17,P =0.00).Conclusions The central,superior and temporal corneal thicknesses are significantly different between the right and the left eyes among healthy Chinese school-age children,but corneal thickness change is not associated with age or gender.The thinnest corneal area does not locate at the vertex.
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Background Epidemiologieal survey suggests that visual impairment in teenagers is a worldwide public health problem,and its leading cause is uncorrected refractive error.To conduct an extensive screening of visual impairment in teenagers and analyze the relevant affecting factors are significant works for the prevention and management of refractive errors.But high-quality epidemiological data on visual impairment and refractive error from large groups of children are lacking in Shanghai.Objective This study was to investigate the prevalence of ametropia and visual impairment in schoolchildren aged 6 to 12 years old.Methods In this cross-sectional study,4 686 students from 6 elementary schools in Baoshan District of Shanghai,a rural-urban fringe zone,China were selected by clustering sampling from May 2010 to April 2011.The eye examinations included visual acuity,ocular surface,ocular anterior segment,ocular media,fundus and intraocular pressure measurement,and the data autorefraction under cycloplegia and eye position were recorded.The cause of visual impairment was evaluated.Results A total of 4 594 students received examination with the response rate 98.0％,and autorefraction under cycloplegia was completed in 84.8％ schoolchildren (3 975/4 594).The prevalence rate of uncorrected visual acuity 0.5 or worse in both eyes was 14.4％ (662/4 594),with the wearing glasses rate 51.8％ (343/662).The percentage of students with the uncorrected visual acuity 0.5 or worse in at least one eye was 22.4％ (1 031/4 594).The prevalence rate of refractive error in the visual impaired students was 96.9％ (999/1 031),followed by amblyopia (37/1 031,3.6％).The prevalence rate of myopia,hyperopia,and astigmatic in the pupils after cycloplegia was 31.1％,4.3 ％ and 33.0％,respectively.In addition,the prevalence rate of myopia in public elementary schools was higher than that in migrant elementary schools (33.9％ versus 30.3％) (x2 =5.46,P =0.02).Logistic regression analysis showed that myopia was associated with age (OR =1.60,95 ％ CI:1.53-1.68,P ＜ 0.01) and female (OR =1.33,95％ CI:1.16-1.54,P＜0.01).Conclusions The leading cause of vision impairment is myopia in the elementary school students in Shanghai,China.The screening-ratio of refractive error and the coverage of refractive correction in the elementary school students in Shanghai are matters of urgent concern.