Effects of a new-generation hybrid contact lens on visual performance and vision-related quality of life in patients with keratoconus / Os efeitos de uma lente de contato híbrida de nova geração no desempenho visual e na qualidade de vida relacionada à visão em pacientes com ceratocone

ABSTRACT Purpose: The aim of this study was to evaluate the efficacy of a new-generation hybrid contact lens for improving visual outcomes and vision-related quality-of-life performance in patients with keratoconus who had intolerance or treatment failure of conventional correction methods such as the use of soft silicone-hydrogel or rigid gas-permeable contact lenses. Methods: Twenty-eight patients with keratoconus (42 eyes) were enrolled in this prospective cross-sectional study. Airflex (Swisslens) lenses were fitted in the patients' eyes in accordance with the manufacturer's instruction. Ophthalmologic examinations, including manifest refraction, best-corrected distance visual acuity, slit-lamp biomicroscopy, and National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) assessment, were performed at baseline and the 6-month visit. Results: An adequate fit was achieved in 39 eyes (92.9%) of 26 patients. Six eyes of 3 patients were excluded from the study owing to discontinuation of lens wearing. The mean age of the successful wearers was 20.3 ± 4.9 years. The mean best-corrected distance visual acuity was statistically significantly improved from 0.62 ± 0.30 to 0.11 ± 0.06 logMAR with the Airflex hybrid contact lenses (p<0.001). The mean overall composite NEI-VFQ-25 score statistically significantly increased with the Airflex hybrid contact lenses at the 6-month visit as compared with that at baseline (from 77.1 ± 16.3 to 90.9 ± 7.3, p=0.036). Statistically significantly better scores were obtained with the Airflex hybrid contact lenses in all the NEI-VFQ-25 subscale items (all p<0.05). No significant adverse effects were observed. Conclusions: New-generation hybrid contact lenses can be used as an effective alternative for correction of irregular astigmatism in patients with keratoconus who have intolerance or treatment failure of conventional methods. Significant improvement in vision-related quality-of-life in patients with keratoconus can be achieved with these lenses.

RESUMO Objetivo: Este estudo tem como objetivo avaliar a eficácia de lentes de contato híbridas de nova geração nos resultados visuais e na qualidade de vida relacionada à visão em pacientes com ceratocone com intolerância ou insucesso dos métodos de correção habituais, tais como lentes flexíveis de silicone-hidrogel ou rígidas permeáveis a gases. Métodos: Foram incluídos neste estudo transversal prospectivo 42 olhos de 28 pacientes com ceratocone. Uma lente Airflex (Swisslens) foi aplicada nos olhos de acordo com as instruções do fabricante. Um exame oftalmológico, incluindo refração manifesta, melhor acuidade visual corrigida para longe, biomicroscopia com lâmpada de fenda e a aplicação do National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), foi realizado no início do estudo e na visita de 6 meses. Resultados: Foi possível obter um ajuste adequado em 39 olhos (92,9%) de 26 pacientes. Foram excluídos do estudo 6 olhos de 3 pacientes devido à cessação do uso de lentes. A idade média dos usuários bem-sucedidos era de 20,3 ± 4,9 anos. A média da melhor acuidade visual corrigida para longe foi melhorada estatisticamente de 0,62 ± 0,30 para 0,11 ± 0,06 logMAR com as lentes de contato híbridas Airflex (p<0,001). A pontuação média geral composta no questionário NEI-VFQ-25 aumentou de forma estatisticamente significativa com a lente de contato híbrida Airflex na visita de 6 meses, em comparação com a pontuação inicial (de 77,1 ± 16,3 para 90,9 ± 7,3, p=0,036). As lentes de contato híbridas Airflex apresentaram pontuações melhores com significância estatística em todos os itens das sub-escalas do NEI-VFQ-25 (todos com p<0,05). Nenhum efeito adverso significativo foi observado. Conclusões: Lentes de contato híbridas de nova ge ração podem ser usadas como uma alternativa eficaz para a correção do astigmatismo irregular em pacientes com ceratocone com intolerância ou insucesso dos métodos habituais. Com essas lentes, pode-se alcançar uma melhora significativa na qualidade de vida relacionada à visão em pacientes com ceratocone.

Meta-analysis of repeated low-level red light therapy for retarding myopia progression in children / 中华实验眼科杂志

Objective:To systematically evaluate the effect of repeated low-level red light (RLRL) therapy on controlling the progression of myopia in children.Methods:Medline, Embase, Cochrane Library, Web of Science, ClinicalTrial.gov and the CNKI, VIP, Wanfang database, and Chinese Clinical Trial Registry (www.chictr.org.cn) were searched from their establishment to September 2022 to obtain the randomized controlled trial (RCT) about RLRL controlling myopia progression in children.Grey literature was also searched.Inclusion and exclusion criteria were developed according to the PICOS principle.Two researchers screened the literature independently, extracted data, and assessed the risk of bias in the included studies using the Cochrane collaboration tool for assessing risk of bias.The data were imported into RevMan 5.4 software for meta-analysis.Mean and standard deviation of data were used to obtain mean differences and 95% confidence intervals of included studies.Changes in spherical equivalent (SE) and axial length (AL) were compared between before and after the intervention in RLRL and single-vision spectacle (experimental group) and single-vision spectacle (control group). The GRADE system was used to grade the quality of evidence for the outcome indicators.Results:A total of 157 studies were obtained.After the screening, 7 RCT studies including 1 038 study subjects met the inclusion criteria.Meta-analysis results showed that retarded SE progression was retarded and AL elongation was reduced significantly after different follow-up durations (1, 3, 6, 12 and 24 months) in experimental group compared with control group.As the follow-up duration extended from 1 month to 24 months, the retard of SE progression increased from 0.14 to 0.93 D, and the reduction of AL increased from 0.07 to 0.48 mm.Both 635 and 650 nm red light significantly retarded SE progression and reduced AL elongation.The two outcome indicators, SE change and AL change were moderate-strength evidence by GRADE.Conclusions:The current moderate-strength evidence shows that RLRL can better retard myopia progression in children than single-vision spectacle glasses.

Inhibitory effects of 1% atropine on form deprivation-induced myopia development in guinea pigs and its mechanism / 中华实验眼科杂志

Objective:To observe the prevention and control effect of 1% atropine on the progression of form deprivation myopia (FDM) in guinea pigs and the potential biological mechanism.Methods:Sixty-nine 3-week-old tricolor guinea pigs with normal refraction were randomly divided into a normal control group ( n=19), a FDM group ( n=19), a FDM+ atropine group ( n=19), and an atropine group ( n=12). No intervention was given to guinea pigs in normal control group.The FDM model was established by covering the right eye of guinea pigs with a semitransparent latex facemask for 4 weeks in FDM and FDM+ atropine groups.For the FDM+ atropine group, 1% atropine gel was topically administered to the form-deprived right eyes once a day for 4 weeks.For the atropine group, the right eye was treated with 1% atropine gel once a day for 4 weeks.Refraction and axial length of guinea pigs were measured by retinoscopy and ophthalmic A-scan ultrasonography respectively at baseline, experiment week 2 and week 4.In experiment week 4, eyeballs were enucleated to make sections via the paraffin wax processing procedure, and the microstructural and ultrastructural changes of the sclera were observed under the light microscope and transmission electron microscope, respectively.The isobaric tags for relative and absolute quantitation labeling combined with liquid chromatography-tandem mass spectrometry were used to identify the differentially expressed proteins.Use and care of the animals complied with the Regulation for the Administration of Affairs Concerning Experiment Animals by State Science and Technology Commission.The study protocol was approved by the Institutional Animal Care and Use Committee of Tianjin Medical University (No.TJYY2020111028). Results:There were statistically significant differences in the diopter of guinea pigs at different time points among the four groups ( Fgroup=138.892, P<0.001; Ftime=167.270, P<0.001). Compared with normal control group, the diopter of guinea pigs in FDM group at experiment weeks 2 and 4, and FDM+ atropine group at experiment week 4 developed toward myopia, showing statistically significant differences (all at P<0.001). Compared with FDM group, the diopter of guinea pigs in FDM+ atropine group at experiment weeks 2 and 4 developed toward hyperopia, showing statistically significant differences (both at P<0.001). There were statistically significant differences in the axial length of guinea pigs at different time points among the four groups ( Fgroup=32.346, P<0.001; Ftime=353.797, P<0.001). The axial lengths of FDM group at experiment weeks 2 and 4 and FDM+ atropine group at experiment week 4 were longer than those of normal control group, and the axial lengths in FDM+ atropine group at experiment weeks 2 and 4 were shorter than those in FDM group, and the differences were statistically significant (all at P<0.001). The collagenous fibers of posterior sclera of guinea pigs were loose and disordered in FDM group, and were regular in FDM+ atropine group.The posterior scleral thickness of normal control group, FDM group, FDM+ atropine group and atropine group was (141.74±16.98), (101.46±9.15), (112.74±6.24) and (134.30±18.19) μm, respectively, with a statistically significant difference ( F=6.709, P=0.005). The posterior sclera was significantly thinner in FDM group than in normal control group and FDM+ atropine group (both at P<0.05). The diameter of posterior scleral collagen fiber gradually increased from inside to outside in normal control group, FDM+ atropine group and atropine group, and the diameters of the inner, middle and outer posterior scleral collagen fibers were smaller in FDM group than in normal control group.Proteomic analysis revealed 85 differentially expressed proteins (fold change>1.30) between FDM group and normal control group, FDM+ atropine group and FDM group, of which 38 were up-regulated and 47 were down-regulated after atropine treatment.Gene Ontology enrichment analysis showed that biological processes mainly involved were biological regulation, cell process, localization and metabolic process.Molecular function mainly involved were binding, catalytic activity, molecular function regulator, structural molecule activity and transporter activity.Cell components mainly involved were in cellular anatomical entity, intracellular and protein-containing complex. Conclusions:Atropine can increase the diameter of scleral collagen fibers in guinea pigs of FDM model, improve the arrangement of scleral collagen fiber, inhibit scleral thinning.The mechanism of atropine to control myopia progression is closely related to the tight junction between scleral cells, cytoskeleton and extracellular matrix remodeling.

Association of peripheral axial length, retinal curvature with refraction in school-aged children / 中华实验眼科杂志

Objective:To investigate the association of peripheral axial lengths and retinal curvatures with refractive status.Methods:A cross-sectional study was conducted out.Two hundred and eighty-seven eyes of 287 consecutive children aged 6-15 years old who recieved eye examinations at Beijing Tongren Hospital from July to October 2021 were enrolled, including 154 males and 133 females.Uncorrected and best corrected visual acuity were tested with a standard logarithmic visual acuity chart.Spherical equivalent (SE) was measured via an auto refractometer after cycloplegia with tropicamide.The hyperopic, emmetropic and myopic groups were defined with a SE >+ 0.5 D, SE >-0.5 D to ≤+ 0.5 D and SE≤-0.5 D, respectively.Central and 30° peripheral eye lengths (nasal, temporal, superior, inferior) were obtained using the Lenstar LS900.Retinal coordinates were derived from partial coherence interferometry modeling and converted to retinal curvatures.According to the median horizontal peripheral eye length differences (absolute difference between nasal and temporal), participants were assigned to H1 group (absolute difference <0.35 mm) or H2 group (absolute difference ≥0.35 mm). According to the median vertical peripheral eye length differences (absolute difference between superior and inferior), participants were assigned to V1 group (absolute difference <0.32 mm) or V2 group (absolute difference ≥0.32 mm). Four groups of V1H1, V1H2, V2H1 and V2H2 were constructed according to the grouping methods in both directions above.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital, Capital Medical University (No.TRECKY2021-162). Written informed consent was obtained from guardians of each subject prior to any medical examination.Results:The central axial length was 23.53(22.93, 24.10)mm.Peripheral eye lengths of temporal, nasal, superior and inferior were 22.75(22.11, 23.22)mm, 22.99(22.32, 23.45)mm, 23.24(22.58, 23.75)mm and 23.12(22.52, 23.56)mm, respectively.Temporal eye length was shorter than nasal, showing a statistically significant difference ( Z=-3.58, P<0.01). Compared with H2 group, H1 group had shorter central, nasal, superior and inferior eye lengths, showing statistically significant differences (all at P<0.05). Compared with V2 group, V1 group had shorter central, nasal and superior eye lengths, showing statistically significant differences (all at P<0.05). SE of H1 group was + 0.06 (-1.06, + 0.75) D, which was significantly greater than -0.32 (-1.64, + 0.56) D of H2 group ( Z=-2.10, P=0.04). SE of V1 group was + 0.13 (-0.81, + 0.80) D, which was significantly greater than -0.56 (-1.83, + 0.48) D of H2 group ( Z=-3.39, P<0.01). The myopia ratio of V1 group was 33.5% (58/173), which was significantly lower than 50.5% (53/105) of V2 group ( χ2=7.83, P<0.01). There was a significant overall difference in SE among VIH1, V1H2, V2H1 and V2H2 groups ( H=24.79, P<0.01). SE was greater in V1H1 group than V1H2, V2H1 and V2H2 groups (all at P<0.01). There was a significant difference in both horizontal and vertical retinal curvatures among different refractive groups ( H=22.34, 19.30; both at P<0.01). The retical curvature in both directions of hyperopic and emmetropic groups were significantly larger than those of myopic group (both at P<0.01). Conclusions:Peripheral eye lengths are asymmetric in school-aged children.Higher asymmetry is associated with myopic shifts.Myopic children have a steeper retina than the hyperopic and emmetropic children.

Comparing the vision quality using double-pass technique in eyes with corrected refractive errors and emmetropic eyes / Comparação da qualidade óptica usando a técnica de dupla passagem em olhos com erros de refração corrigidos e olhos emetrópicos

ABSTRACT Purpose: To evaluate the vision quality by measuring the objective light scatter index and objective optical quality parameters (Strehl Ratio and Modulation Transfer Function) in patients with emmetropia and ametropia. Methods: This prospective, cross-sectional study included 408 eyes. The ametropic group comprised of eyes with best-corrected visual acuity of 0.0 logMAR or better and present at least a refractive error of ≥0.25 D. Patients underwent slit lamp examination, visual acuity, refraction, and vision quality using the HD Analyzer. Results: The mean objective light scatter indices were 0.62 ± 0.63, 0.77 ± 0.70, 0.74 ± 0.30, 0.93 ± 0.55, and 0.85 ± 0.61, and mean Strehl Ratio and Modulation Transfer Function scores were 38.17 ± 10.4, 37.37 ± 10.06, 29.84 ± 9.71, 33.2 ± 12.11, and 33.13 ± 10.09 in emmetropes, myopia, hyperopia, spherical equivalent of ≥0, and spherical equivalent of <0, respectively. Differences in all variables were significant between emmetropic and corrected hyperopic and between spherical equivalent of ≥0, and spherical equivalent of <0 eyes (p<0.05). Conclusion: In spectacle-corrected conditions (with trial frames), emmetropic and simple myopic eyes had significantly better vision quality compared to hyperopic and astigmatic eyes. The clinical significance of these results should be investigated in further studies.

RESUMO Objetivo: Avaliar a qualidade óptica medindo o índice de dispersão objetiva de luz e os parâmetros de qualidade óptica objetiva (Razão de Strehl e Função de Transferência de Modulação) em indivíduos com emetropia e ametropia. Métodos: Estudo prospectivo, transversal, incluindo 408 olhos. O grupo ametrópico era de olhos com melhor acuidade visual corrigida de 0,0 logMAR ou melhor e apresentando, pelo menos, um erro refrativo de 0,25 D ou mais. Os pacientes foram submetidos a exame com lâmpada de fenda, acuidade visual, refração e qualidade óptica com o HD Analyzer. Resultados: O índice de dispersão objetiva de luz médio foi de 0,62 ± 0,63, 0,77 ± 0,70, 0,74 ± 0,30, 0,93 ± 0,55, 0,85 ± 0,61 e a média da Razão de Strehl e de Função de Transferência de Modulação foram 38,17 ± 10,4, 37,37 ± 10,06, 29,84 ± 9,71, 33,2 ± 12,11 e 33,13 ± 10,09 em olhos emetrópicos, míopes, hipermétropes, equivalente esférico ≥0 e equivalente esférico <0 respectivamente. Foram encontradas diferenças significativas em todas as variáveis entre olhos emetrópicos e com hipermetropia corrigida, equivalente esférico ≥ 0 e equivalente esférico <0 (p<0,05). Conclusão: Em condições com lentes corrigidas (com armações de prova), os olhos emetrópicos e com miopia simples apresentaram qualidade óptica significativamente melhor em comparação com os olhos hipermétropes e astigmáticos. O significado clínico destes resultados deve ser estudado posteriormente.

Effects of different intensity of lighting on refractive development and form deprivation myopia in guinea pigs / 中华实验眼科杂志

Objective:To investigate the effects of different intensity of lighting on normal refractive development and form deprivation myopia (FDM) in guinea pigs.Methods:A total of 108 healthy 3-week-old guinea pigs were divided into normal refractive development guinea pigs ( n=54) and FDM guinea pigs ( n=54). FDM models were prepared in FDM animals by occlusion of the left eyes using an opaque mask, and the bilateral eyes were open in the normal refractive development guinea pigs.The guinea pigs were randomized to low (20 lx), normal(300 lx), and high intensity-lighting (5 000 lx) groups with a 12-hour light/12-hour dark cycle for 6 consecutive weeks under LED light.The ocular biometry was performed in a two-week interval.Axial length (AL) and dilated diopter were measured by A-scan ultrasonography and retinoscopy, respectively, and were compared after different lighting durations, and the change trends of them in normal refractive development and FDM guinea pigs were evaluated. Results:The AL values were not significantly different among low, normal and high intensity-lighting groups ( Fgroup=0.365, P=0.697), and the AL was gradually prolonged over the lighting duration ( Ftime=353.750, P<0.001). The diopters showed a statistically significant difference among different intensity-lighting groups ( Fgroup=3.576, P=0.034). The diopter in high intensity-lighting for 4 weeks was (+ 2.75±2.15) D, which was significantly higher than (0.41±3.07) D in the normal refrective development guinea pigs ( P<0.001). In the FDM guinea pigs, both AL and diopter were not significantly different among low, normal and high intensity-lighting groups ( Fgroup=0.105, P=0.900; Fgroup=0.973, P=0.387), and significant differences were seen in AL and diopter among three groups ( Ftime=408.302, 27.407; both at P<0.001). The diopter in FDM eyes of low intensity-lighting for 2 weeks was (+ 2.35±1.95) D, which was higher than (+ 1.90±0.97) D before lighting, with no statistically significant difference between them ( P>0.05). The AL was shortest and the AL change was smallest in normal refractive development guinea pigs of high intensity-lighting group.The diopter change in FDM guinea pigs of the low intensity-lighting group was significantly smaller than that in the normal intensity-lighting group ( P<0.001), with a transient hyperopia drift. Conclusions:The 5 000 lx lighting can slow down the development toward myopia in the normal refractive development eyes, and 20 lx lighting tends to delay the progression FDM eyes with a hyperopic shift after lighting for 2 weeks.

Changes and health equity of low vision among children and adolescents in Chongqing during 2018 to 2021 / 中国学校卫生

Objective@#To understand changes and health equity of low vision in children and adolescents in Chongqing, and to provide reference for student myopia prevention and control.@*Methods@#Using longitudinal studies, all school students in grades 1 to grade 12 in Chongqing were examined for visual acuity during 2018 to 2021, and the prevalence as well as changes of low vision were analyzed. In 2021, stratified random sampling was used to evaluate the health equity of uncorrected visual acuity and diopter(spherical equivalent, SE).@*Results@#The prevalence of low vision for children and adolescents in Chongqing from 2018 to 2021 was 54.12%, 58.17%, 60.03% and 58.20% respectively. Low vision showed an increasing trend in the first three years and decreased by 1.83% in 2021 as compared with 2020( χ 2 trend =13 870.45, P <0.01). The difference in the detection rate of poor vision among students in different grades was statistically significant( χ 2=17 396.36, 2 093.95, 771.87, P <0.01). From 2018 to 2021, the detection rate of low vision in girls was higher than that of boys( P <0.01). The Gini coefficient was 0.054 57 for uncorrected visual acuity in urban area, higher than in rural areas (0.035 94). Meanwhile, the Gini coefficient of urban and rural SE was 0.065 82, higher than the country (0.049 30). The results showed that myopia in children and adolescents was more uneven in urban areas.@*Conclusion@#The adjustment of myopia prevention and control strategies in the late stage of the novel coronavirus pneumonia epidemic is related to the reduction of the detection rate of poor vision in children and adolescents in Chongqing. Low vision varied by grade and gender, suggesting tailored myopia prevention and control strategy. The detection rate of poor vision in cities is more uneven than in rural areas, and different myopia prevention and control measures need to be implemented according to regional characteristics.

Effects of environmental factors on refractive development of children and adolescents in different pubertal stages / 中国学校卫生

Objective@#To explore the effect of puberty on refractive development of children and adolescents and its interaction with outdoor activities, near work and the use of electronic products, so as to provide a reference for strategies for intervening myopia.@*Methods@#Cluster sampling method was used to select 776 students aged 7-13 from a nine year consistent school in Shanghai to participate and were followed up for 2 years. All participants underwent cycloplegic refraction and ocular axial length measurement once a year, as well as pubertal development, average daily outdoor time, near work time and time of electronic products usage. The influencing factors and interaction effects of refractive parameters in different puberty stages were analyzed by generalized estimation equation.@*Results@#At baseline, 634 children participated in cycloplegic refraction, of which 350 were myopic (55.2%). There were significant differences in axial length, average daily outdoor time, near work time and time of using electronic products at different stages of puberty ( F = 4.10 ，4.24，5.54，9.20， P <0.05). There was interaction between puberty and outdoor time on axial length development ( β =0.133, P < 0.05), and the interaction between puberty and the time of near work or using electronic products was not statistically significant ( P >0.05).@*Conclusion@#Puberty may play a regulatory role in the relationship between outdoor time and refractive development among Chinese children and adolescents.

Analysis of refractive status of preschool children in Suzhou High tech Zone / 中国学校卫生

Objective@#To observe the refractive status of preschool children, and to explore the prevalence and development trend of ametropia in preschool children, so as to provide support for controlling adolescent ametropia and improving children s health care service.@*Methods@#This cross sectional survey was conducted among 27 561 preschool children (55 122 eyes) aged 3-6 years old in the High tech Zone of Suzhou from September to December 2020. The refractive status was screened by the US Weilun binocular optometry.@*Results@#The total detection rate of ametropia was 9.5%, including 8.6% of astigmatism, 1.3% of hyperopia and 0.5% of myopia. The detection rates of myopia (1.1%) and hyperopia (2.2%) were the highest in the 6-year-old group, and the older the age was, the lower the spherical diopter was, and the higher the cylindrical diopter was. The abnormal rate of colposcopy in girls ( 1.3% ) was higher than that in boys (0.9%), and the abnormal rate of total anisometropia in women (2.3%) was also higher than that in men (1.9%). The main astigmatism was mixed astigmatism (49.1%) and compound hyperopia astigmatism (39.2%); The older the age, the lower the detection rate of compound hyperopia astigmatism. And it is dominated by regular astigmatism( 97.5% ); The higher the age, the higher the detection rate of astigmatism with the rule, while the lower the detection rates of astigmatism against the rule and oblique axis astigmatism.@*Conclusion@#The detection rate of myopia and hyperopia increased significantly at the age of 6, and anisometropia and axial astigmatism also reached the highest at the age of 6. Local health care departments should pay attention to children s astigmatism, especially astigmatism with the rule.

Is hypermetropia regressing in accommodative esotropia? / A hipermetropia regride na esotropia acomodativa?

ABSTRACT Purposes: To evaluate the relationship of changes in hypermetropia and ocular alignment in patients with accommodative esotropia. Methods: The medical records of consecutive patients diagnosed with refractive accommodative esotropia (esotropia eliminated or decreased to within 10 D with full hyperopic correction) were retrospectively reviewed. Cycloplegic refractions culled from medical records were converted into spherical equivalents. Presence of amblyopia, changes in refractive error and ocular alignment at admission and after the follow-up period were evaluated. Results: Seventy patients (mean age: 6.01 ± 5.41 years; female: 60.6%; mean follow-up: 5.8 ± 3 years) had corrected esotropia of 40 ± 20 prismatic diopters at admission. The average decrease per year in near and distance deviations with glasses was 1.71 ± 3.96 prismatic diopters/year and 1.09 ± 3.25 prismatic diopters/year, respectively. The total myopic shift of the right and left eyes was 1.08 ± 1.35 D and 1.20 ± 1.40 D, respectively. Myopic shift/year was 0.22 D/year and 0.26 D/year, respectively. The correlation between the rate of myopic shift and rate of change in corrected near deviation was weak. The correlation for the rate of myopic shift was not high for the right and left eyes (r=0.18; p=0.15). Conclusion: The amount of deviation and hypermetropia gradually decreased in accommodative esotropia during follow-up. On the other hand, it may be incorrect to assure patients that the amount of deviation will decrease in parallel with the refractive error.(AU)

RESUMO Objetivo: Avaliar a relação entre alterações na hipermetropia e o alinhamento ocular em pacientes com esotropia acomodativa. Métodos: Foram analisados retrospectivamente prontuários médicos de pacientes consecutivos diagnosticados com esotropia acomodativa refrativa (com esotropia eliminada ou reduzida a menos de 10 D com correção completa da hipermetropia). As medidas de refração em cicloplegia obtidas dos prontuários foram convertidas em equivalentes esféricos. Avaliaram-se ainda a presença de ambliopia, alterações do erro refrativo e o alinhamento ocular à admissão e depois do período de acompanhamento. Resultados: Setenta pacientes (média de idade=6,01 ± 5,41 anos, 60,6% do sexo feminino, acompanhamento médio de 5,8 ± 3 anos) apresentaram esotropia de 40 ± 20 dioptrias prismáticas (DP) para perto à admissão. A diminuição média anual no desvio para perto e para longe com o uso de óculos foi de 1,71 ± 3,96 DP/ano e 1,09 ± 3,25 DP/ano, respectivamente. Os desvios miópicos totais dos olhos direito e esquerdo foram de 1,08 ± 1,35 D e 1,20 ± 1,40 D, respectivamente. Os desvios miópicos anuais foram de 0,22 D/ano e 0,26 D/ano para os olhos direito e esquerdo, respectivamente. A correlação entre a taxa de desvio miópico e a taxa de alteração do desvio para perto corrigido foi fraca. A correlação da taxa de desvio miópico não foi alta para os olhos direito e esquerdo (r=0,18, p=0,15). Conclusão: A quantidade de desvio e a hipermetropia diminuem gradualmente na esotropia acomodativa durante o acompanhamento. Por outro lado, pode não ser apropriado garantir aos pacientes que o desvio diminuirá em paralelo ao erro refrativo.(AU)

Comparação das medidas refratométricas através da utilização do Photoscreener 2win® e da retinoscopia manual em pré-escolares assintomáticos / Comparison of refractometric measurements using 2win® Photoscreener and manual retinoscopy in asymptomatic preschoolers

RESUMO Objetivos: Avaliar a sensibilidade, especificidade e acurácia da refratometria obtida através do aparelho photoscreener 2WIN® como método de rastreio de ametropias com indicação de prescrição de óculos pelos critérios da Sociedade Brasileira de Oftalmopediatria em crianças assintomáticas, de origem extra-hospitalar, de 6 a 36 meses de idade, e determinar se a cicloplegia influencia a capacidade de rastreio do aparelho. Métodos: Cento e setenta e oito (178) de crianças com idades entre 6 e 36 meses tiveram sua refratometria mensurada pelo método padrão-ouro, a retinoscopia manual sob cicloplegia, e pelo método em teste, o photoscreener 2WIN®, antes e após a cicloplegia. Resultados: O photoscreener 2WIN® é capaz de identificar aqueles pacientes que deveriam receber prescrição de óculos pelos critérios da Sociedade Brasileira de Oftalmopediatria com sensibilidade de 100%, especificidade de 93,18% e acurácia de 93,26%, quando comparado a retinoscopia estática. Sob cicloplegia, o 2WIN® mantém sensibilidade de 100%, porém aumenta sua especificidade para 96,59% e a acurácia para 96,63%. Conclusão: O photoscreener 2WIN® se mostrou altamente sensível, específico e acurado para uso como equipamento de triagem daqueles pacientes de 6 a 36 meses que se beneficiariam do uso de óculos pelos critérios da Sociedade Brasileira de Oftalmopediatria, com discreto aumento da especificidade e acurácia quando aplicado em pacientes cicloplegiados.

ABSTRACT Objective: Evaluate the sensitivity, specificity e accuracy of the ocular refraction measured by the 2WIN® photoscreener as a screening method to identify children in need of spectacles prescription according to the criteria published by the Brazilian Society of Pediatric Ophthalmology (BSPO) in asymptomatic children, 6 to 36 months old, and determine the impact of cycloplegia in the sensitivity, specificity and accuracy of this method. Methods: One hundred seventy-eight (178) eyes of asymptomatic children between the ages of 6 and 36 months have been submitted to ocular refraction measurements by the gold-standard method, the manual retinoscopy under cycloplegia, and the method been tested, the 2WIN® photoscreening, both before and under cycloplegia. Results: The 2WIN® photoscreener before cycloplegia was able to identify those patients in need of spectacles prescription according to the criteria published by the BSPO with 100% sensitivity, 93.18% specificity and 93.26% accuracy, when compared to the manual retinoscopy under cycloplegia. The 2WIN® photoscreener under cycloplegia maintained a sensitivity of 100%, but increased specificity to 96.59% and accuracy to 96.63%. Conclusion: The 2WIN® photoscreener before cycloplegia showed high sensitivity, specificity, and accuracy in detection of patients in need of spectacles prescription according to the criteria published by the BSPO in the tested population, with minor increase in specificity and accuracy when the measurements were performed under cycloplegia.

Comparison of prediction accuracy of five different biometric formulas / Comparação da acurácia preditiva de cinco fórmulas biométricas diferentes

ABSTRACT Objective To compare the performance of Sanders-Retzlaff-Kraft/Theoretical, Hoffer Q, Barrett Universal II, Kane, and Hill-radial basis function formulas to calculate intraocular lens power in eyes with normal axial length, in terms of predicting target refraction by using partial coherence interferometry technology. Methods Phacoemulsification and intraocular lens implantation were performed in 135 eyes of 135 patients with an axial length between 22 and 24.5 mm. Axial length, keratometry, and anterior chamber depth were measured by intraocular lens Master 500. Sanders-Retzlaff-Kraft/Theoretical, Hoffer Q, Barrett Universal II, Kane, and Hill-radial basis function formulas were used for intraocular lens power calculations. The difference between the expected postoperative refraction and the mean absolute prediction error was calculated for each eye. Statistical significance was evaluated at the level of p<0.05. Results The study included 135 subjects. The mean axial length, anterior chamber depth, keratometry, and intraocular lens power were 23.2±1.2 (22 to 24.5) mm, 3.2±0.4 (2.4 to 4.4) mm, 43.5±1.5 (40.8 to 46.2) diopter, 21.5±1.8 (18.5 to 25.5) diopter, respectively. The mean absolute prediction error for Sanders-Retzlaff-Kraft/Theoretical, Hoffer Q, Barrett Universal II, Kane, and Hill-radial basis function was 0.306±0.291, 0.312±0.257, 0.314±0.268, 0.299±0.206 and 0.308±0.280, respectively (p>0.05). Conclusion The study showed the third-generation (Sanders-Retzlaff-Kraft/Theoretical and Hoffer Q), fourth-generation (Barrett Universal II) and new-generation (Kane and Hill-radial basis function) intraocular lens power calculation formulas had similar performances regarding calculation of intraocular lens power to predict target refraction after phacoemulsification in eyes with normal axial length.

RESUMO Objetivo Comparar o desempenho das fórmulas Sanders-Retzlaff-Kraft/Teórica, Hoffer Q, Barrett Universal II, Kane, e Hill-radial basis function (RBF) para cálculo de poder dióptrico das lentes intraoculares, em olhos com comprimento axial normal, em termos de predição da refração alvo, utilizando a tecnologia de interferometria de coerência parcial. Métodos Facoemulsificação e implante de lentes intraoculares foram realizados em 135 olhos de 135 pacientes com comprimento axial entre 22 e 24.5 mm. Comprimento axial, ceratometria, e profundidade da câmara anterior foram medidos por lente intraocular Master 500. As fórmulas Sanders-Retzlaff-Kraft/Teórica, Hoffer Q, Barrett Universal II, Kane, e Hill-radial basis function foram empregadas para cálculo de poder dióptrico das lentes intraoculares. A diferença entre a refração esperada no pós-operatório e a média dos erros absolutos preditivos foi calculada para cada olho. Os valores de p<0,05 foram considerados estatisticamente significativos. Resultados O estudo incluiu 135 sujeitos. As médias de comprimento axial, profundidade da câmara anterior, ceratometria, e poder dióptrico das lentes intraoculares foram 23,2±1,2 (22 a 24,5) mm, 3,2±0,4 (2,4 a 4,4) mm, 43,5±1,5 (40,8 a 46,2) dioptria, 21,5±1,8 (18,5 a 25,5) dioptria, respectivamente. A média de erro absoluto preditivo para as fórmulas Sanders-Retzlaff-Kraft/Teórica, Hoffer Q, Barrett Universal II, Kane, e Hill-radial basis function foi 0,306±0,291, 0,312±0,257, 0,314±0,268, 0,299±0,206 e 0,308±0,280, respectivamente (p>0,05). Conclusão O estudo mostrou que as fórmulas de terceira geração (Sanders-Retzlaff-Kraft/Teórica e Hoffer Q), de quarta geração (Barrett Universal II) e as da nova geração (Kane e Hill-radial basis function) para cálculo de poder dióptrico das lentes intraoculares, têm desempenhos semelhantes para cálculo do poder dióptrico das lentes intraoculares, para predizer a refração alvo após facoemulsificação em olhos com comprimento axial normal.

Intraoperative complications and treatment in femtosecond laser small incision lenticule extraction / 中华实验眼科杂志

As a relatively new procedure, femtosecond laser small incision lenticule extraction (SMIIE) is still in its initial stage.Despite the safety, efficacy, predictability and stability it has showed in refractive error correction, there are still reports of intraoperative complications resulting in different clinical outcomes in SMILE.SMILE includes the production of lenticule by femtosecond laser, the separation and extraction of lenticule, and intraoperative complications may occur in every step.The production of the lenticule is completely dependent on the femtosecond laser, so complications related to femtosecond lasers are inevitable, such as suction loss, opaque bubble layer and black spots.Separation and extraction of the lenticule relies on the experience and surgical skills of surgeon, during which, torn corneal cap, difficult lenticule extraction, lenticule remnants, bleeding and lenticule decentration may occur.In this article, the categories, reasons, management and effects of intraoperative complications on outcome in SMILE were summarized to improve the ability of ophthalmologists to handle intraoperative incidents and enhance surgical safety.

Effect of intensive intervention for improving the referral rate among preschoolers with vision abnormalities / 中国学校卫生

Objective@#To explore effect of intensive intervention for improving the referral rate of children with visual refractive disorders, and to provide a reference for myopia prevention and control of children and adolescents.@*Methods@#A total of 4 464 preschool children were selected from Zhuanqiao county, Minghang district in Shanghai for the eyesight investigation during April to June in 2019. Stratified random cluster sampling method was used to divide 1 724 children into intervention group and (896) control group (828) depending on the type of kindergartens. The intervention group was provied with an intensive intervention, including children s vision health assessment, parental self management guidance for children s eye care, and community based eye care services, while the control group carried out routine intervention measures.@*Results@#In 2019, the incidence of visual and primary refractive screen abnormalities in preschoolers of Zhuanqiao community was 38.62%. The incidence of naked eye vision abnormalities was 4.40%, the incidence of myopia risk group, hyperopia risk group and astigmatism risk group was 37.10%, 2.20%, and 6.10 %, respectively. After the intervention, the referral rate of the intervention group (68.75%) was significantly higher than that of the control group (17.15%)( χ 2=465.09, P <0.01). The differences between two groups were statistically significant in choosing the hospital for treatment ( χ 2=10.01, 51.51, 15.40, 27.79, 19.96, 24.24, P <0.01).@*Conclusion@#The vision and refractive status of preschoolers worths further attention. Intensive intervention can improve the referral rate for children with screened vision abnormalities, which facilitates the prevention and early diagnosis of vision problems among preschoolers.

Effects of orthokeratology lenses and frame glasses on anisometropia in primary and middle school students with low myopia in one eye / 中国学校卫生

Objective@#To investigate the effects of orthokeratology lenses and frame glasses on anisometropia in children with low myopia in one eye.@*Methods@#Between January 2017 and January 2018, 120 children of primary and secondary school age with myopic anisometropia low myopia in one eye presenting to the Second People s Hospital of Yunnan Province were selected as research objects,with average refractive error of(-1.00,-2.50)D in one eye and(-0.50,0.50)D in another eye. Participants were divided into an experimental group and a control group (60 cases per group), according to a random number grouping method. The control group were given frame glasses, while the experimental group were given orthokeratology lenses. A prospective study was conducted to compare and analyze the lengths of the posterior eye axis (AL) and spherical equivalent (SE), measured at different time intervals between the two groups.@*Results@#There were some initial differences in AL and SE between the two groups before the experiment began; however, this difference was not statistically significant (P>0.05). After 12 months, participants myopic eyes given the orthokeratology lenses had shorter AL[(24.91±0.11)mm] compared to the control group[(25.02±0.09)mm],participants health eyes had longer AL[(24.58±0.24)mm] compared to the control group[(24.20±0.13)mm]. One month after the subjects stopped wearing plastic mirrors,participants myopic eyes had higher SE[(-2.22±0.78)D] compared to the control group[(-2.64±0.21)D],and had lower that in the control group[(-0.96±0.84)(-0.37±0.54)D](t=4.02，-4.58，P<0.05).@*Conclusion@#In children with low myopia in one eye, compared with wearers of frame glasses, wearing corneal shape lenses can effectively restrain AL extend and control the progression of eye myopia. At the same time, wearing corneal shape lenses can promote contralateral healthy eye axial extension and an increase in diopter, reduce the anisometropia value, solve the problems of a binocular visual axis development imbalance, and promote coordinated eye development.

Eyeglass prescription and refractive examination of grade 4-6 primary school students in Henan / 中国学校卫生

Objective@#To analyze the prevalence of poor vision and eyeglass prescription, refractive examination among primary school students of grade 4-6 in Henan, so as to provide scientific basis for precise interventions for student vision health.@*Methods@#A stratified cluster random sampling method was used to investigate a total of 29 187 students of grade 4-6 from 17 cities in Henan Province. Distant vision examination and questionnaire survey were conducted.@*Results@#The overall prevalence of poor vision for grade 4-6 students in Henan was 63.6%, with girls (69.0%) higher than boys (59.0%),urban students (65.3%) higher than suburban students (62.5%)( χ 2=312.6, 23.6, P <0.01). The prevalence of severe poor vision was 28.5%.With the increase of grade, the detection rate of poor vision and severe poor vision increased( χ 2 trend =278.7, 775.4, P <0.01). Totally 13.2% of pupil did not have a visual examination in the past year. The rate of wearing glasses was 27.0% for students with poor eyesight and 3.2% for students with poor monocular eyesight. Totally 46.8% of the students wearing glasses received mydriatic optometry before wearing glasses.@*Conclusion@#The problem of poor vision among students of grade 4-6 in Henan is prominent, so it is necessary to strengthen eyesight monitoring and eye health education.

Study on the growth curve of uncorrected visual acuity of children and adolescents with relative safe refractive range / 中国学校卫生

Objective@#To analyze the distribution of uncorrected visual acuity in children and adolescents aged 3-18 years with relative safe refractive range, and to develop the growth curve and reference range of uncorrected visual acuity in children and adolescents of different ages, so as to provide reference for formulating the referral threshold for myopia screening practice.@*Methods@#Using cluster sampling method, 9 146 children and adolescents aged 3-18 years old in Shanghai were selected for uncorrected visual acuity, cycloplegic refraction, slit lamp and other ophthalmic examinations, and the percentiles and growth curve of uncorrected visual acuity of children and adolescents in the relative safe refractive range were fitted by LMS method. Besides, the area under the ROC curve and the sensitivity and specificity of different cut-off values were analyzed.@*Results@#The uncorrected visual acuity was skewed, with a median of 4.8. There were 4 675 individuals with safe refraction, the median of uncorrected visual acuity in which was 4.9. The LMS curve showed that the uncorrected visual acuity increased with age in the lower age group, and gradually stabilized to the best level at the age of 6-10. P 50 was 4.8 in 3-4 years old, 4.9 in 5-8 years old, 5.0 in 9 years old and above. The area under ROC curve of uncorrected visual acuity predicting refractive abnormality increased with age, with the lowest value of 0.55(95%CI=0.50-0.61) at 3 years old and the highest value of 0.95 (95%CI=0.94-0.96) at 12-18 years old. The Youden index was the highest for P25 at 3-6 years old, and the highest for P 10 at 7 years old and above. With the increase of the cut off value, the sensitivity increased and the specificity decreased.@*Conclusion@#The uncorrected visual acuity increases gradually with age, and reaches the best level after 6-10 years old. The screening effect of uncorrected visual acuity predicting refractive abnormality increased with age. It is suggested that the referral threshold of children and adolescents with abnormal uncorrected visual acuity should be set according to their ages, and P 25-P 75 can be selected according to the screening purposes.

Refractive development during the past 5 years among primary school students in Jinshan District of Shanghai / 中国学校卫生

Objective@#To explore refractive development of primary school students in Jinshan district of Shanghai during the past five years.@*Methods@#A total of 201 first grade pupils enrolled in 2013 were followed up for 5 years. Annual examination of non-cycloplegic refraction and axial length (AL) was implemented and analyzed.@*Results@#The mean spherical equivalents (SEs) of boys at each grade was (0.22±0.53)(-0.04±0.64)(-0.36±0.92)(-0.74±1.23)(-1.14±1.67)D, respectively; for girls, (0.26±0.88)(-0.03±1.02)(-0.28±1.02)(-0.64±1.32)(-1.13±1.65)D, respectively. The mean ALs of boys at each grade was (22.94±0.60)(23.13±0.68)(23.45±0.69)(23.65±0.81)(24.03±0.93)mm, respectively and was (22.40±0.67)(22.67±0.70)(22.95±0.74)(23.14±0.79)(23.59±0.90)mm for girls at each grade, respectively. There were negative correlations between dioptres and ALs in each grade(r=-0.26, -0.35, -0.41, -0.53, -0.59, P<0.05).@*Conclusion@#The dioptre and AL among primary school students in Jinshan district of Shanghai increased gradually and results in developing into myopia. The dioptre negatively associates with AL, which should be both paid attention to among primary school students.

Analysis between two optical biometric devices in patients with cataract / Análise entre dois dispositivos de biometria óptica em pacientes com catarata

ABSTRACT Objective: To evaluate the correlation of optical biometry and target with variable ages, anterior chamber depth, axial length, R1/K1 and R2/K2 established by two optical biometry devices in patients with cataract. Methods: The study included the analysis of 348 medical records, from which 503 cataract eyes were selected, which underwent evaluation by the optical biometric devices IOL Master 700 and Lenstar LS 900 in the period of April to July 2017. Data collected were: age, anterior chamber depth, axial length, R1/K1 and R2/K2. Results: The average of the biometrics obtained using Lenstar was 21.02, varying 3.46, more or less, with an average target of -0.02, varying 0.45. In relation to the IOL Master it was 21.19, with a variation of 3.40 and average target of -0.01, a variation of 0.11. It can be observed that despite close values in relation to the mean, there was significance (p<0.001). Axial length (p<0.001) and R1/K1 (p<0.001) had an influence on the difference of the biometric values between the devices. Conclusion: A high degree of clinical and statistical correspondence was observed between the results obtained by the biometry devices in patients with cataract.

RESUMO Objetivos: Avaliar a correlação da biometria óptica e target com as variáveis idade, profundidade da câmara anterior, comprimento axial, R1/K1 e R2/K2 estabelecidos por dois dispositivos de biometria óptica em pacientes com catarata. Métodos: O trabalho abrangeu a análise de 348 prontuários dos quais foram selecionados 503 olhos com catarata ,que passaram pela avaliação nos dispositivos de biometria óptica IOL Master 700 e Lenstar LS 900 no período de abril a julho de 2017. Os dados colhidos foram: idade, profundidade da câmara anterior, comprimento axial, R1/K1 e R2/K2 . Resultados: A média da biometria obtida utilizando o Lenstar foi de 21,02, variando 3,46 para mais ou para menos, com target médio de -0,02, variando 0,45. Já em relação ao IOL Master foi de 21,19, com variação de 3,40 e target médio de -0,01, variação de 0,11. Pode-se observar que apesar de valores próximos em relação à média, houve significância (p < 0,001). Houve a concordância da biometria em relação ao comprimento axial (p < 0,001) e R1/K1(p < 0,001). Conclusão: Observou-se alto grau de correspondência clínica e estatística entre os resultados obtidos pelos dispositivos de biometria em pacientes com catarata.

Straatsma syndrome: two case reports / Síndrome de Straatsma: dois relatos de caso

Abstract This article reports two cases of Straatsma Syndrome, a rare disease, emphasizing its clinical features that inclued myopia, strabismus and amblyopia associated with persistent myelinated fibers in the retina. Ophthalmic examination, color retinography and optical coherence tomography were performed.

Resumo Este artigo relata dois casos de síndrome de Straatsma, uma doença rara, enfatizando suas características clínicas que incluem miopia, estrabismo e ambliopia associada a persistência de fibras de mielina na retina. Foram realizados exame oftalmológico, retinografia e tomografia de coerência óptica.