Refractive profile of children treated with intravitreal bevacizumab for retinopathy of prematurity

Purpose: To study the refractive profile of children after they received intravitreal injection of bevacizumab for retinopathy of prematurity (ROP). Methods: The study was conducted at a tertiary eye care hospital in South India. ROP patients of more than 1 year of age, presenting to the Pediatric Ophthalmology Clinic and Retina Clinic and having history of treatment for type ? ROP with intravitreal bevacizumab (IVB) or intravitreal bevacizumab and laser photocoagulation were included in the study. Cycloplegic refraction was done, and the refractive status was evaluated. The refractive status of age?matched, full?term children with uneventful perinatal and neonatal history was also recorded and compared to the study group. Results: Among 134 eyes of 67 study subjects, the major refractive error was myopia in 93 eyes (69.4%; spherical equivalent [SE] = ?2.89 ± 3.1, range = ?11.5 to ?0.5 D). There were 75 eyes (56%) with low?to?moderate myopia; high myopia was seen in 13.4%, emmetropia in 18.7%, and hypermetropia in 11.9% of eyes. The majority of them (87%) had with?the?rule (WTR) astigmatism. In 134 eyes, the SE was ?1.78 ± 3.2 (range = ?11.5 to 4 D); the SE of the 75 eyes with low?to?moderate myopia was ?1.53 ± 1.2 (range = ?0.50 to ?5 D). In the control group, the majority had emmetropia (91.8%). There was no significant association between the age at which IVB had been injected and the development of refractive errors (P = 0.078). The prevalence of low?to?moderate myopia was more than high myopia in patients with zone ? and zone ? ROP before treatment (60.0% and 54.5%, respectively). Conclusion: Myopia was the major refractive error seen in post?IVB pediatric patients. WTR astigmatism was more commonly seen. The age at which IVB injection had been given had no effect on the development of refractive errors

Clinical correlation between automated vision screening under cycloplegia and retinoscopy in young children / Correlação clínica entre triagem visual automatizada sob cicloplegia e retinoscopia em crianças pequenas

ABSTRACT Purpose: To evaluate the clinical performance of the Spot Vision Screener and establish clinical correlations between automated screening and retinoscopy following induction of cycloplegia in preverbal children. Methods: In this prospective, cross-sectional study, children aged 6-36 months were evaluated using the Spot Vision Screener. A complete ophthalmologic examination, including cycloplegic refraction assessment, was performed, followed by repeat spot vision screening and retinoscopy in all cases to establish correlations regarding hypermetropia, myopia, and astigmatism following induction of induction cycloplegia. Results: The study included 185 children. The sensitivity of the automated screener after cycloplegia was 100% (95%CI: 85.18-100%), and specificity was 87.04% (95%CI: 80.87-91.79%). Positive and negative predictive values were 52.27% (42.36-62.01%) and 100%, respectively. Compared to retinoscopy, the Spot Vision Screener overestimated spherical values by 0.62 D (95%CI: 0.56-0.69) in the right eye and by 0.60 (95%CI: 0.54-0.66) in the left eye and cylindrical values by -0.38 D in the right eye (95%CI: -0.42--0.33) and by -0.39 D in the left eye (95%CI: -0.43--0.34). For overall spherical and cylindrical values, the difference was 0.61 D (95%CI: 0.57-0.65) and -0.38 D (95%CI: -0.41--0.35) in the left and right eyes, respectively. Conclusion: A substantial correlation was found between retinoscopy and objective data captured by the device. This shows that technology can be used in conjunction, reaching a more accurate diagnosis and identifying amblyopia risk factors as early as possible. Photoscreening may make a difference at the population level for early screening and intervention.

RESUMO Objetivo: Avaliar o desempenho clínico do Spot Vision Screener e estabelecer correlações clínicas entre a triagem automatizada e a retinoscopia após indução de cicloplegia em crianças pré-verbais. Métodos: Neste estudo transversal prospectivo, crianças de 6 a 36 meses foram avaliadas usando o Spot Vision Screener. O exame oftalmológico completo, incluindo refração cicloplégica, foi então realizado, seguido de repetição da triagem automatizada e retinoscopia em todos os casos, a fim de estabelecer correlações quanto à hipermetropia, miopia e astigmatismo após a indução de cicloplegia. Resultados: O estudo incluiu 185 crianças. A sensibilidade do dispositivo de triagem automática após cicloplegia foi de 100% (IC 95%: 85,18-100%) e a especificidade foi de 87,04% (IC 95%: 80,87-91,79%). Os valores preditivos positivos e negativos foram de 52,27% (42,36 - 62,01%) e 100%, respectivamente. Em comparação com a retinoscopia, o Spot Vision Screener superestimou os valores esféricos em 0,62 D (IC 95%: 0,56 - 0,69) no olho direito e em 0,60 (IC 95%: 0,54 - 0,66) no olho esquerdo e os valores cilíndricos em -0,38 D (IC 95%: -0,42 a -0,33) no olho direito e por -0,39 D (IC 95%: -0,43 a -0,34) no olho esquerdo. A diferença para os valores esféricos e cilíndricos de forma geral foi de 0,61 D (IC 95%: 0,57 - 0,65) e -0,38 D (IC 95%: -0,41 a -0,35), respectivamente. Conclusão: Foi encontrada correlação substancial entre a retinoscopia e os dados objetivos captados pelo dispositivo. Isso mostra que a tecnologia pode ser usada em conjunto, contribuindo para um diagnóstico mais preciso e identificando os fatores de risco de ambliopia o mais precocemente possível. A técnica automatizada pode fazer a diferença em nível populacional para triagem e intervenção precoce.

CLINICAL EVALUATION OF INTRAOCULAR PRESSURE MEASUREMENTS USING DIFFERENT TONOMETERS IN PATIENTS OF VARIOUS REFRACTIVE ERRORS

Background: Intraocular pressure (IOP)is an important ?rst indicator of probability and suspicion of Glaucoma. The virtual IOP status is grossly in?uenced by multiple factors including Refractive errors ,corneal biomechanics ,central corneal thickness(CCT) and Scleral rigidity. To compare relative IOP measurements and Aim: its variability in Emmetropes, myopic and hypermetropic patients using Schiotz, Goldmann Applanation(GAT)and I-Care Rebound tonometer to establish an equation between virtual and real time IOP. This observational Materials and Methods: prospective study comprised of 100 subjects above the age of 18 years inclusive37 Emmetropes , 31 Hypermetropes and remaining 32 belonged to myopia . Descriptive statistics were performed using SPSS for Windows Statistical Analysis : version 17.0 to calculate the demographic characteristics of the study cohort. The data were expressed as mean values including the standard deviation (SD) and the 95% con?dence interval (CI). Mean IOP measurements between Schiotz, I-Care and GAT were compared by One way ANOVA along with Individual pair wise comparison by applying Post Hoc Tukey Test for comparison of IOP measurements using a particular method of Tonometry in individuals of myopia, hypermetropia and emmetropia. The highest mean value of CCT 536.667 mum was in Hypermetropes whereas the lowest CCT value of Results: 507.031mum was in myopic eyes with statistically signi?cant (P<0.05). The mean value for IOP in Emmetropes was16.665 mm Hg for Schiotz , 15.027 Hg for GAT and 15.081 mm Hg for I –Care .Whereas Hypermetropes revealed mean value of 15.055 mm Hg for Schiotz , 14.323 mm Hg for GAT and 14.065 mm Hg for I –Care . The mean value for IOP in Myopic eyes was 16.875 mm Hg for Schiotz , 14.375 mm Hg for GAT and 14.688 mm Hg for I –Care . The study had revealed higher mean Conclusion : value of IOP in Myopic eyes as compare to Emetropic and Hypermetropic subjects.IOP measurements by the Schiotz tonometer were signi?cantly higher as compare to GAT and I-Care tonometer. Whereas recordings by GAT and I Care tonometers were almost in agreement .De?nitive correlation could not be established between pachymetry readings and adjusted IOP following GAT and I –Care tonometry .

A cross-sectional study analyzing the correlation between the mean retinal nerve fiber layer and ganglion cell layer thickness with axial length and refractive errors among children aged 5–15 years

Purpose: To analyze the correlation between the mean retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness with axial length and refractive errors among children aged 5–15 years. Methods: This cross?sectional, observational study was done on 130 eyes of 65 consecutive subjects with refractive errors. The patients were evaluated for RNFL thickness and macular GCL thickness using spectral domain? optical coherence tomography. Results: One hundred and thirty eyes of 65 subjects aged between 5 and 15 years were divided into three groups based on their spherical equivalent in diopters (D). The children with a spherical equivalent of ??0.50 D were considered myopic, ??0.5 to ?+0.5 D were considered emmetropic, and ?+0.50 D were considered hypermetropic. RNFL thickness and GCL thickness were correlated with age, gender, spherical equivalent, and axial length. The mean global RNFL thickness was 104.58 ?m ± 7.567. Conclusion: There exists a negative correlation between RNFL thickness and macular GCL thickness with increasing severity of myopia and increase in axial length, and the possible reason could be stretching of the sclera, which further leads to stretching of the retina, resulting in thinner RNFL and macular GCL thickness

Accuracy of different intraocular lens power calculation formulas in cataract patients with shallow anterior chamber: a meta-analysis / 中华实验眼科杂志

Objective:To systematically compare the accuracy of intraocular lens (IOL) power calculation formulas in cataract patients with shallow anterior chamber.Methods:A comprehensive literature search was conducted in MEDLINE, EMBASE, Cochrane Library, and the Chinese databases including CNKI, Wanfang, and VIP databases.The peer-reviewed literature on the accuracy of IOL power calculation formulas in cataract patients with shallow anterior chamber was searched from the establishment of the database until August 2020.Literature screening, data extraction and quality assessment were performed according to inclusion and exclusion criteria.The mean difference ( MD) of mean absolute error (MAE) among different formulas was analyzed.Meta-analysis was performed using Revman 5.3 software. Results:Seven studies involving 499 eyes were included.The accuracy of six formulas, Barrett Universal Ⅱ, Haigis, SRK/T, Hoffer Q, Holladay 1 and Holladay 2, was evaluated.The MAE of Barrett Universal Ⅱ was significantly lower than that of Hoffer Q ( MD=0.11 D; 95% CI: 0.05-0.17 D; P<0.001), Haigis ( MD=0.08 D; 95% CI: 0.03-0.13 D; P=0.002), and Holladay 2 ( MD=-0.06 D; 95% CI: -0.11--0.01 D; P=0.020). No significant difference was found in the remaining pairwise comparisons (all at P>0.05). Conclusions:The Barrett Universal Ⅱ formula is more accurate than Hoffer Q, Haigis, and Holladay 2 formulas in predicting IOL power in cataract patients with shallow anterior chamber.

An interpretation of AAPOS uniform guidelines for instrument-based pediatric vision screen validation 2021 / 中华实验眼科杂志

In January 2022, after an eight-year hiatus, the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) published the latest version of AAPOS uniform guidelines for instrument-based pediatric vision screen validation.Based on recent studies, the new guidelines have been updated and supplemented in many aspects, such as screening population, key points, methods and diagnosis criteria, including clinically significant refractive errors and myopia, simplified age subgroups, and adopted meridional refractive power.The updated guidelines will improve pediatric eye care, early detection of amblyopia and refractive screening, reduce excessive referral and ultimately improve the effectiveness of vision screening.In this article, the background and specific content of the updated guidelines were interpreted to guide clinical practice.

Aumento das aberrações de alta ordem pós-ceratectomia fotorrefrativa guiada por frente de onda: relato de caso / Increased high-order aberrations after wavefront-guided photorefractive keratectomy: case report

RESUMO Ao remodelar a córnea usando um perfil de ablação individualizado para cada olho obtido por meio de aberrometria de frente de onda, o tratamento guiado por frente de onda tenta reduzir aberrações preexistentes e induzidas cirurgicamente, minimizando as aberrações de alta ordem (HOAs) visualmente significativas. No entanto, o aumento de HOA ainda é uma preocupação, mesmo com ablações personalizadas. Na cirurgia refrativa a laser miópica, como o feixe de laser entra na periferia, algumas partes são refletidas, e o feixe circular se torna elíptico, resultando em diminuição na eficácia da energia do laser. A subablação da córnea periférica pode ser induzida por esses fatores que aumentam a HOA, especialmente a aberração esférica. Este relato tem por finalidade mostrar uma paciente alto míope submetida à PRK guiada por frente de onda que evoluiu com aumento das HOAs.

ABSTRACT By reshaping the cornea using an individualized ablation profile for each eye obtained through wavefront aberrometry, wavefront guided treatment attempts to reduce preexisting and surgically induced aberrations while minimizing visually significant higher-order aberrations (HOAs). However, HOA enhancement is still a concern, even with custom ablations. In the myopic laser refractive surgery, as the laser beam enters the periphery, some parts are reflected, and the circular beam becomes elliptical, resulting in a decrease in the effectiveness of the laser energy. Peripheral corneal subablation can be induced by these factors that increase HOA, especially spherical aberration. This report aims to show a high myopic patient undergoing wavefront-guided PRK, who evolved with an increase in HOAs.

Alterações oculares em escolares e adolescentes após início da pandemia por COVID-19 / Acute eye symptoms in schoolchildren and adolescents after the onset of COVID-19 pandemic

RESUMO Objetivo Identificar as alterações oculares em crianças e adolescentes secundárias ao fator do isolamento social e ao consequente aumento do uso de telas. Métodos Estudo observacional, descritivo e analítico, do tipo transversal realizado no período de julho a agosto de 2021, por meio da aplicação de questionários. Resultados Apresentaram cefaleia associada ao uso excessivo de tela 26,51% dos estudantes e 38,8% relataram suspeita de insuficiência de convergência. Em relação ao questionário de olho seco, 18,8% foram sintomáticos e 7,5% sintomáticos de difícil manejo. O computador foi o dispositivo mais utilizado em atividades escolares (71,5%), e, em segundo lugar, esteve o celular (66,3%). Casos sintomáticos de olho seco foram mais relatados em participantes que não faziam uso de computador (36,4%). Não foi possível identificar relação entre insuficiência de convergência e tempo de uso de dispositivos. Em relação ao olho seco, aqueles que passaram mais tempo em frente a tela relataram maior porcentagem de sintomas de difícil manejo (42,9%). Conclusão Foram mais prevalentes olho seco e sintomas de insuficiência de convergência na população estudada.

ABSTRACT Objective To identify eye conditions associated to social distancing and related increase in screen time exposure on children and teenagers. Methods Observational, descriptive and analytical study, with a cross-section design, carried out between July and August 2021, by questionnaire survey. Results Headaches related to excessive screen time exposure were reported by 26.51% of the students surveyed, while 38.8% reported suspect convergence insufficiency. Regarding the questionnaire about dry eye, 18.8% were symptomatic and 7.5% reported hard-to-manage symptoms. Computers were the devices most used for schoolwork (71.5%), followed by cellphones on second place (66.3%). Symptomatic cases of dry eye were mostly reported by participants that did not make use of computers (36.4%). It was not possible to establish a connection between convergence insufficiency and device usage time. Those participants that reported more screen time exposure also reported an increased percentage of hard-to-manage symptoms (42.9%), regarding dry eye. Conclusion Dry eye and convergence insufficiency symptoms were more prevalent in the surveyed population.

Analysis of refractive parameters and theirs correlation with spherical equivalent in preschool children aged 3 to 6 years / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the distribution of refractive parameters and theirs correlation with spherical equivalent(SE)in preschool children aged 3 to 6 years, and evaluate the accuracy of each screening index in diagnosing refractive errors.METHODS: Cross-sectional study. A total of 791 preschool children, ranging from 3 to 6 years old, who consented to undergo mydriatic refraction were selected. Axial length(AL), corneal refractive power(K), and SE were measured after microcoria optometry and mydriatic optometry. Additionally, the corneal radius of curvature(CR)and the axial length/corneal radius of curvature(AL/CR)ratio were calculated.RESULTS: A total of 791 students participated in the study, out of which 400(50.6%)were male and 391(49.4%)were female. The mean values for AL, CR, AL/CR, and SE were 22.62±0.94mm, 7.81±0.29mm, 2.90±0.09, and +1.95±1.31D, respectively. AL, CR, and AL/CR increased with age. AL and CR were significantly higher in males than in females(all P&#x003C;0.001), while there was no statistically significant difference between AL/CR and SE in males and females(P=0.82, 0.19). The correlation coefficients of SE and AL/CR, AL and CR were -0.86, -0.50 and 0.16, respectively. The results of multiple linear regression analysis indicate that for each unit increase in AL/CR, there was a corresponding shift of 10.91 towards myopia in SE. The sensitivity of AL/CR in screening for myopia was 94.44%, with a specificity of 90.46% and a Youden index of 0.84. For screening myopia under microcoria optometry, the sensitivity was 100%, with a specificity of 66.09% and a Youden index of 0.66. The area under the curve was 0.967 and 0.809 when the ROC curves were plotted using AL/CR and AL as indicators for screening myopia, respectively.CONCLUSION: For large group screening activities where mydriatic optometry is not feasible, AL/CR is better for evaluating refractive status and identifying children with myopia and hyperopia reserve that are lower than normal for their age, compared to AL and microcoria optometry.

Comparative application of three methods for testing distance visual acuity among children / 中国学校卫生

Objective@#To understand the differences in the application of three distant vision examination methods in children, so as to provide a reference for developing a unified distant vision examination for this population.@*Methods@#The study involved 98 children aged 4 to 16 years who visited the ophthalmology department of a children s hospital in Anhui Province between August 15 and 25, 2022. Vision was measured using the distant vision test method specified in the 2014 National Student Physical Fitness and Health Survey (V1), the 2019 National Student Physical Fitness and Health Survey (V2), and Specification for Screening of Refractive Error in Primary and Secondary School Students (WS/T 663-2020) (V3). The paired samples McNemar s test and Wilcoxon test were performed to compare the detection rate of poor vision and the difference between the visual acuity test results of the three methods.@*Results@#The results of the 98 children examined according to V1, V2, and V3 showed that the M (P25, P 75 ) of the right eye were 4.8（4.6，5.0），4.8（4.7，5.0），and 4.8（4.7，5.0）while the left eye visual acuity M ( P 25 , P 75 ) were 4.8 （4.6，5.0），4.9（ 4.7 ，5.0），and 4.9（4.7，5.0），respectively. The rates of poor visual acuity detection for the right eye were 63.3%, 58.2% and 58.2 % for V1, V2, and V3, respectively, while for the left eye, they were 58.2%, 54.1% and 53.1%, respectively. McNemar test results showed that there were no statistically significant differences in the rates of poor visual acuity detection between the right and left eyes for V1 vs. V2, V1 vs. V3, and V2 vs. V3 (left eyes： χ 2=2.25，2.29，0.00，right eyes： χ 2=3.20，3.20，0.00， P >0.05).Wilcoxon test results indicated that there were statistically significant differences between the right and left eye visual acuity groups for V1 vs. V2 and V1 vs. V3 (left eyes： Z =-4.15，-4.60, right eyes： Z = -4.70，-4.99, P <0.01).@*Conclusion@#Irrespective of whether the starting visual standard starts at row 4.0 or 5.0, different standards of visual standard passage have an impact on the visual acuity results. It is recommended that existing methods of screening for distance vision are standardized.

Clinical observation of acupuncture treatment for children with accommodative myopia / 针灸推拿医学（英文版）

Objective:To observe the effect of acupuncture in the treatment of accommodative myopia in children.Methods:A total of 76 children with accommodative myopia who met the inclusion criteria were divided into a control group or a test group according to the random number table method,with 38 cases in each group.The control group was given education on eye hygiene,and the test group was treated with acupuncture twice a week for 2 months in addition to the intervention used in the control group.The patient's uncorrected visual acuity(UCVA),refraction,and axial length(AL)were measured before treatment and 1 month and 2 months after treatment.Results:After 1 month of treatment,there was no significant difference in the UCVA between the two groups(P＞0.05);after 2 months of treatment,the UCVA of the test group was better than that of the control group(P＜0.05).After 1 and 2 months of treatment,the refraction of the two groups was significantly different from that before treatment(P＜0.01),but there was no significant difference between the two groups(P＞0.05).After 1 and 2 months of treatment,the AL in the control group was increased compared with that before treatment(P＜0.05),while there was no significant change in the test group(P＞0.05),and there was no significant difference between the two groups(P＞0.05).Conclusion:Acupuncture treatment can improve UCVA in children with accommodative myopia.

Pattern of Refractive Errors in a Tertiary Hospital in South East, Nigeria

Background: Uncorrected refractive errors (RE) are a major cause of visual impairment. They affect a large proportion of the population globally and have psychological and socio-economic effects on the individual, family and society. They could lead to poor quality of life.Aim: To determine the pattern and predisposing factors of refractive errors among patients seen in the outpatient clinic.Methodology: A cross-sectional, descriptive study involving patients with refractive error that presented to the eye clinic in the year 2017. Data were obtained from patients’ records, entered into and analysed using IBM SPSS version 25.Results: A total of 300 patients with refractive errors were seen in the period of study. This comprised of 93 males and 207 females with mean age of 40.13±17.6 years. The commonest presenting complaint was blurring of both far & near vision (24%), other presenting complaints in decreasing order of frequency were blurring of distant vision, itching, blurring of near vision, eye pain, headache and red eyes in 18%,15%, 9.6%, 5.6%, and 3.2% respectively. Presbyopia was noted in 55.3% while myopia, anisometropia, astigmatism and hypermetropia were noted in 20.7%, 19.3%, 7.0% and 1.3% respectively. Nuclear sclerosis was the commonest co-existing ocular pathology or morbidity.Statistically significant association was found between age of the patients and presence of ocular disease existing with RE (p=0.016).Conclusion: Fifty-one percent of the study population had refractive errors. The commonest refractive error was myopia while hypermetropia was the least common refractive error in this environment.

Steep increase in myopia among public school-going children in South India after COVID-19 home confinement

Purpose: Novel coronavirus has brought huge changes in lifestyle, especially among children. Reports indicate that the prevalence of refractive errors among children has increased due to home confinement. Hence, this study was done to understand the current status of refractive errors among children from public schools in southern India. Methods: This cross-sectional study was conducted as part of school eye screening conducted between September and October 2021. Children between 14 and 17 years of age from public schools underwent a three-phased comprehensive eye examination. Children identified with refractive errors and an equal proportion of children without any refractive errors underwent a survey on outdoor activities. Prevalence estimates and 95% confidence interval were calculated. Chi-square tests and regression analysis were used to understand the association between refractive error and other variables. Results: From the data of 3,850 (90.69%) children, the prevalence of vision impairment, refractive errors, and myopia in at least one eye was found to be 12.83% (n = 494), 21.51% (n = 828), and 19.53% (n = 752), respectively. The average myopic spherical equivalent error was found to be -2.17 ± 1.11D (range:-0.50 D to -14.00 D). Almost 96.82% of girls had less than 3 h of outdoor activities. Refractive errors were 7.42 and 2.77 times more (95% CI: 3.51-15.70), P < 0.001) among children who had outdoor activities less than 3 h per day and sleep less than 7 h per day. Conclusion: Comparing to previous studies from North Indian and South Indian public schools, this study reports a three- to six-fold rise in myopia post-home confinement among public school children from India.

Oculo-visual Assessment of Children and Adolescents with Special Needs in Selected Schools within IMO State, Nigeria

Aim: This was a cross-sectional study conducted to assess the oculo-visual status of children with special needs in three selected special schools in Imo State, Nigeria.Children with special needs are at a higher risk of visual impairment as compared to normal population. Interestingly, majority of the ocular disorders are treatable.Methodology: The study was conducted on children ages 5-25years (mean 12.0 � 3.2 years) and detailed ocular examination on 296 children using standard examination techniques was recorded. Results: Results revealed that oculo-visual disorders were seen in 196 (66.2%) children. Oculo-visual disorders were found in 75.5% of children with hearing impairment, 83.3% in children with cerebral palsy, 75% in children with autism, 85.7% in children with Down syndrome, 38.6% in children with speech disability, and 64% in children who are deaf and dumb. The most common ocular disorders seen in these children were refractive errors (30.5%), strabismus (12.7%), amblyopia (8.9%) and cataract (7.7%). Children requiring further evaluation were referred to base hospitals in Imo State, Nigeria.Conclusion: Oculo-visual problem is highly prevalent among children with special needs in Imo State, most commonly, the problems were refractive errors, strabismus, amblyopia, cataract and cornea disorders. The prevalence was predominant among the female teenagers (15-19years). Government and stakeholders in the health care and humanitarian sectors should place more priority on the ocular-health status of children with special needs.

Assessment of stereopsis in pediatric and adolescent spectacle-corrected refractive error – A cross-sectional study

Purpose: To assess the level of stereopsis in school children with spectacle?corrected refractive errors using Titmus fly and Randot stereo tests, evaluate the factors associated with the level of stereopsis, and determine the level of agreement between the two tests. Methods: A cross?sectional study was done on 5? to 18?year?old school?children wearing spectacles for at least 1?month duration. Visual acuity was assessed using Snellen’s visual acuity chart, and their spectacle correction being used currently was measured using an auto lensmeter. The level of stereopsis was assessed using Randot and Titmus fly stereo tests. Data were entered using Microsoft Excel and analyzed using IBM?SPSS version 20, Chicago, IL. The associations between stereopsis and type of refractive error, visual acuity, age, and gender were analyzed. An agreement between Randot and Titmus fly test was done using Kappa statistics. Results: A total of 222 children (101 boys and 121 girls; mean age 13 years) were assessed. Astigmatism was the most prevalent refractive error (60.4%), followed by myopia (24.8%) and hypermetropia (1.4%). Thirty children (13.5%) had anisometropia. All hyperopes had normal stereopsis. Children with spherical myopia had better stereopsis, followed by astigmatism and anisometropia in the same order (P = 0.036). Children with anisometropia ?1.5 D had better stereopsis than anisometropia more than 1.5 D. Stereopsis was also found to have no correlation with the age and visual acuity at the time of testing or the age at which the child first started wearing spectacles. Stereopsis values obtained from Randot and Titmus fly stereo tests showed moderate agreement with Kappa value 0.581. Conclusion: Anisometropia and astigmatism are the most critical factors determining the level of stereopsis in refractive errors

Corneal morphology and visual quality observation after Trans-PRK with smart pulse technology in the correction of myopia and astigmatism / 中华实验眼科杂志

Objective:To observe the corneal morphology and visual quality after transepithelial photorefractive keratectomy (Trans-PRK) with smart pulse technique (SPT) and 1 050 Hz cutting frequency in the correction of myopia and astigmatism.Methods:A self-controlled case series study was conducted.Sixty five eyes of 33 patients who underwent Trans-PRK surgery in Ineye Hospital of Chengdu University of TCM from July 2017 to June 2018 were followed up for 6 months.The uncorrected visual acuity (UCVA) converted to logarithm of the minimum angle of resolution (LogMAR) unit, best corrected visual acuity (BCVA) (LogMAR), and spherical equivalent (SE) of the subjects were recorded.The anterior corneal surface symmetry index (SI), the anterior corneal surface Q value in the range of 6, 7, 8, and 9 mm diameter, the spherical aberration, coma, trefoil and total higher-order aberration of the anterior corneal surface, the strehl ratio (SR), and the modulation transfer function (MTF) of 10, 20, 30, and 40 c/d in the horizontal and vertical meridian directions before and after surgery were measured with Sirius corneal topography analyzer.The differences of each index among different time points were compared, and the correlation between indexes was analyzed by Pearson correlation analysis.This study followed the Declaration of Helsinki.The study protocol was approved by the Medical Ethics Committee of Ineye Hospital of Chengdu University of TCM (No.2020yh-004). All patients signed the informed consent form before surgery.Results:The average preoperative BCVA and SE were -0.09±0.06 and (-4.24±1.24)D.The mean UCVA and SE at 7 days, 1, 3 and 6 months postoperatively were -0.10±0.08 and (0.03±0.63)D, -0.12±0.06 and (0.08±0.53)D, 1.16±0.06 and (0.02±0.79)D, -0.18±0.05 and (0.08±0.37)D, respectively.The SI at different time points after the surgery were significantly higher than that before operation (all at P<0.05). At 1, 3 and 6 months after surgery, the Q value of anterior corneal surface in different diameter ranges increased from negative to positive, showing statistically significant differences (all at P<0.05). At each time point after surgery, the trefoil and total higher-order aberrations of the anterior corneal surface increased to varying degrees.Coma at 7 days and 6 months after surgery were significantly higher than that before surgery, and spherical aberration at 3 and 6 months after surgery were significantly higher than that before surgery (all at P<0.05). The SR values at 3 and 6 months after operation were significantly higher than that before operation (all at P<0.05). At 6 months after operation, the MTF values at different spatial frequencies of the horizontal meridian and the MTF values at 30 and 40c/d spatial frequencies of the vertical meridian were lower than those before operation, and the differences were statistically significant (all at P<0.05). The correlation analysis showed that the Q value of different diameter ranges was positively correlated with spherical aberration ( r=0.798-0.925, P<0.05), total higher-order aberration ( r=0.596-0.630, P<0.05), SI ( r=0.235-0.303, P<0.05) and corneal ablation depth ( r=0.583-0.659, P<0.05) at 6 months after surgery.SI was positively correlated with spherical aberration ( r=0.307, P<0.05), coma ( r=0.424, P<0.05), total higher-order aberration ( r=0.300, P<0.05), corneal ablation depth ( r=0.227, P<0.05), and eccentric cutting amount ( r=0.281, P<0.05). There was no correlation between SR and aberration, corneal ablation depth, eccentric cutting amount, etc.(all at P≥0.05). Conclusions:Trans-PRK using SPT to correct myopic astigmatism can improve vision, stabilize diopter, enhance retinal imaging quality, increase the asymmetry of the anterior corneal surface, and introduce different degrees of higher-order aberrations.

Vision screening using a smartphone platform / Triagem visual usando uma plataforma no smartphone

ABSTRACT Objective: The main aim of this study was to evaluate the performance of a platform designed for pediatricians to screen amblyopia using a smartphone. Methods: The medical records of consecutive children who received visual screening using a smartphone platform were retrospectively reviewed. The smartphone was used with a flash concentrator case and a software for capturing images of both eyes simultaneously by a photorefraction mechanism. The platform performance was compared to the comprehensive ophthalmological examination, which is considered the gold standard for detecting amblyopia. Sensitivity, specificity, positive predictive value, and negative predictive value of the software in detecting amblyopia risk factors were calculated. Results: A total of 157 children were included, with a mean age of 6.0±.5 years (range 5-7). In 94% of the cases, the software was able to analyze the images and release a result, determining whether or not the child presented with amblyopia risk factors. Compared to the ophthalmological examination, the smartphone platform sensitivity in detecting amblyopia risk factors was 84%, the specificity was 74%, the positive predictive value was 86%, and the negative predictive value was 70%. Conclusions: The sensitivity and specificity of the smartphone photoscreening platform to detect amblyopia risk factors were within the range of traditional instrument-based vision screening technology. A smartphone photorefraction platform appears to be a promising cost-effective alternative to assist pediatricians and minimize obstacles to vision screening and amblyopia detection. Future studies are needed to gather additional comparative data.

RESUMO Objetivo: Avaliar a performance de uma plataforma desenvolvida para pediatras para triagem de ambliopia utilizando um smartphone. Métodos: Os prontuários consecutivos de crianças submetidas a triagem visual usando uma plataforma no smartphone foram analisados retrospectivamente. Uma capa concentradora de flash foi utilizada no smartphone com um software para capturar imagens simultâneas dos dois olhos por um mecanismo de fotorrefração. A performance da plataforma foi comparada ao exame oftalmológico completo, considerado o padrão ouro para detecção de ambliopia. Foram calculados sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo do software em detectar fatores de risco para ambliopia. Resultados: Foram incluídas 157 crianças com idade média de 6.0±0.5 anos (variação de 5 a 7 anos). Em 94% dos casos, o software foi capaz de analisar as imagens e fornecer um resultado, determinando se a criança apresentava ou não fatores de risco para ambliopia. Comparados ao exame oftalmológico, a sensibilidade da plataforma no smartphone em detectar fatores de risco para ambliopia foi de 84%, a especificidade foi de 74%, o valor preditivo positivo foi de 86% e o valor preditivo negativo foi de 70%. Conclusões: A plataforma de triagem por fotorrefração usando o smartphone apresentou sensibilidade e especificidade para detectar fatores de risco para ambliopia semelhantes às encontradas em instrumentos tradicionais de triagem por fotorrefração. Uma plataforma no smartphone é uma alternativa custo-efetiva promissora para auxiliar pediatras a minimizar os obstáculos para triagem visual e detecção da ambliopia. Estudos futuros são necessários a fim de reunir dados comparativos adicionais.

Impact of a mobile unit on access to eye care in São Paulo, Brazil / Impacto do uso de unidade móvel no acesso à saúde ocular em São Paulo, Brasil

ABSTRACT Purpose: The goal of this study was to determine the impact of a mobile eye health unit on access to eye care and to generate a profile of the population requiring ophthalmic care by age, nature of their ophthalmic diseases, and optimal management. Methods: The study was conducted in 14 cities in the southwest region of São Paulo, Brazil. Subjects included individuals who participate in the Brazilian Unified Health System who were in need of eye care. There were no restrictions on age, gender or socioeconomic status. Data was transferred to an Excel table for statistical analyses. Results: We evaluated 6,878 participants in this survey with mean age of 44 years (range 4 months to 96 years); 65.5% were female. Among the diagnoses, 78.6% presented with refractive errors, 9.6% presented with cataracts and 8.3% presented with pterygium. New corrective lenses were prescribed for 60.9% of the participants; 10% retained their existing lenses, ~28% required counseling only and18.1% of the participants were referred to a tertiary facility for specialized exams and/or surgical procedures. Of the participants who required outside referrals, 36.4% required oculoplastic/external eye surgery and 31.8% required cataract surgery. Conclusion: The vast majority of patients presenting to a mobile eye health unit required prescriptions for corrective lenses. The rate of detection of ocular disorders was relatively high and the mobile unit provided effective treatment of refractive errors and referrals for specialized ophthalmic examinations and procedures. A mobile eye health unit can be an effective alternative method for improving access to basic eye care, for promoting eye health education and preventing blindness.

RESUMO Objetivo: Determinar o impacto do uso de unidade móvel no acesso à saúde ocular e avaliar o perfil da população que necessita de cuidados oftalmológicos, as doenças oculares mais frequentes e o tratamento. Métodos: Estudo transversal realizado em 14 municípios da região sudoeste do Estado de São Paulo utilizando uma unidade móvel oftalmológica. Os participantes eram usuários do Sistema Único de Saúde que procuraram atendimento oftalmológico, sem restrição quanto a idade, gênero ou condição socioeconômica. Os dados foram transferidos para a tabela Excel para análise estatística. Resultados: Participaram do estudo 6.878 pessoas, com média de idade de 44 anos (variação de 4 meses a 96 anos) e 65,5% eram mulheres. Erros refrativos estavam presentes em 78,6% dos participantes, catarata em 9,6% e pterígio em 8,3%. Para 60% foram prescritos óculos, para 10% foi mantida a correção óptica em uso e para 28% foram necessárias apenas orientações. Exames especializados ou procedimentos cirúrgicos foram indicados para 18,1% dos casos que foram encaminhados para tratamento em serviço terciário. Dentre os pacientes referenciados, 36,4% necessitavam de cirurgia oculoplástica ou para tratar afecções externas do olho e 31,8%, de cirurgia de catarata. Conclusão: A grande maioria dos pacientes que procurou atendimento na unidade móvel necessitava de prescrição de óculos. A unidade móvel oftalmológica possui alto grau de resolutividade para os problemas oculares, com oportunidade de tratar os erros refrativos e referenciar os pacientes que necessitam de atendimento espe­cializado, geralmente relacionado a condições cirúrgicas. Unidades móveis podem ser uma alternativa aos cuidados oftalmológicos básicos, melhorando o acesso, atuando na promoção da saúde ocular e prevenindo a cegueira.

Investigation of ametropia in primary school students from first to third grade in Kashgar city / 中华实验眼科杂志

Objective:To investigate the differences in ametropia among school-age children and between Han and Uygur ethnic groups in the main urban area of Kashgar, and to understand the epidemiological characteristics of myopia among children in Kashgar.Methods:A cross-sectional study was conducted.Random stratified sampling method was used to select the first to third grade students from 6 primary schools in the main urban areas of Kashgar, Xinjiang, from April to June 2018.Visual acuity was examined by the international standard visual acuity chart and refraction was detected by the automatic computer refractometer without cycloplegia.The subjects were classified into low vision (uncorrected visual acuity<0.8 in either eye), hyperopia≥2.00 D, myopia≥-1.00 D, astigmatism≥1.00 D and anisometropia≥1.00 D according to examination results.The percentage of different refraction states and percentage of different ethnic groups among myopic students in the three grades were analyzed.The study protocol was approved by an Ethics Committee of The First People's Hospital in Kashgar ([2021] QSY No.81).Results:A total of 6 108 students were enrolled, among which, there were 3 119 males and 2 989 females, 3 395 Uygur and 2 713 Han people, 2 016 first grade, 2 155 second grade and 1 937 third grade students.The detection rate of low vision was 13.5% (825/6 108) in the whole, 21.5% (584/2 713) in the Han people and 7.1% (241/3 395) in the Uygur people, 8.8% (176/2 016) in the first grade, 11.8% (254/2 155) in the second grade and 20.4% (395/1 937) in the third grade.The detection rate of myopia was 9.9% (606/6 108) in the whole, 17.6% (477/2 713) in the Han people and 3.8% (129/3 395) in the Uygur people, 4.4% (89/2 016) in the first grade, 8.1% (174/2 155) in the second grade and 17.7% (343/1 937) in the third grade.There were significant differences in percentage of low vision, myopia, astigmatism and anisometropia among different grades and between the two nationalities (all at P<0.001), and no significant difference in the percentage of hyperopia was found (P>0.05).Conclusions:The percentage of visual abnormalities and myopia in the first to third grade children in Kashgar is lower than the national average, but the percentage is gradually increasing with age.The percentage of visual abnormalities and myopia among Han pupils is close to the national average, and far higher than that of Uygur pupils.

Progress of posterior chamber implantable collamer lens implantation for the treatment of refractive errors / 国际眼科杂志(Guoji Yanke Zazhi)

@#Refractive errors are a common ophthalmic disease, which can be corrected by wearing glasses, laser refractive surgery and so on. However, there are some limitations of these methods for treating high myopia, keratoconus, <i>etc</i>. The implantation of the posterior chamber implantable collamer lens(ICL)is one of the most common surgry for correcting refractive errors(mainly apply to high myopia and astigmatism). This study aim to explore the safety and effectiveness of implanting ICL to correct low to moderate and high myopia or hyperopia. This review will summarize the research progress of implanting ICL to correct refractive errors.