Myopia progression in children and adolescents: impact of COVID-19 pandemic and current and future control strategies.

Myopia is a significant and growing public health problem with typical onset or progression during childhood adolescence. High myopia has lifelong impact on ocular health and socio-economic aspects of patients 'lives. COVID-19 lockdown resulted in demonstrable increase in incidence and progression rate of myopia in children and adolescence. Low dose atropine and Orthokeratology contact lenses appear to be most effective in slowing down myopia progression. Rebound progression after stopping both modalities were reported. Defocus modifying spectacle lenses and contact lenses are less effective but possibly better tolerated.

Simultaneous perception of prosthetic and natural vision in AMD patients.

Loss of photoreceptors in atrophic age-related macular degeneration (AMD) results in severe visual impairment. Since the low-resolution peripheral vision is retained in such conditions, restoration of central vision should not jeopardize the surrounding healthy retina and allow for simultaneous use of the natural and prosthetic sight. This interim report, prespecified in the study protocol, presents the first clinical results with a photovoltaic substitute of the photoreceptors providing simultaneous use of the central prosthetic and peripheral natural vision in atrophic AMD. In this open-label single group feasibility trial (NCT03333954, recruitment completed), five patients with geographic atrophy have been implanted with a wireless 2 x 2 mm-wide 30 µm-thick device, having 378 pixels of 100 µm in size. All 5 patients achieved the primary outcome of the study by demonstrating the prosthetic visual perception in the former scotoma. The four patients with a subretinal placement of the chip demonstrated the secondary outcome: Landolt acuity of 1.17 ± 0.13 pixels, corresponding to the Snellen range of 20/460-20/565. With electronic magnification of up to a factor of 8, patients demonstrated prosthetic acuity in the range of 20/63-20/98. Under room lighting conditions, patients could simultaneously use prosthetic central vision and their remaining peripheral vision in the implanted eye and in the fellow eye.

Perceptual Adaptation to Continuous Versus Intermittent Exposure to Spatial Distortions.

Purpose: To examine perceptual adaptation when people wear spectacles that produce unequal retinal image magnification. Methods: Two groups of 15 participants (10 male; mean age 25.6 ± 4.9 years) wore spectacles with a 3.8% horizontal magnifier over one eye. The continuous-wear group wore the spectacles for 5 hours straight. The intermittent-wear group wore them for five 1-hour intervals. To measure slant and shape distortions produced by the spectacles, participants adjusted visual stimuli until they appeared frontoparallel or equiangular, respectively. Adaptation was quantified as the difference in responses at the beginning and end of wearing the spectacles. Aftereffects were quantified as the difference before and after removing the spectacles. We hypothesized that intermittent wear may lead to visual cue reweighting, so we fit a cue combination model to the data and examined changes in weights given to perspective and binocular disparity slant cues. Results: Both groups experienced significant shape adaptation and aftereffects. The continuous-wear group underwent significant slant adaptation and the intermittent group did not, but there was no significant difference between groups, suggesting that the difference in adaptation was negligible. There was no evidence for cue reweighting in the intermittent wear group, but unexpectedly, the weight given to binocular disparity cues for slant increased significantly in the continuous-wear group. Conclusions: We did not find strong evidence that adaptation to spatial distortions differed between the two groups. However, there may be differences in the cue weighting strategies employed when spectacles are worn intermittently or continuously.

The impact of COVID-19 on soft contact lens wear in established European and US markets.

PURPOSE: To characterise changes in soft contact lens wearing habits during the COVID-19 pandemic. METHODS: A detailed online questionnaire was circulated to individuals aged 40-70 years, during the period April to May 2021. Data sampling took place in the United Kingdom (UK), United States of America (USA), Netherlands, Germany, France, Spain and Italy. Only data pertaining to individuals who were soft contact lens wearers were included. Data were extracted for questions relating to contact lens wearing habits pre- and during the COVID-19 pandemic, and expectations for future lens wear beyond the pandemic. RESULTS: Seven-hundred and twenty-eight individuals were identified as soft contact lens wearers of which six-hundred and nineteen wore a combination of contact lenses and spectacles. Most respondents indicated contact lens wear times had either remained the same (57.3%) or increased (9.8%) during the pandemic. The country with the greatest proportion of respondents decreasing wear time during COVID-19 was the UK (45.3%), and the least in the Netherlands (20.0%). The primary cause of decreased lens wear was attributed to leaving the home less often (70.0%), and the second most common reason due to concerns about hygiene (10.8%). Most respondents (83.9%), however, expressed a desire to return to pre-pandemic wear times once the pandemic was over. CONCLUSIONS: Practitioner concerns about contact lens market recovery ought to be assuaged by the survey outcomes which show most individuals to have maintained lens wear during the pandemic. In view of the continued lens wear, as and when restrictions ease, ECPs may wish to encourage patients to return for routine check-ups that may have been missed due to the pandemic.

Face masks versus sunglasses: limited effects of time and individual differences in the ability to judge facial identity and social traits.

Some research indicates that face masks impair identification and other judgements such as trustworthiness. However, it is unclear whether those effects have abated over time as individuals adjust to widespread use of masks, or whether performance is related to individual differences in face recognition ability. This study examined the effect of masks and sunglasses on face matching and social judgements (trustworthiness, competence, attractiveness). In Experiment 1, 135 participants across three different time points (June 2020-July 2021) viewed unedited faces and faces with masks, sunglasses, or both. Both masks and sunglasses similarly decreased matching performance. The effect of masks on social judgements varied depending on the judgement and whether the face was depicted with sunglasses. There was no effect of timepoint on any measure, suggesting that the effects of masks have not diminished. In Experiment 2, 12 individuals with developmental prosopagnosia (DP) and 10 super-recognisers (SRs) completed the same tasks. The effect of masks on identity matching was reduced in SRs, whereas the effects of masks and sunglasses for the DP group did not differ from controls. These findings indicate that face masks significantly affect face perception, depending on the availability of other facial information, and are not modified by exposure.

Are estimates of faces' ages less accurate when they wear sunglasses or face masks and do these disguises make it harder to later recognise the faces when undisguised?

This study examined whether our ability to accurately estimate unfamiliar faces' ages declines when they are wearing sunglasses or surgical-style face masks and whether these disguises make it harder to later recognise those faces when undisguised. In theory, both disguises should harm age estimation accuracy and later face recognition as they occlude facial information that is used to determine a face's age and identity. To establish whether this is the case, we had participants estimate the age of unfamiliar faces that were pictured wearing no disguises, sunglasses, or face masks. The participants then completed a face recognition test where they had to distinguish between the previously seen faces and new faces. Importantly, none of faces wore disguises in this latter test. Participants' estimates of the undisguised faces' ages were inaccurate by a Median of 5.15 years. Their accuracy barely changed when the faces wore sunglasses but declined by a Median of 1.30 years when they wore face masks. Moreover, subsequent undisguised face recognition was less likely to occur when the faces previously wore sunglasses or face masks, with large effects observed. These findings demonstrate the relative importance of different facial areas when estimating faces' ages and later recognising them. They also have implications for policing as they suggest it may be harder for eyewitnesses to accurately estimate the age of criminals who wear face masks during offences, and it may be harder for them to later recognise criminals in line-ups if the criminals wear sunglasses or face masks during offences.

Evaluation of an Optical Defocus Treatment for Myopia Progression Among Schoolchildren During the COVID-19 Pandemic.

Importance: Myopia progression has been found to be worsening during the COVID-19 pandemic. It is important to control the rapid myopia progression in this period. Objective: To analyze the association of COVID-19-related lockdown measures with myopia progression in schoolchildren and to compare the performance of defocus incorporated multiple segments (DIMS) lens with that of single vision lens (SVL) treatment in reducing myopia progression. Design, Setting, and Participants: This cohort study involved an exploratory, prespecified, comparison of 2 independent longitudinal studies performed at the same institute beginning in 2019. Data from Hong Kong schoolchildren (aged 7-13 years) were gathered and analyzed. Data analysis was performed from June to July 2021. Exposure: Schoolchildren in study 1 wore a DIMS lens for 18 months, and those in study 2 wore a SVL for 24 months. Main Outcomes and Measures: Cycloplegic spherical equivalent refraction and axial length were measured. Studies 1 and 2 started before the start of lockdown measures and continued throughout the lockdown. In both studies, periods of fewer and more COVID-19-related lockdown measures were identified. Because COVID-19 lockdown caused deviations from the visit schedule, myopia progression was normalized to 12-month change, which were compared between DIMS and SVL groups, also during the periods with less and more lockdown time. Results: There were 115 participants (58 girls [50.4%]; mean [SD] age, 10.3 [1.5] years) in the DIMS group; their mean (SD) baseline refraction was -4.02 (1.46) D. There were 56 participants (29 girls [51.8%]; mean [SD] age, 10.8 [1.5] years) in the SVL group; their mean (SD) baseline refraction was -2.99 (1.06) D. After controlling for the covariates, DIMS treatment was significantly associated with 34% less axial elongation (0.19 mm [95% CI, 0.16 to 0.22 mm] vs 0.30 mm [95% CI, 0.25 to 0.35 mm]; P < .001) and 46% less myopic progression after 12 months (-0.31 D [95% CI, -0.39 to -0.23 D] vs -0.57 D [95% CI, -0.69 to -0.45 D]; P = .001) compared with SVL treatment. In both the DIMS and SVL groups, more lockdown time was associated with significantly more spherical equivalent refraction (-0.54 D [95% CI, -0.64 to 0.44 D] vs -0.34 D [95% CI, -0.44 to -0.25 D]; P = .01) and axial length (0.29 mm [95% CI, 0.25 to 0.32 mm] vs 0.20 mm [95% CI, 0.16 to 0.24 mm]; P = .001) compared with less lockdown time. No significant interaction between treatment type and lockdown time was observed. Conclusions and Relevance: In this exploratory analysis, myopia progressed more rapidly in schoolchildren during the period when there were more COVID-19-related lockdown measures. However, optical treatment with DIMS was significantly associated with slower myopia progression compared with SVL treatment during the lockdown period.

Myopia-correcting lenses decrease eye fatigue in a visual search task for both adolescents and adults.

The steady, world-wide increase in myopia prevalence in children over the past decades has raised concerns. As an early intervention for axial-length-related myopia, correcting lenses have been developed (such as Defocus Incorporated Multiple Segment (DIMS) lenses), which have been shown to be effective in slowing myopia progression. Beyond this direct effect, however, it is not known whether such lenses also affect other aspects important to the wearer, such as eye fatigue, and how such effects may differ across age, as these lenses so far are typically only tested with adolescents. In the present work, we therefore investigated perceived fatigue levels according to lens type (normal vs DIMS) and age (adolescents vs adults) in a demanding visual search task ("Finding Wally") at two difficulty levels (easy vs difficult). Whereas age and difficulty did not result in significant differences in eye fatigue, we found a clear reduction of fatigue levels in both age groups when wearing the correcting lenses. Hence, the additional accommodation of these lens types may result in less strain in a task requiring sustained eye movements at near viewing distances.

Using face masks with spectacles versus contact lenses.

PURPOSE: To test the hypothesis that various subjective ocular and task-related parameters associated with wearing a face mask would be better in neophyte contact lens (CL) wear compared to habitual spectacle (Sp) wear. METHODS: Thirty participants were randomised to continue in Sp (n = 15) or wear somofilcon A daily disposable CL (n = 15) ('group'). A surgical face mask (Type II R) was worn for at least one hour per day on four or more days per week. After two weeks, participants completed the Quality of Life Impact of Refractive Correction Questionnaire (QIRC), a two-part face mask usability questionnaire and graded ocular-related symptoms using 0-100 visual analogue scales. RESULTS: There was no difference between groups for overall QIRC score but some individual question scores reflected better quality of life in the CL: 'outdoor activities', 'keep fit' and 'able to do things' (all p < 0.05). Differences in favour of the CL were seen for the following in the face mask usability questionnaire: 'breathing', 'heat', 'comfort on ears', 'overall comfort', 'walking', 'driving', 'reading', 'computer use', 'exercising' and 'socialising' (all p < 0.05). Significant differences were also seen for the 0-100 VAS symptoms probing vision quality in favour of the CL: glare, distance and near vision, fogging, restricted field of view and peripheral blur. CONCLUSION: This work supports anecdotal reports that CL are a better vision correction option than Sp when used in conjunction with a face mask. Participants reported a range of benefits to the CL/face mask combination for vision-related symptoms, breathing and heat-related symptoms and a number of day-to-day activities including walking, driving and exercising. All of the benefits relating to the CL are likely to result in improved adherence to face mask use. Overall, the findings of this work suggest that where possible, CL should be the preferred vision correction option for people using face masks.

Eyeglasses Reduce Risk of COVID-19 Infection.

BACKGROUND/AIM: A study of patients in the Hubei Province, China, at the beginning of the pandemic demonstrated that among a group of 276 patients admitted to a hospital with laboratory-confirmed COVID-19, the proportion of patients who said they routinely wore eyeglasses more than 8 hours per day was lower than in the general population. Therefore, wearing eyeglasses more than 8 hours per day may be protective against SARS-CoV-2 infection, possibly because eyeglasses are a barrier that reduces the frequency with which people touch their eyes. The aim of the study was to determine if eyeglasses protect from COVID-19 infection. MATERIALS AND METHODS: We used UK Biobank (UKB) data to corroborate findings of the Hubei study in the UK population. RESULTS: Eyewear was associated with a reduced risk of infection, odds ratio (OR)=0.77. The effects of sex, age, and eyewear were independent and significant at the 95% level. Men are 1.24-times more likely to be infected than women; subjects' risk of infection is less (0.95) for every year of age. CONCLUSION: The public at large may profit from wearing glasses, as well as wearing face masks and practicing social distancing.

Determinants of compliance to the facemask directive in Greece: A population study.

PURPOSE: Primary objective of this study was to identify potential difficulties and/or discomfort when using a facemask. Moreover, to explore the impact of spectacles, contact lenses and visual acuity on the compliance to the facemask directive. METHODS: This is a prospective study that was conducted at the Department of Ophthalmology, University Hospital of Alexandroupolis, Greece between June 2020 and August 2020. Greek speaking citizens with permanent residency in Greece above 18 years old were included. A custom questionnaire (DeMask-20) was constructed and validated, which pertained to the perceived difficulty and discomfort when using a facemask. It contained 20 items grouped in 8 subscales (driving, near vision, distance vision, ocular discomfort, role limitation, collaboration, dependency on others, emotional stress). Perceived difficulty and discomfort when using a facemask, compliance and correlations of compliance with DeMask-20 scores, demographics, spectacle and/or contact lens use, and visual acuity were evaluated. RESULTS: The number of factors was determined through factor analysis. Cronbach's alpha ranged from 0.716 for the "Role limitation" subscale to 0.938 for "Ocular discomfort" subscale. 1,214 participants (402 men, 812 women, mean age 36.79±12.50 years) completed the DeMask-20 instrument. Mean DeMask-20 score of all study participants was 3.79±0.71. Significant differences in DeMask-20 score were detected in gender (p = 0.009), spectacle use (p = 0.034), contact lens use (p = 0.049), and binocular distance visual acuity (bDVA) (p = 0.001). Mean compliance of all participants was 4.05±0.96. Men, people <50 years and spectacle wearers showed significantly worse compliance (p<0.05). Moreover, professional workers and professional drivers demonstrated significantly better compliance (p = 0.008 and p = 0.047). Significant correlation was detected between compliance and DeMask-20 score (p<0.001, R2 = 0.471). Significant correlations were detected with driving, near vision, distance vision, collaboration, role limitation, emotional stress (p<0.05, R2: 0.386-0.493). CONCLUSIONS: Factor analysis suggested that the DeMask-20 instrument demonstrates adequate validity, while Cronbach's alpha indicated sufficient internal consistency of all subscales. This study provided the necessary methods that could evaluate compliance trends and the efficacy of healthcare interventions against COVID-19. Our outcomes suggest that young males who use spectacles should be targeted by Greek Healthcare authorities in order to improve compliance rates.

SARS-CoV-2: how safe is it to fly and what can be done to enhance protection?

With lockdown restrictions over coronavirus disease 2019 being relaxed, airlines are returning to the skies. Published evidence of severe acute respiratory syndrome (SARS) coronavirus 2 transmission on aircraft is limited, but in-flight transmission of respiratory infections such as tuberculosis, influenza and SARS has been well described. Risk factors include proximity to index patients and sitting in aisle seats. Personal protection on aircraft could be enhanced by always wearing a well-fitting face mask and face shield or sunglasses, wiping surfaces and hands with alcohol-based sanitizers, not touching the face, not queuing for washrooms, changing seats if nearby passengers are coughing and choosing a window rather than an aisle seat.

Association of Daily Wear of Eyeglasses With Susceptibility to Coronavirus Disease 2019 Infection.

Importance: The proportion of daily wearers of eyeglasses among patients with coronavirus disease 2019 (COVID-19) is small, and the association between daily wear of eyeglasses and COVID-19 susceptibility has not been reported. Objective: To study the association between the daily wearing of eyeglasses and the susceptibility to COVID-19. Design, Setting, and Participants: This cohort study enrolled all inpatients with COVID-19 in Suizhou Zengdu Hospital, Suizhou, China, a designated hospital for COVID-19 treatment in the area, from January 27 to March 13, 2020. COVID-19 was diagnosed according to the fifth edition of Chinese COVID-19 diagnostic guidelines. The proportion of persons with myopia who wore eyeglasses in Hubei province was based on data from a previous study. Exposures: Daily wearing of eyeglasses for more than 8 hours. Main Outcomes and Measures: The main outcomes were the proportions of daily wearers of eyeglasses among patients admitted to the hospital with COVID-19 and among the local population. Data on exposure history, clinical symptoms, underlying diseases, duration of wearing glasses, and myopia status and the proportion of people with myopia who wore eyeglasses in Hubei province were collected. People who wore glasses for more than 8 hours a day were defined as long-term wearers. Results: A total of 276 patients with COVID-19 were enrolled. Of these, 155 (56.2%) were male, and the median age was 51 (interquartile range, 41-58) years. All those who wore glasses for more than 8 hours a day had myopia and included 16 of 276 patients (5.8%; 95% CI, 3.04%-8.55%). The proportion of people with myopia in Hubei province, based on a previous study, was 31.5%, which was much higher than the proportion of patients with COVID-19 who had myopia in this sample. Conclusions and Relevance: In this cohort study of patients hospitalized with COVID-19 in Suizhou, China, the proportion of inpatients with COVID-19 who wore glasses for extended daily periods (>8 h/d) was smaller than that in the general population, suggesting that daily wearers of eyeglasses may be less susceptible to COVID-19.