The Longitudinal Danish High Myopia Study, Cohort 1948: at age 66 years visual ability is only occasionally affected by visual field defects.

PURPOSE: A descriptive study on visual fields, as part of a 50-year follow-up of high myopia in an unselected cohort-based Danish sample, now aged 66 years. METHODS: In a Copenhagen 1948 birth cohort (n = 9243), 39 individuals aged 14 years were identified with myopia of at least -6 D, and with regular clinical follow-ups since then. In 2002 (n = 34, age 54 years) and 2008 (n = 32, age 60), the individual ambulatory visual field was outlined by kinetic Goldmann large object perimetry (IV or V,4e). At age 66 years, 28 attended for the 2014-2015 follow-up, at which smaller Goldmann objects (II and I,4e) were added, further to identify relative defects. RESULTS: Repeated large object perimetry disclosed statistically significant general peripheral narrowing over the 12-13-year test period, though slight and without practical implications. Two new cases showing absolute defects were however added to the three already known. The addition of small Goldmann objects disclosed relative defects in another eight participants, in some to suggest a refraction-related pattern (fundus ectasia; uncorrected high myopia). However, comparing eyes with and without defects, statistical importance could not be attached to the degree of myopia, fundus ectasia or optic disc morphology (χ2 , n.s.). CONCLUSION: (i) Serial large object Goldmann isopters over the 'senior' decade up to age 66 demonstrated a slight general peripheral narrowing by age of visual fields in high myopia. (ii) Overall 42% of the participants had absolute or relative defects (in 5 and 8, respectively), however, without socio-visual consequences when binocular. (iii) Visual field loss by age still appears a minor issue in clinically unselected high myopia.

Choroidal thickness and myopia in relation to physical activity - the CHAMPS Eye Study.

PURPOSE: To describe the relationship between choroidal thickness (CT) and myopia in relation to physical activity (PA) in a population-based child cohort. METHODS: In a prospective study of 307 children from the CHAMPS Study Denmark, we used objective data from GT3X accelerometer worn at four periods between 2009 and 2015 to determine the amount and intensity of PA. Intensity was estimated as counts/minutes, and cut-off points were defined at four intensity levels. Eye examinations were performed in 2015 and included autorefraction in cycloplegia, axial length (AL) by biometric and fovea-centred enhanced depth imaging optical coherence tomography. By a semi-automated method, we measured the CT at 17 targets per eye representing anatomically different locations (subfoveal, 1 and 3 millimetre in each direction of fovea). RESULTS: Mean age at the eye examination was 15.4 ± 0.7 years. The mean AL was 23.5 ± 0.9 mm, and the mean subfoveal CT was 369 ± 87 µm. Choroidal thickness (CT) was 331 ± 68 µm for the overall macula, 355 ± 78 µm for the 1-mm zone and 304 ± 60 µm for the 3-mm zone. All CT measurements were thinner in myopic eyes (p < 0.0001) and in boys (p < 0.05). We found no association between total PA and the CT by either mixed model analysis (p = 0.074) or linear regression by any intensity levels (p = 0.22, p = 0.15 and p = 0.43). CONCLUSION: Among adolescents aged 14-17 years, there was no association between objective PA exposures and the CT, AL or refractive error.

Choroidal thickness at age 66 years in the Danish high myopia study cohort 1948 compared with follow-up data on visual acuity over 40 years: a clinical update adding spectral domain optical coherence tomography.

BACKGROUND AND PURPOSE: A population-based Copenhagen birth year 1948 cohort with high myopia recorded since age 14 years (spherical equivalent less than or equivalent to -6 D) has been followed over 50 years. Despite complications, current follow-ups have outlined a better visual prognosis than usually drawn from selected clinical series in the literature. For the present status at age 66 years, focus was on visual ability and choroidal thickness. METHODS: Twenty-eight of the original 39 participants were available in 2014. Medical history was updated. Best-corrected visual acuity (BCVA) data were compared with subfoveal choroidal thickness (SFCT), now measured by enhanced depth optical coherence tomography. RESULTS: Due to at least better eye visual acuity (VA), all patients had maintained their everyday visual capacity. Only one participant was marginal regarding visual status for a driver's licence; low vision was not on record. Based on all eyes, choroidal thickness correlated negatively with axial length (AL), which also held for the fraction with high myopia (AL >26.5 mm). In high myopia, the mean choroidal subfoveal thickness was 114 ± 75 µm versus 182 ± 94 µm in lower myopia (p = 0.01). CONCLUSION: Despite the generally maintained individual visual capacity in the series, significant correlation could be demonstrated between SFCT and (i) axial elongation and (ii) recorded VA, with a negative and a positive sign, respectively. Overall, the visual prognosis was relatively benign, in particular when compared with the selected high myopia hospital series that predominate in the ophthalmic literature.

Physical activity and myopia in Danish children-The CHAMPS Eye Study.

PURPOSE: To determine associations between physical activity (PA) and myopia in Danish school children and investigate the prevalence of myopia. METHODS: This is a prospective study with longitudinal data on PA in a Danish child cohort. Physical activity (PA) was measured objectively by repeated ActiGraph accelerometer measurement four times with different intervals (1-2.5 years) at the mean ages 9.7, 11.0, 12.9 and 15.4 years. Mean intensity of PA was estimated as counts/minutes, and time spent in sedentary, light, moderate and vigorous PA was summed using defined cut-off points. The ophthalmologic examination was conducted at the mean age of 15.4 ± 0.7 years and included cycloplegic autorefraction and biometry. RESULTS: A total of 307 children participated in the Childhood Health, Activity, and Motor Performance School (CHAMPS) Eye Study. The cycloplegic spherical equivalent (SE) was 0.30 ± 1.46 dioptres. The prevalence of myopia was 17.9% (SE ≤-0.5 dioptres). Mean axial length (AL) was 23.5 ± 0.9 mm. For all participants, the overall mean daily distribution of PA was 67.2% in sedentary, 25.6% in light, 4.4% in moderate and 2.9% in vigorous PA. Age- and sex-adjusted linear regression showed no association between PA and SE or AL. In a prospective slope analysis, there was no association between accumulated PA during the 7 years and AL or SE. CONCLUSION: The prevalence of myopia among Danish children was 17.9%. By logistic regression and slope analysis, we found no association between PA and myopia, in this first of its kind study based on objective and repeated PA data.

Human parallels to experimental myopia? A literature review on visual deprivation.

Raviola and Wiesel's monkey eyelid suture studies of the 1970s laid the cornerstone for the experimental myopia science undertaken since then. The aim has been to clarify the basic humoral and neuronal mechanisms behind induced myopization, its eye tissue transmitters in particular. Besides acquiring new and basic knowledge, the practical object of the research is to reduce the burden of human myopia around the world. Acquisition and cost of optical correction is one issue, but associated morbidity counts more, with its global load of myopia-associated visual loss and blindness. The object of the present PubMed literature-based review is to evaluate apparent similarities between experience from disturbed imaging in experimental laboratory science and varieties within the spectrum of childhood human myopia. So far, the main impression is that macroscopical optical deprivation appears absent in the prevalent types of human myopia, nor is myopia a regular sequel where early eye pathology has led to poor imaging and optical deprivation. Optical aberrations of a higher order are a relatively new issue in myopia research, and microstructural deprivation is only marginally dealt within the survey. Links between experimental and human myopia appear mainly occasional, and with only few examples in humans where factual parallels appear credible. Clinical and epidemiological data on refraction remain important, in particular with a view to life style and environmental factors. Such knowledge may further serve as inspiration to the laboratory research, which aims at solving the basic enigmas on a tissue level.

The highly myopic eye--oculometric considerations.

After a brief historical oculometry review, the purpose is to bring a longitudinal update on an unselected Danish high myopia series, which was first presented at 1978 SIDUO. The sample was recruited from a Copenhagen school cohort (N=9,423, born 1948) as 14-year-olds with myopia of at least -6 D (n=39) in 1962. Clinical follow-up studies were conducted in 1976, 1986, 1995 and 2002, with A-scan ultrasound oculometry (Kretztechnik 7000, immersion method; and Sonometrics 400, contact method) as a regular part of the schedule. For comparison, IOL Master evaluations were added in 2002. The following results and conclusions were made: (a) up to age 54, most subjects had maintained good or fair vision; (b) as in other myopia series, axial and vitreous length were found to be the most important optical parameters, with corneal curvature radius ranking next; (c) however, as previously described by Francois and Goes, not all long eyes have flat corneas. In our high myopia series, a significant subgroup could thus be discerned who had peaked corneas, which led to mathematically slight reduction of the usual positive correlation between axial length and curvature radius in the ametropia population; and (d) we found positive correlation between myopia increase in adult age and axial elongation, stressing that, in contrast to other outgrown body structures, the adult eye globes may still expand in size. This feature seems to be found not only in the eyes with posterior staphyloma, but also in myopic eyes of regular round shape.

Epibulbar lipodermoids, preauricular appendages and polythelia in four generations: a new hereditary syndrome?

A new syndrome with abnormalities along the first branchial arch and the milk list is described in a family of four affected generations. The characteristics of the syndrome are epibulbar lipodermoids, preauricular appendages and polythelia. The expressivity varies but all affected have supernumerary nipples and preauricular manifestations while visible epibulbar lipodermoids do not seem obligatory. The syndrome has a typical dominant pattern of heredity.

Optic disc appearance and retinal temporal vessel arcade geometry in high myopia, as based on follow-up data over 38 years.

PURPOSE: To discuss (i) optic disc appearance and (ii) the retinal course of the temporal vessel arcade in a longitudinal series of high myopia patients followed between the ages of 16 and 54. METHODS: Thirty-nine individuals from a 1948 Copenhagen birth cohort (n=9243) who had myopia of -6 to -15 D when aged 14 years were invited for current follow-up exams with 7-10-year intervals. Fundus photos were available from up to five occasions over 38 years, and single eye photo collages were studied with respect to posterior pole changes over time. RESULTS: Fifty-two eyes with high myopia were available. (i) Contrary to the expected predominance of large flat optic discs in long eyes, more than half the eyes in the sample had neurodiscs that were perceived to be small; many were also oval/kinked/tilted and with minimum or absent physiological cups. Among the fellow eyes with unilateral high myopia only one out of the 10 discs appeared as small/tilted. (ii) By age, a more acute angle between upper and lower temporal retinal vessel trunks was found in 12/20 eyes with adult myopia progression (change over time 5-23 degrees ) and in 6/24 eyes with stable myopia. In the myopia-progression subgroup, peaking of the angle was correlated with myopia degree, myopia increase and axial elongation. CONCLUSION: Contrary to clinical expectation, we found neurodiscs that appeared to be small and dense in eyes with high myopia. We further discussed the eventual peaking of the angle between the temporal vessel arcades that is sometimes observed in high myopia. Occasionally, literature on myopia reports the presence of small and tilted discs whereas no mention was found of the issue of temporal vessel arcade peaking.

Eye shape and peripheral visual field recording in high myopia at approximately 54 years of age, as based on ultrasonography and Goldmann kinetic perimetry.

PURPOSE: This study describes the posterior pole contour and visual field (VF) findings in an unselected series of adults (aged approximately 54 years) with high myopia. METHODS: In 1962, 39 14-year-old teenagers with myopia of >or=6 D, in one or both eyes, were identified in a 1948 Copenhagen birth cohort (n=9243). At a follow-up in 2002, 61 eyes (52 with high myopia and nine fellow eyes; n=31 subjects) were examined by ultrasound B-scan, to allow: (a) measurement of the axial vitreous length supplementary to the customary axial A-scan, and (b) assessment of the posterior pole contour of the eye. Further, the large-object (V, 4e) kinetic Goldmann perimetry isoptre was recorded to outline the ambulatory VF. RESULTS: An irregular posterior pole contour was observed in 15 eyes, unilaterally in 11 eyes and bilaterally in four (two subjects). Nasal fundus ectasia was suggested in six and other deviations from the sphere in seven subjects. Kinetic Goldmann perimetry showed marginal restriction in 14 eyes (12 subjects). Larger defects were found in four eyes (three subjects); the corresponding axial lengths exceeded 32 mm in the two subjects with unilateral defects, and symmetrical inferior binasal defects, probably unrelated to the myopia, were found in the bilateral subject. CONCLUSIONS: Unselected adult-age high myopia mainly presented with a regular eye shape that was close to spherical. An irregular shape suggesting posterior staphyloma was seen in 13 of the 32 subjects under study, mainly unilaterally. No subjects were restricted in everyday activities by VF defects. Marginal Goldmann perimetry restrictions were described in 12 and significant defects in three subjects. Generally, longer eyes more often tended to show irregular posterior eye contours and/or VF defects.

Oculometry findings in high myopia at adult age: considerations based on oculometric follow-up data over 28 years in a cohort-based Danish high-myopia series.

PURPOSE: To present and discuss oculometry data in a series of adults with high myopia followed between the ages of 26 and 54 years. Emphasis is on axial length (AL) findings and corneal curvature radius (Crad). METHODS: Thirty-four out of the 39 individuals recruited as teenagers from a Copenhagen 1948 birth cohort with myopia of at least 6 D have had current follow-up exams, to include AL measurements (by ultrasound, 1974-2002; the latter year also with the Zeiss IOLMaster) and keratometry. The cross-sectional and longitudinal analyses are based primarily on the eyes with high myopia; however, the fellow eye is also assessed in unilateral cases. RESULTS: At age 54 years, the maximum myopia in the series was -26 D; the highest AL value was 35.4 mm. The myopia had increased in most, with an increase from the 26-year oculometry baseline averaging 1.0 D [standard deviation (SD) 1.84]. Ultrasound measurements over the 28 years gave a significant correlation between axial eye elongation and myopia progression of adult age (r = 0.65). The regression line was y = 0.43 + 0.36x, with myopia increase on the x-axis. Throughout sessions, the association between AL and refraction was given by correlation coefficients numerically above 0.8, whereas AL and Crad had r-values of 0.3-0.5. However, a mean Crad in the sample of 7.66 (SD 0.28) mm meant that the more general expectancy of rather flat corneas in high myopia was not fulfilled. Our data further suggested a reduction in lens power over the study period. CONCLUSION: In relation to refraction, AL and Crad remain the two main oculometry parameters. Apparently the correlation patterns regarding the cornea that are broadly valid for axial ametropia in the population cannot be extended to the marginal high myopia tail of the distribution. A significant proportion of eyes with high myopia thus had steeper corneas than expected, as a so-called index contribution (albeit a small one) to the marginal refractive error.

Does the level of physical activity in university students influence development and progression of myopia?--a 2-year prospective cohort study.

PURPOSE: To study whether physical activity has a protective effect on the development and progression of myopia in medical students. METHODS: In a 2-year longitudinal cohort study, 156 Caucasian first-year medical students from the University of Copenhagen were enrolled. The baseline examination included visual acuity, subjective refraction, Maddox Wing test (Clement Clarke International Ltd., Harlow, UK), partial coherence interferometry, slit lamp examination, automated refraction in cycloplegia, an oral questionnaire, and a cycle ergometer test. Measurements were repeated at the follow-up. A total of 151 (97%) participants completed the study. RESULTS: The prevalence of myopia (spherical equivalent [SE]

Is poor glycaemic control in diabetic patients a risk factor of myopia?

PURPOSE: As a consequence of an increasing prevalence of short-sightedness (myopia) in countries that have adopted western dietary patterns, it has been hypothesized that hyperglycaemia and hyperinsulinaemia induce myopia. The purpose of this study was to evaluate the relation between glycosylated haemoglobin (HbA(1c)), insulin dosage and myopia in diabetic patients. METHODS: All type 1 diabetic patients aged 16-26 years [mean age 22.0, standard deviation (SD) 2.9] attending the eye clinic at Steno Diabetes Center, Copenhagen, in 1995-1997 were included in the study (n = 393). The following data were collected from the medical records from baseline to 2005: age at diabetes onset, age at baseline, sex, weight, HbA(1c), insulin dosage, refractive error, visual acuity and ocular diabetes complications. RESULTS: The prevalence of myopia [spherical equivalent (SE) < or = -0.5 D] was 53.3% [95% confidence interval (CI) +/- 5.29] at baseline. We followed 252 patients for 7.1 years (SD 2.2). In a logistic regression analysis, age at baseline [odds ratio (OR) 0.90 (95% CI 0.82; 0.99), P = 0.031], duration of diabetes at baseline [OR 0.95 (95% CI 0.91; 0.99), P = 0.047] and HbA(1c) [OR 1.26 (95% CI 1.03; 1.47), P = 0.022] were associated with myopia. The relative risk of a myopic shift was 1.7 (95% CI 1.28; 2.26) in patients aged 16-21 years and 1.6 (95% CI 1.19; 2.14) in patients with HbA(1c) above 8.8%. Insulin dosage was not related to myopia. CONCLUSION: The prevalence of myopia in diabetic patients is considerably higher than in the background Danish population. Poor metabolic control of glucose is a suggested risk factor of myopia. The study suggests that myopia may be regarded as a complication of hyperglycaemia in diabetes.

Vogt-Koyanagi-Harada syndrome in a Greenlandic Inuit.

PURPOSE: To report a case of Vogt-Koyanagi-Harada syndrome (VKH) in an Inuit. METHODS: We carried out a medical evaluation and human leucocyte antigen (HLA) genotyping. RESULTS: A 36-year-old male Inuit developed severely decreased vision, intense headache and vertigo over a 3-week period. Ocular examination revealed panuveitis with bilateral serous retinal detachment and optic nerve head oedema. There was no history of ocular trauma or evidence suggestive of other disease entities. The patient responded well to high-dose systemic prednisolone. Vitiligo presented late in the course. CONCLUSIONS: This case report describes the first published case of VKH in a patient of Inuit ancestry. The patient was homozygous for HLA-DR4, a genotype previously associated with VKH.

Prevalence of myopia in Danish conscripts.

PURPOSE: This study aimed to determine the prevalence of myopia among Danish conscripts and compare the results with those from similar Danish studies carried out in 1882 and 1964. Furthermore, the relationships between myopia and educational level, ethnicity, intelligence (IQ), body mass index (BMI) and height were analysed. METHODS: We carried out a cross-sectional study based on medical reports for 4681 male conscripts. The following data were collected from September to December 2004: age; place of birth; weight; height; power of spectacles or contact lenses; visual acuity; number of years at school (8-13 years); occupation; intelligence test (IQ test) score, and ethnicity. RESULTS: The prevalence of myopia (

High myopia progression and visual impairment in a nonselected group of Danish 14-year-olds followed over 40 years.

PURPOSE: The purpose of this study was to document the adult age progression of myopia and the incidence of visual impairment in a representative sample of Danish adolescents with high myopia. METHODS: This study consisted of a scheduled regular ophthalmic follow-up over 40 years of 39 otherwise unselected Copenhagen 14 year olds with uni- and bilateral myopia of at least -6 D, as screened from a 1948 birth-year school cohort comprising 9243 pupils. Thirty-six of the 39 had satisfactory refractive and corrected visual acuity data for a longitudinal analysis. RESULTS: Myopia progression for the full period ranged from 0 to 14 D, and the peak myopia value increased from -14 to -26 D. The mean progression from age 16 to 26 years was 2.09 D, and from age 26 and on it was 1 D. Using both eyes and relevant correction, at the preliminary end point of 54 years, 32 of the 36 had a corrected visual acuity (VA) of 0.5 or better. Four had a corrected VA of < or = 0.3, but the visual loss was partly explained by other eye pathology. Significant visual reduction in single eyes mainly affected the subgroup of eyes with unilateral high myopia (n = 9). CONCLUSIONS: With only a slight overrisk recorded as associated with high myopia (in three or four of 36 subjects), the adult visual prognosis for working age appeared better than usually claimed. There seems to be a correlation between degree of myopia at age 14 and consecutive visual loss, but it was not possible to identify subjects at high risk at that early age.

Prevalence of myopia in local and international schools in Hong Kong.

PURPOSE: This study aims to investigate genetic and environmental influences on physiological myopia by studying the difference in myopia prevalence between local schools and international schools in Hong Kong. METHODS: Vision screening was carried out in local and international schools for students 13 to 15 years old. Types of refractive error were identified by visual acuity measurement, the presence of spectacles, a simple refraction, and the use of plus and minus ophthalmic lenses. RESULTS: Three local schools and six international schools participated in the study. Two hundred eighty-nine students were from the local schools, and 789 students were from the international schools. Prevalence of myopia at the local schools ranged from 85 to 88%, whereas it ranged from 60 to 66% in the international schools. Students in the international schools were subdivided into Chinese origin, white, mixed Chinese, and Asian. Prevalence of myopia was highest in the Chinese group (82.8%) and lowest in the white group (40.5%). There was no age or gender difference in the prevalence of myopia. CONCLUSIONS: Hong Kong Chinese students had a higher prevalence of myopia regardless of whether they studied in local or international schools when compared with other ethnic groups, such as whites. This further supports a genetic input into myopia development.

Ocular anisometropia and laterality.

PURPOSE: To study the difference in refraction between right and left eyes (anisometropia) in different age groups, look for evidence of eye laterality (more refractive error in one eye) and compare the size of anisometropia in the myopic and emmetropic ranges. METHODS: The study was based on children in Hong Kong (examined at the age of 6 years and again at the age of 8.5 years) and their parents (aged 26-60 years). RESULTS: In all age groups the difference between right and left eyes in sphere and cylinder was modest, in most cases < or = 0.25 D. In both children and their parents a tendency towards spherical right eye laterality was found in the myopic individuals (p < 0.05). This was not the case with the cylinder. In the 8.5-year-old children and in their parents, the numerical size of spherical anisometropia increased with myopia (p < 0.05 and p < 0.01, respectively). Cylindrical anisometropia did not exhibit such an increase. CONCLUSION: In Hong Kong children and their parents we found a tendency towards more spherical myopia in right eyes (laterality) in myopic cases. The numerical size of spherical anisometropia also increased in myopia in these groups. Cylindrical anisometropia appeared to be independent of spherical ametropia. In most cases right/left differences in both sphere and cylinder were small and our findings justify the use of data from one eye only in publications on refraction.

The mystery of myopia.

Published data from all parts of the world show that myopia is rare before school age, gradually increases during school life and reaches its highest level of prevalence during the years of most intense study at university. It is widely held that continuous reading harms the eyes, but none of the attempts made so far to reduce accommodative fatigue by introducing pauses during reading and teaching, eye exercises, etc. have been successful in reducing the number of children who develop myopia. However, we should not exclude the possibility that the introduction into schools of better tables, better lighting, more breaks and more sport has not only benefited the general health of children, mentally as well as physically, but has also decreased the development and progression of myopia. More research in this area is needed, but relevant protocols are difficult to establish. The aetiology of myopia is multifactorial and both genes and environment play important roles. Twin studies indicate a strong genetic influence and a weak environmental impact, while extreme myopia prevalences among selected population groups (university students) point to the opposite.