Myopia Progression in Adults: A Retrospective Analysis.

SIGNIFICANCE: Studies on adult myopia progression are limited. This retrospective analysis of a large data set of young adult myopes characterizes myopia progression during adulthood. PURPOSE: This study aimed to determine the mean annual progression of myopia and to estimate the proportion of progressors in adult myopes. METHODS: Longitudinal, noncycloplegic subjective refraction data for young adult myopes (spherical equivalent refractive error, -0.5 D or more), age ranging from 18 to 30 years, were retrospectively analyzed. The mean annual progression, as well as the proportion of progressors (at least -0.50 D shift between visits and annualized progression of -0.25 D or more), was estimated. RESULTS: A total of 354 myopes (230 females [64.7%]), with a mean (standard deviation) age of 22.2 (3.8) years, were considered. The mean (standard deviation) annualized progression was -0.10 (0.21), -0.08 (0.2), and -0.04 (0.21) D in the 18- to 21-year, 22- to 26-year, and 27- to 30-year age groups, respectively ( P = .003). The difference between 18- to 21- and 27- to 30-year age groups was significant ( P = .05), whereas all other pairwise comparisons were not significant. The proportion (95% confidence interval) of progressors in the 18- to 21-, >21- to 26-, and >26- to 30-year age groups was 18.3% (14.9 to 21.7%), 10.9% (7.1 to 14.7%), and 8.8% (4.4 to 13.1%), respectively. The proportion of progressors working or studying in a higher learning/academic environment was 16.2% with an odds ratio (95% confidence interval) for progression of 2.07 (1.15 to 3.74) compared with those in nonacademic environments ( P = .02), with no significant effect of sex or ethnicity. CONCLUSIONS: This study is consistent with other studies on myopia in young adults, which show that myopia does not progress by substantial amounts throughout the adult years, particularly after the age of 21 years. Although future studies may be challenged by the small rates of change and the small proportion of progressors, further research is needed to understand the implications of adult myopia progression on clinical management.

Myopia and sleep in children-a systematic review.

Worldwide, approximately one in three people are myopic or short-sighted. Myopia in children is of particular concern as younger onset age implies a higher risk of progression, and consequently greater risk of developing vision-threatening complications. The importance of sleep in children's health has long been acknowledged, but evidence for its role in childhood myopia is fairly new and mixed results were presented across studies. To facilitate better understanding of this relationship, a broad literature search, up to and including October 31, 2022, was performed using three databases (PubMed, Embase, and Scopus). Seventeen studies were included in the review, covering four main aspects of sleep, namely duration, quality, timing, and efficiency, and their associations with myopia in children. The present literature review discussed these studies, revealed potential limitations in their methodologies, and identified gaps that need to be addressed in the future. The review also acknowledges that current evidence is insufficient, and the role of sleep in childhood myopia is far from being fully understood. Future studies that primarily, objectively, and accurately assess sleep and myopia, taking other characteristics of sleep beyond duration into consideration, with a more diverse sample in terms of age, ethnicity, and cultural/environmental background, and control for confounders such as light exposure and education load are much needed. Although more research is required, myopia management should be a holistic approach and the inclusion of sleep hygiene in myopia education targeting children and parents ought to be encouraged.

Sleeping late is a risk factor for myopia development amongst school-aged children in China.

Myopia, a leading cause of distance vision impairment, is projected to affect half of the world's population in 30 years. We analysed the relationship between certain demographic, environmental, and behavioural factors and myopia from a 2-year school-based, prospective trial conducted in Shanghai, China. This trial enrolled 6295 school-aged children at baseline and followed them up for 24 months. The relationship between abovementioned factors and myopia was examined and the role of sleep in childhood myopia development was highlighted. Our results suggest that 'sleeping late' is a risk factor for myopia prevalence at baseline (odds ratio [OR] = 1.55, p = 0.04), 2-year myopia incidence (odds ratio [OR] = 1.44, p = 0.02) and progression over 24 months (p = 0.005), after adjusting for residency area, age, gender, sleep duration, and time spent outdoors. The identification and consistency of results with late sleepers being a susceptible group to both myopia onset and progression suggests a complex relationship between circadian rhythm, indoor environment, habitual indoor activities and myopia development and progression. These results can offer new insights to future myopia aetiology studies as well as aid in decision-making of myopia prevention strategies.

Profile of off-axis higher order aberrations and its variation with time among various refractive error groups.

Peripheral higher order aberrations (HOA) of 646 children at 30° temporal, nasal and inferior visual field were measured under cycloplegia (5 mm pupil diameter) using a commercially available Shack-Hartmann aberrometer in the Sydney Myopia Study [age, 12.7 ±â€¯0.4 years (mean ±â€¯standard deviation)] and five years later in the Sydney Adolescent Vascular and Eye Study. At baseline, 176 eyes were emmetropic, 95 were myopic and 375 were hyperopic. Coma, 3rd order and RMS of coma increased with eccentricity for all eyes and no difference was observed for 4th order and RMS of C(4,0) among refractive error groups. More positive C(4,0) was observed for hyperopic eyes at periphery. At follow up, 26% had 'myopic change' and 70% had 'no change' in refractive error. At follow-up, horizontal coma became more negative at nasal field and more positive at temporal field for all eyes. More positive C(4,0) for hyperopic eyes at baseline may indicate variation in optical characteristics of peripheral cornea and crystalline lens. An increase in horizontal coma with time, irrespective of refractive error change, may be attributed to variation in the shape factor of peripheral cornea and crystalline lens and/or misalignment of optical surfaces/components relative to the visual axis (angle kappa) as the eye grows in axial length.

External ocular surface and lens microbiota in contact lens wearers with corneal infiltrates during extended wear of hydrogel lenses.

OBJECTIVES: To determine whether carriage of microbes on the contact lens or ocular surfaces during extended wear (EW) with soft hydroxyethyl methacrylate (HEMA)-based contact lenses predisposes the wearer to adverse events. METHODS: Participants (non-contact lens wearers) were enrolled in a clinical study involving wear of HEMA-based hydrogel lenses on a six night EW basis with weekly replacement. Type and number of bacteria colonizing the lower lid margins, upper bulbar conjunctiva, and contact lenses during EW after one night, 1 week, 1 month, and thereafter every 3 months for 3.5 years were determined. The association of bacteria with adverse responses was compared between carriers (defined as having significant microbes cultured from two or more samples with 1 year) and noncarriers, and the strength of the association was estimated using multivariate logistic regression. RESULTS: Carriers of gram-positive bacteria on lenses (particularly coagulase negative staphylococci or Corynebacterium spp.) were approximately three and eight times more likely to develop contact lens-induced peripheral ulcers (CLPUs) and asymptomatic infiltrates (AIs), respectively. Staphylococcus aureus was most frequently isolated from lenses during CLPU. Carriers of gram-negative bacteria on lenses were five times more likely to develop contact lens-induced acute red eye (CLARE). Haemophilus influenzae was isolated most frequently from lenses during CLARE and AI events. CONCLUSIONS: Bacterial carriage on contact lenses during EW predisposes the wearer to the development of corneal inflammatory events including CLARE, CLPU, and AI.

Lid and conjunctival micro biota during contact lens wear in children.

PURPOSE: To determine the types of microorganisms and their frequency of isolation on the external ocular surface in children wearing soft contact lenses on a daily wear schedule. METHODS: Children aged 8 to 14 years were fitted with commercially available, soft contact lenses which were worn on a daily wear basis. The upper bulbar conjunctiva and the lower lid margins of each eye were swabbed at baseline and then at 6-monthly intervals for 2 years during lens wear. Swabs were processed, cultured and microorganisms identified using standard microbiological techniques. RESULTS: At baseline, 36% of the upper bulbar conjunctivae and 53% of the lower lid margins were contaminated with predominantly gram-positive bacteria. Recovery of samples with positive growth from the upper bulbar conjunctivae decreased during lens wear and ranged from 27 to 14%. The difference was statistically significant at the 12-month visit(14%, p = 0.011). The lower lid margins generally showed similar levels of contamination as at baseline except for less contamination at the 12-month visit (33%) (p = 0.05). Staphylococcus epidermidis and Propionibacterium sp. were the predominant microorganisms isolated from both the sites with and without lens wear. Gram-negative bacteria were infrequent and when isolated, the numbers of colonies were few. Fungus was isolated in a small percent (ranging from 0 to 4.8%) of eyes at various time points. CONCLUSIONS: The external ocular surface of children is contaminated with gram-positive bacteria that are resident microbiota. During lens wear, there was a trend for lesser recovery of organisms from the upper bulbar conjunctival samples,but there was no change in the type of microorganisms isolated. At all times, lower lid margins showed consistently greater colonization and is a source of potential contamination of the conjunctival surface.

Monochromatic aberrations in hyperopic and emmetropic children.

We investigated differences in higher order monochromatic aberrations between hyperopic and emmetropic eyes from two large cohorts (mostly 6 and 12 year old) of Caucasian children. Additionally, we investigated the differences of higher order monochromatic aberrations between age groups. In both cohorts, hyperopic eyes had significantly higher levels of positive spherical aberration (SA) and higher orders (HO) RMS than emmetropic eyes. Higher levels of positive SA were also found in the older cohort (irrespectively of the refractive error) although this difference was statistically significant only for emmetropic, low hyperopic and moderate hyperopic eyes. The observed higher levels of positive SA found in hyperopic eyes could explain for the previously reported differences in accommodative responses between hyperopic and non-hyperopic eyes. Our results provide some evidence of a relationship between ocular changes that typically occur during eye growth and the observed levels of higher order aberrations in children eyes.

IgE antibody on worn highly oxygen-permeable silicone hydrogel contact lenses from patients with contact lens-induced papillary conjunctivitis (CLPC).

PURPOSE: To investigate whether the level of IgE is increased in the eyes of patients during general contact lens-induced papillary conjunctivitis (CLPC) events, which involve enlarged papillae across the entire palpebral conjunctiva, or local CLPC events, in which papillae are confined to one or two parts of the area. METHODS: Worn contact lenses were collected and soaked in phosphate-buffered saline. The levels of eluted IgE and IgE retained on contact lenses were detected by enzyme-linked immunosorbent assay. RESULTS: IgE was detected in 6 of 12 cases of general CLPC, 8 of 21 cases of local CLPC, and none of 14 control contact lenses. The average level of eluted IgE was 0.54 +/- 1.06 IU/contact lens, 0.28 +/- 0.54 IU/contact lens, and 0.04 +/- 0.06 IU/contact lens for general CLPC, local CLPC, and the control group, respectively. The incidences of positive IgE were significantly higher in patients with CLPC (general and local) than in control subjects, but no statistical difference was found between general and local CLPC. Generally higher amounts of retained IgE were detected on contact lenses that had increased levels of eluted IgE. Contact lenses that were collected before or after a CLPC event did not show increased levels of IgE. CONCLUSIONS: The level of IgE is increased in the eyes of some patients during an acute event of CLPC. The similar incidence of IgE-positive cases and levels of IgE from general and local CLPC contact lenses suggest that the conditions may share similar causal pathways.

Accommodative facility in eyes with and without myopia.

PURPOSE: To compare accommodative facility in eyes with myopia to that in eyes with emmetropia or hyperopia and to determine whether accommodative facility can be used to predict an association with myopia. METHODS: In the Sydney Myopia Study, year-1 school children (6.7 +/- 0.4 years) were assessed for accommodative facility at distance (3 m) and near (33 cm) with semiautomated flippers. Spherical equivalent refractive error (RE) was defined as myopia (< or = -0.50 D), emmetropia (> -0.50 D, but < +1.50 D), and hyperopia (> or = +1.50 D) based on postcycloplegia readings. Only right eye data were considered. Differences between groups were analyzed with the Brown-Forsythe F test after adjustment for age and gender. Multiple comparisons were adjusted with the by the Games-Howell RESULTS: Of the 1328 right eyes assessed, 20 (1.5%) eyes were myopic, 977 (73.6%) were emmetropic, and 331 (24.9%) were hyperopic. At distance, mean facility was less for myopic eyes at 5.5 +/- 2.0 cycles per minute (cpm) in comparison to 6.9 +/- 1.7 cpm for eyes with emmetropia or hyperopia (P = 0.005). Myopic eyes recorded greater positive and negative accommodative response times than did emmetropic or hyperopic eyes (P < 0.05). There were no differences among the groups in near facility. The area under the receiver operating characteristic (ROC) curve for distance facility was 0.692 (P = 0.003, 95% CI, 0.580-0.805). CONCLUSIONS: Myopic eyes have reduced accommodative facility at distance, and accommodative responsiveness to both positive and negative defocus is slow. However, accommodative facility as a test does not have sufficient power to discriminate eyes with myopia from other refractive errors.

Salicylic acid reduces the production of several potential virulence factors of Pseudomonas aeruginosa associated with microbial keratitis.

PURPOSE: Pseudomonas aeruginosa is a common cause of contact-lens-related microbial keratitis. This bacterium is becoming increasingly resistant to antibiotics, and even if the infection can be treated with antibiotics, damage to the cornea resulting from the combined effect of bacteria and host factors can lead to loss of vision. The purpose of this study was to test the effect of salicylic acid on the production of potential virulence factors during the growth of P. aeruginosa. METHODS: Bacterial cells were grown in a subinhibitory concentration of salicylic acid, and supernatants were collected and analyzed for presence of proteases by using zymography and hydrolysis of chromogenic substrates. The supernatants were also analyzed for the amount of acetylated homoserine lactones by using bacterial reporter strains. Pseudomonas cells from salicylic acid cultures were analyzed for their twitching and swimming motility as well as their ability to invade or cause the death of corneal epithelial cells. RESULTS: Growth in a subinhibitory concentration of salicylic acid resulted in a significant reduction in the number of bacterial cells and a reduction in the rate of the number of bacteria increasing during logarithmic growth, but the time to reach the stationary phase of growth was unchanged. These changes in growth pattern affected the amount of acylated homoserine lactones produced by P. aeruginosa 6294. Also affected by growth in salicylic acid was the ability of strain 6294 to show twitching or swimming motility. Salicylic acid also reduced the invasion of strain 6294 into corneal epithelial cells and the epithelial cell death caused by strain 6206. Furthermore, production of proteases by P. aeruginosa was significantly reduced by growth in salicylic acid. CONCLUSIONS: The results of this study clearly demonstrate that salicylic acid has a significant impact on several potential virulence factors of P. aeruginosa that may be involved in the production of microbial keratitis. These effects were probably mediated by reduction in the cell density and concomitant reduction in the quorum-sensing signaling molecules, the acylated homoserine lactones, produced by P. aeruginosa.

Two presentations of contact lens-induced papillary conjunctivitis (CLPC) in hydrogel lens wear: local and general.

PURPOSE: The purpose of this study was to confirm that two distinct clinical presentations of contact lens-induced papillary conjunctivitis (CLPC), local and general, occur in hydrogel lens wear. METHODS: Retrospective analyses of 124 CLPC events were identified. The classification of CLPC was based on location and extent of papillae. CLPC was classified as local if papillae were present in one to two areas of the tarsal conjunctiva and general if papillae occurred in three or more areas. The CLPC events were compared with an asymptomatic control group in prospective clinical trials conducted from 1993 until 2003 at two clinical sites, Australia and India. Two hundred sixteen subjects from Australia and 914 subjects from India wore either high Dk silicone hydrogel or low Dk hydrogel lenses on a 6-night (6N) or 30-night extended-wear (EW) schedule. The physiological responses of the ocular surface, including tarsal conjunctiva redness and roughness, number of papillae present, lens fit and performance, and subjective patient symptoms, were measured during each visit at each site. These variables listed were compared between local CLPC groups and asymptomatic controls and general CLPC groups and asymptomatic controls. RESULTS: Two types of CLPC in hydrogel lens wearers have been confirmed. Of the 124 CLPC events, there were 61 local and 63 general events. Local and general CLPC cases reported significantly greater frequency of symptoms compared with the asymptomatic controls, in particular itching, lens awareness, secretion, and blurred vision (p < 0.1). CONCLUSIONS: The classification of CLPC into two types, local and general, in hydrogel lens wear was confirmed based on presentations at both sites. This distribution of papillae between local and general CLPC may indicate separate etiologies involved in the pathogenesis of the condition.

Microbial keratitis in prospective studies of extended wear with disposable hydrogel contact lenses.

PURPOSE: To report the annualized incidence of microbial keratitis with extended wear of low oxygen transmissible (Dk/t) disposable soft contact lenses from prospective postmarket clinical trials. METHODS: Seven hundred ninety subjects were enrolled at the L.V. Prasad Eye Institute (LVPEI), Hyderabad, India from March 1993 to March 2000, resulting in 1231 patient eye years, and 167 subjects were enrolled at the Cornea and the Contact Lens Research Unit (CCLRU), Sydney, Australia from July 1987 to December 1999, resulting in 842 patient eye years. RESULTS: The annualized incidence of microbial keratitis per 10,000 eyes per year of lens wear was 32.5 (95% CI 8.9 to 83.2) for LVPEI, 23.8 (95% CI=2.9 to 85.8) for CCLRU; when data are combined across both centers, the incidence was 28.9 (95% CI=10.6 to 63) per 10,000 eyes per year of lens wear. This equates to 57.0 per 10,000 wearers or 1 in 173 wearers per year of lens wear. All events were rated as slight to moderate in severity and did not result in visual loss. Two events were described to highlight the challenges in diagnosis and treatment of microbial keratitis. CONCLUSIONS: The incidence of microbial keratitis with extended wear of low-Dk/t disposable lenses was higher in these prospective studies (1 in 210 wearers per year at CCLRU and 1 in 154 wearers per year at LVPEI) than that seen in retrospective population-based surveillance studies (1 in 500 wearers per year). Practitioners and patients should always be alert to signs and symptoms, and practitioners should adopt conservative strategies for diagnosis and management of contact lens-related adverse events.

Comparison of adverse events with daily disposable hydrogels and spectacle wear: results from a 12-month prospective clinical trial.

OBJECTIVE: To evaluate the type and incidence of adverse events seen with daily disposable hydrogel contact lens wear compared with a control (spectacle) group over 12 months. DESIGN: Prospective, randomized, observer-masked, comparative clinical trial. PARTICIPANTS: Two hundred eighty-one myopes with no prior contact lens wear experience were enrolled from August to December 1996. Subjects were 16 to 35 years old and had refractive errors ranging from a -0.75-diopter (D) sphere to a -6.00-D sphere with a cylinder less than -1.00 D. INTERVENTION: Each subject was randomly assigned to wear either bilateral disposable hydrogels on a daily disposable wear schedule or spectacles. MAIN OUTCOME MEASURE: Type and incidence of adverse events from each group. Adverse events were categorized as serious, significant, and nonsignificant based on the potential to cause vision impairment, severity at event, and level of clinical concern. RESULTS: At baseline, 1.6% of eyes had asymptomatic infiltrates that were nonsignificant. During the study, asymptomatic infiltrates were seen in both contact lens and spectacle groups at 20.5 events versus 11.3 events per 100 eyes per year of wear. No significant events were seen with the spectacle group. With the contact lens group, the type and incidence of significant events per 100 eyes per year of lens wear were corneal peripheral ulcer, 2.5 events; infiltrative keratitis, 1.5 events; and papillary conjunctivitis, 1 event. The incidence of both significant and nonsignificant events was greater with the contact lens group (P<0.05). No serious events (i.e., microbial keratitis) were seen in either group. A greater number of subjects were lost to follow-up or permanently discontinued from the contact lens group relative to the spectacle group (33% vs. 17%, P = 0.002). Lens-related problems such as dryness, discomfort, and difficulty with insertion and removal accounted for 27% of discontinuations from the contact lens group. Poor compliance (40%) was the greatest reason for discontinuations from the spectacle group. CONCLUSIONS: No clinically serious events were seen with either group. Only a small percentage of contact lens-wearing eyes presented with significant events, which is promising for daily disposable lens wear. Far more contact lens subjects were lost to follow-up or discontinued. Small, asymptomatic, subepithelial corneal infiltrates of unknown significance were seen in both contact lens- and spectacle-wearing eyes.

Clinical characterization of corneal infiltrative events observed with soft contact lens wear.

PURPOSE: Corneal infiltrates are commonly observed during adverse reactions associated with contact lens wear. Broad ranges of presentations are encountered, and there is no well-established classification system. The aim of this paper is to categorize corneal infiltrates associated with soft lens wear and present the typical clinical characteristics associated with each type of event. METHODS: All events of corneal infiltrates occurring in soft contact lens clinical trials over 10 years (9 years retrospective and 1 year prospective) and conducted at two contact lens research centers were reviewed by a panel of experts comprising ophthalmologists, optometrists, and other biologic scientists. Classification of each event was based on assessment of a range of signs and symptoms by the review panel. RESULTS: A classification scheme was devised to distinguish infiltrative events that were serious and symptomatic (microbial keratitis), clinically significant and symptomatic (contact lens-induced peripheral ulcer, contact lens-induced acute red eye, infiltrative keratitis), and clinically nonsignificant and asymptomatic (asymptomatic infiltrative keratitis and asymptomatic infiltrates). CONCLUSION: Corneal infiltrates can be classified into six distinct categories. This classification scheme, based on clinical characteristics, should aid diagnosis, management, and treatment of corneal infiltrates as well as assisting investigations into the etiology of each of these conditions.

Microbial keratitis and vision loss with contact lenses.

PURPOSE: Microbial keratitis is the only sight-threatening adverse event that occurs with contact lens wear. This article gives a preliminary estimation of the incidence of microbial keratitis and vision loss with continuous-wear contact lenses made from highly oxygen permeable (Dk) materials. METHODS: The most up-to-date data available on microbial keratitis and vision loss are collected from a range of sources including industry, private practice, and publications and is reviewed. RESULTS: There have been 16 cases of microbial keratitis with high-Dk silicone hydrogel lenses. Of the 13 where data are available, none have lost two or more lines of best-corrected visual acuity (BCVA). CONCLUSION: First approximation indicates that the incidence of microbial keratitis with high-Dk silicone hydrogel lenses may be lower than the incidence with low-Dk soft lenses during extended wear. The rate of loss of more than two lines of BCVA is low in patients that develop microbial keratitis with low- and high-Dk soft lenses.

Hypersensitivity responses and contact lens wear.

Hypersensitivity diseases that involve the eye are common reasons why patients present to eyecare practitioners. Common ocular hypersensitivity disorders include allergic conjunctivitis, giant or contact lens induced papillary conjunctivitis and atopic keratoconjunctivitis. The diagnosis and management of ocular hypersensitivity can present a challenge to eyecare practitioners and an understanding of the mechanisms that underlie the signs and symptoms of such conditions is necessary for their appropriate management. This article reviews the mechanisms by which the eye responds to antigenic challenges, the pathogenesis of ocular hypersensitivity responses, particularly in relation to contact lens wear, and illustrates possible management strategies.