Spectacle lenses with highly aspherical lenslets for slowing axial elongation and refractive change in low-hyperopic Chinese children: A randomized controlled trial.

PURPOSE: Spectacle lenses with highly aspherical lenslets (HAL) have been shown to effectively retard myopia progression in myopic children. This study aimed to investigate the impact of spectacle lenses with HAL on refractive and axial length (AL) changes in Chinese children with low amount of hyperopia. DESIGN: Randomized controlled trial METHODS: : A total of 108 Chinese children aged 6.0 to 9.9 years and spherical equivalent refractive error (SERE) from 0.00 to +2.00 D were randomly allocated into two groups: the HAL group and the single vision spectacle lens (SVL) group. Cycloplegic refraction, AL, and uncorrected visual acuity (UCVA) was measured at baseline, three months, six months, and 12 months after lens dispensing. The duration of spectacle lens wear was monitored using a wearable device attached to the spectacle frame and by questionnaire logs provided by participants at each follow up visit. RESULTS: The one-year SERE change was -0.19 [-0.32, 0.03] D and -0.23 [-0.36, 0.05] D in the SVL and HAL groups (P=0.883). The one-year AL elongation was 0.24 [0.18, 0.34] mm and 0.19 [0.12, 0.27] mm in the SVL and HAL groups (P=0.057). In the HAL group, changes in AL and SERE were significantly correlated to lens wearing time (P<0.001 and P=0.024, respectively). Participants in the HAL group who wore their lenses for more than 30 hours per week had significantly slower AL elongation (0.11 [0.05, 0.17] mm) compared to their SVL counterparts (0.27 [0.21, 0.33] mm) (P<0.001). CONCLUSION: Spectacle lenses with HAL significantly reduced AL elongation in low hyperopic children who wore lenses for over 30 hours per week. A dose-response relationship was evident with longer lens wearing time associated with less AL change.

Intraocular amphiregulin and axial elongation in non-human adolescent primates.

The purpose of the experimental interventional study was to examine the influence of intraocularly applied amphiregulin, a member of the epidermal growth factor (EGF) family, on axial length in young non-human primates. It included three non-human primates (Macaca mulatta), aged 4-6 years. The left eyes received three intravitreal injections of amphiregulin (400ng/50 µl) in intervals of 4 weeks, while the right eyes received three intravitreal injections of phosphate buffered solution (50 µl) at the same time points. Ocular biometry was performed in weekly intervals. At baseline, the left eyes (study eyes) were shorter than the right (control) eyes (20.69 ± 0.21 mm versus 20.79 ± 0.24 mm; P < 0.001), with an inter-eye axial length (AL) difference (left minus right eye) of -0.10 ± 0.23 mm. Inter-eye AL difference increased (P < 0.001) to 0.15 ± 0.18 mm at study end, at 12 weeks after baseline. Axial elongation during the study was higher (P < 0.001) in the left eyes (20.69 ± 0.21 mm to 21.05 ± 0.29 mm or 0.36 ± 0.30 mm) than in the right eyes (20.79 ± 0.24 mm to 20.90 ± 0.31 mm or 0.11 ± 0.17 mm). In a parallel manner, inter-eye difference in vitreous cavity depth combined with lens thickness (left eye minus right eye) increased from -0.04 ± 0.17 mm at baseline to -0.02 ± 0.21 mm (P = 0.02), 0.04 ± 0.10 mm (P = 0.002), and to 0.42 ± 0.67 mm (P < 0.001) at 5, 6, and 12 weeks after baseline, respectively. The results suggest that intravitreally applied amphiregulin as EGF family member led to an increase in axial length in adolescent non-human primates. It supports the hypothesis of amphiregulin as EGF family member being involved in the process of axial elongation.

Refractive surgery to correct visual impairments in 267 children with autism spectrum and related neuro-developmental disorders: improvements in vision and behavior.

Background: Children with autism spectrum disorder (ASD) may have impaired vision owing to high refractive errors and aversion to spectacles or contact lenses. Visual blurring is caused by near-sighted myopia, far-sighted hyperopia, or astigmatism in one or both eyes. Refractive surgery can restore sharp vision and eliminate the need for spectacles and contact lenses. Restoration of sharp vision may improve ASD behavior. We aimed to determine the refractive outcomes in this cohort using ophthalmic measures and behavioral and school performance alterations after refractive surgery by employing parent-proxy reports. Methods: This interventional, retrospective case series included data from 267 children with refractive errors and neurodevelopmental disorders (NDDs) diagnosed as ASD alone or NDD with ASD-like behaviors over a 15-year period. One of three refractive surgery methods was employed, with the choice of method uniquely tailored to the child's eye anatomy. Laser photorefractive keratectomy (PRK) was performed in 131 children, implantation of a phakic intraocular lens (pIOL) in 115 children, and removal of the crystalline lens and implantation of an intraocular lens (refractive lens exchange, RLE) in 21 children. All procedures were performed under brief general anesthesia, with the child returning home on the same day. Results: The median age at surgery was 10.9 years and the median follow-up period was 3.1 years. Pre-operative refractive errors ranged from a mean (standard deviation) +7.5 (0.09) D to -14.3 (4.8) D. Surgery corrected 87% of the children to normal focal length (± 1 D). Visual acuity improved an average of 0.6 logarithm of the minimum angle of resolution, the equivalent of 6 lines on a standard eye chart. Change in visual acuity was significant (all P < 0.01) between baseline and the most recent follow-up examination in each of subgroups. Change in spherical equivalent refractive error at 3, 12, 24, 36, 60, and > 60 months post-operatively were significant (all P < 0.01) between baseline and each follow-up visit in each of subgroups. Social interactions and ASD behaviors improved in 72% (192) of the treated children (P < 0.01). The incidence of sight-threatening complications was low. Conclusions: Refractive surgery improves both visual function and behavior in most children with ASD and major myopia, hyperopia, or astigmatism. The PRK, pIOL, and RLE procedures appear to be effective and reasonably safe methods for improving refractive error, visual acuity, and behavior in many ametropic children with ASD and ASD-like NDDs.

Visual and Ocular Characteristics of Anisometropic Children.

Purpose: To compare the demographic and ocular characteristics of patients with low and high levels of anisometropia compared with non-anisometropic individuals. Methods: This cross-sectional study was conducted on 1803 individuals (age range, 1 to 30 years) examined at strabismus clinics between January 2019 and December 2020. Of these, 203 subjects had anisometropia (11.2%); 66 cases were excluded due to the history of prior ocular surgery except from strabismus surgery. Finally, data from 137 subjects were analyzed. Spherical or cylindrical differences of 1.50 or 3.00D between the two eyes were defined as low or high anisometropia, respectively, and isometropic subjects (n = 1600) served as controls. Results: No significant difference was observed between cases and controls regarding age (10.25 ± 8.41 vs. 9.2 ± 1.7 years; P = 0.133) and sex (P = 0.051). History of ocular surgery was present in 33% of anisometropic patients versus 0.8 % of isometropic cases. The rate of amblyopia was 83% and 2.3% in anisometropic and non-anisometropic groups, respectively. Best corrected visual acuity (BCVA) was comparable in amblyopic eyes in both study groups, while BCVA of non-amblyopic eyes of non-anisometropic subjects was better (non-anisometropic: 0.01 ± 0.01 vs. anisometropic: 0.06 ± 0.17 LogMAR; P = 0.001). Eye deviation was significantly more prevalent among anisometropic patients (36.5% vs. 3.25%, P < 0.001) and exotropia was the common type of deviation. Anisohyperopia and anisomyopia were the most common refractive errors under low and high anisometropia categories, respectively. Simultaneous manifestation of amblyopia and strabismus were observed in 30.6% of anisometropic cases, while only 0.7% of subjects with isometropia had a similar status (P < 0.001). Conclusion: High rates of amblyopia and strabismus in anisometropic subjects, especially with higher degrees of anomaly, indicate the necessity of early visual acuity and refractive error screening to improve detection and enhance the outcomes of treatment.

Refractive Errors of School Children from Economically Disadvantaged Areas in Northwest México.

Background: Refractive errors, including myopia, hyperopia, and astigmatism, are the leading causes of visual impairment in school-aged children and can significantly impact their academic performance and quality of life. This study aimed to assess the prevalence of refractive errors among school children from economically disadvantaged areas in Northwest México, using a consistent methodology to facilitate comparison with global data. Methods: We adopted the Refractive Error Study in Children (RESC) protocol by the World Health Organization to examine the prevalence of myopia, hyperopia, and astigmatism. The study comprised a systematic sampling of children aged 6 to 18 years from diverse schools in Northwest México. Trained optometrists conducted visual acuity testing and autorefraction, while ophthalmologists performed cycloplegic refraction to ensure accuracy. Results: The study found a myopia (SE ≤-1.50 D at least one eye) prevalence of 14.55% (95% CI: 13.27-15.91), with a higher incidence in females (6.92%) compared to males (6.00%) in at least one eye. Hyperopia (SE ≥ +1.00 D at least one eye) was less common, at 3.23% (95% CI: 2.61-3.95), with a slightly higher occurrence in males in at least one eye. Astigmatism (Cylinder ≥ 0.75 D at least one eye) was present in 18.63% (95% CI: 17.21-20.12) of the students in at least one eye, with no significant difference between genders. These findings are consistent with other studies in regions such as Puerto Rico and Iran, indicating widespread refractive error issues among schoolchildren. Conclusions: The high prevalence of refractive errors, particularly myopia and astigmatism, highlights the critical need for regular vision screenings in schools and the implementation of public health interventions to provide corrective eyewear. Our study confirms the importance of utilizing standardized methodologies like the RESC protocol to compare refractive error prevalence across different geographical and socio-economic contexts, thereby informing global public health strategies.

The relationship between refractive error and the risk of diabetic retinopathy: a systematic review and meta-analysis.

Purpose: This meta-analysis was conducted to collect all available data and estimate the relationship between refractive error and the risk of diabetic retinopathy (DR) in patients with diabetes, and to assess whether vision-threatening DR (VTDR) is associated with refractive error. Methods: We systematically searched several literature databases including PubMed, Embase, Cochrane Library, Web of Science, CNKI, CBM, Wan Fang Data, and VIP databases. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using fixed or random effects models. Four models were developed to assess the relationship between refractive error and the risk and DR, VTDR: hyperopia and DR, VTDR; myopia and DR, VTDR; spherical equivalent (SE per D increase) and DR, VTDR; and axial length (AL per mm increase) and DR, VTDR. The included literature was meta-analyzed using Stata 12.0 software, and sensitivity analysis was performed. Publication bias in the literature was evaluated using a funnel plot, Begg's test, and Egger's test. Results: A systematic search identified 3,198 articles, of which 21 (4 cohorts, 17 cross-sectional studies) were included in the meta-analysis. Meta-analysis showed that hyperopia was associated with an increased risk of VTDR (OR: 1.23; 95% CI: 1.08-1.39; P = 0.001), but not with DR (OR: 1.05; 95% CI: 0.94-1.17; P = 0.374). Myopia was associated with a reduced risk of DR (OR: 0.74; 95% CI: 0.61-0.90; P = 0.003), but not with VTDR (OR: 1.08; 95% CI: 0.85-1.38; P = 0.519). Every 1 diopter increase in spherical equivalent, there was a 1.08 increase in the odds ratio of DR (OR: 1.08; 95% CI: 1.05-1.10; P<0.001), but not with VTDR (OR: 1.05; 95% CI: 1.00-1.10; P = 0.06). AL per mm increase was significantly associated with a decreased risk of developing DR (OR: 0.77; 95% CI: 0.71-0.84; P<0.001) and VTDR (OR: 0.63; 95% CI: 0.56-0.72; P<0.001). Analysis of sensitivity confirmed the reliability of the study's findings. Conclusion: This meta-analysis demonstrates hyperopia was associated with an increased risk of VTDR in diabetes patients. Myopia was associated with a reduced risk of DR. AL is an important influencing factor of refractive error. Every 1 mm increase in AL reduces the risk of DR by 23% and the risk of VTDR by 37%. Systematic review registration: identifier: CRD42023413420.

Prescribing patterns for hyperopia: an insight of the optometrist perspective and practice.

BACKGROUND: To investigate the current prescribing patterns for correcting hyperopia among optometrists in clinical practice in Saudi Arabia and compare those to current international guidelines. And explore the factors that influence practitioners' prescribing decision. METHOD: This cross-sectional study employed 30 items online survey that encompass demographic data, current practice and cycloplegia use, numerical response to indicate the minimum level of hyperopia at which optometrists would consider prescribing spectacles to non-strabismic children and determine the diopter value required for prescribing correction for hyperopia if present with other factors. RESULT: A total of 104 optometrists responded to the survey (52 females and 52 males). They recruited from 35 cities across Saudi Arabia. Out of total, 44% of them considered cycloplegic refraction essential under 12 years and 56% of them extended the range to 18 years. Large variation were found between the optometrists' responses and current guideline recommendations. Several factors influenced the decision-making of the practicing optometrist including signs and symptoms, bilateral hyperopia, average dioptric value, reading difficulty, and accommodative function. CONCLUSION: There are some matches between the international guidelines and the practice patterns that followed by optometrists in Saudi Arabia, however, the optometrists did not report that they are following them purposefully. These findings highlight the need to improve optometrists' practice about spectacle prescription in pediatric population.

Prevalence of Refractive Errors Among Medical Students of Raichur Institute of Medical Sciences, Raichur, Karnataka, India.

Introduction Refractive errors (REs) are on the rise among medical students due to the high academic pressure of long hours of reading and their association with close technology. Uncorrected REs cause impaired vision and blindness with considerable morbidity. Documenting the prevalence of REs among medical students helps with early detection and appropriate remedial measures to prevent eye morbidity. Aim The aim of the study was to find the prevalence of REs among medical students at Raichur Institute of Medical Sciences, a medical institution in Raichur City, Karnataka, India. Methodology This hospital-based cross-sectional study was conducted with a total of 425 medical students. An examination of the eye for REs was carried out using a streak retinoscope. The REs were noted in myopia <-0.5 diopters (D), hypermetropia >+0.5 D, and astigmatism >0.5 cylinder D. The data was statistically subjected. Categorical measurements have been presented as frequency (percentage). The chi-square test was applied to the association between the parameters. A p-value less than 0.05 was considered statistically significant. Results Among the 425 observed participants, 160 (37.6%) subjects had REs. Among the REs in the total population, myopia 78 (18.4%) was the most prevalent, followed by hypermetropia and astigmatism, both with 41 (9.6%) and 41 (9.6%) prevalence, respectively. Gender-wise and age-wise, myopia was highly prevalent in both genders and in all age groups except the 20 years age group. Conclusion The prevalence of REs in our study among medical students is a matter of concern, although it is less compared to other previous studies in different geographical areas of India. Regular checkups, early detection, and immediate treatment are very important to prevent further ocular complications.

Effect of spectacle correction on hyperopic children.

Background: Hyperopia is a significant refractive error in children, often leading to vision impairment. This study aimed to investigate whether partial or full spectacle correction is benefit for hyperopia in preschool-aged children. Methods: A retrospective study was conducted on hyperopic children visited to teaching medical center outpatient clinic between October 2011 and October 2018, and were categorized into three groups: full correction, overcorrection, and undercorrection. The study was approved by the institutional ethical committee of Tri-Service General Hospital. Results: Following a minimum of one-year follow-up period, no statistically significant differences were observed in best-corrected visual acuity (BCVA) among children receiving full, over, or under spectacle correction. Notably, the overcorrection group exhibited a significant reduction in spherical equivalent (SE) compared to both the full and under correction groups, indicating a better SE with spectacle overcorrection. Conclusions: Spectacle overcorrection may offer potential benefits for enhancing SE in preschool children with hyperopia. Nevertheless, further investigation through randomized controlled trials is warranted to establish the validity of this approach and its impact on visual outcomes in this hyperopic pediatric population.

Longitudinal Changes in Refractive Development in Highly Hyperopic Children: A 2.6-11.2 Year Follow-up of Preschoolers Diagnosed with High Hyperopia.

PURPOSE: This study aims to elucidate the longitudinal refractive and ocular biometric alterations in preschool children with high hyperopia who underwent early interventions. METHODS: We conducted a retrospective analysis of preschool children diagnosed with high hyperopia at Tianjin Medical University Eye Hospital between 2011 and 2023. Inclusion criteria required an initial examination with cycloplegic refraction, bilateral spherical equivalent power (SE) ≥ +5.00D with a difference <1.00D, a minimum two-year follow-up, and at least three ocular biometric measurements. The annual axial growth rate evaluated emmetropization in highly hyperopic children. We applied Restricted Cubic Spline (RCS) models to explore potential nonlinear relationships between age and spherical equivalent, axial length, corneal curvature, and axial length-to-corneal curvature ratio. Additionally, Mixed-effects models were employed to investigate factors associated with changes in refractive error and axial length. RESULTS: The study enrolled 60 eligible subjects, with a median initial diagnosis age of 3.5 years (IQR, 2.8-4.9 years) and a median last visit age of 9.3 years (IQR, 8.1-10.8 years). The average follow-up duration was 5.7 years. RCS analysis revealed notable nonlinear changes in spherical equivalent power, axial length, and axial length-to-corneal curvature ratio, although corneal curvature displayed no statistically significant nonlinear trend. Factors affecting SE changes included the presence of strabismus, the use of cycloplegia, baseline SE, and age. Conversely, changes in axial length solely correlated with baseline axial length and age. CONCLUSION: Highly hyperopic preschool children undergoing early intervention display a marked emmetropization tendency, though most still remain moderately to highly hyperopic, with the progression of refractive changes showing non-uniform patterns with respect to age.

Comparison of photorefraction by Plusoptix A12 and cycloplegic autorefraction in children.

BACKGROUND: Plusoptix photoscreeners are capable of measuring refractive errors of children from 1 meter distance, without cyloplegia. We aimed to compare refractive data obtained from the newest version of Plusoptix (model 12) with cycloplegic autorefraction. METHODS: We examined 111 consecutive children aged 3-7 years first by Plusoptix A12C under manifest condition and subsequently for cycloplegic refraction by Topcon KR-1 tabletop autorefractometer. Sphere, spherical equivalent, cylinder and axis of astigmatism measured by the two methods were analyzed to determine correlation, agreement and differences. RESULTS: Binocular examination of 111 children aged 4.86±1.27 years revealed good agreement between refractive data obtained by Plusoptix and cycloautorefraction, according to Bland-Altman plots. Significant (p < 0.001) and strong correlation was found between all refractive measurements (Pearson's r value of 0.707 for sphere, 0.756 for pherical equivalent, and 0.863 for cylinder). Plusoptix mean sphere, spherical equivalent and cylinder were 1.22, 0.56, and -1.32 D, respectively. Corresponding values for cycloautorefraction were 1.63, 1.00, and -1.26 D. The difference between axis of cylinder measured by the two methods was < 10° in 144 eyes (64.9%). CONCLUSIONS: Considering the significant agreement and correlation between Plusoptix photoscreener and cycloplegic autorefraction, the need for cycloplegic drops in refractive examination of children may be obviated. The mean difference between cylinder measurements are considerably trivial (0.06 D), but sphere is approximately 0.4 D underestimated by Plusoptix compared to cycloautorefraction, on average.

Lamellar surgeries with SMILE-derived lenticules.

PURPOSE: Lamellar surgeries with SMILE lenticules are an evolving field of refractive surgery. This chapter intends to discuss the reported clinical results of using SMILE derived lenticules in terms of feasibility, safety and predictability; or the potential management of hyperopia, keratoconus, SMILE ectasia and presbyopia. MATERIALS AND METHODS: Donor SMILE lenticules were prepared under microscope tocreate doughnut shaped lenticules. For hyperopia, this tissue was then inserted into afemtosecond laser enabled pocket created using VisuMax FS Laser at a depth of 160µm. For ectasia induced by keratoconus and post refractive procedure (SMILE), 0.23% riboflavin dye was instilled into the interface and then lenticule was inserted followed by exposure to UV-A radiation with total energy of 6.3 J. RESULTS: Spherical equivalent (S.E.) of within ± 0.5 D was observed in 50% (n=21) eyes and within 1 D was seen in 71% eyes treated for hyperopia. A significant increase in the K mean anterior, central corneal thickness, Q-value and corneal aberrations was seen 2 weeks post-op. Clinical improvement in terms of S.E. and uncorrected distance visual acuity in eyes treated for ectasia after keratoconus and post refractive procedure (SMILE) was seen. CONCLUSION: With the ample availability of SMILE- derived lenticules, researchers are exploring the possibility of using this tissue for the treatment of various refractive and corneal conditions.

Detection of significant vision conditions in children using QuickSee wavefront autorefractor.

PURPOSE: This study evaluated the ability of QuickSee to detect children at risk for significant vision conditions (significant refractive error [RE], amblyopia and strabismus). METHODS: Non-cycloplegic refraction (using QuickSee without and with +2 dioptre (D) fogging lenses) and unaided binocular near visual acuity (VA) were measured in 4- to 12-year-old children. Eye examination findings (VA, cover testing and cycloplegic retinoscopy) were used to determine the presence of vision conditions. QuickSee performance was summarised by area under the receiver operating characteristic curve (AUC), sensitivity and specificity for various levels of RE. QuickSee referral criteria for each vision condition were chosen to maximise sensitivity at a specificity of approximately 85%-90%. Sensitivity and specificity to detect vision conditions were calculated using multiple criteria. Logistic regression was used to evaluate the benefit of adding near VA (6/12 or worse) for detecting hyperopia. A paired t-test compared QuickSee without and with fogging lenses. RESULTS: The mean age was 8.2 (±2.5) years (n = 174). RE ranged up to 9.25 D myopia, 8 D hyperopia, 5.25 D astigmatism and 3.5 D anisometropia. The testability of the QuickSee was 94.3%. AUC was ≥0.92 (excellent) for each level of RE. For the detection of any RE, sensitivity and specificity were 84.2% and 87.3%, respectively, using modified Orinda criteria and 94.5% and 78.2%, respectively, using the American Academy for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines. For the detection of any significant vision condition, the sensitivity and specificity of QuickSee were 81.1% and 87.9%, respectively, using modified Orinda criteria and 93% and 78.6%, respectively, using AAPOS criteria. There was no significant benefit of adding near VA to QuickSee for the detection of hyperopia ≥+2.00 (p = 0.34). There was no significant difference between QuickSee measurements of hyperopic refractive error with and without fogging lenses (difference = -0.09 D; p = 0.51). CONCLUSIONS: QuickSee had high discriminatory power for detecting children with hyperopia, myopia, astigmatism, anisometropia, any significant refractive error or any significant vision condition.

Efficacy and safety of small-incision corneal intrastromal lenticule implantation for hyperopia correction: a systematic review and meta-analysis.

Purpose: To assess the efficacy and safety of intrastromal lenticule implantation for the treatment of hyperopia. Methods: A systematic search of PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Internet, and Wan Fang Database identified studies on small-incision intrastromal lenticule implantation for hyperopia correction until January 2023. The Joanna Briggs Institute (JBI) critical appraisal tool was used to assess the quality of the retrospective research, and the Methodological Index for Non-randomized Studies (MINORS) was used to assess the quality of the prospective research. This study included postoperative visual outcomes, corneal morphology, and biomechanical outcomes. Results: A total of 456 articles were identified, of which 10 were included in the meta-analysis. Ten single-arm studies involving 190 eyes were included. A meta-analysis demonstrated that corneal intrastromal lenticule implantation treatment significantly improved hyperopia. Uncorrected distance visual acuity (UDVA) significantly improved compared to the preoperative value (p = 0.027), corrected distance visual acuity showed no difference compared to the preoperative value (p = 0.27), and 87% eyes have no loss of one or more lines in the Snellen lines of CDVA (p < 0.00001). There was a significant difference between the spherical equivalent refractive (SE) and preoperative examination (p < 0.00001), 52% of eyes had ±0.5 diopters (D) postoperative SE (p < 0.00001), and 74% eyes had ±1.0 D postoperative SE (p < 0.00001). The central corneal thickness (CCT) increased by 72.68 µm compared to that preoperatively (p < 0.00001), and corneal curvature increased by 4.18D (p < 0.00001). The Q-value decreased by 0.82 (p < 0.00001), and higher-order aberration (HOA) decreased by 0.66 (p < 0.00001). Conclusion: Small-incision intrastromal lenticule implantation may be an effective solution for correcting hyperopia. The effect of improved vision is significant, but further exploration is needed for changes in corneal biomechanics and long-term safety.Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42023432343.

Progressive hyperopic refractive changes after posterior capsule tear following blunt ocular trauma.

Purpose: To describe the mechanism of progressive hyperopia and its management in the long-term course of traumatic cataract with a posterior capsule tear (PCT) following blunt ocular trauma. Observation: A 37-year-old woman presented with blurry vision and photophobia after being hit in the right eye by a slipper. She was found to have PCT with the formation of a traumatic cataract with emmetropia (0 diopters [D]). Three years after the injury, a broader hyperopic change of +8.0 D was found in the patient at her first visit to our clinic. Optical coherence tomography (OCT) analysis of the anterior segment of the eye revealed damage to the posterior capsule and cataracts due to disorganization of the lens fibers and liquefaction of the lens. Femtosecond laser-associated cataract surgery was performed for anterior capsulotomy and segmentation of the nucleus without further enlargement of the PCT, facilitating the placement of a capsular tension ring segment and a multifocal intra ocular lens (IOL) in the capsular bag. At 1-month post-operation, her uncorrected visual acuity was 20/20 in the right eye, with a well-centered IOL. Conclusions and Importance: Isolated PCT due to blunt trauma is rare, and there have been no reports of progressive hyperopia after three years of follow-up. In such cases, the lens may liquefy, resulting in decreased refraction and significant hyperopia.

Bilateral helicoid peri-papillary sub-retinal fibrosis due to a biallelic NR2E3 mutation: Describing variable expressivity of a mutation.

BACKGROUND: To describe different clinical presentations of a same NR2E3 recessive mutation in two families and within one family. DESIGN: Interventional family study. RESULTS: Our first case was a one-year-old male child with high hyperopia and refractive accommodative esotropia. In retinal examination, peri-papillary sub-retinal fibrosis with a helicoid configuration was observed in both eyes. The parents and the only sibling had no pathologic findings in the eyes. The child showed to have severely reduced responses in both photopic and scotopic electroretinogram components. In the genetic investigation, a homozygous autosomal recessive mutation in the NR2E3 gene (IVS1-2A > C) was discovered in the affected child, while the other family members were heterozygous for this mutation. We followed up with the patient for 3 years and no new lesion developed during this period. The second case was a 13-year-old male child referred to the retina clinic for decreased vision in the right eye. In retina examination, there were nummular pigmentary changes at the level of retinal pigment epithelium and along the vascular arcades with foveo-schitic changes in both eyes. A choroidal neovascularization (CNV) was noticed in the macula of his right eye. The genetic evaluation proved the same mutation in the NR2E3 gene as in the first case. Family history was remarkable for an uncle, an aunt, and two cousins with night blindness. CONCLUSION: Same NR2E3 gene mutation can cause heterogeneous clinical manifestations such as slight retinal changes in the absence of any visual symptoms to high hyperopia associated with helicoid peri-papillary sub-retinal fibrosis.

Impact of stimulant treatment on refractive errors and pupil diameter in attention deficit hyperactivity disorder.

PURPOSE: The relationship between attention deficit hyperactivity disorder (ADHD) and visual impairment remains poorly understood, and the impact of visual impairment on the development of ADHD is uncertain. The aim of this study was to investigate the refractive profile and ocular biometric characteristics in patients diagnosed with ADHD and compare them with a control group. Additionally, we aimed to explore the potential influence of sex and medication intake. METHODS: A cohort of 100 participants, including 50 individuals with ADHD and 50 age- and sex-matched control subjects, was included in this study. Ocular biometric parameters were measured, and refractive error was assessed using cycloplegic and non-cycloplegic autorefraction. Subgroup analyses were performed within the ADHD group based on sex, medication intake and age to investigate potential associations with the ocular findings. RESULTS: We observed no statistically significant differences in axial length, corneal topography parameters or anterior chamber characteristics between ADHD and control subjects. However, subgroup analysis within the ADHD group revealed that the prevalence of ametropia under cycloplegia was significantly higher in unmedicated (69.6%) compared to medicated (37.5%) (X2(2) = 7.320, p = 0.026) participants. Pupil diameter was significantly larger in medicated (3.91 mm) compared to unmedicated (3.58 mm; p = 0.017) individuals. Males had flatter (p = 0.004) and thicker (p = 0.008) corneas than females. Older ADHD participants had higher refractive error (p = 0.008 for non-cycloplegic and p = 0.0.003 for cycloplegic), axial length (p = 0.002) and corneal astigmatism (p = 0.049). CONCLUSIONS: Our study provides compelling evidence that individuals diagnosed with ADHD exhibit a similar incidence of refractive errors and ocular parameters compared to normal subjects. Nonetheless, the prevalence of refractive errors appears to be higher in unmedicated ADHD patients, suggesting the potential benefit of stimulant treatment. Additionally, stimulant use is associated with an increase in pupil diameter.

Refractive error and vision related quality of life.

BACKGROUND: To investigate and compare the vision-related quality of life (QOL) in different types of refractive error (RE). METHODS: This cross-sectional study was performed on 200 subjects, categorized into four groups of 50 each, consisting of subjects with myopia, hyperopia, astigmatism, and emmetropia, the latter being the control group. The mean age of the participants was 23.88 ± 5.87 (range, 15 to 38: 110 females and 90 males). RE was defined as myopia, spherical equivalent (SE) < -0.25 diopters (D), hyperopia, SE > + 0.25 D, astigmatism, cylinder < -0.25 D, and emmetropia (-0.25 ≤ SE(D) ≤ + 0.25, cylinder ≥ -0.25). Groups are subdivided into very low magnitudes of RE (0.50 and 0.75) and significant RE (1.00 ≤). Vision-related QOL was assessed using the Persian version of the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25). The NEI-VFQ was scored as visual function and socioemotional scales using Rasch analysis. RESULTS: Corrected myopia, astigmatism, uncorrected myopia, and hyperopia had a lower vision-related QOL than emmetropes. (P < 0.001). Vision-related QOL in myopic subjects was lower than that in astigmatic participants. Very low myopes, who often do not use correction, had a significantly lower QOL than other groups. CONCLUSION: Individuals with refractive errors experience a lower QOL score than those without. Notably, the adverse impact on QOL score is significantly greater in myopic cases, particularly very low myopia, compared to other refractive errors. Therefore, it is strongly recommended not to neglect managing very low myopia since it may improve participants' QOL.

Refractive outcomes of immediately sequential bilateral cataract surgery in eyes with long and short axial lengths.

PURPOSE: To report the refractive outcomes of long (≥25.00 mm) and short (≤22.00 mm) axial length (AL) eyes undergoing immediately sequential bilateral cataract surgery (ISBCS). METHODS: In this retrospective cohort study, patients who underwent ISBCS were identified and eyes of patients with bilateral long and short ALs were included. Pre- and postoperative biometry, autorefraction, and ocular comorbidities or complications were recorded. The primary outcome was the mean refractive prediction error. RESULTS: Thirty-seven patients (74 eyes) with long ALs and 18 patients (36 eyes) with short ALs were included. The means ± standard deviations of the ALs were 26.40 ± 1.38 mm and 21.44 ± 0.46 mm in the long and short AL groups, respectively. In long AL eyes, the mean absolute error from the biometry-predicted refraction was - 0.16 ± 0.46 D, corresponding to 74% of eyes achieving a refraction within ±0.50 D of the predicted value. In short AL eyes, the mean absolute error was - 0.63 ± 0.73 D, corresponding to 44% of eyes achieving a refraction within ±0.50 D of the predicted value. Eight (44.4%) patients with short AL eyes had a myopic deviation greater than ±0.50 D from the predicted result in both eyes. CONCLUSIONS: Compared to patients with long AL eyes, ISBCS in patients with short ALs had a wider variance in refractive outcome and a lower rate of achieving a postoperative refraction within ±0.50 D of the predicted target.

Subjective versus objective refraction in healthy young adults.

PURPOSE: To evaluate objective and subjective refraction differences in healthy young adults. METHODS: Data concerning candidates for the Israeli Air Force Flight Academy, as well as active air force pilots in all stages of service who underwent a routine health checkup between the years 2018 and 2019 were retrospectively analyzed. Objective refraction measured using a single autorefractometer was compared with subjective refraction measured by an experienced military optometrist during the same visit. The results were converted to power vectors (spherical equivalent [SE], J0, and J45). To interpret astigmatism using power vector values, the cylinder power (Cp) was determined. RESULTS: This study included 1,395 young adult participants. The average age was 22.17 years (range, 17-39, 84.8% males). The average SE was - 0.65 ± 1.19 diopter (D) compared with - 0.71 ± 0.91D in the auto- and subjective refraction, respectively (p = 0.001). Cp was 0.91 ± 0.52D and 0.67 ± 0.40D, respectively (p < 0.001). This difference was more common in older participants (p < 0.001). J0 and J45 value differences were not significant. The absolute SE value of subjective refraction was lower in the myopic (p < 0.001) and hyperopic (p < 0.001) patients. CONCLUSIONS: Young hyperopic participants tended to prefer "less plus" in subjective refraction compared with autorefraction. Young myopic participants tended to prefer "less minus" in subjective refraction compared with autorefraction. All participants, but mainly older participants, preferred slightly "less Cp" than that measured using autorefraction; The astigmatic axis did not differ significantly between the methods.