Utility of retinoscopy to examine peripheral refraction

Purpose: This study explored whether retinoscopy (RET) provides comparable results of relative peripheral refraction (RPR) to open–field autorefractometry (AR) in myopic subjects.Methods: Peripheral refraction was measured in 20 myopic and 20 control adult subjects. Both central and peripheral refraction (20° nasal and temporal eccentricity) were measured using RET and open-field AR. Differences in the median central spherical equivalent (SE), median RPR, and median J45/J180 power vectors between the RET and AR techniques were analyzed. Moreover, Bland – Altman plots were used to assess the agreement between RET and AR methods for RPR measurements in MG. Results: For MG, the median RPR values were positive (hyperopic shift), and no significant differences were observed between the RET and AR techniques with respect to RPR measurement. In addition, we did not observe any significant differences in the RPR values between the nasal and temporal eccentricities for either the RET or AR technique for myopic subjects. There was also a significant correlation and agreement between the RET and AR technique for RPR measurements. With respect to central refraction, the median SE was slightly more positive for the RET than for the AR technique. Inside the CG, we also found significant correlation between the RET and AR technique for RPR measurements, and we observed a myopic shift in peripheral eccentricities. Conclusion: Our results show that retinoscopy may be a useful tool for objective measurements of RPR in myopic subjects and may be used interchangeably with the open-field AR method in everyday clinical practice. (AU)

Soft peripheral contact lens for eye elongation control (SPACE): 1-year results of a double-blinded randomized controlled trial.

PURPOSE: To examine the safety and efficacy of soft multifocal contact lenses on slowing the rate of myopia progression. METHODS: A prospective, randomized, double-masked clinical trial was conducted including 115 children (55 boys and 60 girls) aged 8 to 15 years. Children were assigned to wear one of two daily disposable soft contact lens designs; a multifocal design (Pegavision) or a dual-focus design (MiSight, Coopervision) in both eyes for at least 8 h per day for one year. All contact lenses were replaced on a daily basis. Measurements were obtained using a logMAR vision meter, including objective refraction, handheld retinoscopy, high (96 %) and low (12 %) contrast sensitivity, and distance and near visual acuity. Axial length was measured every 6 months. RESULTS: After one year, the spherical equivalent refractive error and axial length of the experimental group (Pegavision) increased by -0.50 ± 0.48 D and 0.24 ± 0.16 mm, respectively, in the right eye and -0.47 ± 0.37 D and 0.23 ± 0.16 mm, respectively, in the left eye. The spherical equivalent refractive error and axial length of the control group (MiSight) increased by -0.48 ± 0.47 D and 0.22 ± 0.13 mm, respectively, in the right eye and by -0.50 ± 0.44 D and 0.23 ± 0.14 mm, respectively, in the left eye, with no significant differences observed between the two lens types. CONCLUSIONS: The one-year results from this clinical trial show that the multifocal soft contact lenses used in the experimental group have a similar myopia control efficacy with respect to spherical equivalent refraction and axial length elongation as a commercially available dual focus soft contact lens design.

Characteristic features of patients with myopia depending on the expressiveness of anxiety/depression.

OBJECTIVE: Aim: To determine the peculiarities of character traits of patients with myopia at different levels of anxiety and depression. PATIENTS AND METHODS: Materials and Methods: 30 patients with moderate myopia and mild myopic astigmatism in both eyes were examined. The "Kettel Test" was used to study the characteristics of the patient's character, and the Hospital Anxiety and Depression Scale was used to assess the levels of anxiety and depression. All examined patients were divided into 3 groups: the 1st group with a normal level of anxiety, the 2nd group with subclinical anxiety/depression, the 3rd grоup with clinically pronounced anxiety/depression. Mathematical processing of the research results was carried out using the methods of mathematical statistics. RESULTS: Results: Characteristic features of patients with myopia include conservatism, restraint, subordination, anxiety, developed imagination and high self-control. In half of people with myopia, anxiety/depression is subclinically determined, and in a third - clinically expressed anxiety/depression is observed. In the absence of anxiety in patients with myopia, the main character traits were conservatism, restraint, subordination, sufficient normative behavior, high self-control, and self-confidence; in the presence of subclinical anxiety - sufficient self-control and normative behavior, sociability, developed imagination, conservatism; with clinically expressed anxiety and depression - developed imagination, anxiety, significant normative behavior, conservatism, restraint, subordination. CONCLUSION: Conclusions: Studying the characteristic features of patients with myopia is necessary to clarify the peculiarities of the formation of the internal picture of the disease, the etiopathogenesis of the formation of nosogenies due to this pathology, and the development of individual psycho-corrective programs for such patients.

Causal relationships between height, screen time, physical activity, sleep and myopia: univariable and multivariable Mendelian randomization.

Background: This study aims to investigate the independent causal relation between height, screen time, physical activity, sleep and myopia. Methods: Instrumental variables (IVs) for exposures and outcome were obtained from the largest publicly available genome-wide association studies (GWAS) databases. First, we performed a bidirectional univariate MR analysis using primarily the inverse variance weighted method (IVW) with height, screen time, physical activity and sleep as the exposure and myopia as the outcome to investigate the causal relationship between exposures and myopia. Sensitivity analysis was used to demonstrate its robustness. Then the multivariable MR (MVMR) and MR-based mediation approach was further used to estimate the mediating effect of potential confounders (education and time outdoors) on causality. Results: The results of univariate MR analysis showed that taller height (OR = 1.009, 95% CI = 1.005-1.012, p = 3.71 × 10-7), longer time on computer (OR = 1.048, 95% CI = 1.029-1.047, p = 3.87 × 10-7) and less moderate physical activity (OR = 0.976, 95% CI = 0.96-0.991 p = 2.37 × 10-3) had a total effect on the increased risk of developing myopia. Meanwhile our results did not have sufficient evidence to support the causal relationship between chronotype (p = 0.637), sleep duration (p = 0.952) and myopia. After adjusting for education, only taller height remains an independent risk factor for myopia. After adjusting for education, the causal relationship between height, screen and myopia still had statistical significance. A reverse causal relationship was not found in our study. Most of the sensitivity analyses showed consistent results with those of the IVW method. Conclusion: Our MR study revealed that genetically predicted taller height, longer time on computer, less moderate physical activity increased the risk of myopia. After full adjustment for confounders, only height remained independently associated with myopia. As a complement to observational studies, the results of our analysis provide strong evidence for the improvement of myopia risk factors and provide a theoretical basis for future measures to prevent and control myopia in adolescents.

Effect of capsule treatment on visual acuity and quality after phacoemulsification lens implantation in myopic patients with cataract.

BACKGROUND: Cataracts pose a significant clinical burden due to their complex pathogenesis. In recent years, an increase in cataracts coexisting with myopia has heightened the incidence of retinopathy and posterior vitreous detachment. Additionally, symptoms of ocular axis elongation, lens nucleus hardening, and vitreous liquefaction have become more prevalent. While conventional extracapsular cataract extraction is commonly employed, it often yields suboptimal visual outcomes. Subsequent advancements in cataract phacoemulsification and lens implantation surgeries have gained widespread acceptance for their ability to improve refraction and significantly improve uncorrected visual acuity. AIM: To investigate the effect of capsular treatment after phacoemulsification lens implantation in myopic patients with cataract. METHODS: We selected 110 patients (with 134 eyes) with myopia and cataracts treated. These patients were categorized into two groups: an observation group (57 patients with 70 eyes) and a control group (53 patients with 64 eyes). The control group underwent cataract phacoemulsification and lens implantation, while the observation group received a refined capsular treatment based on the control group's procedure. We assessed the differences in visual acuity and quality between the two groups before and after surgery. RESULTS: At six months post-operation, the observation group exhibited significantly improved far vision, intermediate vision, near vision, lower objective scattering index, higher Modulation transfer function cut-off frequency, and overall vision metrics at different contrast levels (100%, 20% and 9%) compared to the control group (P < 0.05). The total score of the National Eye Institute Visual Function Questionnaire in the observation group at 6 months after operation was significantly higher than that in the control group (P < 0.05). No significant difference in the incidence of adverse reactions was observed between the observation group and control group (P > 0.05). CONCLUSION: Capsular treatment demonstrates efficacy in improving visual acuity and quality after phacoemulsification lens implantation in myopic patients with cataracts, warranting its clinical application.

Assessing Glaucoma Severity and Progression in Individuals with Asymmetric Axial Length: An Intra-Patient Comparative Study.

PURPOSE: To investigate whether there is a difference in inter-eye glaucoma severity and progression in patients with asymmetric axial length DESIGN: Long-term observational study PARTICIPANTS: Patients over 20 years of age who had been diagnosed with glaucoma at Seoul National University Hospital, Seoul, Korea, between 2010 and 2020. METHODS: Patients diagnosed with glaucoma in both eyes with an axial length difference of more than 1.0 mm were included. Each individual's eyes were classified into "longer eye" and "shorter eye," and the baseline and follow-up clinical data were analyzed using the paired test. MAIN OUTCOME MEASURES: Differences in clinical characteristics in patients with asymmetric axial length RESULTS: A total of 190 eyes of 95 glaucoma patients with asymmetric axial length were included in the study. The patients' mean age was 51.2 ± 12.3 years, and the mean follow-up period was 10.1 ± 3.9 years. There was no difference in the baseline intraocular pressure (IOP) or central corneal thickness (CCT) between longer eyes and shorter eyes. Among the baseline disc parameters, ovality index, beta-zone and gamma-zone parapapillary atrophy (PPA) area were larger in the longer eyes. In the baseline OCT data, the retinal nerve fiber layer (RNFL) thickness and ganglion cell-inner plexiform layer (GCIPL) thickness were thinner in the longer eyes. According to a baseline visual field (VF) test, the mean deviation (MD) and visual field index (VFI) values were significantly lower in the longer eyes. Based on an analysis of glaucoma progression, the rate of change of superior GCIPL (longer eyes : -0.65 µm/yr, shorter eyes : -0.40 µm/yr) , MD (longer eyes : -0.40 dB/yr, shorter eyes : -0.21 dB/yr) , and VFI (longer eyes : -0.92 %/yr, shorter eyes : -0.46 %/yr) were larger in the longer eyes. The greater the difference between the mean IOP and beta-zone PPA area between inter-eyes, the greater the difference in the rate of change of RNFL and GCIPL. Additionally, the greater the difference in IOP fluctuation, the greater the difference in the rate of change between MD and VFI. CONCLUSIONS: When there was an axial length difference of more than 1.0 mm, glaucoma tended to be more severe and to progress faster in the longer eyes. The inter-eye difference in glaucoma progression rate is related to both mean IOP and IOP fluctuation.

Effects of orthokeratology on corneal reshaping and the delaying of axial eye growth in children.

Purpose: To investigate the inhibition of myopia progression and axial elongation in children wearing orthokeratology (OK) lenses, as well as to evaluate the status of corneal reshaping, this study explores the relationship between changes in central corneal curvature (K-value) and e-value induced by OK lenses and axial elongation. Methods: In this study, it is planned to select children aged 8-15 who wear orthokeratology lenses at the Pediatric Ophthalmology and Strabismus Clinic of the Second Affiliated Hospital of Dalian Medical University. All children will undergo slit lamp examination, visual acuity assessment, computerized refraction, intraocular pressure measurement, biometry, and corneal topography examination before lens wear and at 1 month, 3 months, and 6 months after lens wear in the pediatric ophthalmology clinic. Based on age (lower age group (8 < age ≤12 years); higher age group (12 < age ≤15 years)) and baseline equivalent spherical (SE) value (mild myopia group (-1.00 D < SE ≤ -3.25D); moderate myopia group (-3.25 D < SE ≤ -6.00 D)), four groups will be formed by pairing these factors. Suitable data will be selected according to inclusion and exclusion criteria, and different groups will be included. Data will be organized, and statistical analysis will be performed using SPSS software to obtain the results. The expected results will be discussed and analyzed. Results: After wearing OK lenses, all four groups achieved good visual acuity at follow-up. At 6 months, there were no significant differences in visual acuity among the four groups (P = 0.149, >0.05). There were no significant differences in refractive error among the four groups (P = 0.066, >0.05). Baseline axial length differed significantly among the four groups (P = 0.000, <0.001), with the LM group having longer axial length than the LL group (P < 0.001, paired samples t-test), and the HM group having longer axial length than the HL group (P < 0.001, paired samples t-test). However, there were no significant differences in axial length change compared to baseline among the groups at 1 month, 3 months, and 6 months (P 1 = 0.053; P 3 = 0.557; P 6 = 0.329, >0.05). Significant differences were observed in corneal flat K-value change compared to baseline among the four groups at 1 month, 3 months, and 6 months (P 1 = 0.001, P 3 = 0.001, P 6 = 0.004, <0.05). There were no significant differences in e-value change among the groups at 1 and 3 months (P 1 = 0.205, P 3 = 0.252, >0.05), but significant differences were found in e-value change compared to baseline at 6 months (P 6 = 0.010, <0.05). Multiple regression analysis with changes in central corneal flat K-value and e-value as independent variables and axial elongation as the dependent variable showed a correlation between e-value change at 6 months and axial elongation (P = 0.004, <0.05), indicating a negative correlation. Conclusion: Orthokeratology (OK) lenses effectively improve myopic children's vision by reshaping the cornea, leading to reduced central corneal curvature and flattening of its anterior surface. The effectiveness of OK lenses is not significantly affected by age or initial myopia severity. Children of varying ages and myopia levels experience similar levels of axial length control with OK lens wear. Changes in corneal shape due to OK lenses affect axial elongation, with greater changes in corneal morphology associated with smaller increases in axial length.

Myopia Prevalence in Latin American Children and Adolescents: A Systematic Review and Meta-Analysis.

Although myopia is a growing global concern, comprehensive studies on its prevalence among Latin American (LATAM) children and adolescents are still lacking. Thus, we conducted a systematic review and meta-analysis to determine the prevalence of myopia in LATAM children and adolescents aged three to 20. The study conducted a thorough literature search from January 1, 1975, to February 28, 2023, identifying 24 studies on the prevalence of myopia in LATAM that met the inclusion criteria. Quality assessment and standardized data collection were performed. The meta-analysis used a random-effects model due to heterogeneity and calculated prevalence rates. Finally, the analysis of data from 24 eligible studies revealed a myopia prevalence of 8.61% (range 0.80-47.36%, 95% confidence interval (CI): 5.22-13.87%, p < 0.05) among 165,721 LATAM children and adolescents. No significant age-based associations or temporal trends were observed in this study. Studies with non-cycloplegic or objective assessment exhibited a numerically higher, although statistically non-significant, myopia prevalence (10.62%, 95% CI: 4.9-21.6%) compared to studies using cycloplegia (7.17%, 95% CI: 3.40-14.50%). In conclusion, myopia affects approximately one in 11 LATAM children and adolescents. Given the increasing exposure of LATAM youth to known myopia risk factors, such as extensive near-work, online learning, and limited outdoor activities, it is crucial to monitor myopia trends in this region. Further research is imperative to address and prevent myopia in LATAM.

Incidence of myopia in Swedish schoolchildren: A longitudinal study.

PURPOSE: The prevalence of myopia in Scandinavia tends to be lower than in other parts of the world. This study aimed to investigate the incidence of myopia and its predictors in Swedish children to characterise this trend. METHODS: A 2-year longitudinal study was conducted following a cohort of schoolchildren aged 8-16 years. Myopia was defined as a spherical equivalent refraction (SER) ≤ -0.50 D. The study enrolled 128 participants, 70 (55%) females with a mean age of 12.0 years (SD = 2.4). RESULTS: The cumulative incidence of myopia during the follow-up period was 5.5%, and the incidence rate of myopia was 3.2 cases per 100 person-years. Participants with myopia at baseline exhibited a faster increase in refractive error during the follow-up period. Likewise, participants with two myopic parents exhibited a more marked change towards myopia, regardless of their initial refractive error. CONCLUSION: In the current study, similar to prevalence, the incidence of myopia was low when compared with other parts of the world. These results lead us to formulate a new hypothesis that the normal emmetropisation process may be protected by low educational pressure practised in Sweden during early childhood. Further research is necessary to test this new hypothesis.

Novel LOXL3-associated stickler syndrome-like phenotype: a case report.

PURPOSE: To report the case of a young boy with early onset high myopia (eoHM), foveal hypoplasia and skeletal dysplasia due to a homozygous LOXL3 pathogenic variant. Atypically, this was from a paternal uniparental isodisomy (UPiD) of chromosome 2. CLINICAL CASE: Four-year-old boy with several months history of holding items close to his face was found to have reduced visual acuity 6/30 in both eyes, bilateral vitreous syneresis, foveal hypoplasia and bilateral high myopia (-8.50D). A skeletal survey showed spondylo-epi-metaphyseal dysplasia. Whole-exome sequencing (WES) revealed a homozygous LOXL3 variant c.1448_1449del, p.(Thr483Argfs*13), inherited through paternal UPiD of chromosome 2. CONCLUSION: To our knowledge, this is the first reported case of LOXL3-associated eoHM, foveal hypoplasia and mild skeletal dysplasia due to the rare phenomenon of paternal UPiD of chromosome 2. This case further delineates the phenotype associated with LOXL3 pathogenic variants and supports truncating LOXL3 pathogenic variants being associated with a phenotypic spectrum; from isolated eoHM through to a Stickler syndrome-like phenotype.

Complications of high myopia: An update from clinical manifestations to underlying mechanisms.

Background: High myopia is one of the major causes of visual impairment and has an ever-increasing prevalence, especially in East Asia. It is characterized by excessive axial elongation, leading to various blinding complications that extend beyond mere refractive errors and persist immovably after refractive surgery, presenting substantial public health challenge. Main text: High myopia-related complications include lens pathologies, atrophic and tractional maculopathy, choroidal neovascularization, peripheral retinal degenerations and retinal detachment, and glaucoma and heightened susceptibility to intraocular pressure (IOP) elevation. Pathological lens changes characteristic of high myopia include early cataractogenesis, overgrowth of lens, weakened zonules, and postoperative capsular contraction syndrome, possibly driven by inflammatory pathogenesis, etc. Dome-shaped macula and cilioretinal arteries are two newly identified protective factors for central vision of highly myopic patients. These patients also face risks of open-angle glaucoma and IOP spike following intraocular surgery. Morphologic alternations of optic nerve in high myopia can complicate early glaucoma detection, necessitating comprehensive examinations and close follow-up. Anatomically, thinner trabecular meshwork increases this risk; conversely lamina cribrosa defects may offer a fluid outlet, potentially mitigating the pressure. Notably, anxiety has emerged as the first recognized extra-ocular complication in high myopia, with an underlying inflammatory pathogenesis that connects visual stimulus, blood and brain. Conclusions: High myopia induces multiple ocular and potential mental health complications, underscoring the need to develop more effective strategies to improve both physical and emotional well-being of these patients, among which anti-inflammation might possibly represent a promising new target.

Choroidal vascularity features of fundus tessellation in adults with high myopia.

BACKGROUND: To investigate alterations in choroidal vascularity index among highly myopic adults with fundus tessellation, utilizing optical coherence tomography. METHODS: Total of 143 highly myopic adults (234 eyes) with fundus tessellation were collected in this cross-sectional study, which was stratified into different lesion groups based on the novel tessellated fundus classification. Subfoveal choroidal thickness (SFCT), choroidal luminal area (LA), stromal area (SA), total choroidal area (TCA), and choroidal vascularity index (CVI) were analyzed utilizing optical coherence tomography (OCT) with enhanced depth imaging (EDI) mode, enabling precise quantification of these parameters. RESULTS: Comparison analysis demonstrated notable distinctions in spherical equivalent (SE), axial length (AL), and SFCT across the four tessellation grades (p < 0.001). Analysis of the choroidal vascularity parameters, including LA, TCA, and CVI, demonstrated notable disparities across the four groups (p < 0.001), while no significant variations were observed in SA when comparing Grade 1 versus Grade 2, as well as Grade 2 versus Grade 3 (p > 0.05). Logistic regression analyses illustrated that the higher grade of tessellated exhibited a positive association with AL (OR = 1.701, p = 0.027), while negatively associated with SFCT (OR = 0.416, p = 0.007), LA (OR = 0.438, p = 0.010) and CVI (OR = 0.529, p = 0.004). Multiple regression analyses demonstrated a significant negative association between CVI and both SE and AL after adjusting for age, while positively associated with SFCT (p < 0.05). CONCLUSION: Subtle choroidal vascularity changes may have a meaningful contribution to the development and progression of fundus tessellation. CVI and LA dramatically decreased during the early stages of tessellation development and maintained a relatively stable status when in the severe tessellated grades.

Corrigendum: The impact of patient-reported visual disturbance on dynamic visual acuity in myopic patients after corneal refractive surgery.

[This corrects the article DOI: 10.3389/fnins.2023.1278626.].

Anisomyopia and orthokeratology for myopia control - Axial elongation and relative peripheral refraction.

PURPOSE: To investigate axial elongation (AE) and changes in relative peripheral refraction (RPR) in anisomyopic children undergoing orthokeratology (ortho-k). METHODS: Bilateral anisomyopic children, 7-12 years of age, were treated with ortho-k. Axial length (AL) and RPR, from 30° nasal (N30°) to 30° temporal (T30°), were measured at baseline and every 6 months over the study period. AE, changes in RPR and changes in the interocular AL difference were determined over time. RESULTS: Twenty-six of the 33 subjects completed the 2-year study. The AE of the higher myopic (HM) eyes (at least 1.50 D more myopia than the other eye) (0.26 ± 0.29 mm) was significantly smaller than for the less myopic (LM) eyes (0.50 ± 0.27 mm; p = 0.003), leading to a reduction in the interocular difference in AL (p = 0.001). Baseline RPR measurements in the HM eyes were relatively more hyperopic at T30°, N20° and N30° (p ≤ 0.02) and greater myopic shifts were observed at T20° (p < 0.001), T30° (p < 0.001), N20° (p = 0.02) and N30° (p = 0.01) after lens wear. After 2 years of ortho-k lens wear, temporal-nasal asymmetry increased significantly, being more myopic at the temporal locations in both eyes (p < 0.001), while AE was associated with the change in RPR at N20° (ß = 0.134, p = 0.01). The interocular difference in AE was also positively associated with the interocular difference in RPR change at N30° (ß = 0.111, p = 0.02). CONCLUSIONS: Ortho-k slowed AE in bilateral anisomyopia, with slower growth in the HM eyes leading to a reduction in interocular AL differences. After ortho-k, RPR changed from hyperopia to myopia, with greater changes induced in the HM eyes, and slower AE was associated with a more myopic shift in RPR, especially in the nasal field of both eyes.

The induced defocus by Defocus Incorporated Soft Contact lenses is dependent on visual distance and ambient illuminance.

PURPOSE: Defocus Incorporated Soft Contact (DISC) lenses, a commonly used type of multifocal lens in clinical practice, may slow down myopia progression by inducing myopic retinal defocus. The purpose of this study was to explore whether the induced defocus across the retina could be affected by visual environments encountered in the real world, such as differences in viewing distance and ambient illuminance. METHODS: In this cross-over trial, 30 myopic adults wore both DISC lenses and single vision contact (SVC) lenses in random order. An open-view Hartmann-Shack scanning wavefront sensor was used to measure defocus at different retinal locations along the horizontal meridian under four experimental conditions: far target (3 m) and near targets (0.33 m) under scotopic (<1 lux) or photopic (~300 lux) conditions. RESULTS: The results showed that DISC lenses induced more myopic retinal defocus than SVC lenses in all conditions (all p < 0.05), except for the scotopic near target. In addition, for DISC lenses, the defocus was greater in the photopic than the scotopic conditions for both the far and near targets (both p < 0.05). CONCLUSION: In conclusion, the retinal defocus induced by these multifocal lenses was dependent on both visual distance and ambient illuminance, indicating that the visual conditions might affect the anti-myopia efficacy of these devices.

Autostereoscopic 3D viewing can change the dimensions of the crystalline lens in myopes.

PURPOSE: Autostereoscopic displays have become increasingly common, but their impact on ocular dimensions remains unknown. We sought to identify changes in the crystalline lens dimensions induced by autostereoscopic three-dimensional (3D) viewing. METHODS: Forty young adults (age: 22.6 ± 2.0 years, male/female: 15/25) were consecutively enrolled and randomly divided into two groups (3D and two-dimensional [2D] viewing groups) to watch a 30-min movie clip displayed in 3D or 2D mode on a tablet computer. The lens thickness (LT), diameter, curvature, decentration and tilt were measured with anterior segment optical coherence tomography under both non-accommodating (static) and accommodating conditions. RESULTS: In the static condition, the LT decreased by 0.03 ± 0.03 mm (p < 0.001) and the anterior radius of curvature (ARC) increased by 0.49 ± 0.59 mm (p = 0.001) post-3D viewing. In contrast, following 2D viewing, the ARC decreased by 0.23 ± 0.25 mm (p = 0.001). Additionally, the increase in the steep ARC post-3D viewing was greater in high-myopic eyes than low to moderate myopic eyes (p = 0.04). When comparing the accommodative with the static (non-accommodative) condition, for 3D viewing the lens decentration decreased (-0.03 ± 0.05 mm, p = 0.02); while for 2D viewing, the posterior curvature radius (-0.14 ± 0.20 mm, p = 0.006) and diameter (-0.13 ± 0.20 mm, p = 0.01) decreased. CONCLUSIONS: Viewing with the autostereoscopic 3D tablet could temporally decrease the thickness and curvature of the lens under non-accommodating conditions. However, its long-term effect requires further exploration.

Development and evaluation of a deep neural network model for orthokeratology lens fitting.

PURPOSE: To optimise the precision and efficacy of orthokeratology, this investigation evaluated a deep neural network (DNN) model for lens fitting. The objective was to refine the standardisation of fitting procedures and curtail subjective evaluations, thereby augmenting patient safety in the context of increasing global myopia. METHODS: A retrospective study of successful orthokeratology treatment was conducted on 266 patients, with 449 eyes being analysed. A DNN model with an 80%-20% training-validation split predicted lens parameters (curvature, power and diameter) using corneal topography and refractive indices. The model featured two hidden layers for precision. RESULTS: The DNN model achieved mean absolute errors of 0.21 D for alignment curvature (AC), 0.19 D for target power (TP) and 0.02 mm for lens diameter (LD), with R2 values of 0.97, 0.95 and 0.91, respectively. Accuracy decreased for myopia of less than 1.00 D, astigmatism exceeding 2.00 D and corneal curvatures >45.00 D. Approximately, 2% of cases with unique physiological characteristics showed notable prediction variances. CONCLUSION: While exhibiting high accuracy, the DNN model's limitations in specifying myopia, cylinder power and corneal curvature cases highlight the need for algorithmic refinement and clinical validation in orthokeratology practice.

Characteristics and Prognostic Factors Associated With the Progression of Myopic Traction Maculopathy in Mexican Patients.

Background In this study, the characteristics and prognostic factors associated with the progression of myopic traction maculopathy (MTM) were evaluated in a Mexican population. Methods This is a retrospective observational study that analyzed patients with MTM who underwent optical coherence tomography (OCT). Clinical-ocular information, the MTM classification, and initial and final visual acuity (VA) were recorded. Results In total, 101 eyes of 84 patients (mean age 63.5 ± 10.7 years) were included (88.1% female and 11.9% male). The mean spherical equivalent was -16.8 ± 6.4 D, axial length was 29.6 ± 2.1 mm, and mean initial VA was 0.8 ± 0.5 logMAR. The mean follow-up time was 25.7 ± 27.6 months. The change in final VA from diagnosis to the last follow-up was +0.1 (0.2) (p = 0.001). Overall, 24.8% of patients progressed, 72.3% did not progress, and 3% showed regression. The patient-year progression rate was 0.20 ± 0.44. Factors associated with progression were initial logMAR VA (p= 0.012) and staphyloma (p= 0.001). Conclusions One in four patients with MTM progressed, and the patient-year progression rate was 0.5. The factors associated with disease progression were initial VA and the presence of staphyloma. The characteristics of Mexican patients with MTM are similar to those described in other populations.

RETINAL AND VITREOUS CHANGES ASSOCIATED WITH SPONTANEOUS IMPROVEMENT IN MYOPIC MACULAR SCHISIS.

PURPOSE: To describe the retinal and vitreous changes in eyes showing myopic macular schisis (MMS) improvement when vitrectomy was not performed and identify triggering factors. DESIGN: Retrospective observational study. SUBJECTS: Patients with non-operated myopic macular schisis METHODS: The records of patients with MMS who were followed without performing surgery for more than 6 months were retrospectively reviewed, and the eyes showing an anatomical improvement were included. MMS evolution was analyzed quantitatively (central foveal thickness [CFT], parafoveal thickness, maximum height) and qualitatively (presence/absence of foveal detachment, lamellar hole, epiretinal membrane, choroidal neovascularization, inner and outer retinoschisis, vitreous status) at baseline and at the final visit. An anatomical improvement was defined as a decrease in CFT by at least 50 µm. MAIN OUTCOME MEASURE: The rate anatomical improvement of MMS without performing vitrectomy and the morphological changes observed in these cases. RESULTS: In a cohort of 74 non-operated eyes with MMS, MMS improved in 14 eyes (19%) after a mean follow-up of 55 ± 38 months (range: 8-138). In these improved cases, the mean decrease in CFT was 153 ± 166 µm (range: 24-635, p=0.005) and a complete resolution of MMS was observed in 9 eyes (64%). In 9 eyes (64%), the improvement was associated with visible vitreous changes in the macular area on the OCT scans. The mean visual acuity, which was already good at baseline (20/50, 0.4 ± 0.2 LogMAR), increased at the last visit (20/40, 0.3 ± 0.3 LogMAR) but without reaching significance. CONCLUSION: This long-term follow-up analysis showed that almost 20% of MMS in eyes without indication for surgery could improve over time. In most cases, the improvement was associated with an apparent resolution of vitreous tensions.