Increase in choroidal thickness after blue light stimulation of the blind spot in young adults.

BACKGROUND: Blue light activates melanopsin, a photopigment that is expressed in intrinsically photosensitive retinal ganglion cells (ipRGCs). The axons of ipRGCs converge on the optic disc, which corresponds to the physiological blind spot in the visual field. Thus, a blue light stimulus aligned with the blind spot captures the ipRGCs axons at the optic disc. This study examined the potential changes in choroidal thickness and axial length associated with blue light stimulation of melanopsin-expressing ipRGCs at the blind spot. It was hypothesized that blue light stimulation at the blind spot in adults increases choroidal thickness. METHODS: The blind spots of both eyes of 10 emmetropes and 10 myopes, with a mean age of 28 ± 6 years (SD), were stimulated locally for 1-minute with blue flickering light with a 460 nm peak wavelength. Measurements of choroidal thickness and axial length were collected from the left eye before stimulation and over a 60-minute poststimulation period. At a similar time of day, choroidal thickness and axial length were measured under sham control condition in all participants, while a subset of 3 emmetropes and 3 myopes were measured after 1-minute of red flickering light stimulation of the blind spot with a peak wavelength of 620 nm. Linear mixed model analyses were performed to examine the light-induced changes in choroidal thickness and axial length over time and between refractive groups. RESULTS: Compared with sham control (2 ± 1 µm, n = 20) and red light (-1 ± 2 µm, n = 6) stimulation, subfoveal choroidal thickness increased within 60 min after blue light stimulation of the blind spot (7 ± 1 µm, n = 20; main effect of light, p < 0.001). Significant choroidal thickening after blue light stimulation occurred in emmetropes (10 ± 2 µm, p < 0.001) but not in myopes (4 ± 2 µm, p > 0.05). Choroidal thickening after blue light stimulation was greater in the fovea, diminishing in the parafoveal and perifoveal regions. There was no significant main effect of light, or light by refractive error interaction on the axial length after blind spot stimulation. CONCLUSIONS: These findings demonstrate that stimulating melanopsin-expressing axons of ipRGCs at the blind spot with blue light increases choroidal thickness in young adults. This has potential implications for regulating eye growth.

Objective Measures of Gaze Behaviors and the Visual Environment during Near-Work Tasks in Young Adult Myopes and Emmetropes.

Purpose: To objectively quantify near-work gaze behaviors and the visual environment during reading tasks performed on a smartphone and on paper in both indoor and outdoor environments in myopes and emmetropes. Methods: A novel wearable gaze and viewing distance tracking device was used to quantify near-work gaze behaviors (focusing demand) and the visual environment (20° peripheral scene relative defocus) during a series of reading tasks. Data from nine myopes (mean age, 21 ± 1.4 years) and 10 emmetropes (21 ± 0.8 years) were analyzed. Five-minute reading tasks (matched for font type and size) were performed under four conditions: reading from a smartphone indoors, paper indoors, smartphone outdoors, and paper outdoors. Results: A significantly greater focusing demand (closer viewing distance) was found with smartphone-based reading (mean, 3.15 ± 0.74 D) compared to paper-based reading (2.67 ± 0.48 D) (P < 0.001), with the differences being greatest for myopic participants (P = 0.04). Smartphone reading was also associated with greater peripheral scene relative myopic defocus (P < 0.001). Although near-work behaviors were similar between environments, significantly more relative myopic defocus was found at the start of the paper-based task when performed outdoors compared to indoors (P = 0.02). Conclusions: Significant differences in focusing demand and scene relative defocus within a 20° field were found to be associated with reading tasks performed on a smartphone and paper in indoor and outdoor environments. Translational Relevance: These findings highlight the complex interaction between near-work behaviors and the visual environment and demonstrate that factors of potential importance to myopia development vary between paper-based and smartphone-based near tasks.

Seasonal variations in anterior segment angle parameters in myopes and emmetropes.

CLINICAL RELEVANCE: Seasonal variations are known to occur in a range of ocular parameters and in conditions including refractive error and glaucoma. It is of clinical importance to know if seasonal changes also occur in anterior segment angle parameters, given that they can influence these conditions. BACKGROUND: The study aimed to examine the seasonal variations in anterior segment angle parameters in healthy young adults. METHODS: Twenty-three emmetropic participants with a mean age of 26.17 ± 4.43 years and 22 myopic participants with a mean age of 27.27 ± 4.47 years completed four seasons of data collection. Anterior segment angle parameters were measured using swept-source anterior segment optical coherence tomography. Intraocular pressure (IOP) and objective refraction were also measured. Repeated-measures analysis of variance was used to determine the effect of season and refractive error on the various ocular parameters. RESULTS: A significant main effect of season was found for the majority of anterior segment angle parameters, including the angle opening distance at 500 and 750 µm from the scleral spur (p = 0.02, p = 0.006, respectively), angle recess area at 500 and 750 µm from the scleral spur (both p = 0.002), and trabecular iris space area at 500 and 750 µm from the scleral (p = 0.02, p = 0.008, respectively). However, measures of anterior chamber depth and trabecular iris angle did not exhibit statistically significant seasonal variations (all p > 0.05). A significant main effect of season was also found for the changes in IOP (p = 0.004) and objective refraction (p < 0.001). There was no season by refractive group interaction for any anterior segment angle parameter or IOP (all p > 0.05). CONCLUSION: There is a small but significant seasonal changes in the anterior segment angle parameters, refractive error, and IOP in healthy young adult males, in which the anterior segment angle dimensions are narrower, the IOP is higher, and the refraction is more myopic during winter.

Vision Abnormalities in Children and Young Adults With Cerebral Palsy; A Systematic Review.

AIM: The current study was designed to provide detailed information on the prevalence of ocular abnormalities in patients with cerebral palsy (CP). METHODS: Four international online scientific databases, including Web of Science, PubMed, Scopus, and Google Scholar were systemically searched. First, the titles of the articles were evaluated, and if relevant, their abstracts and full texts were reviewed. The quality of the studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. RESULTS: A total of 147 articles were found in the initial search. After applying the exclusion criteria, 65 articles were chosen for further review, from which 17 articles, comprising a total of 1734 patients with CP ranging in age from birth to 22 years, passed the STROBE quality check and were included in this review. The prevalence of ocular abnormalities in the CP patients reported in the evaluated studies ranged between 34% to 100%, with refractive error, strabismus, and nystagmus exhibiting the greatest overall prevalence at 52%, 48%, and 11%, respectively in this population. CONCLUSION: Early ocular assessment of children with CP is essential for an accurate diagnosis, personalized rehabilitation and performing early interventions to improve their visual function.

Retinal OFF-Pathway Overstimulation Leads to Greater Accommodation-Induced Choroidal Thinning.

Purpose: To examine the interactions between accommodation and overstimulation of the retinal ON- and OFF-pathways, and their association with changes in choroidal thickness (ChT) and vascularity. Methods: Optical coherence tomography imaging of the choroid of twenty young adults (ages 25 ± 5 years) was performed before and after a series of 30-minute-long viewing tasks, including reading a bright text on dark background (ON-pathway overstimulation) and dark text on bright background (OFF-pathway overstimulation), and a control task of viewing a movie with unbiased ON-/OFF-pathway activation. The viewing tasks were performed with relaxed, and 5 diopter (D) accommodation (induced by soft contact lenses) demands. Both reading texts were matched for the mean luminance (35 cd/m2), luminance contrast (87%), and letter size (approximately 11.8 arc minutes). The change in ChT from baseline associated with contrast polarity and accommodation was examined using linear mixed model analysis. Results: The subfoveal ChT decreased significantly by -7 ± 1 µm with 5 D accommodation compared with relaxed accommodation (-3 ± 1 µm; P < 0.001), and by -9 ± 1 µm with OFF-pathway compared with ON-pathway overstimulation (-4 ± 1 µm; P = 0.002) and the control condition (-2 ± 1 µm; P < 0.001). Overstimulation of the OFF-pathway, but not the ON-pathway, resulted in a significantly greater choroidal thinning compared with the control condition, both at relaxed (-7 ± 1 µm; P = 0.003) and 5 D (-11 ± 1 µm; P = 0.005) accommodation levels. Similar changes were also observed for macular total, stromal, and luminal ChT. Conclusions: Retinal OFF-pathway stimulation enhanced the choroidal thinning associated with accommodation, thereby providing a potential mechanism that involves accommodation and the retinal OFF-signaling pathway, linking near work and myopia.

Wide-field choroidal thickness and vascularity index in myopes and emmetropes.

PURPOSE: To study regional variations in choroidal thickness (CT), luminal thickness and stromal thickness of the choroid, and choroidal vascularity index (CVI) in low myopic and emmetropic eyes using wide-field optical coherence tomography (OCT). METHODS: Sixty-nine healthy young adults between 20 and 38 years of age participated in this study, including 40 low myopes (mean ± SD spherical equivalent (MSE) refractive error: -3.00 ± 1.39 D, range: -6.00 to -0.62 D) and 29 emmetropes (MSE: -0.05 ± 0.09 D, range: -0.25 to +0.12 D). Wide-field CT, luminal thickness, stromal thickness and CVI were measured across five eccentricities (fovea, parafovea, perifovea; near-periphery and periphery) and four quadrants (nasal, temporal, inferior and superior), in vertical and horizontal meridians, while controlling for a range of extraneous factors potentially influencing the CT. Custom-written software was used to segment and binarize the OCT images. RESULTS: Wide-field CT, luminal thickness and stromal thickness, averaged across all participants, exhibited significant topographical variation, with the foveal (379 ± 8 µm, 200 ± 4 µm, 179 ± 4 µm, respectively) and peripheral (275 ± 8 µm, 161 ± 4 µm, 114 ± 4 µm, respectively) regions presenting the thickest and thinnest regions (all p < 0.001). Wide-field CVI showed a progressively higher percentage (greater vascularity) with increasing eccentricity from the fovea towards the periphery (p < 0.001). Macular CT and stromal choroidal thickness were significantly thinner in myopes compared to emmetropes (p < 0.05). Myopes (55.7 ± 0.3%) showed a slightly higher CVI compared with emmetropes (54.4 ± 0.4%) (p < 0.05). CONCLUSIONS: Low myopia in young adults was associated with significant choroidal thinning across the macular, but not extramacular regions, with this decrease in choroidal thickness mostly attributed to thinning in the stromal component of the choroid, rather than the luminal (vascular) component.

Astigmatic Defocus Leads to Short-Term Changes in Human Choroidal Thickness.

Purpose: To examine the choroidal thickness (ChT) response to short-term with-the-rule (WTR) and against-the-rule (ATR) simple myopic astigmatic defocus, with the response to spherical myopic defocus and clear vision used as control conditions. Methods: The left eye of 18 healthy adults aged 28 ± 6 years was exposed to clear vision, +3 D spherical myopic defocus, +3 D × 180 WTR, or +3 D × 90 ATR astigmatic defocus for 60 minutes, over four randomly ordered visits, while their right eye was optimally corrected. The macular ChT was measured with optical coherence tomography along the vertical and horizontal meridians before and after 20, 40, and 60 minutes of defocus. Results: After 60 minutes of defocus, ChT increased by +8 ± 5 µm (P < 0.001) with spherical myopic defocus, but varied with simple myopic astigmatic defocus, depending on the axis of astigmatism (P < 0.001), increasing by +5 ± 6 µm (P = 0.037) with WTR and decreasing by -4 ± 5 µm (P = 0.011) with ATR astigmatic defocus. These changes were similar across the vertical and horizontal meridians (P = 0.22). The ChT changes were greater than the change during the clear vision control condition (-1 ± 4 µm) for WTR (+5 ± 5 µm, P = 0.002) but not ATR (-4 ± 6 µm, P = 0.09) astigmatic defocus. Conclusions: These results provide insights into the human ChT response to short-term astigmatic defocus and highlight a potential difference in the myopiagenic signal associated with the orientation of astigmatic blur.

Regional alterations in human choroidal thickness in response to short-term monocular hemifield myopic defocus.

PURPOSE: To examine the regional changes in human choroidal thickness following short-term exposure to hemifield myopic defocus using optical coherence tomography (OCT). METHODS: The central 26˚ visual field of the left eye of 25 healthy young adults (mean age 26 ± 5 years) was exposed to 60 min of clear vision (control session), +3 D full-field, +3 D superior retinal and +3 D inferior retinal myopic defocus, with the right eye occluded. Choroidal thickness across the central 5 mm (17°) macular region was examined before and after 60 min of defocus using a high-resolution, foveal centred vertical OCT line scan, with optical defocus simultaneously imposed using a Badal optometer and cold mirror system mounted on a Spectralis OCT device. RESULTS: Averaged across the central 5 mm macular area, choroidal thickness decreased by -4 ± 7 µm during the control session (p = 0.01), most likely due to the unique stimulus conditions of this study. The mean macular choroidal thickness increased during full-field (+2 ± 8 µm), inferior retinal (+3 ± 7 µm) and superior retinal myopic defocus (+5 ± 9 µm), representing a significant thickening of the choroid compared to the control session (all p < 0.05). The defocus induced changes in macular choroidal thickness differed between the superior and inferior hemiretinal regions (F2.26, 54.27  = 29.75, p < 0.001). When only the superior retina was exposed to myopic defocus, the choroid thickened in the superior region (+7 ± 8 µm, p < 0.001), but did not change significantly in the inferior region (+3 ± 9 µm, p = 0.12). When only the inferior retina was exposed to myopic defocus, the choroid thickened inferiorly (+4 ± 8 µm, p = 0.005), with no significant change observed in the superior region (+1 ± 8 µm, p = 0.46). CONCLUSIONS: These findings provide evidence supporting a local regional choroidal response to myopic defocus in the human eye, with hemifield myopic defocus leading to significant thickening of the choroid localised to the retinal region exposed to defocus. The novel finding of a localised response of the human choroid to hemifield myopic defocus, particularly in the superior hemiretina, may have important implications in optimising the optical design of myopia control interventions.

Repeatability of wide-field choroidal thickness measurements using enhanced-depth imaging optical coherence tomography.

BACKGROUND: To examine the repeatability of choroidal thickness measurements across a 55° field, in a sample of healthy young adults using wide-field enhanced-depth imaging optical coherence tomography. METHODS: High-resolution wide-field volumetric enhanced-depth imaging scans were obtained from the right eye of 27 adults (mean age 27 ± 5 years) during two sessions, separated by 19 ± 15 days, using the follow-up feature of the Spectralis instrument, while controlling for confounding factors known to influence choroidal thickness. Semi-automatic segmentation of the choroidal boundaries was corrected by a single masked observer. This process was repeated on images from the first session of 12 randomly selected subjects, allowing the intersession (n = 27) and intraobserver (n = 12) co-efficients of repeatability for regional measures of choroidal thickness to be calculated. RESULTS: The observer-related variability in choroidal thickness was highest at the fovea (intraobserver co-efficient of repeatability [95% confidence interval], 13 [7-19] µm, p < 0.001), then reduced gradually toward the perifovea (2 [1-4] µm, p < 0.001), and plateaued in the near-peripheral (2 [1-3] µm) and peripheral (4 [2-6] µm) regions. The intersession variability improved significantly from the fovea (intersession co-efficient of repeatability [95% confidence interval], 27 [16-38] µm, p < 0.01) and parafovea (25 [15-36] µm, p < 0.02) toward the periphery (16 [10-23] µm). CONCLUSION: Wide-field choroidal thickness measurements using enhanced-depth imaging optical coherence tomography are highly repeatable in the macular region, and improve in precision in more peripheral regions in healthy young adults. A change of up to 38 and 28 µm is required to distinguish true clinical change from measurement variability in individual measurements of macular and extra-macular choroidal thickness, respectively.

Wide-field choroidal thickness in myopes and emmetropes.

There is a paucity of knowledge regarding the normal in-vivo thickness of the choroid beyond the macula (~17°). In this study, the choroidal thickness of 27 healthy young adults was examined across the macular (the central 5 mm including the fovea, parafovea, and perifovea) and extra-macular (a 5-14 mm annulus including the near-periphery and periphery) regions using wide-field optical coherence tomography, and compared between emmetropes (n = 14) and myopes (n = 13). The choroid progressively thinned beyond the parafovea (350 ± 86 µm) towards the periphery (264 ± 44 µm), and was thickest superiorly (355 ± 76 µm) and thinnest nasally (290 ± 79 µm). Choroidal thickness also varied with refractive error; myopes exhibited a thinner choroid than emmetropes in the macular region (311 ± 88 vs. 383 ± 66 µm), however, this difference diminished towards the periphery (251 ± 48 vs. 277 ± 37 µm). Meridional variations in choroidal thickness were not different between myopes and emmetropes. In conclusion, the choroid was thickest within the perifovea; thinned substantially towards the periphery, and exhibited the minimum and maximum peripheral thinning superiorly and nasally across a 55° region respectively. Choroidal thinning associated with myopia was more pronounced in the macular than extra-macular regions.

Impact of image averaging on wide-field choroidal thickness measurements using enhanced-depth imaging optical coherence tomography.

BACKGROUND: The aim of this study was to examine the influence of B-scan averaging on choroidal thickness using wide-field enhanced-depth imaging optical coherence tomography. METHODS: Six high-resolution trans-foveal horizontal enhanced-depth imaging line scans (spanning a 60° field) were acquired consecutively from the right eye of 10 healthy adults (mean age 30 ± 5 years), with each line scan an average of 10, 20, 30, 40, 50 or 100 B-scans, using the automated real-time image averaging and follow-up features of a Spectralis device. The impact of B-scan averaging on regional measures of wide-field choroidal thickness (across macular and peripheral regions) and their accuracy was investigated, assuming that averaging 100 B-scans would provide the most accurate estimate of choroidal thickness. RESULTS: Regional estimates of wide-field choroidal thickness did not vary across the different B-scan averaging conditions (all p > 0.05). The mean choroidal thickness averaged across the full wide-field area exhibited the closest agreement to measures obtained with 100 averaged B-scans, when frame averaging exceeded 30 B-scans (95 per cent limits of agreement +10 to -7, +7 to -7 and +6 to -3 µm for 30, 40 and 50 averaged B-scans, respectively), compared to 10 and 20 averaged B-scans (95 per cent limits of agreement +13 to -8 and +13 to -6 µm, respectively; p < 0.01 and p < 0.02 compared to the accuracy of 50 averaged B-scans). CONCLUSION: Averaging 30 B-scans for an individual enhanced-depth imaging optical coherence tomography line scan provided accurate measures of choroidal thickness across a wide-field (60°) area in young healthy eyes. This information can assist in designing the volumetric scan protocols required for detailed examination of the macular and peripheral choroid.

Prevalence of Refractive Errors among High School Students in Western Iran.

PURPOSE: To determine the prevalence of refractive errors among high school students. METHODS: In a cross-sectional study, we applied stratified cluster sampling on high school students of Aligoudarz, Western Iran. Examinations included visual acuity, non-cycloplegic refraction by autorefraction and fine tuning with retinoscopy. Myopia and hyperopia were defined as spherical equivalent of -0.5/+0.5 diopter (D) or worse, respectively; astigmatism was defined as cylindrical error >0.5 D and anisometropia as an interocular difference in spherical equivalent exceeding 1 D. RESULTS: Of 451 selected students, 438 participated in the study (response rate, 97.0%). Data from 434 subjects with mean age of 16±1.3 (range, 14 to 21) years including 212 (48.8%) male subjects was analyzed. The prevalence of myopia, hyperopia and astigmatism was 29.3% [95% confidence interval (CI), 25-33.6%], 21.7% (95%CI, 17.8-25.5%), and 20.7% (95%CI, 16.9-24.6%), respectively. The prevalence of myopia increased significantly with age [odds ratio (OR)=1.30, P=0.003] and was higher among boys (OR=3.10, P<0.001). The prevalence of hyperopia was significantly higher in girls (OR=0.49, P=0.003). The prevalence of astigmatism was 25.9% in boys and 15.8% in girls (OR=2.13, P=0.002). The overall prevalence of high myopia and high hyperopia were 0.5% and 1.2%, respectively. The prevalence of with-the-rule, against-the-rule, and oblique astigmatism was 14.5%, 4.8% and 1.4%, respectively. Overall, 4.6% (95%CI, 2.6-6.6%) of subjects were anisometropic. CONCLUSION: More than half of high school students in Aligoudarz had at least one type of refractive error. Compared to similar studies, the prevalence of refractive errors was high in this age group.