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)

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.

Shaping school for childhood myopia: the association between floor area ratio of school environment and myopia in China.

AIM: To investigate the association of floor area ratio (FAR), an indicator of built environments, and myopia onset. METHODS: This prospective cohort study recruited 136 753 children aged 6-10 years from 108 schools in Shenzhen, China at baseline (2016-2017). Refractive power was measured with non-cycloplegic autorefraction over a 2-year follow-up period. FAR was objectively evaluated using geographical information system technology. Mixed-effects logistic regression models were constructed to examine the association of FAR with a 2-year cumulative incidence of myopia among individuals without baseline myopia; multiple linear regression model, with a 2-year cumulative incidence rate of myopia at each school. RESULTS: Of 101 624 non-myopic children (56.3% boys; mean (SE) age, 7.657±1.182 years) included in the study, 26 391 (26.0%) of them developed myopia after 2 years. In the individual-level analysis adjusting for demographic, socioeconomic and greenness factors, an IQR in FAR was associated with a decreased risk of 2-year myopia incidence (OR 0.898, 95% CI 0.866 to 0.932, p<0.001). Similar findings were observed in the analysis additionally adjusted for genetic and behavioural factors (OR 0.821, 95% CI 0.766 to 0.880, p<0.001). In the school-level, an IQR increase in FAR was found to be associated with a 2.0% reduction in the 2-year incidence rate of myopia (95% CI 1.3% to 2.6%, p<0.001). CONCLUSIONS: Exposure to higher FAR was associated with a decreased myopia incidence, providing insights into myopia prevention through school built environments in China.

Quantitative assessment of colour fundus photography in hyperopia children based on artificial intelligence.

OBJECTIVES: This study aimed to quantitatively evaluate optic nerve head and retinal vascular parameters in children with hyperopia in relation to age and spherical equivalent refraction (SER) using artificial intelligence (AI)-based analysis of colour fundus photographs (CFP). METHODS AND ANALYSIS: This cross-sectional study included 324 children with hyperopia aged 3-12 years. Participants were divided into low hyperopia (SER+0.5 D to+2.0 D) and moderate-to-high hyperopia (SER≥+2.0 D) groups. Fundus parameters, such as optic disc area and mean vessel diameter, were automatically and quantitatively detected using AI. Significant variables (p<0.05) in the univariate analysis were included in a stepwise multiple linear regression. RESULTS: Overall, 324 children were included, 172 with low and 152 with moderate-to-high hyperopia. The median optic disc area and vessel diameter were 1.42 mm2 and 65.09 µm, respectively. Children with high hyperopia had larger superior neuroretinal rim (NRR) width and larger vessel diameter than those with low and moderate hyperopia. In the univariate analysis, axial length was significantly associated with smaller superior NRR width (ß=-3.030, p<0.001), smaller temporal NRR width (ß=-1.469, p=0.020) and smaller vessel diameter (ß=-0.076, p<0.001). A mild inverse correlation was observed between the optic disc area and vertical disc diameter with age. CONCLUSION: AI-based CFP analysis showed that children with high hyperopia had larger mean vessel diameter but smaller vertical cup-to-disc ratio than those with low hyperopia. This suggests that AI can provide quantitative data on fundus parameters in children with hyperopia.

Reflectance spectroscopy: a non-invasive strategy to explore skin reactions to topical products.

Reflectance spectroscopy has emerged as a powerful analytical technique in the field of dermatology, offering a non-invasive strategy to assess several cutaneous properties and skin response to topical products. By analyzing reflected light across different wavelengths, reflectance spectroscopy allows the quantification of cutaneous parameters, such as erythema index and melanin content. Moreover, this analytical technique enables the monitoring of any changes in skin physiology facilitating the assessment of long-term effects of topical products as well as predicting cutaneous diseases. This review provides an overview of the application of reflectance spectroscopy in investigating skin properties and reaction to topical applied products, including both pharmaceutical and cosmetic formulations, thereby aiding in the development of personalized solutions tailored to individual needs.

Short-term effects of sunlight exposure on fundus blood flow perfusion in children: a randomised controlled trial.

AIM: To evaluate the short-term effects of different sunlight exposure on fundus blood flow perfusion (BFP) after near work. METHODS: In this parallel randomised controlled trial, 81 students aged 7-15 with spherical equivalent refraction between -2.00 and +3.00 diopters were randomly assigned to either a low-illuminance (4k lux) group (N=40) or high-illuminance (10k lux) (N=41). Following 1 hour indoor reading, participants had sunlight exposure matching their group's intensity for 15 minutes. BFPs in the superficial retina, deep retina and choroid were measured at four time points: pre-reading, post-reading, 5th-minute and 15th-minute sunlight exposure. RESULTS: Within the initial 5 minutes of sunlight exposure, the 10k lux group showed a tendency for decreased BFP, particularly in the choroid (superficial retina: -0.2, 95% CI -0.9 to 0.5; deep retina: -0.1, 95% CI -0.6 to 0.4; choroid: -0.4, 95% CI -0.8 to 0.0), while the 4k lux group exhibited an increase (superficial retina: 0.7, 95% CI 0.1 to 1.3; deep retina: 0.3, 95% CI -0.2 to 0.8; choroid: 0.1, 95% CI -0.2 to 0.5). From 5 to 15 minutes, BFP decreased in both groups. At the 5th-minute mark, the 10k lux group exhibited a greater decrease in choroid (10k -0.4 vs 4k 0.1, p=0.051). No significant difference was observed after 15 minutes of exposure. CONCLUSION: Higher illuminance sunlight exposure can restore fundus BFP more rapidly than lower; however, duration remains pivotal. To prevent myopia, continuous sunlight exposure for over 15 minutes is recommended to aid in reinstating the fundus BFP increased by near work. TRIAL REGISTRATION NUMBER: NCT05594732.

Determination of the time of refractive stability after uneventful phacoemulsification in Indian eyes.

BACKGROUND: Knowledge about refractive stabilization and the accuracy of postoperative refractive error measurements are crucial for improved patient outcomes after phacoemulsification. Existing guidelines typically recommend waiting 4-6 wk before prescribing corrective lenses. Our research focused on identifying factors that influence refractive errors in the early stages of post-cataract surgery, thus contributing to the existing literature on this topic. AIM: To investigate the time required for refraction stability after uneventful phacoemulsification surgery. METHODS: We compared the variation and statistical significance of the difference in spherical, cylindrical components, and the spherical equivalent between the 1- and 6-wk follow-up period in a group of 257 eyes that underwent uneventful phacoemulsification with foldable intraocular lens implantation, all performed by a single experienced surgeon. The Wilcoxon-Signed Rank Test was utilized to assess the magnitude of the change and determine its statistical significance. The refractive stability was defined as the point at which the change in spherical equivalent was within ± 0.5 dioptres for two consecutive visits. RESULTS: The average age of the patients was 64.9 ± 8.9 yr. The differences observed in both the visits in spherical power (0.1 ± 0.2), cylinder power (0.3 ± 0.4), and spherical equivalent (0.2 ± 0.2) were minimal and not statistically significant. The majority of eyes (93.4%) achieved refractive stability within 6 wk after the surgery. The cylindrical power differed between age groups at the 6th wk post-operative and the difference was statistically significant (P value 0.013). There were no significant differences in refractive stability when considering sex and axial length. CONCLUSION: Phacoemulsification with foldable intraocular lens implantation results in no significant changes in refraction for the majority of cases during the 6-wk follow-up period. Therefore, a spectacle prescription can be given at the completion of 1 wk.

Characteristics of peripheral refractive errors in eyes of patients with non-amblyopic myopic anisometropia.

BACKGROUND: This study aims to investigate relative peripheral refractive (RPR) characteristics in children with non-amblyopic myopic anisometropia and explore potential associations between relative peripheral refractive errors (RPRE) and myopia. METHODS: Relative peripheral refractive errors were assessed in 64 children diagnosed with non-amblyopic myopic anisometropia utilizing multispectral refraction topography (MRT). Two eyes of each patient were divided into into the more myopia eyes group (ME) and the fellow eyes group (FE). Evaluated parameters encompassed total defocus values (TRDV), defocus values at eccentricities spanning 0 to 15 degrees (RDV-15), 0 to 30 degrees (RDV-30), 0 to 45 degrees (RDV-45), as well as superior (RDV-S), inferior (RDV-I), temporal (RDV-T), and nasal (RDV-N) positions. RESULTS: The study revealed a noteworthy contrast in TRDV values between Group ME (0.52 ± 0.36) and Group FE (0.17 ± 0.41), with a substantial significance (P < 0.0001). While no significant RDV-15 difference emerged between Group ME (0.01 ± 0.05) and Group FE (-0.01 ± 0.07) (P > 0.05), a meaningful RDV-30 difference existed between Group ME (0.11 ± 0.14) and Group FE (0.03 ± 0.19) (P = 0.0017). A significant discrepancy in RDV-45 was also observed between Group ME (0.39 ± 0.29) and Group FE (0.13 ± 0.34) (P < 0.001). Notably, RDV-I and RDV-T positions demonstrated marked differences between Group ME and Group FE (P < 0.0001), whereas no significant disparity was noted in RDV-S and RDV-N positions (P > 0.05). CONCLUSION: Eyes exhibiting greater myopia manifested more hyperopic peripheral defocus in the context of anisometropia. MRT as a novel ophthalmic evaluation technique, holds promising potential for broader clinical applications in the future.

Saving one's face while saving one's soul? The refraction of tactical approaches to penance as a disciplinary device in Counter-Reformation Italy.

Sociohistorical research suggests that religious discourses and practices have been powerful in producing disciplined lines of conduct. Typically, however, this work has only considered the long-term consequences of discursive shifts or the one-sided outcomes of disciplinary practices. In contrast, this paper shows how the creative appropriation of disciplinary devices can instigate their transfiguration into additional disciplinary tools. By examining manuals for confession published in Counter-Reformation Italy, I identify three tactics via which believers allegedly approached Sacramental Penance as an impression management tool. The authors of these cultural objects detected the diffusion of these tactics and circulated their depictions to alert confessors and stigmatize believers who enacted them. These findings suggest that the theorizing of disciplining processes has to consider how the tactical appropriation of disciplinary practices can trigger processes of refraction via which their negative representations are reified and circulated as further disciplinary tools.

The CroMyop study: myopia progression in Croatian children and adolescents-a 15-year retrospective analysis.

Purpose: Myopia is a major global health issue, especially among children and adolescents. Understanding its traits and progression is vital for proper management and prevention. This study aimed to fill a gap in research by analyzing demographic and refractive data concerning myopia among children and adolescents in Croatia, with the goal of providing insights into myopia prevalence, progression rates, and associated risk factors within the Croatian population. Design: This retrospective study utilized a comprehensive dataset from pediatric ophthalmology clinics at the University Eye Department, University Hospital "Sveti Duh," Zagreb, Croatia. The dataset included electronic medical records spanning from January 2008 to July 2023, encompassing demographic and refractive data. Methods: Data analysis focused on individuals aged 4 to 18 years who were diagnosed with primary myopia and/or compound myopic astigmatism. Ophthalmic examinations, including visual acuity tests, cycloplegic refraction, and assessments for eye comorbidities, were conducted by experienced pediatric ophthalmologists. Statistical analysis, including t-tests, survival analysis, and logistic regression, was performed to assess myopia prevalence, progression rates, and associated factors. These analyses were adjusted for covariates such as age, parental myopia, and gender. Results: The study included 895 individuals, 51 premyopes, 813 low myopes, and 31 high myopes. The average age of diagnosis was 11.37 ± 3.59 years for premyopes, 11.18 ± 3.53 years for low myopes, and 11.44 ± 4.35 years for high myopes. The fastest progression occurred in 2021 and 2022, -0.5 ± 0.12 D/y for premyopes and - 0.45 ± 0.1 D/y for low myopes. Premyopic progression to low myopia was associated with age 7-9 years (HR 2.42, 1.53 to 3.21) and both parents being myopic (HR 920.27. 850.16 to 950.53). Low myopic individuals with both myopic parents displayed the fastest 11-24 months after first visit progression rates, -0.69 (-0.52 to -0.87) D/y, while the 7-9 age group demonstrated -0.36 (-0.24 to -0.45) D/y. Low myopes aged 7-9 years with baseline SE between -6 D and -4 D were more strongly associated with ≤ - 0.5 D progression (OR = 2.0, 95% CI -1.00 to 2.39). Conclusion: This study highlights the importance of environmental factors, genetics, and age in addressing myopia progression among Croatian youth, urging further research for effective local intervention strategies.

Strategies to address inequity of uncorrected refractive error in the Western Pacific: A modified Delphi process.

PURPOSE: Uncorrected refractive error is the leading cause of vision impairment globally; however, little attention has been given to equity and access to services. This study aimed to identify and prioritise: (1) strategies to address inequity of access to refractive error services and (2) population groups to target with these strategies in five sub-regions within the Western Pacific. METHODS: We invited eye care professionals to complete a two-round online prioritisation process. In round 1, panellists nominated population groups least able to access refractive error services, and strategies to improve access. Responses were summarised and presented in round 2, where panellists ranked the groups (by extent of difficulty and size) and strategies (in terms of reach, acceptability, sustainability, feasibility and equity). Groups and strategies were scored according to their rank within each sub-region. RESULTS: Seventy five people from 17 countries completed both rounds (55% women). Regional differences were evident. Indigenous peoples were a priority group for improving access in Australasia and Southeast Asia, while East Asia identified refugees and Oceania identified rural/remote people. Across the five sub-regions, reducing out-of-pocket costs was a commonly prioritised strategy for refraction and spectacles. Australasia prioritised improving cultural safety, East Asia prioritised strengthening school eye health programmes and Oceania and Southeast Asia prioritised outreach to rural areas. CONCLUSION: These results provide policy-makers, researchers and funders with a starting point for context-specific actions to improve access to refractive error services, particularly among underserved population groups who may be left behind in existing private sector-dominated models of care.

Association Between Myopia and Pupil Diameter in Preschoolers: Evidence from a Machine Learning Approach Based on a Real-World Large-Scale Dataset.

INTRODUCTION: Previous studies have explored the connections between various ocular biological parameters with myopia. Our previous study also found that pupil data can predict the myopic progression during the interventions for myopia. However, studies exploring the association between pupil diameter and myopia in preschoolers with myopia were lacking. Hence this study was aimed to investigate the association between pupil diameter and myopia in preschoolers with myopia based on a real-world, large-scale dataset. METHODS: Data containing 650,671 preschoolers were collected from a total of 1943 kindergartens in Shenzhen, China. Refraction and pupil parameters were collected. After data filtering, the occurrence of myopia and its association with age, gender, pupil diameter, and other variables, were analyzed. Random forest (RF) and eXtreme gradient boosting (XGBoost) were selected from seven machine learning algorithms to build the model. The mean decrease accuracy (MDA), mean decrease Gini (MDG), and gain feature importance (GFI) techniques were employed to quantify the importance of pupil diameter and other features. RESULTS: After the assessments, 51,325 valid records with complete pupil data were included, and 3468 (6.76%) were identified as myopia based on the calculated cycloplegic refraction. Preschoolers with myopia presented reduced pupil diameter and greater variation (5.00 ± 0.99 mm) compared to non-myopic preschoolers (6.22 ± 0.67 mm). A nonlinear relationship was found according to the scatterplots between pupil diameter and refraction (R2 = 0.14). Especially preschoolers with myopia had reduced pupil diameter compared to emmetropic preschoolers, but hyperope did not experience additional pupil enlargement. After adjusting for other covariates, this relationship is still consistent (P < 0.001). XGBoost and RF algorithms presented the highest performance and validated the importance of pupil diameter in myopia. CONCLUSIONS: Based on a real-world large-scale dataset, the current study illuminated that preschoolers with myopia had a reduced pupil diameter compared to emmetropic preschoolers with a nonlinear pattern. Machine learning algorithms visualized and validated the pivotal role of pupil diameter in myopia. TRIAL REGISTRATION: chictr.org Identifier: ChiCTR2200057391.

Phase-contrast neutron imaging compared with wave propagation and McStas simulations.

Propagation-based phase contrast, for example in the form of edge enhancement contrast, is well established within X-ray imaging but is not widely used in neutron imaging. This technique can help increase the contrast of low-attenuation samples but may confuse quantitative absorption measurements. Therefore, it is important to understand the experimental parameters that cause and amplify or dampen this effect in order to optimize future experiments properly. Two simulation approaches have been investigated, a wave-based simulation and a particle-based simulation conducted in McStas [Willendrup & Lefmann (2020). J. Neutron Res. 22, 1-16], and they are compared with experimental data. The experiment was done on a sample of metal foils with weakly and strongly neutron absorbing layers, which were measured while varying the rotation angle and propagation distance from the sample. The experimental data show multiple signals: attenuation, phase contrast and reflection. The wave model reproduces the sample attenuation and the phase peaks but it does not reproduce the behavior of these peaks as a function of rotation angle. The McStas simulation agrees better with the experimental data, as it reproduces attenuation, phase peaks and reflection, as well as the change in these signals as a function of rotation angle and distance. This suggests that the McStas simulation approach, where the particle description of the neutron facilitates the incorporation of multiple effects, is the most convenient way of modeling edge enhancement in neutron imaging.

Characteristics of refractive development in children aged 4 months to 8 years in urban China: A retrospective screening analysis.

PURPOSE: To conduct a large retrospective study of screening refractive error in young children. METHODS: This retrospective study included children aged from 4 months to 8 years in Daxing District, Beijing, who underwent refractive examinations without cycloplegia. It included a cross-sectional assessment of refractive error screening for all children, and a longitudinal component for a subgroup with data available for two to five visits. RESULTS: A total of 14,987 children were included in the cross-sectional study. In the group <1 year of age, the percentage of children with a spherical equivalent (SE) >+2.00 D or with cylinder <-1.50 D was 15.25% and 33.24%, respectively. These were significantly higher than for the 1- to 4-year-old group (SE 8.1% higher, cylinder 13.2% higher) (χ2 = 53.57, p < 0.001; χ2 = 790.39, p < 0.001). Furthermore, 34.83% of children in the 0-year-old group had amblyopia risk factors (ARFs). In the 4-year-old group, boys had a significantly longer axial length (AL) than girls (differences in the right and left eyes were 0.53 and 0.56 mm, respectively; z = 5.48 p < 0.001, z = 5.80, p < 0.001). AL increased with age, while the AL difference between boys and girls remained stable at 4-8 years of age. The percentage of children aged 5-8 years with myopia in 2020-2021 was significantly higher than that in 2018-2019 (H = 12.44, p = 0.006). In the longitudinal study of 4406 children (up to 12-month follow-up), annual changes in SE were -0.27, -0.06, 0.19 and 0.13 D between 0 and 3 years, and -0.38, -0.58, -0.70 and -0.75 D between 5 and 8 years. CONCLUSIONS: Children's refractive error varied significantly from ages 4 months to 1 year, with a high proportion having ARFs. Children aged 5-8 years showed a trend towards myopia. The prevalence of myopia in the cross-sectional analysis in 2020-2021 was greater than in 2018-2019. Screening refraction changed minimally over a 12-month period for children aged 1-3 years, but became more myopic for children aged 5-8 years.

Design and Development of a Non-invasive Opto-Electronic Sensor for Blood Glucose Monitoring Using a Visible Light Source.

Background The management of diabetes is critically dependent on the continuous monitoring of blood glucose levels. Contemporary approaches primarily utilize invasive methods, which often prove to be uncomfortable and can deter patient adherence. There is a pressing need for the development of novel strategies that improve patient compliance and simplify the process of glucose monitoring. Aim and objectives The primary objective of this research is to develop a non-invasive blood glucose monitoring system (NIBGMS) that offers a convenient alternative to conventional invasive methods. This study aims to demonstrate the feasibility and accuracy of using visible laser light at a wavelength of 650 nm for glucose monitoring and to address physiological and technical challenges associated with in vivo measurements. Methods Our approach involved the design of a device that exploits the quantitative relationship between glucose concentration and the refraction phenomena of laser light. The system was initially calibrated and tested using glucose solutions across a range of concentrations (25-500 mg/dL). To get around the problems that come up when people's skin and bodies are different, we combined an infrared (IR) transmitter (800 nm) and receiver that checks for changes in voltage, which are indicative of glucose levels. Results The prototype device was compared with a commercially available blood glucose monitor (Accu-Chek active machine; Roche Diabetes Care, Inc., Mumbai, India). The results demonstrated an average linearity of 95.7% relative to the Accu-Chek machine, indicating a high level of accuracy in the non-invasive measurement of glucose levels. Conclusions The findings suggest that our NIBGMS holds significant promise for clinical application. It reduces the discomfort associated with blood sampling and provides reliable measurements that are comparable to those of existing invasive methods. The successful development of this device paves the way for further commercial translation and could significantly improve the quality of life for individuals with diabetes, by facilitating easier and more frequent monitoring.

The effect of individualized ocular refraction customized spectacle lenses on myopia control in schoolchildren: A 1-year randomised clinical trial.

PURPOSE: The aim of this study was to investigate the effect of individualized ocular refraction customized (IORC) spectacle lenses with different actual amounts of peripheral myopic defocus (MD) on myopia control over 1 year. These lenses compensate for the original peripheral refraction via the free-form surface on the back of the lens. METHODS: This 1-year, double-masked randomised clinical trial included 184 myopic schoolchildren aged 8-12 years. Participants were randomised to receive IORC lenses with high (IORC-H group, +4.50 D), medium (IORC-M group, +3.50 D) or low (IORC-L group, +2.50 D) MD or single-vision (SV) lenses. The spherical equivalent refractive error (SER) and axial length (AL) were measured at baseline and 6-monthly intervals. RESULTS: After 1 year, the mean (SD) changes in SER were -0.18 (0.37), -0.36 (0.37), -0.52 (0.39) and -0.60 (0.42) D for the IORC-H, IORC-M, IORC-L and SV groups, respectively. Compared with the SV group, the effects of slowing myopia progression were 70%, 40% and 13% for the IORC-H (difference of 0.47 D, p < 0.001), IORC-M (difference of 0.32 D, p = 0.001) and IORC-L (difference of 0.15 D, p > 0.05) groups, respectively. The mean (SD) changes in AL were 0.12 (0.16), 0.23 (0.17), 0.29 (0.17) and 0.36 (0.17) mm for the IORC-H, IORC-M, IORC-L and SV groups, respectively. The axial elongation was 67%, 36% and 19% lower in the IORC-H (difference of 0.25 mm, p < 0.001), IORC-M (difference of 0.15 mm, p < 0.001) and IORC-L (difference of 0.10 mm, p = 0.04) groups, respectively, compared with the SV group. The IORC-H group exhibited significantly less axial elongation than the IORC-M and IORC-L groups (p = 0.01 and p < 0.001, respectively). CONCLUSION: Compared with the IORC-M and IORC-L lenses, the IORC-H lens was found to have superior efficacy in inhibiting myopic progression and slowing eye growth in schoolchildren, with better myopia control efficacy in younger children.

Ophthalmic quality of life in the adult Danish population: an epidemiological study.

BACKGROUND: Ophthalmic quality of life (OQoL) has been investigated in selected parts of general populations and in patients with ocular disease, but OQoL in unselected general populations has not been studied in detail. The present study reports OQoL obtained from a representative sample of the adult Danish population 2020-2022. METHODS: The FORSYN study invited 10 350 citizen representatives for the adult Danish population for a non-mydriatic eye examination and answer the National Eye Institute Visual Function Questionnaire with 39 items in the validated Danish translation. The results from the 3384 (32.7%) persons who participated in the study were weighted on the basis of relevant socio-economic factors, and data were projected to represent the total population. Binocular visual acuity was below 0.1 corresponding to legal blindness in 0.22% of this population. RESULTS: OQoL was positively correlated with binocular visual acuity up to better than 93 ETDRS letters, negatively correlated with age for persons younger than 60 years of age and again positively correlated with age for persons older than 60 years. OQoL was negatively correlated with increasing ametropia and refractive error above 1 dioptre and encompassed more OQoL parameters for hyperopic than for myopic persons. CONCLUSIONS: The study underlines the benefits of improving visual acuity even within the normal range and of adjusting uncorrected refraction errors in the general population. OQoL is positively correlated with age in older persons independently of visual acuity, sex, refractive power and previous cataract surgery.

Advances in myopia control strategies for children.

Myopia has long been a global threat to public health. Timely interventions are likely to reduce the risk of vision-threatening complications. There are both established and rapidly evolving therapeutic approaches to slow myopia progression and/or delay its onset. The effective methods for slowing myopia progression include atropine eye-drops, defocus incorporated multiple segments (DIMS) spectacle lenses, spectacle lenses with highly aspherical lenslets target (HALT), diffusion optics technology (DOT) spectacle lenses, red light therapy (RLT), multifocal soft contact lenses and orthokeratology. Among these, 0.05% atropine, HALT lenses, RLT and +3.00 peripheral addition soft contact lenses yield over 60% reduction in myopia progression, whereas DIMS, DOT and MiSight contact lenses demonstrate at least 50% myopia control efficacy. 0.05% atropine demonstrates a more optimal balance of efficacy and safety than 0.01%. The efficacy of 0.01% atropine has not been consistent and requires further validation across diverse ethnicities. Combining atropine 0.01% with orthokeratology or DIMS spectacles yields better outcomes than using these interventions as monotherapies. Increased outdoor time is an effective public health strategy for myopia prevention while recent studies suggest that 0.05% low-concentration atropine and RLT therapy have promising potential as clinical myopia prevention interventions for high-risk groups. Myopia control spectacle lenses, being the least invasive, are safe for long-term use. However, when considering other approaches, it is essential to ensure proper instruction and regular follow-ups to maintain safety and monitor any potential complications. Ultimately, significant advances have been made in myopia control strategies, many of which have shown meaningful clinical outcomes. However, regular use and adequate safety monitoring over extended durations are imperative to foster confidence that can only come from extensive clinical experience.

Relationship between retraction and refraction values in patients with Duane's retraction syndrome.

PURPOSE: To evaluate refractive findings in patients with unilateral Duane's retraction syndrome (DRS). METHODS: This retrospective study included 40 patients followed for unilateral DRS. Detailed ophthalmological examinations of the patients were performed. The spherical and cylindrical refractive error, spherical equivalent, and type of refractive error in the eyes with DRS and the fellow eyes were determined. The patients were divided into three subgroups according to their type of DRS. The refractive properties of the eyes with DRS were examined in subgroup analyses. Eye movement limitation was graded between +1 and +4 and compared according to the refractive error type. RESULTS: The mean age of the patients was 16.8±12.6 (range, 1-60) years. Of the eyes with DRS, 11 (27.5%) were emmetropic, four (10%) were hyperopic, two (5%) were myopic, 11 (27.5%) were myopic astigmatic, and 12 (30.0%) were hyperopic astigmatic. There was no statistically significant difference between the eyes with DRS and fellow eyes in relation to the spherical or cylindrical refractive errors or spherical equivalent (P>0.05 for all). The refraction values for the patients with type 1, type 2 and type 3 DRS were similar between groups (P>0.05). No statistically significant difference was detected in the degree of eye movement limitation according to refractive status (P>0.05). CONCLUSION: In patients with unilateral DRS, there was no significant difference between the affected eyes and the fellow eyes in terms of refractive error values or types. Refractive status did not significantly differ according to the degree of eye movement limitation. Therefore, although extraocular muscles are affected by DRS, there may not be any significant refractive changes.

Light exposure profiles differ between myopes and non-myopes outside school hours.

PURPOSE: Considering the putative role of light in myopia, and variations in socioeconomic, lifestyle, educational and environmental factors across ethnicities, we objectively investigated light exposure patterns in Indian school children. METHODS: The light exposure profile of 143 school children (9-15 years, 50 myopes) recorded using a validated wearable light tracker for six continuous days was analysed. Additional data for non-school days were available for 87 children (26 myopes). The illuminance exposure levels, time spent outdoors and epoch (number of times participant is exposed to a predefined range of lux level per day) were compared between myopes and non-myopes across different light conditions: ≥1000, ≥3000, ≥5000 and ≥10 000 lux. For school days, light exposure profiles during (1) before school, school and after school hours; and (2) class, break and transition (when a student travels to and from school) time were analysed. RESULTS: The overall median (IQR) daily illuminance exposure level, time spent outdoors and epochs at outdoors (≥1000 lux) were 807 (507-1079) lux/day, 46 (30-64) min/day and 9 (6-12) times/day, respectively. The daily illuminance exposure on non-school days was significantly higher in non-myopes than myopes (6369 (4508-9112) vs 5623 (2616-6929) lux/day, p=0.04). During transition time (school days), non-myopes had significantly higher illuminance exposure (910 (388-1479) vs 550 (263-1098) lux/day, p=0.04), spent more time outdoors (25 (10-43) vs 14 (4-29) min/day, p=0.01) and had higher outdoor epochs (6 (4-11) vs 5 (2-8) times/day, p=0.01) than myopes. CONCLUSIONS: A small but significant difference in illuminance exposure, time spent outdoors and epoch was noted between myopes and non-myopes during transition time, which may have implications in myopia control.