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Du Y, Meng J, He W, Qi J, Lu Y, Zhu X. Complications of high myopia: An update from clinical manifestations to underlying mechanisms. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2024; 4:156-163. [PMID: 39036706 PMCID: PMC11260019 DOI: 10.1016/j.aopr.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/15/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024]
Abstract
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.
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Affiliation(s)
- Yu Du
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Jiaqi Meng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Wenwen He
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Jiao Qi
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Yi Lu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Xiangjia Zhu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
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Ye H, Tang R, Fang W, Di Y, Qiao T. Clinical outcomes of posterior scleral reinforcement in Chinese high myopia children. Sci Rep 2024; 14:16479. [PMID: 39013945 PMCID: PMC11252263 DOI: 10.1038/s41598-024-67078-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 07/08/2024] [Indexed: 07/18/2024] Open
Abstract
We aim to observe the posterior scleral reinforcement (PSR) clinical outcomes of children with high myopia and analyze the retinal vessel alteration before and after PSR by using angiography optical coherence tomography (angio-OCT). Fifty-six pediatric participants (112 eyes) clinically diagnosed high myopia were recruited and were treated by PSR in Shanghai Children's Hospital from June 1, 2021 to May 1, 2023. The average age ranged from 5.42 to 14.83 years (mean 8.83 years) and mean follow up duration was 8.7 months (3-24 months). The axial length (AL) was significantly shortened after PSR (p < 0.05). The spherical equivalent (SE) and the best-corrected visual acuity (BCVA) were also improved without severe rejection in the follow-up. Compared with baseline, angio-OCT parafoveal vessel indices including vascular area density (VAD) and vascular skeleton density (VSD) on the superficial capillary plexus layer (SCPL), as well as VAD and vessel perimeter index (VPI) on the deep capillary plexus layer (DCPL), were significantly increased after PSR surgery (p < 0.05). VPI on the SCPL, vascular diameter index (VDI) and VSD on the DCPL were also improved without statistical difference after PSR. The VSD on SCPL, VAD on DCPL of the right eyes and the VPI on SCPL of the left eyes were significantly increased after PSR (p < 0.05). PSR surgery can shorten the AL and can stable BCVA and SE in high myopia children. The angio-OCT parameters indicated that the retinal microcirculation supply was significantly improved after PSR.
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Affiliation(s)
- Haiyun Ye
- Department of Ophthalmology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Shanghai, 200062, China
| | - Ruizhi Tang
- Ghent University Centre for X-Ray Tomography (UGCT), Proeftuinstraat 86/N12, 9000, Ghent, Belgium
| | - Wangyi Fang
- Department of Ophthalmology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Shanghai, 200062, China
| | - Yue Di
- Department of Ophthalmology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Shanghai, 200062, China
| | - Tong Qiao
- Department of Ophthalmology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Shanghai, 200062, China.
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Li J, Dan YS, Chua SQ, Wong QY, Chong RS, Ang M, Wong CW, Hoang QV. Pathologic myopia in highly myopic patients with high axial anisomyopia. Br J Ophthalmol 2024; 108:411-416. [PMID: 36690422 DOI: 10.1136/bjo-2022-322285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/06/2023] [Indexed: 01/25/2023]
Abstract
PURPOSE To determine prevalence of anisomyopia (axial length (AL) difference ≥2.5 mm) among high myopes ((HMs), defined by spherical equivalent of ≤6.0 diopters or AL ≥ 26.5 mm). To characterise the shorter anisomyopic eye (SAE) and evaluate if pathologic myopia (PM) in the longer anisomyopic eye (LAE) was associated with increased risk of PM in the SAE. METHODS 1168 HMs were recruited from Singapore National Eye Centre clinic for this cross-sectional study. Biometry, fundus photography and swept-source optical coherence tomography were performed. Patients with high axial anisomyopia were identified. Structural characteristics and presence of PM were described. Stepwise multivariate regression explored associations between PM in the LAE and pathology in the SAE, controlling for confounding variables. RESULTS Prevalence of anisomyopia was 15.8% (184 of 1168 patients). Anisomyopic patients (age 65.8±13.5 years) had mean AL of 30.6±2.0 mm and 26.2±2.3 mm in the LAE and SAE, respectively. 52.7% of SAEs had AL < 26.5 mm. Prevalence of myopic macular degeneration, macula-involving posterior staphyloma (PS), myopic traction maculopathy (MTM) and myopic choroidal neovascularisation (mCNV) in the SAE was 52.2%, 36.5%, 13.0% and 8.2%, respectively. Macular hole in the LAE was associated with increased risk of MTM in the SAE (OR=4.88, p=0.01). mCNV in the LAE was associated with mCNV in the SAE (OR=3.57, p=0.02). PS in the LAE was associated with PS in the SAE (OR=4.03, p<0.001). CONCLUSIONS Even when controlled for AL, PM complications in the LAE predict similar PM complications in the SAE. Patients with high axial anisometropia with PM in the LAE should be monitored carefully for complications in the SAE.
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Affiliation(s)
- Jonathan Li
- Department of Ophthalmology, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
| | | | - Si Qi Chua
- Singapore Eye Research Institute, Singapore
| | | | - Rachel S Chong
- Department of Ophthalmology, Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
| | - Marcus Ang
- Department of Ophthalmology, Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
| | - Chee Wai Wong
- Department of Ophthalmology, Singapore National Eye Centre, Singapore
| | - Quan V Hoang
- Department of Ophthalmology, Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore
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Zheng B, Zhang M, Zhu S, Wu M, Chen L, Zhang S, Yang W. Research on an artificial intelligence-based myopic maculopathy grading method using EfficientNet. Indian J Ophthalmol 2024; 72:S53-S59. [PMID: 38131543 PMCID: PMC10833160 DOI: 10.4103/ijo.ijo_48_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 08/04/2023] [Accepted: 08/15/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE We aimed to develop an artificial intelligence-based myopic maculopathy grading method using EfficientNet to overcome the delayed grading and diagnosis of different myopic maculopathy degrees. METHODS The cooperative hospital provided 4642 healthy and myopic maculopathy color fundus photographs, comprising the four degrees of myopic maculopathy and healthy fundi. The myopic maculopathy grading models were trained using EfficientNet-B0 to EfficientNet-B7 models. The diagnostic results were compared with those of the VGG16 and ResNet50 classification models. The leading evaluation indicators were sensitivity, specificity, F1 score, area under the receiver operating characteristic (ROC) curve area under curve (AUC), 95% confidence interval, kappa value, and accuracy. The ROC curves of the ten grading models were also compared. RESULTS We used 1199 color fundus photographs to evaluate the myopic maculopathy grading models. The size of the EfficientNet-B0 myopic maculopathy grading model was 15.6 MB, and it had the highest kappa value (88.32%) and accuracy (83.58%). The model's sensitivities to diagnose tessellated fundus (TF), diffuse chorioretinal atrophy (DCA), patchy chorioretinal atrophy (PCA), and macular atrophy (MA) were 96.86%, 75.98%, 64.67%, and 88.75%, respectively. The specificity was above 93%, and the AUCs were 0.992, 0.960, 0.964, and 0.989, respectively. CONCLUSION The EfficientNet models were used to design grading diagnostic models for myopic maculopathy. Based on the collected fundus images, the models could diagnose a healthy fundus and four types of myopic maculopathy. The models might help ophthalmologists to make preliminary diagnoses of different degrees of myopic maculopathy.
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Affiliation(s)
- Bo Zheng
- School of Information Engineering, Huzhou University, Huzhou, China
- Zhejiang Province Key Laboratory of Smart Management and Application of Modern Agricultural Resources, Huzhou University, Huzhou, China
| | - Maotao Zhang
- School of Information Engineering, Huzhou University, Huzhou, China
| | - Shaojun Zhu
- School of Information Engineering, Huzhou University, Huzhou, China
- Zhejiang Province Key Laboratory of Smart Management and Application of Modern Agricultural Resources, Huzhou University, Huzhou, China
| | - Maonian Wu
- School of Information Engineering, Huzhou University, Huzhou, China
- Zhejiang Province Key Laboratory of Smart Management and Application of Modern Agricultural Resources, Huzhou University, Huzhou, China
| | - Lu Chen
- Shenzhen Eye Hospital, Jinan University, Shenzhen, China
| | | | - Weihua Yang
- Shenzhen Eye Hospital, Jinan University, Shenzhen, China
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Zhang XJ, Chen XN, Tang FY, Szeto S, Ling XT, Lin ZX, Tham CC, Pang CP, Chen LJ, Yam JC. Pathogenesis of myopic choroidal neovascularization: A systematic review and meta-analysis. Surv Ophthalmol 2023; 68:1011-1026. [PMID: 37517683 DOI: 10.1016/j.survophthal.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
Myopic choroidal neovascularization (CNV) is a vision-threatening complication of high myopia. Here, we systematically review cohort, case-control, and cross-sectional studies in PubMed, Embase, and Web of Science, and summarize the associated factors of myopic CNV using meta-analysis where applicable. Among 1,333 records assessed, 50 were found eligible, all having a low-to-moderate risk of bias. Highly myopic eyes with CNV had a higher risk of lacquer cracks (odds ratio = 2.88) and patchy chorioretinal atrophy (odds ratio = 3.43) than those without. The mean posterior staphyloma height (µm) was greater in myopic CNV eyes than in highly myopic eyes without CNV (mean difference = 82.03). The thinning of choroidal thickness (µm) between myopic eyes with and without CNV differed significantly (mean difference = -47.76). The level of vascular endothelial growth factor (pg/ml) in the aqueous humor of myopic CNV eyes was significantly higher than in highly myopic eyes without CNV (mean difference = 24.98), the same as interleukin-8 (IL-8) (pg/ml, mean difference = 7.73). Single-nucleotide polymorphisms in the vascular endothelial growth factor, complement factor I, and collagen type VIII alpha 1 genes were associated with myopic CNV. We found that myopic CNV eyes have a higher ratio of lacquer cracks and patchy chorioretinal atrophy, thinner choroid, greater posterior staphyloma height, and a higher level of vascular endothelial growth factor and IL-8 in aqueous. Structural predisposing lesions, hemodynamic, genetic, and systemic factors are also associated with myopic CNV.
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Affiliation(s)
- Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China
| | - Xiu Nian Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Fang Yao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Simon Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - Xiang Tian Ling
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Zi Xuan Lin
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong; Hong Kong Eye Hospital, Hong Kong; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong; Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong.
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong; Hong Kong Eye Hospital, Hong Kong; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong; Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong.
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Guo D, Qi J, Du Y, Zhao C, Liu S, Lu Y, Zhu X. Tear inflammatory cytokines as potential biomarkers for myopic macular degeneration. Exp Eye Res 2023; 235:109648. [PMID: 37704045 DOI: 10.1016/j.exer.2023.109648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/26/2023] [Accepted: 09/10/2023] [Indexed: 09/15/2023]
Abstract
Previous studies have reported that inflammatory cytokine levels increase in the intraocular fluids (aqueous humor and vitreous) of highly myopic eyes, However, there has been currently no study revealing the levels of inflammatory cytokines in tear. Therefore, this study aimed to determine tear cytokine levels of highly myopic eyes, and their relationships with myopic macular degeneration (MMD). This case-control study screened inflammatory cytokines of tear samples from 132 highly myopic and 105 emmetropic eyes using a multiplex cytokine antibody array, and cytokines showing significant intergroup differences were further validated using ProQuantum immunoassays in tear samples from another 60 highly myopic and 60 emmetropic eyes. Ultra-widefield fundus photographs of eyes were classified according to the meta-analyses of the Pathologic Myopia Classification. Associations between tear cytokine levels and MMD category were investigated. As a result, tear levels of interleukin (IL)-6, IL-13 and monocyte chemoattractant protein (MCP)-1 were screened significantly higher in highly myopic eyes than in emmetropic controls (IL-6: 11.70 ± 16.81 versus 8.22 ± 10.76 pg/mL; MCP-1: 63.60 ± 54.40 versus 33.87 ± 43.82 pg/mL; both P < 0.05). Validation assays further demonstrated the elevated concentrations of IL-6 and MCP-1 (IL-6: 13.97 ± 8.41 versus 8.06 ± 7.94 pg/mL, P < 0.001; MCP-1: 32.69 ± 8.41 versus 18.07 ± 8.41 pg/mL, P = 0.003). Tear levels of IL-6 and MCP-1 differed significantly among MMD categories (both P < 0.05). The area under receiver operating characteristic curve were 0.783 and 0.682 respectively (both P < 0.05), when using tear IL-6 and MCP-1 levels to predict the presence of MMD (category ≥2). The ordered logistic regression model also indicated that longer axial length, and higher IL-6 and MCP-1 tear levels were independent predictors of higher MMD category. In our study, highly myopic eyes presented significantly higher levels of tear IL-6 and MCP-1, which may also serve as potential biomarkers for MMD.
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Affiliation(s)
- Dongling Guo
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia, Fudan University, Shanghai, China; Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jiao Qi
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia, Fudan University, Shanghai, China; Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yu Du
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia, Fudan University, Shanghai, China; Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Chen Zhao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Shuyu Liu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia, Fudan University, Shanghai, China; Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yi Lu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia, Fudan University, Shanghai, China; Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xiangjia Zhu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia, Fudan University, Shanghai, China; Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China.
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Ji Y, Huang SQ, Cheng Q, Fu WW, Zhong PP, Chen XL, Shu BL, Wei B, Huang QY, Wu XR. Exploration of static functional connectivity and dynamic functional connectivity alterations in the primary visual cortex among patients with high myopia via seed-based functional connectivity analysis. Front Neurosci 2023; 17:1126262. [PMID: 36816124 PMCID: PMC9932907 DOI: 10.3389/fnins.2023.1126262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023] Open
Abstract
Aim This study was conducted to explore differences in static functional connectivity (sFC) and dynamic functional connectivity (dFC) alteration patterns in the primary visual area (V1) among high myopia (HM) patients and healthy controls (HCs) via seed-based functional connectivity (FC) analysis. Methods Resting-state functional magnetic resonance imaging (fMRI) scans were performed on 82 HM patients and 59 HCs who were closely matched for age, sex, and weight. Seed-based FC analysis was performed to identify alterations in the sFC and dFC patterns of the V1 in HM patients and HCs. Associations between mean sFC and dFC signal values and clinical symptoms in distinct brain areas among HM patients were identified via correlation analysis. Static and dynamic changes in brain activity in HM patients were investigated by assessments of sFC and dFC via calculation of the total time series mean and sliding-window analysis. Results In the left anterior cingulate gyrus (L-ACG)/left superior parietal gyrus (L-SPG) and left V1, sFC values were significantly greater in HM patients than in HCs. In the L-ACG and right V1, sFC values were also significantly greater in HM patients than in HCs [two-tailed, voxel-level P < 0.01, Gaussian random field (GRF) correction, cluster-level P < 0.05]. In the left calcarine cortex (L-CAL) and left V1, dFC values were significantly lower in HM patients than in HCs. In the right lingual gyrus (R-LING) and right V1, dFC values were also significantly lower in HM patients than in HCs (two-tailed, voxel-level P < 0.01, GRF correction, cluster-level P < 0.05). Conclusion Patients with HM exhibited significantly disturbed FC between the V1 and various brain regions, including L-ACG, L-SPG, L-CAL, and R-LING. This disturbance suggests that patients with HM could exhibit impaired cognitive and emotional processing functions, top-down control of visual attention, and visual information processing functions. HM patients and HCs could be distinguished from each other with high accuracy using sFC and dFC variabilities. These findings may help to identify the neural mechanism of decreased visual performance in HM patients.
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Li KKW, Wong DHT, Li PSH. Are we facing an increasing surgical demand for high myopic traction maculopathies? A 12-year study from Hong Kong. BMC Ophthalmol 2023; 23:31. [PMID: 36690997 PMCID: PMC9869563 DOI: 10.1186/s12886-022-02709-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/28/2022] [Indexed: 01/24/2023] Open
Abstract
PURPOSE We aimed to investigate the longitudinal change in the number of surgically operated myopic traction maculopathies (MTM) cases at a tertiary eye centre. METHODS A retrospective study of all consecutive cases of surgically operated MTM over 12 years (2009-2020) was conducted in a myopia prevalent region. We compared outcomes among three groups: (1) myopic macular hole (MH), (2) myopic macular hole with retinal detachment (MHRD), and (3) myopic foveoschisis with retinal detachment (MFRD). RESULTS Fifty-one cases were included in the study (8 cases of MH, 33 cases of MHRD and 10 cases of MFRD). The overall mean age was 63.8 +/- 8.7 with a female preponderance (2:1). The mean age of the MH group (58.6) was significantly younger than the MHRD group (64.2) and MFRD group (66.6) (p = 0.02). Subgroup analysis using ATN classification did not show its correlation with both visual improvement and anatomical success. When comparing the first 6-year period (2009-2014) with the second 6-year period (2015-2020), there was a significant increase in the number of cases (p = 0.01). CONCLUSION We observe an increase in the number of surgically operated MTM. This follows the trend of the global rise in the prevalence of myopia and baby boomers entering retirement.
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Affiliation(s)
- Kenneth K. W. Li
- grid.417037.60000 0004 1771 3082Department of Ophthalmology, United Christian Hospital, Hospital Authority, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong SAR, China ,grid.490601.a0000 0004 1804 0692Department of Ophthalmology, Tseung Kwan O Hospital, Hospital Authority, No. 2 Po Ning Lane, Hang Hau, Tseung Kwan O, Hong Kong SAR, China ,grid.194645.b0000000121742757Department of Ophthalmology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Daniel H. T. Wong
- grid.417037.60000 0004 1771 3082Department of Ophthalmology, United Christian Hospital, Hospital Authority, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong SAR, China ,grid.490601.a0000 0004 1804 0692Department of Ophthalmology, Tseung Kwan O Hospital, Hospital Authority, No. 2 Po Ning Lane, Hang Hau, Tseung Kwan O, Hong Kong SAR, China ,grid.194645.b0000000121742757Department of Ophthalmology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Patrick S. H. Li
- grid.417037.60000 0004 1771 3082Department of Ophthalmology, United Christian Hospital, Hospital Authority, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong SAR, China ,grid.490601.a0000 0004 1804 0692Department of Ophthalmology, Tseung Kwan O Hospital, Hospital Authority, No. 2 Po Ning Lane, Hang Hau, Tseung Kwan O, Hong Kong SAR, China
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Choroidal Vascular Density Quantification in High Myopia with or without Choroidal Neovascularization Using Optical Coherence Tomography Angiography. J Ophthalmol 2023; 2023:1504834. [PMID: 36713357 PMCID: PMC9883103 DOI: 10.1155/2023/1504834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/13/2022] [Accepted: 11/24/2022] [Indexed: 01/22/2023] Open
Abstract
Purpose The aim of this study was to analyze choroidal vascular density alteration in high myopia with or without choroidal neovascularization by using optical coherence tomography angiography (OCTA). Methods This was a cross-sectional, observational study that included 60 high-myopia eyes. All the participants had comprehensive ophthalmic assessments with visual acuity, intraocular pressure, slit lamp-assisted biomicroscopy, color fundus photography, axial length, optometry, and OCTA. Age, sex, and comorbidities were collected from their medical charts. Univariate and multiple analyses were made to compare the age, spherical equivalent, choroidal vascular density, gender, and choroidal thickness between normal and patients with choroidal neovascularization. Results 60 eyes with high myopia were included in our study, including 30 eyes with choroidal neovascularization and 30 eyes without choroidal neovascularization or other fundus pathology. The mean age of high myopic patients was older in the choroidal neovascularization group than in the normal group (48.43 ± 19.06 years vs. 28.83 ± 9.92 years, p < 0.01). The mean choroidal thickness of high myopic patients was thinner in the neovascularization group than in the normal group (68.81 ± 48.81 μm vs. 137.80 ± 66.33 μm, p < 0.01). The mean choroidal vascular density in the normal group was greater than in the choroidal neovascularization group (82.43 ± 8.73 vs. 67.54 ± 12.56, p < 0.01). There was no significant difference in spherical equivalent between the choroidal neovascularization group and the normal group (-10.56 ± 2.97D vs. -11.93 ± 3.38D, p = 0.11). Multivariate analysis showed that after adjusting for covariates, less choroidal vascular density and older age were independent factors associated with choroidal neovascularization in the high myopic eye. Conclusion Decreased choroidal vascular density and older age played an important role in the development of choroidal neovascularization in high myopic eyes. OCTA may help us to identify the highly myopic patients that need to intervene.
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Zhang CX, Lou Y, Chi J, Bao XL, Fan B, Li GY. Considerations for the Use of Photobiomodulation in the Treatment of Retinal Diseases. Biomolecules 2022; 12:biom12121811. [PMID: 36551239 PMCID: PMC9775242 DOI: 10.3390/biom12121811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/26/2022] [Accepted: 12/01/2022] [Indexed: 12/11/2022] Open
Abstract
Photobiomodulation (PBM) refers to the beneficial effect produced from low-energy light irradiation on target cells or tissues. Increasing evidence in the literature suggests that PBM plays a positive role in the treatment of retinal diseases. However, there is great variation in the light sources and illumination parameters used in different studies, resulting in significantly different conclusions regarding PBM's therapeutic effects. In addition, the mechanism by which PBM improves retinal function has not been fully elucidated. In this study, we conducted a narrative review of the published literature on PBM for treating retinal diseases and summarized the key illumination parameters used in PBM. Furthermore, we explored the potential molecular mechanisms of PBM at the retinal cellular level with the goal of providing evidence for the improved utilization of PBM in the treatment of retinal diseases.
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Affiliation(s)
- Chun-Xia Zhang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun 130042, China
| | - Yan Lou
- Department of Nephropathy, The Second Hospital of Jilin University, Changchun 130042, China
| | - Jing Chi
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun 130042, China
| | - Xiao-Li Bao
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun 130042, China
| | - Bin Fan
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun 130042, China
- Correspondence: (B.F.); (G.-Y.L.)
| | - Guang-Yu Li
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun 130042, China
- Correspondence: (B.F.); (G.-Y.L.)
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11
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Xia YF, Wei J. Study on Factors Associated with High Myopia CNV in Aqueous Humor and Serum. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8592729. [PMID: 35535041 PMCID: PMC9078789 DOI: 10.1155/2022/8592729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/16/2022] [Accepted: 04/02/2022] [Indexed: 11/30/2022]
Abstract
Objective The objective is to investigate the relationship and correlation between PEDF and TGF-β in aqueous humor and serum and high myopia CNV lesions. Methods For each group of patients (namely, group A: patients with high myopia CNV (mCNV); group B: patients with high myopia without CNV; group C: patients with CNV caused by other eye diseases; and group D (control group): patients with simple cataract (without CNV and high myopia)), 20 patients were collected. A total of 40 patients have been collected since the beginning of the study in December 2020, including 7 patients in group A, 13 patients in group B, 10 patients in group C, and 10 patients in group D. Serum and aqueous humor samples were collected, and PEDF and TGF-β levels in serum and aqueous humor were detected by enzyme-linked immunosorbent assay (ELISA). SPSS 26.0 statistical software was used to process the data. Independent sample t-test was used to compare the data of the same factor in the same group between serum and aqueous humor. Comparisons of the same factors between different groups were performed using a one-way analysis of variance (ANOVA). Correlation analysis was conducted by the Pearson correlation coefficient test. P < 0.05 indicated that the difference was statistically significant. Results There were no significant differences in age, gender, and course of disease among all groups (P > 0.05). The concentration of PEDF in aqueous humor in group A and group C was higher than that in group B and group D. There was no significant correlation between serum PEDF content and the above-mentioned diseases. The concentration of TGF-β in aqueous humor in groups A, B, and C was significantly higher than that in group D. However, there was no significant correlation between TGF-β content in serum and the above-mentioned diseases. There was no significant correlation between aqueous humor and serum PEDF. There was no significant correlation between the content of TGF-β in aqueous humor and serum. Conclusion TGF-β in aqueous humor may be involved in the development of high myopia and intraocular CNV disease. However, PEDF in aqueous humor may be involved in the development of intraocular CNV disease and has no significant correlation with high myopia. At the same time, TGF-β and PEDF in serum had no significant correlation with high myopia and intraocular CNV disease. There was no significant correlation between the concentrations of TGF-β and PEDF in aqueous humor and serum.
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Affiliation(s)
- Yi Fan Xia
- Henan University of Science and Technology, Luoyang, Henan Province 471000, China
| | - Jing Wei
- Henan University of Science and Technology, Luoyang, Henan Province 471000, China
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12
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Li Y, Foo LL, Wong CW, Li J, Hoang QV, Schmetterer L, Ting DSW, Ang M. Pathologic myopia: advances in imaging and the potential role of artificial intelligence. Br J Ophthalmol 2022; 107:600-606. [PMID: 35288438 DOI: 10.1136/bjophthalmol-2021-320926] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/17/2022] [Indexed: 11/04/2022]
Abstract
Pathologic myopia is a severe form of myopia that can lead to permanent visual impairment. The recent global increase in the prevalence of myopia has been projected to lead to a higher incidence of pathologic myopia in the future. Thus, imaging myopic eyes to detect early pathological changes, or predict myopia progression to allow for early intervention, has become a key priority. Recent advances in optical coherence tomography (OCT) have contributed to the new grading system for myopic maculopathy and myopic traction maculopathy, which may improve phenotyping and thus, clinical management. Widefield fundus and OCT imaging has improved the detection of posterior staphyloma. Non-invasive OCT angiography has enabled depth-resolved imaging for myopic choroidal neovascularisation. Artificial intelligence (AI) has shown great performance in detecting pathologic myopia and the identification of myopia-associated complications. These advances in imaging with adjunctive AI analysis may lead to improvements in monitoring disease progression or guiding treatments. In this review, we provide an update on the classification of pathologic myopia, how imaging has improved clinical evaluation and management of myopia-associated complications, and the recent development of AI algorithms to aid the detection and classification of pathologic myopia.
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Affiliation(s)
- Yong Li
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore
| | - Li-Lian Foo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore
| | - Chee Wai Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore
| | - Jonathan Li
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Quan V Hoang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Ophthalmology, Columbia University, New York City, New York, USA
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore.,School of Chemical and Biological Engineering, Nanyang Technological University, Singapore.,Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria.,Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Daniel S W Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore .,Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore
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13
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Jiang Y, Lou S, Li Y, Chen Y, Lu TC. High myopia and macular vascular density: an optical coherence tomography angiography study. BMC Ophthalmol 2021; 21:407. [PMID: 34836532 PMCID: PMC8626942 DOI: 10.1186/s12886-021-02156-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate whether there are differences inmacular vascular density (VD) between patients with high-myopia (HM) and those with non-high myopia (NHM) using Optical Coherence Tomography Angiography (OCTA). Method OCTA was performed on 35 eyes with HM with spherical equivalence (SE) > − 6.00D and 35 eyes with NHM with SE ≤ -6.00D. Vascular densities of the macula (overall macula, fovea, parafovea, superior hemi and inferior hemi) were measured in each of the superficial, deep and choriocapillaris layers of the retina. Results In the superficial retinal layer, overall macular VFD was significantly higher in the NHM compared to the HM group (51.27 ± 3.74 vs. 48.07 ± 5.69, p < 0.05). There were significant differences between the NHM and HM in parafovea (52.58 ± 5.78 vs. 49.4 ± 6.43, p < 0.05), superior-hemi (53.38 ± 4.03 vs 49.78 ± 6.84, p < 0.05) and inferior-hemi regions (53.49 ± 4.61 vs 49.05 ± 6.41, p < 0.05), but not in the fovea region. Similarly, in the deep retinal layer, overall macular VFD was significantly higher in the NHM group compared to the HM group (58.69 ± 2.46 vs. 56.90 ± 4.08, p < 0.05). There was significant differences between the HM and NHM in superior-hemi region (61.97 ± 2.68 vs. 60.08 ± 3.98, p < 0.05), but not in the fovea, parafovea, and inferior-hemi region. In the choriocapillaris, there was no difference in the overall macular VFD, nor any of the individual sectors between the HM and the NHM groups. Conclusion VFD in the superficial and deep retinal layers of the macula are significantly increased in the NHM compared to HM eyes. This is not the case in the choroidal capillary layers of the retina.
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Affiliation(s)
- Yang Jiang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shang Lou
- Department of Ophthalmology, Jiangxi Cancer Hospital, Nanchang Beijing ease road No.519, Jiang xi, China
| | - Ying Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China. .,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Thomas Chengxuan Lu
- School of Medicine, University of New South Wales, Kensington, NSW, 2052, Australia
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Lin KH, Tran T, Kim S, Park S, Chen J, Stout JT, Chen R, Rogers J, Yiu G, Thomasy S, Moshiri A. Age-related changes in the rhesus macaque eye. Exp Eye Res 2021; 212:108754. [PMID: 34506802 PMCID: PMC8785649 DOI: 10.1016/j.exer.2021.108754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess age-related changes in the rhesus macaque eye and evaluate them to corresponding human age-related eye disease. METHODS Data from eye exams and imaging tests including intraocular pressure (IOP), lens thickness, axial length, and retinal optical coherence tomography (OCT) images were evaluated from 142 individuals and statistically analyzed for age-related changes. Quantitative autofluorescence (qAF) was measured as was the presence of macular lesions as related to age. RESULTS Ages of the 142 rhesus macaques ranged from 0.7 to 29 years (mean = 16.4 years, stdev = 7.5 years). Anterior segment measurements such as IOP, lens thickness, and axial length were acquired. Advanced retinal imaging in the form of optical coherence tomography and qAF were obtained. Quantitative assessments were made and variations by age groups were analyzed to compare with established age-related changes in human eyes. Quantitative analysis of data revealed age-related increase in intraocular pressure (0.165 mm Hg per increase in year of age), ocular biometry (lens thickness 7.2 μm per increase in year of age; and axial length 52.8 μm per increase in year of age), and presence of macular lesions. Age-related changes in thicknesses of retinal layers on OCT were observed and quantified, showing decreased thickness of the retinal ganglion cell layer and inner nuclear layer, and increased thickness of photoreceptor outer segment and choroidal layers. Age was correlated with increased qAF by 1.021 autofluorescence units per increase in year of age. CONCLUSIONS The rhesus macaque has age-related ocular changes similar to humans. IOP increases with age while retinal ganglion cell layer thickness decreases. Macular lesions develop in some aged animals. Our findings support the concept that rhesus macaques may be useful for the study of important age-related diseases such as glaucoma, macular diseases, and cone disorders, and for development of therapies for these diseases.
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Affiliation(s)
- Kira H Lin
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, 1 Garrod Drive, Davis, CA, 95695, USA
| | - Tu Tran
- Department of Ophthalmology & Vision Science, School of Medicine, U.C. Davis, Sacramento, CA, 95817, USA
| | - Soohyun Kim
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - Sangwan Park
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - Jiajia Chen
- Department of Ophthalmology & Vision Science, School of Medicine, U.C. Davis, Sacramento, CA, 95817, USA
| | - J Timothy Stout
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Rui Chen
- Human Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA; Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Jeffrey Rogers
- Human Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Glenn Yiu
- Department of Ophthalmology & Vision Science, School of Medicine, U.C. Davis, Sacramento, CA, 95817, USA
| | - Sara Thomasy
- Department of Ophthalmology & Vision Science, School of Medicine, U.C. Davis, Sacramento, CA, 95817, USA; Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - Ala Moshiri
- Department of Ophthalmology & Vision Science, School of Medicine, U.C. Davis, Sacramento, CA, 95817, USA.
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Abstract
PURPOSE To validate the recently developed ATN grading system for myopic maculopathy to classify eyes with pathologic myopia. METHODS Cross-sectional study. A series of consecutive eyes diagnosed with pathologic myopia and signs of myopic maculopathy (grade ≥1 for atrophic, tractional, or neovascular components of the ATN), with a refractive error > -6.0 diopters (D), were included. All patients underwent complete ophthalmological examination including fundus photography and swept-source optical coherence tomography. Six observers graded each eye twice using the ATN system (≥15 days between assessments) based only on the aforementioned data. RESULTS Sixty eyes from 47 patients (61.7% female) were graded. Mean patient age was 63.2 ± 11.7 years. The mean spherical equivalent was -13.8 ± 6.5 D. Mean axial length was 28.6 ± 2.16 mm. Overall, the mean intraobserver agreement (%) for the same image was 92.0%, and the mean interobserver agreement for the second image was 77.5%. The weighted Fleiss k showed excellent correlation (k > 0.8) for the traction and neovascularization components and good correlation (0.75) for atrophy. Interobserver agreement for each of these three components was 95.2%, 98.4%, 95.0%, respectively. CONCLUSION Application of the ATN resulted in high intraobserver and interobserver correlation, underscoring the reproducibility of the system.
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16
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Wang X, Yang Y, Wu Y, Wei W, Dong L, Li Y, Tan X, Cao H, Zhang H, Ma X, Jiang Q, Zhou Y, Yang W, Li C, Gu Y, Ding L, Qin Y, Chen Q, Li L, Lian M, Ma J, Cui D, Huang Y, Liu W, Yang X, Yu S, Chen J, Wang D, Lin Z, Yan P, Lin H. The national multi-center artificial intelligent myopia prevention and control project. INTELLIGENT MEDICINE 2021; 1:51-55. [DOI: 10.1016/j.imed.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
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Liu Z, Xiu Y, Qiu F, Zhu Z, Zong R, Zhou X, An J, Wang Q, Reinach PS, Li W, Chen W, Liu Z. Canonical Wnt Signaling Drives Myopia Development and Can Be Pharmacologically Modulated. Invest Ophthalmol Vis Sci 2021; 62:21. [PMID: 34259818 PMCID: PMC8288060 DOI: 10.1167/iovs.62.9.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the role of the canonical Wnt signaling in the development of the myopia. Methods Plasma from adult patients with myopia, myopic animal models including the adenomatous polyposis coli (APC) gene mutation mouse model, and the form deprivation (FD) induced mouse model of myopia were used. Niclosamide, a canonical Wnt pathway inhibitor, was orally administrated in animal models. Plasma levels of DKK-1 were determined by using enzyme-linked immunosorbent assay. Refraction, vitreous chamber depth (VCD), axial length (AL), and other parameters, were measured at the end of the FD treatment. Canonical Wnt signaling changes were evaluated by Western blot analysis and immunostaining analysis. Results Plasma level of Wnt inhibitor DKK-1 was markedly decreased in patients with myopia. Meanwhile, the canonical Wnt pathway was progressively activated during myopia development in mice. Moreover, inhibition of canonical Wnt signaling by niclosamide in mouse models markedly reduced lens thickness (LT), VCD, and AL elongation, resulting in myopia inhibition. Conclusions Dysregulation of canonical Wnt signaling is a characteristic of myopia and targeting Wnt signaling pathways has potential as a therapeutic strategy for myopia.
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Affiliation(s)
- Zhen Liu
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, Xiamen University, Xiamen, Fujian, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen University, Xiamen, China.,Fujian Engineering and Research Center of Eye Regenerative Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yanghui Xiu
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, Xiamen University, Xiamen, Fujian, China
| | - Fangfang Qiu
- Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
| | - Zhenzhen Zhu
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, Xiamen University, Xiamen, Fujian, China
| | - Rongrong Zong
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, Xiamen University, Xiamen, Fujian, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen University, Xiamen, China.,Fujian Engineering and Research Center of Eye Regenerative Medicine, Xiamen University, Xiamen, Fujian, China
| | - Xiangtian Zhou
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Zhejiang Provincial Key Laboratory of Ophthalmology and Optometry, Wenzhou, Zhejiang, China
| | - Jianhong An
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Zhejiang Provincial Key Laboratory of Ophthalmology and Optometry, Wenzhou, Zhejiang, China
| | - Qiongsi Wang
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Zhejiang Provincial Key Laboratory of Ophthalmology and Optometry, Wenzhou, Zhejiang, China
| | - Peter S Reinach
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Zhejiang Provincial Key Laboratory of Ophthalmology and Optometry, Wenzhou, Zhejiang, China
| | - Wei Li
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, Xiamen University, Xiamen, Fujian, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen University, Xiamen, China.,Fujian Engineering and Research Center of Eye Regenerative Medicine, Xiamen University, Xiamen, Fujian, China
| | - Wensheng Chen
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, Xiamen University, Xiamen, Fujian, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen University, Xiamen, China.,Fujian Engineering and Research Center of Eye Regenerative Medicine, Xiamen University, Xiamen, Fujian, China
| | - Zuguo Liu
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, Xiamen University, Xiamen, Fujian, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen University, Xiamen, China.,Fujian Engineering and Research Center of Eye Regenerative Medicine, Xiamen University, Xiamen, Fujian, China
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Biomarkers of Myopic Choroidal Neovascularization in Women, Determining the Clinical Course and Response to Anti-VEGF Therapy. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.2.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: to identify clinical and laboratory biomarkers that determine the nature of the course of myopic choroidal neovascularization (mCNV) and the response to anti-VEGF therapy in women.Material and methods. A prospective non-randomized study was conducted in 52 patients (52 eyes) with active mCNV, treated with ranibizumab intravitreally, 0.5mg. After 12months, the suppression of CNV activity, the number of injections and the fellow eye inclusion in the pathological process were taken into account. There were 2 groups: with a favorable clinical course (n = 31, age – 33,0 ± 5,1 years, anterior-posterior axis (APA) 28,5 ± 0,3 mm) and an unfavorable clinical course (n = 21, age – 34,0 ± 4,1 years, APA – 29,01 ± 0,1 mm). Structural retinal changes, choroid thickness, retinal blood flow, and heart rate were evaluated using OCT and OCTA protocols (Optovue XR Avanti, USA). Studies were conducted before the start of therapy and then one time per month. The concentration of sex and pituitary hormones (ELISA analyzer “Immunohem-2100”), lipoprotein A, Apo B/Apo A (Accent 200 Cormay, Poland), coagulogram data (Helena C-2, UK), and the concentration of highly sensitive C-reactive protein in blood serum before the start of antiangiogenic therapy were studied once.Results. In the first group, 1.4 ± 0.7 ranibizumab injections were administered to suppress the CNV activity. In the opposite group – 3.5 ± 2.1 injections, in 73.7 % of cases, relapses were diagnosed, in 3 cases – primary CNV in the fellow eye. Clinical and laboratory biomarkers of the unfavorable clinical course of mCNV were identified: extreme choroidal thinning, highly organized membranes of a large area, dome-shaped deformation of the posterior pole, excess of the reference values of lipoprotein A, fibrinogen and highly sensitive C-reactive protein by two or more times, an imbalance of sex and pituitary hormones (excess of the reference values of prolactin, follicle stimulating hormone, cortisol, progesterone concentration decrease), a predominant change in the menstrual-ovarian cycle according to the type of amenorrhea and opsomenorrhea.Conclusion. Myopic CNV biomarkers in women allow predicting the response to anti-VEGF therapy, the formation of relapses and the inclusion of the fellow eye in the pathological process.
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Ruiz-Moreno JM, Puertas M, Flores-Moreno I, Ruiz-Medrano J, Almazán-Alonso E, Garcia-Zamora M. Evolution of Macular Bruch Membrane Defects of Patchy Chorioretinal Atrophy in Pathologic Myopia Based on a Recent Classification System. Ophthalmologica 2021; 244:309-314. [PMID: 33915543 DOI: 10.1159/000516526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/07/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to analyze the progression of macular Bruch membrane defects (BMD) in highly myopic patients with patchy atrophy (PA); and study its correlation with the enlargement of PA and ATN grading. Setting/Venue: Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain. PATIENTS AND METHODS This was a cross-sectional, noninterventional study. A series of 451 highly myopic eyes with spherical equivalent > -6.0 D and/or >26 mm of axial length (AL) were included. All patients underwent a complete ophthalmological examination and swept-source optical coherence tomography (SS-OCT), and were graded using the ATN system by 2 masked retina experts that assessed the atrophic (A), tractional (T), and neovascular (N) components. SS-OCT b-scans were employed to study PA and macular BMD at baseline and at a 1-year follow-up, in patients with good foveal fixation. RESULTS Out of total 451 eyes, 126 eyes (27.9%) had PA (53 patients; 75.4% women). Mean T and N in eyes with PA were 1.1 ± 1.3 and 0.08 ± 0.2, respectively. Sixty-eight of them had >1-year follow-up with a good foveal fixation and enough image quality. From them, BMD were found in 44 eyes (64.7%) at baseline and increased to 59 eyes (86.7%) at a 1-year follow-up. The mean great linear dimension of PA and macular BMD increased with a median of 384.5 ± 462.5 μm (IR 68.0-660.2) and 265.6 ± 418.1 μm (IR 0-331.7), respectively. At 1-year, PA and BMD sizes increase, and were statistically significant (p < 0.001). There was a positive correlation between the growth of macular BMD and the growth of PA (r = 0.490, p < 0.00). T grading correlated significantly with PA growth (p < 0.05). CONCLUSIONS Macular BMD increase its prevalence and its size over time in highly myopic patients with PA. There is a positive correlation between BMD and PA area growth. New studies with a larger sample size, longer follow-up, and AL elongation correlation are necessary to corroborate our findings.
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Affiliation(s)
- José M Ruiz-Moreno
- Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain.,Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain.,Red Temática de Investigación Cooperativa en Salud: "Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Madrid, Spain.,Vissum/Miranza, Madrid, Spain
| | - Mariluz Puertas
- Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain
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20
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Abstract
BACKGROUND This study aimed to investigate the short-term effect of cycloplegia on higher-order aberrations (HOAs) in school-age myopic children who received 0.25% atropine for cycloplegic refraction. METHODS We performed a retrospective chart review of 24 myopic children between the ages of 5 and 15 years, who had received one topical drop of 0.25% atropine for three consecutive nights before undergoing cycloplegic refraction. Auto-refraction, visual acuity, and HOAs measured with the iTrace aberrometer were compared before and after atropine use. To account for the effect of cycloplegia, the amount of HOAs under matching scanning sizes was compared. RESULTS There were statistically significant differences in the spherical equivalent, with a hyperopic shift after atropine use (p < 0.001). Corrected visual acuity and spherical aberrations showed no significant change under the respective pupil and scanning sizes before and after atropine use. Under identical scanning sizes, there was a significant change in total spherical aberration (from 0.03 to 0.06 μm, p = 0.044) and internal spherical aberration (from -0.10 to -0.05 μm, p = 0.049) after atropine use. Differences in corneal spherical aberration were insignificant. CONCLUSION The positive shift of spherical aberration induced by the inhibition of accommodation in myopic children may have a possible effect against myopic progression. Future studies can focus on the long-term effect on HOAs and impact on visual quality with lower concentrations of atropine.
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Affiliation(s)
- Yih-Shiuan Kuo
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - May-Yung Yen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan, ROC
- Sue-Tien Ophthalmology Clinic, Yin Sue-Tien Medical foundation, Taipei, Taiwan, ROC
| | - Pei-Yu Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan, ROC
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21
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Brennan NA, Toubouti YM, Cheng X, Bullimore MA. Efficacy in myopia control. Prog Retin Eye Res 2020; 83:100923. [PMID: 33253901 DOI: 10.1016/j.preteyeres.2020.100923] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 11/17/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022]
Abstract
There is rapidly expanding interest in interventions to slow myopia progression in children and teenagers, with the intent of reducing risk of myopia-associated complications later in life. Despite many publications dedicated to the topic, little attention has been devoted to understanding 'efficacy' in myopia control and its application. Treatment effect has been expressed in multiple ways, making comparison between therapies and prognosis for an individual patient difficult. Available efficacy data are generally limited to two to three years making long-term treatment effect uncertain. From an evidence-based perspective, efficacy projection should be conservative and not extend beyond that which has been empirically established. Using this principle, review of the literature, data from our own clinical studies, assessment of demonstrated myopia control treatments and allowance for the limitations and context of available data, we arrive at the following important interpretations: (i) axial elongation is the preferred endpoint for assessing myopic progression; (ii) there is insufficient evidence to suggest that faster progressors, or younger myopes, derive greater benefit from treatment; (iii) the initial rate of reduction of axial elongation by myopia control treatments is not sustained; (iv) consequently, using percentage reduction in progression as an index to describe treatment effect can be very misleading and (v) cumulative absolute reduction in axial elongation (CARE) emerges as a preferred efficacy metric; (vi) maximum CARE that has been measured for existing myopia control treatments is 0.44 mm (which equates to about 1 D); (vii) there is no apparent superior method of treatment, although commonly prescribed therapies such as 0.01% atropine and progressive addition spectacles lenses have not consistently provided clinically important effects; (viii) while different treatments have shown divergent efficacy in the first year, they have shown only small differences after this; (ix) rebound should be assumed until proven otherwise; (x) an illusion of inflated efficacy is created by measurement error in refraction, sample bias in only treating 'measured' fast progressors and regression to the mean; (xi) decision to treat should be based on age of onset (or refraction at a given age), not past progression; (xii) the decreased risk of complications later in life provided by even modest reductions in progression suggest treatment is advised for all young myopes and, because of limitations of available interventions, should be aggressive.
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Affiliation(s)
- Noel A Brennan
- Johnson & Johnson Vision, 7500 Centurion Pkwy, Jacksonville, FL, 32256, USA.
| | - Youssef M Toubouti
- Johnson & Johnson Vision, 7500 Centurion Pkwy, Jacksonville, FL, 32256, USA
| | - Xu Cheng
- Johnson & Johnson Vision, 7500 Centurion Pkwy, Jacksonville, FL, 32256, USA
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22
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Sim SS, Wong CW, Hoang QV, Lee SY, Wong TY, Cheung CMG. Anti-retinal autoantibodies in myopic macular degeneration: a pilot study. Eye (Lond) 2020; 35:2254-2259. [PMID: 33116263 DOI: 10.1038/s41433-020-01241-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 09/15/2020] [Accepted: 10/16/2020] [Indexed: 11/09/2022] Open
Abstract
AIM The aim of this study is to evaluate the frequency and types of anti-retinal autoantibodies (ARAs) in highly myopic patients and to explore any association between ARAs and the severity of myopic macular degeneration (MMD). METHODS This was a clinic-based study of 16 patients with high myopia (spherical equivalent worse than -6 dioptres or axial length (AL) ≥ 26.5 mm) recruited from the High Myopia clinic of the Singapore National Eye Centre. MMD was graded from fundus photographs according to the Meta-analysis for Pathologic Myopia (META-PM) classification. Severe MMD was defined as META-PM category 3 or 4. AL and logarithm of the minimal angle of resolution (logMAR) best corrected visual acuity (BCVA) were measured. Sera were obtained from subjects and analysed for the presence of ARAs with the western blot technique. RESULTS The mean AL was significantly longer in patients with severe MMD (n = 8) than those without severe MMD (n = 8) (31.50 vs. 28.51, p = 0.005). There was at least one ARA identified in all patients. The most common ARA was anti-carbonic anhydrase II (anti-CAII), present in nine patients (56.3%). Anti-CAII was detected in more patients with severe MMD than those without (75 vs. 37.5%, p = 0.32). LogMar BCVA was also worse in subjects with anti-CAII (0.5 ± 0.38 vs. 0.22 ± 0.08, p = 0.06). The number of ARAs significantly correlated with increasing AL (r = 0.61, p = 0.012). CONCLUSIONS ARAs are prevalent in patients with high myopia, and this increases with increasing AL. In particular, anti-CAII antibodies were highly prevalent in patients with severe MMD, suggesting that ARAs may be associated with MMD. Further studies are necessary to confirm these observations in larger cohorts.
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Affiliation(s)
- Shaun Sebastian Sim
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Quan V Hoang
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.,Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia College of Physicians and Surgeons, New York, NY, USA
| | - Shu Yen Lee
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Singapore, Singapore. .,Singapore Eye Research Institute, Singapore, Singapore. .,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
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Remote screening of retinal and optic disc diseases using handheld nonmydriatic cameras in programmed routine occupational health checkups onsite at work centers. Graefes Arch Clin Exp Ophthalmol 2020; 259:575-583. [PMID: 32728935 PMCID: PMC7391026 DOI: 10.1007/s00417-020-04860-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose To evaluate the first year outcomes of a remote screening program for detection of retinal diseases using handheld nonmydriatic cameras in occupational routine checkups performed onsite at work centers. Methods Cross-sectional, first year screening program outcomes audit. Participants were volunteers recruited from staff within work centers. Retinal fundus images were captured by technicians, and images and data were anonymized and sent securely to a remote server. A team of ophthalmologists, all retinal specialists, remotely read the images using a custom-made software and sent telematic reports of findings within 24–48 h. The main items evaluated were the detection of retinal abnormalities and the relationship between retinal findings and demographic data such as age and sex. Results A total of 19,881 workers were evaluated in 52 centers. Mean age was 41.1 years old, 43.9% men and 56.1% women. Mean duration of the test was around 2 min. Of the workers, 7.8% presented abnormalities in retinal fundus images, being the main findings choroidal nevus (2.4%), macular pigment abnormalities (1.5%), glaucomatous optic disc (1.2%), and macular signs of high myopia (1.1%). The presence of abnormalities was associated with greater age, being 5%, 7.9%, 12.6%, and 19.7% in workers less than 40 years, from 40 to 49, 50–59, and ≥ 60 years (p < 0.05), respectively. Men had more abnormalities in retinal fundus images than women (8.6 vs. 7.2; p < 0.05 RR: 1.2; CI 1092–1322). Conclusions Mass screening of retinal and optic disc abnormalities during occupational health routine checkups is a feasible, quick, and efficient tool for early detection of potential vision-threatening disease markers.
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24
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Jagadeesh D, Philip K, Fedtke C, Jong M, Ly A, Sankaridurg P. Posterior segment conditions associated with myopia and high myopia. Clin Exp Optom 2020; 103:756-765. [PMID: 32227385 DOI: 10.1111/cxo.13060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 12/29/2022] Open
Abstract
Myopia, and especially high myopia, is associated with a number of posterior segment changes that are considered to be mostly a consequence of the increased axial elongation. This can result in mechanical strain, attendant vascular changes, stretching and thinning of tissues, and atrophy/deformation of tissues in later or more advanced stages. Such myopia-related changes are observed as changes and/or abnormalities in the vitreous, choroid, retina and peripheral retina, sclera and/or optic disc. Although many of these changes are benign, at times they may be associated with significant vision impairment that either requires active intervention or may suggest future progression of the disease. This review systematically addresses the posterior segment conditions seen in myopic eyes, describes the features associated with the condition and details management pathways.
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Affiliation(s)
- Divya Jagadeesh
- Research and Development Group, Brien Holden Vision Institute, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Krupa Philip
- Research and Development Group, Brien Holden Vision Institute, Sydney, Australia
| | - Cathleen Fedtke
- Research and Development Group, Brien Holden Vision Institute, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Monica Jong
- Research and Development Group, Brien Holden Vision Institute, Sydney, Australia.,Discipline of Optometry and Vision Science, University of Canberra, Canberra, Australia
| | - Angelica Ly
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia.,Centre for Eye Health, Sydney, Australia
| | - Padmaja Sankaridurg
- Research and Development Group, Brien Holden Vision Institute, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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Ucak T, Icel E, Yilmaz H, Karakurt Y, Tasli G, Ugurlu A, Bozkurt E. Alterations in optical coherence tomography angiography findings in patients with high myopia. Eye (Lond) 2020; 34:1129-1135. [PMID: 32094474 DOI: 10.1038/s41433-020-0824-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/08/2020] [Accepted: 02/12/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The aim of this study was to determine the macular changes using optical coherence tomography (OCT) and OCT-angiography (OCT-A) in eyes with high myopia. Determining the alterations in vascular structures can provide a clearer understanding of the pathophysiological mechanisms of this disease and help define new treatment options and preventive measures. MATERIALS AND METHODS Ninety-two patients with high myopia (axial length ≥ 26 mm) and 70 control cases without any known systemic or ocular diseases were enrolled in this prospective study. One eye of each patient was included in the statistical analyses. RESULTS Retinal nerve fiber layer (RNFL) thickness and Early Treatment Diabetic Retinopathy Study (ETDRS) macula map values were lower in myopia compared with the controls. Both superior and inferior ganglion cell complex (GCC) thicknesses were significantly thinner in the high myopia compared with the controls (p < 0.001). Regarding the OCT-A findings, although superficial or deep foveal avascular zones (FAZ) did not significantly differ between the two groups, the density values of superficial and deep microvessels were significantly lower in the high myopia group compared with the control cases. CONCLUSIONS In patients with high myopia, with an increase in the axial length and a decrease in RNFL and GCC thicknesses, the vascular densities of the superficial and deep retina were reduced in the macular region.
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Affiliation(s)
- Turgay Ucak
- Department of Ophthalmology, Faculty of Medicine, Erzincan University, Erzincan, Turkey.
| | - Erel Icel
- Department of Ophthalmology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Hayati Yilmaz
- Department of Ophthalmology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Yucel Karakurt
- Department of Ophthalmology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Gamze Tasli
- Department of Ophthalmology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Adem Ugurlu
- Department of Ophthalmology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Erdinc Bozkurt
- Department of Ophthalmology, Faculty of Medicine, Kafkas University, Kars, Turkey
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26
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Thorn F, Chen J, Li C, Jiang D, Chen W, Lin Y, Chang X, Deng R, Chen Y. Refractive status and prevalence of myopia among Chinese primary school students. Clin Exp Optom 2019; 103:177-183. [PMID: 31674055 DOI: 10.1111/cxo.12980] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the prevalence of myopia in key (university-oriented) and non-key elementary schools in China using a traditional and a new criterion for myopia diagnosis in an epidemiological study. METHODS This school-based, cross-sectional study examined students from four key schools and seven non-key schools. Non-cycloplegic autorefraction and visual acuity (VA) were performed on each student. Myopia was defined as a spherical equivalent (SE) refractive error not better than -1.00 D. A questionnaire was also administered. RESULTS Of the 13,220 students examined, 6,546 (49.5 per cent) had myopia using the criterion of SE not better than -1.00 D. However, 2,246 (34.3 per cent) of these myopes had VA ≥ 0 logMAR in both eyes, indicating they were not functioning as myopes. Thus, a second myopia criterion was adopted: SE refractive error not better than -1.00 D + uncorrected VA ≥ 0 logMAR in at least one eye. By this definition, only 32.5 per cent of the overall sample had myopia. Students in key schools had a higher prevalence of myopia than those in non-key schools (53.8 per cent versus 44.7 per cent) by the initial criterion. By the new criterion, the prevalence of myopia was 41.2 per cent versus 22.7 per cent. Myopia was equal in grade 1 of both school types, but accelerated faster in key schools, where there was a much higher prevalence of myopia by fourth grade, and continued up to 79.2 per cent prevalence by sixth grade based on SE refractive error not better than -1.00 D. CONCLUSION Students in more competitive university-oriented elementary schools developed myopia much faster than those in regular schools, although they started with the same level of myopia. Since one-third of the 'myopes' had VA ≥ 0 logMAR in both eyes, they would not be prescribed a correction, or be clinically treated as myopes. A new criterion of SE refractive error not better than -1.00 D + uncorrected VA ≥ 0 logMAR in at least one eye was tested. This criterion is more clinically appropriate and could be used in future epidemiological studies.
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Affiliation(s)
- Frank Thorn
- The Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Jie Chen
- The Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chunchun Li
- The Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Dandan Jiang
- The Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wuhe Chen
- The Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yaoyao Lin
- School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiao Chang
- School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ruzhi Deng
- The Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yanyan Chen
- The Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
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Corbelli E, Parravano M, Sacconi R, Sarraf D, Yu SY, Kim K, Capuano V, Miere A, Souied E, Varano M, Boninfante A, Chae B, Carnevali A, Querques L, Bandello F, Querques G. Prevalence and Phenotypes of Age-Related Macular Degeneration in Eyes With High Myopia. Invest Ophthalmol Vis Sci 2019; 60:1394-1402. [PMID: 30938774 DOI: 10.1167/iovs.18-25534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To analyze the frequency and phenotypic variation of AMD in subjects with high myopia (HM), and to describe the clinical course and response to treatment of neovascularization (NV). Methods Patients with HM were identified at five retina tertiary referral centers. Inclusion criteria were myopic patients aged 55 years or more with axial lengths equal or greater than 25.5 mm. Results A total of 874 eyes from 442 HM subjects older than 55 years were identified and 104 eyes of 54 patients (72 ± 11 years) were included in the study and followed up for 23.5 ± 19.5 months. The estimated AMD frequency in HM subjects over 55 years was 11.9% (95% confidence interval; 9.8%-14.0%). A total of 34 of 104 eyes were diagnosed with drusen, 22 with reticular pseudodrusen (RPD), 28 with both drusen and RPD, and 20 with geographic atrophy. Neovascularization was detected in 52 eyes (50%), and type 1 was the most frequent form (39 eyes, 75%). Overall, NV was treated with 4.6 ± 2.6 anti-VEGF injections. Eyes with treatment-naïve NV at baseline (n = 34) required 3.8 ± 1.5 anti-VEGF injections during the first year of treatment. This exceeded the injection number in the purely myopic population (1.8 to 3.6 injections for the first year). Conclusions This study provides evidence to suggest that older patients with HM are at a significant risk of the dry and neovascular forms of AMD. NV in eyes with HM and AMD required more injections in the first year compared to NV in HM eyes without AMD.
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Affiliation(s)
- Eleonora Corbelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy.,Eye Clinic, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, United States.,Greater Los Angeles VA Healthcare Center, Los Angeles, California, United States
| | - Seung-Young Yu
- Department of Ophthalmology, Kyung Hee University, Kyung Hee University Hospital, Seoul, South Korea
| | - Kiyoung Kim
- Department of Ophthalmology, Kyung Hee University, Kyung Hee University Hospital, Seoul, South Korea
| | - Vittorio Capuano
- Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | - Alexandra Miere
- Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | - Eric Souied
- Department of Ophthalmology, Kyung Hee University, Kyung Hee University Hospital, Seoul, South Korea
| | | | | | - Bora Chae
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, United States.,Greater Los Angeles VA Healthcare Center, Los Angeles, California, United States
| | - Adriano Carnevali
- Department of Ophthalmology, University of "Magna Graecia", Catanzaro, Italy
| | - Lea Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
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Flitcroft DI, He M, Jonas JB, Jong M, Naidoo K, Ohno-Matsui K, Rahi J, Resnikoff S, Vitale S, Yannuzzi L. IMI - Defining and Classifying Myopia: A Proposed Set of Standards for Clinical and Epidemiologic Studies. Invest Ophthalmol Vis Sci 2019; 60:M20-M30. [PMID: 30817826 PMCID: PMC6735818 DOI: 10.1167/iovs.18-25957] [Citation(s) in RCA: 461] [Impact Index Per Article: 92.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose We provide a standardized set of terminology, definitions, and thresholds of myopia and its main ocular complications. Methods Critical review of current terminology and choice of myopia thresholds was done to ensure that the proposed standards are appropriate for clinical research purposes, relevant to the underlying biology of myopia, acceptable to researchers in the field, and useful for developing health policy. Results We recommend that the many descriptive terms of myopia be consolidated into the following descriptive categories: myopia, secondary myopia, axial myopia, and refractive myopia. To provide a framework for research into myopia prevention, the condition of “pre-myopia” is defined. As a quantitative trait, we recommend that myopia be divided into myopia (i.e., all myopia), low myopia, and high myopia. The current consensus threshold value for myopia is a spherical equivalent refractive error ≤ −0.50 diopters (D), but this carries significant risks of classification bias. The current consensus threshold value for high myopia is a spherical equivalent refractive error ≤ −6.00 D. “Pathologic myopia” is proposed as the categorical term for the adverse, structural complications of myopia. A clinical classification is proposed to encompass the scope of such structural complications. Conclusions Standardized definitions and consistent choice of thresholds are essential elements of evidence-based medicine. It is hoped that these proposals, or derivations from them, will facilitate rigorous, evidence-based approaches to the study and management of myopia.
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Affiliation(s)
- Daniel Ian Flitcroft
- Children's University Hospital, Technological University Dublin, Dublin, Ireland
| | - Mingguang He
- Centre for Eye Research Australia; Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karis-University Heidelberg, Mannheim, Germany
| | - Monica Jong
- Brien Holden Vision Institute and School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Kovin Naidoo
- Brien Holden Vision Institute and School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Jugnoo Rahi
- Institute of Child Health, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Serge Resnikoff
- Brien Holden Vision Institute and School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Susan Vitale
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Lawrence Yannuzzi
- The Vitreous, Retina, Macula Consultants of New York and the LuEsther T. Mertz Retina Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York, United States
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Choroidal thickness measured with swept source optical coherence tomography in posterior staphyloma strongly correlates with axial length and visual acuity. Int J Retina Vitreous 2019; 5:14. [PMID: 31333879 PMCID: PMC6615153 DOI: 10.1186/s40942-019-0166-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/30/2019] [Indexed: 11/10/2022] Open
Abstract
Purpose To measure the choroidal thickness in patients with high myopia from staphyloma using swept source OCT (SS-OCT) in Early Treatment Diabetic Retinopathy Study (ETDRS) fields and compare to normal cohort. The study also evaluated the correlation between choroidal thickness with axial length and best-corrected visual acuity (BCVA). Methods In this prospective cross sectional study, 37 eyes of 20 patients with high myopia from staphyloma and 86 eyes of 43 normal subjects were included. In each eye, horizontal scans centered on the fovea (12 × 9 mm) were performed using SS-OCT (DRI-OCT, Topcon, Japan). Choroidal thickness in 9 ETDRS subfields, including central subfield (CSF) was analyzed and correlated with axial length as well as BCVA. Results The axial length and BCVA in the high myopia from staphyloma group ranged from 25.12 to 33.54 mm (28.4 ± 1.2) and 20/20–20/400, respectively. The choroidal thickness in staphyloma group was 85.53 ± 48.61 μm as compared to 250.24 ± 71.01 μm in the normal group (p < 0.0001). Stepwise regression analysis showed that axial length strongly correlated with decreased choroidal thickness (p < 0.001) in staphyloma group (r = 0.71, r2 = 0.5). Refractive error and BCVA moderately correlated(r = − 0.47; r2 = 0.22) with choroidal thickness (p < 0.001). Conclusion Choroidal thickness in staphyloma (measured with novel technology of SS-OCT) patients is markedly reduced compared to normal controls. In addition, choroidal thickness strongly correlated with axial length of the eye and inversely correlated with visual acuity. This testing modality maybe used as a good predictor of visual acuity in patients with high myopia from staphyloma.
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Zhang S, Zhang G, Zhou X, Xu R, Wang S, Guan Z, Lu J, Srinivasalu N, Shen M, Jin Z, Qu J, Zhou X. Changes in Choroidal Thickness and Choroidal Blood Perfusion in Guinea Pig Myopia. Invest Ophthalmol Vis Sci 2019; 60:3074-3083. [PMID: 31319419 DOI: 10.1167/iovs.18-26397] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to study changes in choroidal thickness (ChT) and choroidal blood perfusion (ChBP), and the correlation between them, in guinea pig myopia. Methods The reliability of optical coherence tomography angiography (OCTA) for measuring ChT and ChBP was verified in guinea pigs, after cervical dislocation (n = 7) or temporal ciliary artery transection (n = 6). Changes in refraction, axial length, ChT, and ChBP were measured during spontaneous myopia (n = 9), monocular form-deprivation myopia (FDM, n = 13), or lens-induced myopia (LIM, n = 14), and after 4 days of recovery from FDM and LIM. Results The abolition (by cervical dislocation) or reduction (by temporal ciliary artery transection) of ChBP, and of the associated changes in ChT, were verified by OCTA, thus validating the method of measurement. In the spontaneous myopia group, ChT and ChBP were reduced by 25.2% and 31.9%, respectively. In FDM eyes, mean ± SD ChT and ChBP decreased significantly compared with the untreated fellow eyes (ChT fellow: 76.13 ± 9.34 μm versus 64.76 ± 11.15 μm for FDM; ChBP fellow: 37.87 ± 6.37 × 103 versus 30.27 ± 6.06 × 103 for FDM) and increased after 4 days of recovery (ChT: 77.94 ± 12.57 μm; ChBP: 37.41 ± 6.11 × 103). Effects of LIM were similar to those of FDM. Interocular differences in ChT and ChBP were significantly correlated in each group (FDM: R = 0.71, P < 0.001; LIM: R = 0.53, P < 0.001). Conclusions ChT and ChBP were significantly decreased in all three models of guinea pig myopia, and they both increased during recovery. Changes in ChT were positively correlated with changes in ChBP. Therefore, it is possible that the changes of ChT are responsible for the changes of ChBP or vice versa.
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Affiliation(s)
- Sen Zhang
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Guoyun Zhang
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Xuan Zhou
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Renchang Xu
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Siyao Wang
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Zhenqi Guan
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Juan Lu
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Nethrajeith Srinivasalu
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Meixiao Shen
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Zi Jin
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Jia Qu
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Xiangtian Zhou
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
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Pham B, Thomas SM, Lillie E, Lee T, Hamid J, Richter T, Janoudi G, Agarwal A, Sharpe JP, Scott A, Warren R, Brahmbhatt R, Macdonald E, Straus SE, Tricco AC. Anti-vascular endothelial growth factor treatment for retinal conditions: a systematic review and meta-analysis. BMJ Open 2019; 9:e022031. [PMID: 31142516 PMCID: PMC6549720 DOI: 10.1136/bmjopen-2018-022031] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To evaluate the comparative effectiveness and safety of intravitreal bevacizumab, ranibizumab and aflibercept for patients with choroidal neovascular age-related macular degeneration (cn-AMD), diabetic macular oedema (DMO), macular oedema due to retinal vein occlusion (RVO-MO) and myopic choroidal neovascularisation (m-CNV). DESIGN Systematic review and random-effects meta-analysis. METHODS Multiple databases were searched from inception to 17 August 2017. Eligible head-to-head randomised controlled trials (RCTs) comparing the (anti-VEGF) drugs in adult patients aged ≥18 years with the retinal conditions of interest. Two reviewers independently screened studies, extracted data and assessed risk of bias. RESULTS 19 RCTs involving 7459 patients with cn-AMD (n=12), DMO (n=3), RVO-MO (n=2) and m-CNV (n=2) were included. Vision gain was not significantly different in patients with cn-AMD, DMO, RVO-MO and m-CNV treated with bevacizumab versus ranibizumab. Similarly, vision gain was not significantly different between cn-AMD patients treated with aflibercept versus ranibizumab. Patients with DMO treated with aflibercept experienced significantly higher vision gain at 12 months than patients receiving ranibizumab or bevacizumab; however, this difference was not significant at 24 months. Rates of systemic serious harms were similar across anti-VEGF agents. Posthoc analyses revealed that an as-needed treatment regimen (6-9 injections per year) was associated with a mortality increase of 1.8% (risk ratio: 2.0 [1.2 to 3.5], 2 RCTs, 1795 patients) compared with monthly treatment in cn-AMD patients. CONCLUSIONS Intravitreal bevacizumab was a reasonable alternative to ranibizumab and aflibercept in patients with cn-AMD, DMO, RVO-MO and m-CNV. The only exception was for patients with DME and low visual acuity (<69 early treatment diabetic retinopathy study [ETDRS] letters), where treatment with aflibercept was associated with significantly higher vision gain (≥15 ETDRS letters) than bevacizumab or ranibizumab at 12 months; but the significant effects were not maintained at 24 months. The choice of anti-VEGF drugs may depend on the specific retinal condition, baseline visual acuity and treatment regimen. PROSPERO REGISTRATION NUMBER CRD42015022041.
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Affiliation(s)
- Ba' Pham
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Sonia M Thomas
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Erin Lillie
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Taehoon Lee
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Jemila Hamid
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Trevor Richter
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada
| | - Ghayath Janoudi
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada
| | - Arnav Agarwal
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jane P Sharpe
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Alistair Scott
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Rachel Warren
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Ronak Brahmbhatt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Erin Macdonald
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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OLIMPIC: a 12-month study on the criteria driving retreatment with ranibizumab in patients with visual impairment due to myopic choroidal neovascularization. Graefes Arch Clin Exp Ophthalmol 2019; 257:759-768. [DOI: 10.1007/s00417-019-04248-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 12/19/2018] [Accepted: 01/11/2019] [Indexed: 11/26/2022] Open
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Ruiz-Medrano J, Montero JA, Flores-Moreno I, Arias L, García-Layana A, Ruiz-Moreno JM. Myopic maculopathy: Current status and proposal for a new classification and grading system (ATN). Prog Retin Eye Res 2019; 69:80-115. [PMID: 30391362 DOI: 10.1016/j.preteyeres.2018.10.005] [Citation(s) in RCA: 205] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 02/09/2023]
Abstract
Myopia is a highly frequent ocular disorder worldwide and pathologic myopia is the 4th most common cause of irreversible blindness in developed countries. Pathologic myopia is especially common in East Asian countries. Ocular alterations associated with pathologic myopia, especially those involving the macular area-defined as myopic maculopathy-are the leading causes of vision loss in patients with pathologic myopia. High myopia is defined as the presence of a highly negative refractive error (>-6 to -8 diopters) in the context of eye elongation (26-26.5 mm). Although the terms high myopia and pathologic myopia are often used interchangeably, they do not refer to the same eye disease. The two key factors driving the development of pathologic myopia are: 1) elongation of the axial length and 2) posterior staphyloma. The presence of posterior staphyloma, which is the most common finding in patients with pathologic myopia, is the key differentiating factor between high and pathologic myopia. The occurrence of staphyloma will, in most cases, eventually lead to other conditions such as atrophic, traction, or neovascular maculopathy. Posterior staphyloma is for instance, responsible for the differences between a myopic macular hole (MH)-with and without retinal detachment-and idiopathic MH. Posterior staphyloma typically induces retinal layer splitting, leading to foveoschisis in myopic MH, an important differentiating factor between myopic and emmetropic MH. Myopic maculopathy is a highly complex disease and current classification systems do not fully account for the numerous changes that occur in the macula of these patients. Therefore, a more comprehensive classification system is needed, for several important reasons. First, to more precisely define the disease stage to improve follow-up by enabling clinicians to more accurately monitor changes over time, which is essential given the progressive nature of this condition. Second, unification of the currently-available classification systems would establish standardized classification criteria that could be used to compare the findings from international multicentric studies. Finally, a more comprehensive classification system could help to improve our understanding of the genetic origins of this disease, which is clearly relevant given the interchangeable-but erroneous-use of the terms high and pathologic myopia in genetic research.
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Affiliation(s)
- Jorge Ruiz-Medrano
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
| | - Javier A Montero
- Department of Ophthalmology, Rio Hortega University Hospital, Valladolid, Spain; Red Temática de Investigación Cooperativa en Salud: ""Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Spain; Retina Unit, Oftalvist, Madrid, Spain
| | | | - Luis Arias
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
| | - Alfredo García-Layana
- Red Temática de Investigación Cooperativa en Salud: ""Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Spain; Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain
| | - José M Ruiz-Moreno
- Red Temática de Investigación Cooperativa en Salud: ""Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Spain; Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain; Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain; Vissum Corporation, Spain.
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Abstract
BACKGROUND Myopic choroidal neovascularization (CNV) is a common cause of central visual loss in patients with high myopia, and the most common form of CNV in younger individuals. Pharmacologic therapy is the current mainstay of treatment of these patients. METHODS Review of pharmacological treatment options for myopic CNV, which primarily involves intravitreal administration of anti-vascular endothelial growth factor (anti-VEGF) agents. RESULTS At this time, anti-VEGF therapy agents are the first-line therapy in these patients. Comparative trials have not identified any major differences in treatment outcomes between aflibercept, bevacizumab, and ranibizumab. Only ranibizumab is approved for this indication in the US. Best visual outcomes are associated with younger age, smaller lesion size, and absence of chorioretinal atrophy. CONCLUSION Anti-VEGF therapy is generally very effective in the treatment of myopic CNV.
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Affiliation(s)
- Hacer Isildak
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Stephen G Schwartz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
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Moustafa MA, Elsherif W, Attaallah H, Hassanien R. Macular microvaculature evaluation using optical coherence tomography angiography in patients with high myopia. ACTA ACUST UNITED AC 2019. [DOI: 10.4103/erj.erj_12_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Stolowy N, Calabrèse A, Sauvan L, Aguilar C, François T, Gala N, Matonti F, Castet E. The influence of word frequency on word reading speed when individuals with macular diseases read text. Vision Res 2018; 155:1-10. [PMID: 30571997 DOI: 10.1016/j.visres.2018.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 11/30/2022]
Abstract
People with central field loss (CFL) use peripheral vision to identify words. Eccentric vision provides ambiguous visual inputs to the processes leading to lexical access. Our purpose was to explore the hypothesis that this ambiguity leads to strong influences of inferential processes, our prediction being that increasing word frequency would decrease word reading time. Individuals with bilateral CFL induced by macular diseases read French sentences displayed with a self-paced reading method. Reading time of the last word of each sentence (target word) was recorded. Each target word (in sentence n) was matched with a synonym word (in sentence n+1) of the same length. When using absolute frequency value (Analysis 1), we found that reading time of target words decreased when word frequency increases, even when controlling for word length. The amplitude of this effect is larger than reported in previous investigations of reading with normal subjects. When comparing the effect of relative frequency (low vs. high) within each pair of synonyms (Analysis 2), results show the same pattern as the one observed in Analysis 1. Our results demonstrate clear-cut frequency effects on word reading time and suggest that inferential processes are stronger in CFL readers than in normally sighted observers. These results might also help design text simplification tools tailored for low-vision patients.
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Affiliation(s)
| | - Aurélie Calabrèse
- Aix-Marseille University, Marseille, France; Laboratoire de Psychologie Cognitive, CNRS, Marseille, France.
| | | | - Carlos Aguilar
- Nice Sophia-Antipolis University, Nice, France; Laboratoire Bases Corpus Langage, CNRS, Nice, France
| | - Thomas François
- Université catholique de Louvain, Belgium; Institut Langage et Communication, FNRS, Louvain, Belgium
| | - Núria Gala
- Aix-Marseille University, Marseille, France; Laboratoire Parole et Langage, Aix-en-Provence, France
| | - Frédéric Matonti
- North Hospital, Marseille, France; Aix-Marseille University, Marseille, France; University Hospital of La Timone, Marseille, France
| | - Eric Castet
- Aix-Marseille University, Marseille, France; Laboratoire de Psychologie Cognitive, CNRS, Marseille, France
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Melzer C, Ziemssen F, Eter N, Brinkmann C, Agostini H, Haeusser-Fruh G, Rose U, Schargus M, Lorenz K, Holz FG, Schmitz-Valckenberg S. Design and Baseline Characteristics of the HELP Study: An Extended and Long-Term Observation of Pathological Myopia in Caucasians. Ophthalmologica 2018; 240:167-178. [PMID: 29909408 DOI: 10.1159/000489180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/11/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the natural disease progression of high myopia in Caucasians considered at risk for the development of myopic choroidal neovascularization (mCNV). METHODS Subjects were recruited in 25 clinical sites between June 2014 and June 2016. Main inclusion criteria included axial length of ≥26 mm, best-corrected visual acuity ≥0.05 decimal equivalent and presence of at least one out of five predefined morphological disease risk criteria. These were (1) subfoveal choroidal thinning < 50 µm, (2) enhanced choroidal curvature length > 6,300 µm, (3) lacquer cracks, (4) patchy atrophy > 5 mm2 and (5) preexisting mCNV in the fellow eye (German Clinical Trial Register DRKS00007761). RESULTS A total of 150 participants (66% females) with a mean age of 57.2 (±12.7) years (range 21.9-86.2 years) were included. The disease criteria most frequently encountered were choroidal thinning (33.3%) and lacquer cracks (32.7%). Enhanced choroidal curvature length was detected in only 8 subjects and always occurred in combination with other disease criteria. Presence of patchy atrophy was found to be more common in older subjects (p = 0.0012) and also associated with a more severe disease manifestation. CONCLUSION The baseline data of this study indicate that enhanced choroidal curvature might be less common in Caucasians than in Asian populations. Further, disease severity in patients with high myopia is relatively high in the presence of patchy atrophy.
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Affiliation(s)
- Charlotte Melzer
- GRADE Reading Center, Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Focke Ziemssen
- Department of Ophthalmology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Nicole Eter
- Department of Ophthalmology, University of Münster, Münster, Germany
| | - Christian Brinkmann
- GRADE Reading Center, Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | | | - Uwe Rose
- Novartis Pharma Nuremberg, Nuremberg, Germany
| | - Marc Schargus
- Department of Ophthalmology, Heinrich Heine University, Düsseldorf, Germany.,Eye Hospital, Gerolzhofen, Germany
| | - Katrin Lorenz
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Frank G Holz
- GRADE Reading Center, Department of Ophthalmology, University of Bonn, Bonn, Germany
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Choudhury F, Meuer SM, Klein R, Wang D, Torres M, Jiang X, McKean-Cowdin R, Varma R. Prevalence and Characteristics of Myopic Degeneration in an Adult Chinese American Population: The Chinese American Eye Study. Am J Ophthalmol 2018; 187:34-42. [PMID: 29288031 DOI: 10.1016/j.ajo.2017.12.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 12/13/2017] [Accepted: 12/15/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize and provide population-based prevalence estimates of myopic degeneration (MD) among Chinese Americans, the fastest-growing minority population in the United States in the last decade. DESIGN Population-based, cross-sectional study. METHODS A total of 1523 Chinese-American adults with myopia, aged 50 years and older, residing in the city of Monterey Park, California, underwent an interview and comprehensive eye examination, including subjective and objective refraction and stereoscopic fundus photography. For each participant, the eye with the worse myopic refractive error was included in this analysis. MD was assessed in a masked manner by an expert grader. RESULTS The prevalence of any MD was 44.9% among myopic subjects, based on the presence of any degenerative lesion secondary to myopia. The prevalence was 32.2% when MD was defined by a modified version of the Meta-Analysis for Pathologic Myopia. The prevalence of specific lesions included tessellation (31.7%), tilted disc (28.1%), peripapillary atrophy (7.0%), staphyloma (5.7%), diffuse atrophy (6.4%), lacquer cracks (2.6%), intrachoroidal cavitation (2.2%), patchy atrophy (0.9%), and end-stage MD (0.2%). The prevalence of MD was higher among older myopic subjects and among participants with more severe myopia and longer axial length (P < .001). CONCLUSIONS These data provide the first population-based estimates of MD in Chinese Americans and indicate that a high proportion of Chinese Americans might be at risk for MD and associated visual complications. Prevalence of MD in this cohort of Chinese Americans was higher than that observed in other East Asian populations and in people of other ethnicities.
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Affiliation(s)
- Farzana Choudhury
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Stacy M Meuer
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Dandan Wang
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Mina Torres
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Xuejuan Jiang
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Roberta McKean-Cowdin
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Rohit Varma
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California.
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Choroidal and Retinal Thickness of Highly Myopic Eyes with Early Stage of Myopic Chorioretinopathy: Tessellation. J Ophthalmol 2018; 2018:2181602. [PMID: 29607214 PMCID: PMC5828427 DOI: 10.1155/2018/2181602] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/03/2018] [Accepted: 01/18/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose To investigate the choroidal thickness (CT) and retinal thickness (RT) in highly myopic tessellated eyes. Methods In this study, 115 highly myopic eyes were recruited and divided as tessellated fundus (n = 93) and normal fundus (n = 22). RT and CT were quantified using optical coherence tomography with enhanced depth imaging (EDI-OCT). Correlation between subfoveal CT (SFCT) and tessellation was analyzed using logistic regression models. Results Tessellated fundus eyes had thinner CT than did normal fundus eyes, while RT was not statistically different across groups. The tessellated eyes had a thinner choroid than did the control eyes at all measured macular locations (all P < 0.05). After adjustment for AL, age, and gender, the SFCT was significantly associated with tessellation. The odds ratio (OR) and 95% confidence interval (CI) was 0.975 (0.960–0.990, P = 0.001, binary logistics regression) and 0.991 (0.984–0.999, P = 0.022, Cox regression). The area under the curve (AUC) of SFCT was the greatest for detecting tessellation (AUC = 0.824, P < 0.001). For sensitivity and specificity analyses, SFCT had the highest diagnostic value (sensitivity = 81.8%, specificity = 74.2%). Conclusions Highly myopic eyes with tessellation have thinner CT than do normal highly myopic eyes. CT may serve as an early pathologic predictor of high myopia.
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Singh A, Abd AJ, Al-Mashahedah A, Kanwar JR. Corneal Haze, Refractive Surgery, and Implications for Choroidal Neovascularization. DRUG DELIVERY FOR THE RETINA AND POSTERIOR SEGMENT DISEASE 2018:439-477. [DOI: 10.1007/978-3-319-95807-1_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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AttaAllah HR, Omar IAN, Abdelhalim AS. Assessment of Posterior Segment Using Spectral Domain OCT in Highly Myopic Eyes. Open Ophthalmol J 2017; 11:334-345. [PMID: 29299081 PMCID: PMC5725562 DOI: 10.2174/1874364101711010334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/19/2017] [Accepted: 10/30/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose: Spectral Domain Optical Coherence Tomography (SD-OCT) was used to evaluate retinal and vitreo-retinal changes that occur in highly myopic patients. Methods: This prospective study included 472 eyes of 472 patients suffering from high myopia (> -6.00 D), between May 2012 and December 2015. All patients were examined, using Cirrus HD OCT (Zeiss Cirrus TM HD-OCT model 4000), to detect any retinal or vitreo-retinal interface abnormalities. All obtained data was analyzed using Statistical Package for the Social Sciences software version 17 (SPSS Inc, Chicago, IL, USA) and the paired two-sided t-test. Bivariate correlations were performed between different parameters using the Spearman correlation coefficient (r). Results: Mean spherical equivalent (MSE) was -13.11± 4.35D. Mean axial length (AL) was 28.5±1.62 mm. Posterior vitreous detachment (PVD) was the most frequent OCT finding; representing 33.4% of the cases, 13.7% of them were associated with macular traction. A statistically significant positive correlation was found between AL and MTM, full thickness macular hole, PVD with traction, and dome shaped macula (r = 0.49 and P = 0.001, r = 0.422 and P = 0.0001, r = 0.25 and P = 0.03, r=0.475, P=0.001 respectively) Conclusion: OCT is a valuable tool in detecting retinal and vitreo-retinal interface abnormalities in highly myopic eyes, and it can be used for follow up of those patients to avoid advanced retinal damage.
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Affiliation(s)
- Heba Radi AttaAllah
- Ophthalmology Department, Lecturer of Ophthalmology, Minia University Hospital, Faculty of Medicine, Minia University, Al-Minya, Egypt
| | - Ismail Ahmed Nagib Omar
- Ophthalmology Department, Lecturer of Ophthalmology, Minia University Hospital, Faculty of Medicine, Minia University, Al-Minya, Egypt
| | - Ahmed Shawkat Abdelhalim
- Ophthalmology Department, Lecturer of Ophthalmology, Minia University Hospital, Faculty of Medicine, Minia University, Al-Minya, Egypt
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Cheung CMG, Arnold JJ, Holz FG, Park KH, Lai TY, Larsen M, Mitchell P, Ohno-Matsui K, Chen SJ, Wolf S, Wong TY. Myopic Choroidal Neovascularization. Ophthalmology 2017; 124:1690-1711. [DOI: 10.1016/j.ophtha.2017.04.028] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 04/03/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023] Open
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Tan CS, Sadda SR. Anti-vascular endothelial growth factor therapy for the treatment of myopic choroidal neovascularization. Clin Ophthalmol 2017; 11:1741-1746. [PMID: 29026284 PMCID: PMC5627729 DOI: 10.2147/opth.s124518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Myopic choroidal neovascularization (CNV) is a sight-threatening condition which occurs in eyes with myopia, particularly in those with pathologic myopia. It is the most common cause of CNV among patients younger than 50 years. Hemorrhage and exudation from the CNV lesion may eventually result in scarring or chorioretinal atrophy. While myopic CNV was previously treated with focal laser photocoagulation or photodynamic therapy (PDT), the current treatment of choice is anti-vascular endothelial growth factor (VEGF) agents. Many studies have demonstrated the efficacy of intravitreal anti-VEGF agents in the treatment of myopic CNV. The RADIANCE study reported that intravitreal ranibizumab was superior to PDT in eyes with myopic CNV (at 3 months, both groups receiving intravitreal ranibizumab gained 10.5 and 10.6 letters vs 2.2 letters among patients receiving PDT). In addition, the study demonstrated similar visual outcomes in eyes treated on the basis of visual acuity stabilization or disease activity criteria. Other clinical studies have provided evidence for the efficacy of ranibizumab and aflibercept in the treatment of myopic CNV. This review addresses the epidemiology, pathophysiology, and imaging characteristics of myopic CNV, and discusses the evidence for the efficacy of anti-VEGF agents as compared to laser photocoagulation and PDT.
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Affiliation(s)
- Colin S Tan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.,Fundus Image Reading Center, National Healthcare Group Eye Institute, Singapore
| | - SriniVas R Sadda
- Doheny Eye Institute, University of California Los Angeles, CA, USA
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Weinberger D, Bor-Shavit E, Barliya T, Dahbash M, Kinrot O, Gaton DD, Nisgav Y, Livnat T. Mobile Laser Indirect Ophthalmoscope: For the Induction of Choroidal Neovascularization in a Mouse Model. Curr Eye Res 2017; 42:1545-1551. [PMID: 28933966 DOI: 10.1080/02713683.2017.1349154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aims to evaluate and standardize the reliability of a mobile laser indirect ophthalmoscope in the induction of choroidal neovascularization (CNV) in a mouse model. MATERIALS & METHODS A diode laser indirect ophthalmoscope was used to induce CNV in pigmented male C57BL/6J mice. Standardization of spot size and laser intensity was determined using different aspheric lenses with increasing laser intensities applied around the optic disc. Development of CNV was evaluated 1, 5, and 14 days post laser application using fluorescein angiography (FA), histology, and choroidal flat mounts stained for the endothelial marker CD31 and FITC-dextran. Correlation between the number of laser hits to the number and size of developed CNV lesions was determined using flat mount choroid staining. The ability of intravitreally injected anti-human and anti-mouse VEGF antibodies to inhibit CNV induced by the mobile laser was evaluated. RESULTS Laser parameters were standardized on 350 mW for 100 msec, using the 90 diopter lens to accomplish the highest incidence of Bruch's membrane rupture. CNV lesions' formation was validated on days 5 and 14 post laser injury, though FA showed leakage on as early as day 1. The number of laser hits was significantly correlated with the CNV area. CNV growth was successfully inhibited by both anti-human and mouse VEGF antibodies. CONCLUSION The mobile laser indirect ophthalmoscope can serve as a feasible and a reliable alternative method for the CNV induction in a mouse model.
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Affiliation(s)
- Dov Weinberger
- a Laboratory of Eye Research , Felsenstein Medical Research Center , Beilinson Campus, Petach Tikva , Israel.,b Department of Ophthalmology , Rabin Medical Center , Beilinson Campus, Petach Tikva , Israel.,c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Elite Bor-Shavit
- b Department of Ophthalmology , Rabin Medical Center , Beilinson Campus, Petach Tikva , Israel
| | - Tilda Barliya
- a Laboratory of Eye Research , Felsenstein Medical Research Center , Beilinson Campus, Petach Tikva , Israel
| | - Mor Dahbash
- a Laboratory of Eye Research , Felsenstein Medical Research Center , Beilinson Campus, Petach Tikva , Israel
| | | | - Dan D Gaton
- b Department of Ophthalmology , Rabin Medical Center , Beilinson Campus, Petach Tikva , Israel.,c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Yael Nisgav
- a Laboratory of Eye Research , Felsenstein Medical Research Center , Beilinson Campus, Petach Tikva , Israel
| | - Tami Livnat
- a Laboratory of Eye Research , Felsenstein Medical Research Center , Beilinson Campus, Petach Tikva , Israel.,c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,e The Israeli National Hemophilia Center and Thrombosis Unit , Sheba Medical Center , Tel Hashomer , Israel
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Rey-Rodríguez DV, Álvarez-Peregrina C, Moreno-Montoya J. Prevalencia y factores asociados a miopía en jóvenes. REVISTA MEXICANA DE OFTALMOLOGÍA 2017. [DOI: 10.1016/j.mexoft.2016.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
The incidence of myopia is constantly on the rise. Patients of high myopia and pathological myopia are young and can lose vision due to a number of degenerative changes occurring at the macula. With the emergence of new technologies such as swept-source optical coherence tomography (OCT) and OCT angiography, our understanding of macular pathology in myopia has improved significantly. New conditions such as myopic traction maculopathy have been defined. Early, noninvasive detection of myopic choroidal neovascularization and its differentiation from lacquer cracks is possible with a greater degree of certainty. We discuss the impact of these new exciting and promising technologies and management of macular pathology in myopia. Incorporation of OCT in the microscope has also improved macular surgery. New concepts such as fovea-sparing internal limiting membrane peeling have emerged. A review of literature and our experience in managing all these conditions are discussed.
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Affiliation(s)
- Atul Kumar
- Vitreo-Retina and Uveitis Service, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Vitreo-Retina and Uveitis Service, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Devesh Kumawat
- Vitreo-Retina and Uveitis Service, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ganesh Pillay
- Vitreo-Retina and Uveitis Service, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Efforts to reduce the progression of myopia in childhood are on the rise, due to an increasing incidence of myopia worldwide and its associated sight-threatening complications. Interventions are aimed at reducing myopia in childhood and include environmental considerations, spectacles, contact lenses, and pharmacological agents. We reviewed recent literature with interventions aimed at reducing myopia progression in children and found that a number of interventions were significant in reducing the progression of myopia. Of these interventions, atropine showed the largest dose-related effect on myopia progression control. Although higher doses are associated with side effects of pupil dilatation, loss of accommodation, near vision blur, and rebound phenomenon, low-dose atropine has also been shown to provide effective myopia control with minimal side effects and rebound. To a lesser degree, bifocal soft contact lenses have also been shown to be effective in reducing the progression of myopia, though compliance is an issue. Similarly, orthokeratology lenses have also been shown to be effective in reducing axial length elongation and myopia progression, though long-term data on its rebound effects are unavailable.
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Affiliation(s)
- Su Ann Tay
- a Singapore National Eye Centre , Singapore.,b Singapore Eye Research Institute , Singapore
| | - Sonal Farzavandi
- a Singapore National Eye Centre , Singapore.,b Singapore Eye Research Institute , Singapore
| | - Donald Tan
- a Singapore National Eye Centre , Singapore.,c Department of Ophthalmology , National University of Singapore , Singapore.,d Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School , Singapore
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Shchuko AG, Zaytseva NV, Yur'eva TN, Chernykh ER, Mikhalevich IM, Grigor'eva AV. [Role of immunological factors in the development of myopic choroidal neovascularization]. Vestn Oftalmol 2016; 132:5-14. [PMID: 27911420 DOI: 10.17116/oftalma201613255-14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To study the concentration of cytokines in the aqueous humor of the anterior chamber in patients with myopic choroidal neovascularization (mCNV) and to compare the results to their ophthalmic status. MATERIAL AND METHODS A total of 19 patients (19 eyes) with mCNV treated with intravitreal ranibizumab were included in the study. The control group consisted of 15 patients (15 eyes) with myopia who had cataract surgery. Age, sex, and refractive error distribution were similar to that in the study group. All patients underwent a detailed ophthalmic examination as well as immunological study of the aqueous humor for cytokines concentrations using flow fluorometry (Bio-Plex Pro Human Cytokine Panel, 27-Plex, Bio-Rad Laboratories, USA). RESULTS Significant differences in concentrations of 10 cytokines were found between the mCNV and study groups. Vascular endothelial growth factor (VEGF) level was twice as low in patients with mCNV as that in the controls (191.15±142.3 pg/ml and 320.06±170.05 pg/ml, respectively) (p<0.05). The other 9 cytokines were higher in mCNV, namely, platelet-derived growth factor (PDGF-BB), inflammatory and anti-inflammatory cytokines (IL-2, IL-15, IL-17А and IL-5, IL-13, respectively), tumor necrosis factor (TNFα), and chemokines (IL-8, RANTES). The degree of myopia as well as morphological and functional changes in the macular zone were shown to be in close correlation with cytokines involved in inflammation and VEGF. VEGF level appeared to be negatively related to axial eye length, refractive error, and three cytokines: IL-13, INF-γ, and RANTES. At the same time, numerous (6, 8 and more) close correlations were established between inflammatory and anti-inflammatory cytokines, chemokines, and growth factors. CONCLUSION Patients with mCNV have been found to have higher than usual levels of inflammatory and anti-inflammatory cytokines, chemokines, and growth factors as well as a significantly decreased VEGF concentration. Immunological status of these patients differs from that in other ocular neovascular diseases suggesting possible involvement of alternative pathogenetic mechanisms.
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Affiliation(s)
- A G Shchuko
- Irkutsk Branch of the Academician S.N. Fyodorov IRTC "Eye Microsurgery", Ministry of Health of the Russian Federation, 337 Lermontova St., Irkutsk, Russian Federation, 664033; Irkutsk State Medical University, Ministry of Health of the Russian Federation, 1 Krasnogo Vosstaniya St., Irkutsk, Russian Federation, 664003
| | - N V Zaytseva
- Irkutsk Branch of the Academician S.N. Fyodorov IRTC "Eye Microsurgery", Ministry of Health of the Russian Federation, 337 Lermontova St., Irkutsk, Russian Federation, 664033
| | - T N Yur'eva
- Irkutsk Branch of the Academician S.N. Fyodorov IRTC "Eye Microsurgery", Ministry of Health of the Russian Federation, 337 Lermontova St., Irkutsk, Russian Federation, 664033
| | - E R Chernykh
- Scientific and Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St., Novosibirsk, Russian Federation, 630099
| | - I M Mikhalevich
- Irkutsk State Medical Academy of Postgraduate Education, Ministry of Health of the Russian Federation, 100 Yubileynyy m/r, Irkutsk, Russian Federation, 664049
| | - A V Grigor'eva
- Irkutsk Branch of the Academician S.N. Fyodorov IRTC "Eye Microsurgery", Ministry of Health of the Russian Federation, 337 Lermontova St., Irkutsk, Russian Federation, 664033
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Abstract
PURPOSE Higher myopic refractive errors are associated with serious ocular complications that can put visual function at risk. There is respective interest in slowing and if possible stopping myopia progression before it reaches a level associated with increased risk of secondary pathology. The purpose of this report was to review our understanding of the rationale(s) and success of contact lenses (CLs) used to reduce myopia progression. METHODS A review commenced by searching the PubMed database. The inclusion criteria stipulated publications of clinical trials evaluating the efficacy of CLs in regulating myopia progression based on the primary endpoint of changes in axial length measurements and published in peer-reviewed journals. Other publications from conference proceedings or patents were exceptionally considered when no peer-review articles were available. RESULTS The mechanisms that presently support myopia regulation with CLs are based on the change of relative peripheral defocus and changing the foveal image quality signal to potentially interfere with the accommodative system. Ten clinical trials addressing myopia regulation with CLs were reviewed, including corneal refractive therapy (orthokeratology), peripheral gradient lenses, and bifocal (dual-focus) and multifocal lenses. CONCLUSIONS CLs were reported to be well accepted, consistent, and safe methods to address myopia regulation in children. Corneal refractive therapy (orthokeratology) is so far the method with the largest demonstrated efficacy in myopia regulation across different ethnic groups. However, factors such as patient convenience, the degree of initial myopia, and non-CL treatments may also be considered. The combination of different strategies (i.e., central defocus, peripheral defocus, spectral filters, pharmaceutical delivery, and active lens-borne illumination) in a single device will present further testable hypotheses exploring how different mechanisms can reinforce or compete with each other to improve or reduce myopia regulation with CLs.
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Abstract
Pathologic myopia (PM) is one of the leading causes of visual impairment worldwide. The pathophysiology of PM is not fully understood, but the axial elongation of the eye followed by chorioretinal thinning is suggested as a key mechanism. Pathologic myopia may lead to many complications such as chorioretinal atrophy, foveoschisis, choroidal neovascularization, rhegmatogenous retinal detachment, cataract, and glaucoma. Some complications affect visual acuity significantly, showing poor visual prognosis. This article aims to review the types, pathophysiology, treatment, and visual outcome of the complications of PM.
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