IMI-Onset and Progression of Myopia in Young Adults

Patterns of Myopia Progression in European Adults

Objective

Data regarding the progression of myopia and new-onset myopia in young adults are lacking. This study aims to describe the natural history of myopia development and progression in adults using anonymized electronic medical records from Irish optometric practices.

Design

Longitudinal study.

Subjects

Electronic medical record data were extracted from 40 Irish optometry practices with 18 620 (59.5% female) patients meeting the inclusion criteria.

Methods

Refractive error change was determined among patients with multiple eye examination visits during the period January 1, 2003 to December 31, 2022. Patients aged 18 to 39 years, inclusive, at baseline and attending >1 eye examination with an interval of ≥11 months between visits and that were myopic at the final visit were included in the analysis. Annualized myopia progression in diopter (D)/year was assessed using linear mixed models with age, sex, baseline spherical equivalent refraction, and previous myopic progression as fixed effect covariates. The proportion of patients with unstable myopia (progression worse than -0.25 D/year) was determined.

Main Outcome Measures

Proportion of adults across the age range 18 to 39 years with significant myopic progression.

Results

Significant myopia progression (progression <-0.25 D/year) was noted in 10.7% of all myopes. The proportion of myopes with significant progression was clearly related to age with 19.9% of myopes in the youngest age group experiencing progression compared with 6.8% in the oldest age group. Higher proportions of myopic progression were also observed in high myopes with 1 in 12 high myopes (8.0%) exhibiting persistent fast myopic progression as adults (worse than -0.50 D/year). Of patients with emmetropia or hyperopia at baseline in this clinic-based population, 28.5% and 0.8% became myopic during the follow-up period.

Conclusions

Although myopia has stabilized in most adults (>18 years of age), a sizeable proportion of younger adults and high myopes (of all ages) do progress at a clinically significant rate. Almost 3 times as many adults in youngest age group (18-24 years) experienced myopic progression when compared with the oldest age group (40-44 years). Consideration should therefore be given to exploring the efficacy and benefit of myopia management in this cohort of patients.

Financial Disclosures

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Differential impact of 0.01% and 0.05% atropine eye drops on visual performance in young adults

PURPOSE

The onset and progression of myopia can occur during adulthood, suggesting that myopia should be managed in young adults. Low-concentration atropine eye drops have shown promising efficacy in myopia control. This study aimed to evaluate the impact of 0.01% and 0.05% atropine eye drops on the visual performance of university students.

METHODS

Twenty-six myopic students aged 18-30 years received 0.01% and 0.05% atropine in random order. Atropine eye drops were administered once a night in both eyes for 14 days, with a minimum 14-day washout period between concentrations. Visual assessments, including the modulation transfer function (MTF) cut-off, Strehl ratio (SR), objective scattering index, contrast sensitivity (CS) and glare disability, were conducted 1, 2, 7 and 14 days after atropine administration and corresponding time points after cessation. A questionnaire was used to evaluate ocular and general symptoms.

RESULTS

After 1 day of treatment with 0.05% atropine, the MTF cut-off (β = -8.75, p < 0.001) and SR (β = -0.05, p < 0.001) decreased significantly to their lowest levels. The area under the log CS function also decreased significantly (all p < 0.05) during administration of the 0.05% eye drops, especially in the mesopic with glare condition, and reached its lowest point 1 day after administration (β = -0.20, p < 0.001). However, all parameters returned to baseline levels 2 weeks after 0.05% atropine was stopped (all p > 0.05). Additionally, 40.91% of the young adults reported experiencing excessive daytime sleepiness and nocturnal glare during 0.05% atropine use. Treatment with 0.01% atropine had minimal effects on both visual performance and subjective symptoms.

CONCLUSIONS

Administration of 0.05% atropine had a significant but temporary effect on the visual performance of young adult myopic patients, whereas 0.01% atropine had a minimal effect.

Enhancing the biocompatibility of phakic intraocular lens via selective fibronectin trapping

Myopia has become a significant public health problem in recent decades, resulting in a profound public health and financial burden. The phakic intraocular lens (PIOL) utilized in myopia intraocular refractive surgery is constantly facing challenges in terms of uveal biocompatibility. Inspired by the "sandwich theory", this study proposes the hypothesis that fibronectin (FN) can improve biocompatibility, and then creatively constructs a selective in-situ trap FN strategy. Specifically, PIOL surfaces with amide bonds covalently linking collagen were prepared, where selectivity was achieved by specific binding of collagen to FN. The obtained collagen modified material reduces immune response by reducing M1 polarization of macrophages, and its functionality and safety have been verified in vitro and in vivo. The grafting of collagen on the PIOL surface was able to occupy adsorption sites and inhibit the non-specific adsorption of other proteins while mimicking the extracellular matrix (ECM) microenvironment, further reducing the foreign body rejection. Overall, this strategy helps to address the issue of uveal biocompatibility in PIOL from a material design perspective, providing more economical and diversified options for patients with surgical needs. STATEMENT OF SIGNIFICANCE: 1. A phakic intraocular lens material with high ocular biocompatibility has been prepared. 2. By introducing acrylic anhydride and activating it, collagen is covalently grafted onto the surface of HEMA without altering its structure. 3. By utilizing the collagen binding domain in the structure of fibronectin, selective adsorption of fibronectin is enhanced, forming extracellular matrix analogs that reduce macrophage M1 polarization and lower inflammation.

Ocular manifestations in Ehlers-Danlos syndrome

BACKGROUND/OBJECTIVE

To provide a large-scale analysis on the demographics and ocular comorbidities in Ehlers-Danlos Syndrome (EDS) patients in the US.

SUBJECTS/METHODS

This is an exploratory cross-sectional study comparing medical records of EDS patients to the general population on demographic variables and ICD-10 ocular diagnoses. A research platform with de-identified EHR data of over 99 million patients across 60 healthcare organizations was utilized. Groups were stratified by 30-year age groups. Patients aged 0-61+ with an ICD-10 diagnosis of EDS (76,526), the general platform population aged 0-61+ (99,836,639), and patients with a concurrent ICD-10 ocular diagnosis were queried to determine the prevalence of EDS across demographic variables, ocular disease, and odds of ocular disease. Statistical analysis was conducted using Microsoft Excel and R studio, using p < 0.01 and 95% confidence intervals (CI).

RESULTS

An EDS diagnosis was most prevalent in white females aged 0-30 years old (259.6 per 100,000). The majority of ocular diagnoses were more prevalent in the 0-60-year-old EDS population compared to the general population including myopia (5227.0 per 100,000) and dry eye (4211.6 per 100,000). Overall, diagnoses of angioid streaks (POR 18.72, 95% CI 10.32, 33.94) and idiopathic intracranial hypertension (IIH) (POR 18.43, 95% CI 17.51, 19.39) showed the highest increased odds in patients with EDS while significantly decreased odds were shown for type 2 diabetic retinopathy, age-related macular degeneration, and retinal vein occlusion.

CONCLUSIONS

EDS was associated with increased odds of having a concurrent ocular pathology, suggesting that, upon diagnosis of EDS, referral to ophthalmology may be valuable.

Myopia progression in young adults: insights from real-world clinical data

CLINICAL RELEVANCE

Myopia may progress even during adulthood. Clinical trials are required to evaluate the effectiveness of myopia control interventions in adults.

PURPOSE

This study aimed to investigate what proportion of young adults undergo myopia progression of <-0.50 D and the factors associated with this progression based on data from real-world clinical settings.

METHODS

This retrospective study included 2,683 myopes with spherical equivalent (SE) ranging from -0.50D to -14.75D. The spherical and cylindrical components were separately categorised into mild, moderate, and high-magnitude groups. Myopia progression was calculated as the difference between the previous spectacle prescription (obtained from a 1-year-old spectacle) and the current refraction. A binary logistic regression model was used to obtain the odds ratio.

RESULTS

The mean ± standard deviation age of myopic individuals was 24.45 ± 2.74 years (range: 18-30) and annual myopia progression was -0.22 ± 0.38D. Out of 2,683 myopes, 2,341 (87.3%) had stable refraction (annual change: ≤0.25 to ≥-0.50 D), and 342 (12.7%) myopes had progression of <-0.50 D. Overall, 4.6% (n = 124/2,683) of myopes had a change in refraction of ≤-1.00 D. The younger age group (18-20 years, OR 1.63 [95% CI 1.03-2.57], p = 0.04), high-spherical equivalent (OR 2.37 [95% CI 1.28-4.38]), and high-cylinder (OR 6.60 [95% CI 3.40-12.81]) were found to be significantly (p < 0.05) associated with increased odds of myopia progression. Age of apparent myopia onset, gender, and spherical components were not associated with myopia progression (p > 0.05).

CONCLUSION

About 1 out 20 myopes in clinical settings tend to have progression of one dioptre even during adulthood. Regular monitoring of biometry in young adults with high-spherical equivalent and astigmatism could aid in the identification of those with myopia progression.

Myopia in Houston optometry graduates from 2013 to 2023

SIGNIFICANCE

Adult onset and progression of myopia are not well understood. It is of interest to better characterize myopia progression in young adults, who are frequently subjected to risk factors, such as intense near-work demands.

PURPOSE

This study aimed to assess the prevalence and progression of myopia and other refractive errors in optometry students in the United States.

METHODS

This study was a retrospective chart review of electronic medical records of students enrolled in the optometry program at the University of Houston College of Optometry who graduated between 2013 and 2023. For each student, refractive error was noted from the medical record for eye examinations during their time as an optometry student. Exclusion criteria were ocular disease, myopia control treatment, or refractive surgery. Prevalences of hyperopia (≥+ 0.50 D), emmetropia (>-0.50 to <+0.50 D), myopia (≤-0.50 D), astigmatism (>0.50 D), and anisometropia (≥1.0 D) were determined from spherical equivalent refraction (SER) of the right eye. Absolute and annualized differences in SER were calculated between visits.

RESULTS

Records for 1071 students were reviewed, and 961 were included. Prevalences were 80.7% for myopia, 14.9% for emmetropia, and 4.4% for hyperopia. Additionally, 38.4% had astigmatism, and 16.1% had anisometropia. Students with one follow-up exam (n = 639) showed a significant negative change in SER of -0.05 ± 0.38 D over an average follow-up period of 1.60 ± 0.61 years (p=0.001). Myopia onset was observed in 15.7% of emmetropes at baseline. Greater negative SER change was associated with greater follow-up duration and younger age. Hyperopes and emmetropes did not demonstrate significant changes in SER. An annualized negative SER change of ≥-0.25 D was noted in 20% of the 639 students, of which 5.5% showed ≥-0.50 D.

CONCLUSIONS

Findings demonstrate a high prevalence of myopia among optometry students. A small but statistically significant myopic change in refraction was observed. These findings may implicate a role of education and near work in myopia.

Axial Shortening Effects of Repeated Low-level Red-light Therapy in Children With High Myopia: A Multicenter Randomized Controlled Trial

PURPOSE

To evaluate the effectiveness and safety of repeated low-level red-light (RLRL) in delaying the progression of high myopes with -6.00 diopters (D) or worse.

DESIGN

Multicenter, randomized, parallel-group, single-blind clinical trial. A total of 202 high myopic children aged 7 to 12 years with cycloplegia spherical equivalent (SE) refraction ≤-6.00 D, astigmatism less than 2.50 D, and anisometropia of 1.50 D or less were enrolled from March 2022 to December 2022. Follow-up was completed in December 2023.

METHODS

Eligible participants were randomly allocated to the intervention (RLRL + single vision spectacle) or the control group (single vision spectacle). The RLRL treatment was administered every day for 3 minutes, twice a day, with an interval of at least 4 hours. The primary outcome was the change in axial length (AL) at 12 months compared with baseline. Secondary outcomes included changes in SE, changes in choroidal thickness (ChT), and changes in retinal thickness (RT) in different circle sectors. Outcomes were analyzed by means of intention-to-treat and per-protocol methods.

RESULTS

After 12 months of treatment, AL and SE changes were -0.11 ± 0.25 mm and 0.18 ± 0.63 D for the RLRL group and 0.32 ± 0.09 mm and -0.80 ± 0.42 D for the control group, respectively. Axial shortening >0.05 mm was 59% in the RLRL and 0% in the control group at 12 months. ChT and RT from a single center were analyzed. In the RLRL group, ChT was thickened in all sectors at 12 months. RT was increased in parafoveal and perifoveal circles. In the control group, all sectors of ChT and only perifoveal RT were significantly thinner at 12 months. The multivariate linear regression model revealed significant correlations between changes in the ChT central foveal circle and RT perifoveal circle at 1 month and AL changes at 12 months. No fundus structure changes, afterimage exceeding 6 minutes, or best-corrected visual acuity decrease were reported.

CONCLUSIONS

RLRL could effectively shorten the AL and inhibit the progression of myopia in high myopic patients with -6.00 D or worse. AL shortening is sustained over 12 months of treatment. These observed changes appeared to be associated with increases in ChT and RT.

The whole life cycle myopia management

Myopia stands as a prevalent ocular condition with global implications, impacting individuals at various life stages. In school-age children and adolescents, uncorrected myopia impedes reading and academic performance. Among middle-aged and elderly populations, myopia poses severe risks such as macular degeneration, macular holes and retinal detachment, leading to irreversible visual impairment. The term "myopia management" is widely embraced by ophthalmic practitioners and optometry associations worldwide, encompassing strategies to correct refractive errors and ongoing assessment of disease progression, aiming to reduce the progression of myopia and axial elongation. To date, current management strategies for myopia include public health policies, optical solutions, medical interventions and surgical options, but these interventions are general and lack age specificity. Despite existing interventions, we propose the concept of "Whole Life Cycle Myopia Management" in this review. This approach outlined major risk factors of myopia through the whole life cycle, discussed current interventions for myopia and provided age-specific management strategies for myopia of eight different life stages-infancies, toddlers, preschoolers, school-age children, adolescents, young adults, middle-age and old-age, including the prevention of myopia onset, slowing of myopia progression and monitoring of myopia complications. Achieving the "Whole Life Cycle Myopia Management" requires collaborations efforts from government, schools, hospitals and families, to restore vision and enhance the quality of life for those individuals affected by myopia.

Evaluation of Auricular Acupressure on Myopia Prevention among Children Aged 6-12 Years with Pre-Myopia in China: Study Protocol of a Prospective Multi-Center Randomized Controlled Trial

BACKGROUND

The increasing prevalence of myopia among Chinese children and adolescents, especially at younger ages, has emerged as a significant concern in recent years. Pre-myopia is a key period for myopia prevention and control in children and adolescents. Previous studies suggested auricular acupressure (AA) therapy might offer a viable approach to prevent and slow down myopia progression. Nonetheless, these studies lack robust, high-quality, large-scale, multi-center evidence to conclusively support such assertions. The purpose of this research is to evaluate the efficacy, safety, and economic benefits of AA therapy in preventing myopia in Chinese children aged 6-12 years with pre-myopia.

METHODS

The single-blind, multi-center, parallel-group, randomized controlled trial will involve 318 pre-myopic children from 20 different centers across China. After recruitment, these participants will be randomly assigned to two groups (the AA group and the control group) at a 1:1 ratio. The AA group will receive auricular point sticking therapy along with health education for a period of 24 weeks, while the control group will be provided the sham AA treatment and routine health education. The assessments of outcomes will be conducted at the start of this study, and then after 4, 8, 12, and 24 weeks. The primary outcome is the change in spherical equivalent refraction at various follow-up times. The secondary outcomes include the number of myopia cases, uncorrected visual acuity, axial length, corneal curvature radius, accommodation amplitude, retinal and choroidal thickness, and eye behavior management. In addition, the cost-effectiveness analysis will be used as the evaluation index for economic assessment.

DISCUSSION

The results of this research will provide evidence on the efficacy, safety, and economic benefits of AA therapy in preventing myopia among children aged 6-12 years with pre-myopia in China.

Relationship Between Axial Length and Retinal Oxygen Dynamics in Adults With Myopia

Purpose

The purpose of this study was to evaluate the correlation between axial length (AL) and retinal oxygen dynamic parameters in adult patients.

Methods

This was an observational cross-sectional study with 79 Chinese adults with myopia aged 18 to 37 years. All participants underwent AL measurements, cycloplegic refraction, and other ophthalmic examinations. Additionally, the retinal oxygen kinetics imaging and analysis (ROKIA) system was utilized to obtain the retinal oxygen dynamic parameters of all patients. Simple and multiple linear regression tests were used to assess the correlation between various oxygen dynamic parameters and AL.

Results

The mean age, AL, and spherical equivalent (SE) of subjects were 26.32 ± 5.4 years, 25.78 ± 1.06 mm, and -5.13 ± 2.1 diopters (D), respectively. The Pearson correlation coefficients among AL and retinal oxygen delivery (DO2) and retinal oxygen metabolism (MO2) were -0.44 (95% confidence interval = -0.24 to -0.60, P < 0.001), -0.26 (95% confidence interval = -0.04 to -0.46, P = 0.02), respectively. The group with high myopia exhibited lower DO2 and higher oxygen extraction fraction (OEF) compared with the group with moderate myopia, and no significant difference was observed in MO2 between the two groups. In multivariate analyses adjusting for age, sex, intraocular pressure (IOP), and anterior chamber depth (ACD), a longer AL was significantly associated with decreased DO2 (standardized regression coefficient B = -0.47, P < 0.001).

Conclusions

Retinal oxygen dynamic parameters, including DO2 and MO2, were decreased with longer AL in myopic eyes. Patients with high myopia demonstrated an elevated OEF than those with moderate myopia.

Translational Relevance

This study demonstrated that the retinal oxygen metabolism changes in myopia, as confirmed using a novel device that quantifies retinal oxygen dynamic parameters and provides a new monitoring approach for other hypoxic retinal diseases.

Real-world outcomes on myopia management efficacy of diverse segmented defocus optics (DSDO) and defocus incorporated multiple segments (DIMS) spectacle lenses in Chinese children: An initial 12-month prospective clinical study

PURPOSES

To investigate the 12-month effectiveness of Diverse Segmented Defocus Optics (DSDO) and Defocus Incorporated Multiple Segments (DIMS) spectacle lenses in a real-world clinical population in myopic and pre-myopic Chinese children.

METHODS

About 364 subjects prescribed DSDO or DIMS were enrolled. Axial length (AL) and cycloplegic spherical equivalent refraction (SER) changes over 12 months were measured. The subjects were further divided into age sub-group (6-9; 10-14) and SER sub-group (+0.75D≤SER<-0.50D; -0.50D≤SER<-2.00D; -2.00D≤SER<-4.00D; SER≤-4.0D). Contrast sensitivity and visual experience were also reported. The rate of myopia progression was compared with historical single-vision spectacles (SVS) lenses data to evaluate the effectiveness of the regime.

RESULTS

317 subjects were analyzed. At 12-month, AL changes in the DSDO and DIMS group were 0.16±0.16 mm and 0.21±0.22 mm, respectively (P = 0.0202). DSDO spectacle lenses had better control effect in +0.75D≤SER<-0.50D and SER≤-2.0D sub-groups. The proportion of participants had no greater than 0.20 mm AL elongation was 65.00% and 55.41% of in DSDO and DIMS group separately. Myopia control effect in DSDO group was 47%-69% and 33%-62% in DIMS group compared to historical SVS lenses.

CONCLUSIONS

Both DSDO and DIMS spectacle lenses retarded AL elongation. DSDO showed more stable myopia control effect comparing to DIMS, especially in groups of SER≤-2.0D sub-groups and older patients. DSDO showed initial potential myopia prevention effect in pre-myopic children compared with historical SVS lenses data. However, the small sample and no control group in pre-myopes of this study are key limitations. Further research is needed to confirm and understand DSDO's role for pre-myopic children.

Changes in relative peripheral refraction after implantable collamer lenses implantation

PURPOSE

This study aimed to measure the changes in refraction difference value (RDV) in different parts of the retina before and after implantable collamer lenses (ICL) surgery.

DESIGN

Prospective study.

METHODS

This study included 40 eyes of 40 patients who underwent ICL implantation for myopia. RDV measurements were taken across several ranges: 0°-15°, 15°-30°, 30°-45°, and 45°-53°, and categorized into four sectors: superior (RDV-S), inferior (RDV-I), temporal (RDV-T), and nasal (RDV-N), along with total RDV (TRDV). Measurements were taken preoperatively, and at one week and one month postoperatively.

RESULTS

TRDV, RDV beyond 15° eccentricity, and RDV-S, RDV-I, RDV-T, and RDV-N were significantly increased postoperatively. The one-week and one-month follow-up of RDVs had no significant differences. Significant differences in the increments were observed among RDV-15, RDV-15-30, RDV-30-45, and RDV-45-53 both at one-week and one-month follow-up. Similarly, there were significant differences in the increments among RDV-S, RDV-I, RDV-T, and RDV-N both at one-week and one-month follow-up. TRDV, RDV-30-45, RDV-45-53, RDV-S, RDV-T, and RDV-N showed significant differences in the variation preoperatively and postoperatively between the high (SE > -9.00 D) and ultra-high (SE ≤ -9.00 D) myopia groups.

CONCLUSIONS

Peripheral refraction showed a hyperopic defocused state that can stabilize in the early postoperative period after ICL implantation. The variation in the hyperopic defocused shift in peripheral refraction increased more in the regions farther from the central retina. The temporal regions exhibited the most changes.

KEY MESSAGES

WHAT IS KNOWN : Myopia is generally believed to stabilize after adulthood, but some individuals continue to experience myopia progression, accompanied by axial length elongation. Traditional spectacle lenses correct myopia by focusing light on the fovea but may introduce peripheral hyperopic defocus, which is thought to contribute to myopia progression. ICL surgery effectively corrects high degrees of myopia and astigmatism. Previous studies have demonstrated the safety and efficacy of ICL in addressing central refractive errors, but peripheral refraction changes post-surgery have not been well-explored.

WHAT IS NEW

ICL surgery increased peripheral hyperopic defocus while correcting central refractive error, with significant changes in peripheral refraction observed from the preoperative to postoperative one-week and one-month.. After ICL implantation, a hyperopic shift was observed in peripheral areas, with RDV values within 15° of the central retina appearing emmetropic and increasing hyperopic defocus noted moving away from the posterior pole. Peripheral refraction stabilized approximately one week after ICL surgery, with no significant differences observed between the one-week and one-month follow-ups, indicating that stability in peripheral refraction is typically achieved within this timeframe.

Dynamics of Myopia Progression in Ghana-Evidence From Clinical Practice: A Retrospective Cohort Study

Background and Aim

To investigate the pattern of progression of myopia among a Ghanaian clinical cohort.

Methods

A retrospective cohort analysis of a clinical data set of all healthy myopic participants attending a tertiary eye care center was performed. Participants' biennial refraction examinations were tracked for refractive changes 4 years after the date of the first visit. This covered the period from January 2015 to December 2019. Myopia progression was defined as a difference in spherical equivalent between consecutive biennial visits equal to, or greater than -0.50 D of myopia.

Results

The medical records of 169 myopic participants were reviewed, with the majority (53.8%) being female. Most of the participants (51.4%) were younger than 36 years, and at the end of the study period, 96 participants (56.8%), who made up the majority, showed progression of myopia Univariate regression revealed that the 36-59-year-old age range is associated with a 60% [cOR = 0.40, 95% CI: -0.17, 0.97; p = 0.04] reduced likelihood compared to those belonging to the 0-17-year-old age group, and the Mole-Dagbon ethnicity is associated with an almost fourfold [cOR = 3.80; 95% CI: -1.40, 10.316; p = 0.01] increased likelihood of experiencing myopia progression compared to those of Ga-Adangbe ethnicity. Multivariate regression revealed that the Mole-Dagbon ethnicity is associated with an increased likelihood of experiencing myopia progression 4 years after their initial visit [aOR = 3.49; 95% CI: -1.27, 9.63; p = 0.02] compared to those of Ga-Adangbe ethnicity.

Conclusion

Our study provides important insights into myopia progression in Ghana, with findings that are consistent with global trends. The association of myopia progression with age, place of residence, degree of myopia, and ethnicity highlights the need for tailored interventions to manage this growing public health concern in African populations.

Association between dietary inflammatory index and adolescent myopia based on the National Health and Nutrition Examination Survey

The prevalence of adolescent myopia is remarkably increasing. Previous studies have indicated that an unhealthy diet is a risk factor for myopia. However, the link between diet-related inflammation and myopia is unclear. To explore their correlation, we used dietary inflammation index (DII) that is a parameter to quantify the inflammatory potential of diet, to reveal the relationship between DII and myopia in adolescents. We extracted sociodemographic data, information of diets and eye refractive status of adolescents from National Health and Nutrition Examination Survey (NHANES) for period 1999-2008. Dietary intake data was used to calculate DII scores, which were then categorized into quartiles. Multivariable regression models and subgroup analyses were conducted to investigate the association between DII and myopia. Subsequently, smoothed curve analyses were conducted to discern the trend of correlation between DII and myopia across diverse population. A total of 7191 juveniles aged at 12 to 18 years with complete information were included in our study, consisting 3367 participants with diagnosis of myopia. Among these participants, a trend towards an increasing prevalence of myopia was observed with a higher DII. After adjusting for all covariates, stratified logistic regression analyses showed that among the population aged in 16 to 18 years old or with 9-11th grade educational level, the prevalence of myopia was significantly increased with higher DII score (OR = 1.06, 95% CI = 1.01, 1.11, P = 0.006; OR = 1.06, 95% CI = 1.01, 1.11, P = 0.010). In the two subgroups, participants in the highest quartile of DII had a 31.00% higher risk of myopia and a higher 27.00% risk of myopia respectively, compared to those in the lowest quartile of DII. Our results revealed an increasing trend in the prevalence of myopia with increased DII score in adolescents. Particularly, DII was positively associated with the risk of myopia among the population aged in 16 to 18 years old and with 9-11th grade educational level.

Vision Screening and Detection of Ocular Abnormalities in School Children by Teachers in Jordan

Purpose

To evaluate the accuracy of vision screening and detection of ocular abnormalities conducted by teachers in school children in Jordan compared with vision testing by optometrists and ocular disease identification by ophthalmologists.

Methods

A non-random, purposive sampling strategy where 6-year-old and 15-year-old school children from three schools in Amman, Jordan were included. Twenty-two teachers were trained to conduct visual acuity screening using the 0.2 logMAR line of the distance visual acuity (DVA) chart at 10 feet and near visual acuity (NVA) chart at 16 inches, in addition to detecting ocular abnormalities. An optometrist assessed the visual acuity and conducted objective and subjective refraction, while an ophthalmologist examined the ocular health of all children.

Results

A total of 542 children (51% female) were included in the study, of which 47% were 6 years old and 53% were 15 years old. Teacher screening had sensitivities of 76.92% for DVA, 68% for NVA, and 37.50% for abnormality detection. The specificities of DVA, NVA, and ocular abnormalities were 98.22%, 98.48%, and 99.24%, respectively. The positive predictive value for DVA, NVA, and ocular abnormalities were 83.33%, 99.00%, and 60%, respectively. The negative predictive value for each procedure was 98.22% for DVA, 98.48% for NVA, and 98.12% for ocular abnormalities.

Conclusion

Teachers were able to conduct vision screening with a high level of accuracy compared to the gold standard of testing by optometrists, which would be useful for the early detection and referral of refractive errors in school children. However, they were unable to detect ocular abnormalities compared with the gold standard for disease identification by ophthalmologists. Further training and monitoring, or different training approaches should be implemented to enable teachers to identify ocular abnormalities at acceptable levels.

Adult Myopia Progression

Purpose

To explore evidence for myopic shift between the ages of 20 and 50 years.

Methods

Three usable sets of data with long-term adult refractive progression were identified: (1) US population-based prevalence data for those 18 to 24 years of age in 1971 and 1972 and 45 to 54 years of age from 1999 to 2004; a logit transformation of prevalence values at different refractive error thresholds allowed estimation of myopic progression in this group. (2) German clinical data describing 5- to 10-year progression for different refractive error groupings across 5-year age bands from 20 to 49 years; these were extracted, adjusted, and analyzed. (3) Five-year progression rates with similar breakdown of age and refractive error groups as the German data but in a Japanese clinical population.

Results

Estimates of progression between 20 and 50 years for the given studies were: (1) -1.1, -1.4, and -1.9 diopters (D) for baseline refractive errors of -1, -3, and -6 D, respectively; (2) a range from -1.0 to -2.9 D, increasing with degree of baseline myopia; (3) a weighted average of -1.0 D for males and -0.9 D for females but with decreasing progression with increasing myopia. In all studies, average progression rates fell with increasing age, with most progression occurring between 20 and 30 years.

Conclusions

All three studies provide evidence of around -1 D myopia progression between the ages of 20 and 50 years. This has implications for intervention to slow progression during adulthood, as well as projections of visual impairment associated with myopia.

Axial length reduction and choroidal thickening with short-term exposure to cyan light in human subjects

PURPOSE

Given the potential role of light and its wavelength on ocular growth, this study investigated the effect of short-term exposure to red, cyan and blue light on ocular biometry in humans.

METHODS

Forty-four young adults and 20 children, comprising emmetropes and myopes, underwent 2-h sessions of cyan (507 nm), red (638 nm) and broadband white light on three separate days via light-emitting glasses. Additionally, young adults were exposed to blue light (454 nm) on an additional day. Axial length (AL) and choroidal thickness (CT) were measured in the right eye before the light exposure (0 min), after 60 and 120 min of exposure and 30 min after light offset using an optical biometer and optical coherence tomographer, respectively.

RESULTS

Compared to broadband light, exposure to red light resulted in a significant increase in AL (mean difference between white and red light at 120 min, +0.007 mm [0.002]), but no significant change in CT, while cyan light caused a significant AL reduction (-0.010 mm [0.003]) and choroidal thickening (+0.008 mm [0.002]) in young adults (p < 0.05). Blue light caused a significant decrease of -0.007 mm (0.002) in young adult eyes at 60 min (p < 0.05). In children, cyan light led to a significant reduction in AL (-0.016 mm [0.004]) and strong sustained choroidal thickening (+0.014 mm [0.004]) compared to broadband light at 120 min (p < 0.05). The effects of cyan light on AL and CT were found to be stronger in myopic young adults and emmetropic children. The opposing effects of red and cyan light on ocular biometry were similar between the two age groups (p > 0.05).

CONCLUSIONS

Exposure to cyan light resulted in AL reduction and choroidal thickening in both young adults and children. Further research is needed to determine the application of these results in developing interventions for myopia control.

Epidemiology of Myopia: Prevalence, Risk Factors and Effects of Myopia

Myopia is the most common cause of visual impairment in children and young adults. In order to assess the consequences for society, it is necessary to know temporal trends in prevalence, incidence and associated factors in childhood and adolescence, as well as the rate of myopia progression, as based on epidemiological research. This paper presents a literature review of publications from 2020 up to March 2024, supplemented by other relevant publications. The prevalence of myopia in children and adolescents in Germany is almost stable and is significantly lower than in Asia. The development of myopia is influenced by outdoor activity, parental myopia, genetics and near work, while insufficient time spent outdoors in childhood is a significant and controllable risk factor for myopia-related complications such as myopic maculopathy, glaucoma, and retinal detachment.

Lifetime cost-effectiveness of myopia control intervention for the children population

Background

Myopia is a common eye condition and projected to affect half of the global population by 2050. Controlling its progression during childhood may prevent associated ocular diseases in later life. Certain interventions retard myopia progression but their long-term costs and consequences are not well understood. We evaluated the cost-effectiveness of myopia control via an optical approach using the Defocus Incorporated Multiple Segments (DIMS) lens over a lifetime.

Methods

We constructed an individual-based, state-transition model to simulate 1) the development and progression of myopia in childhood with and without control and 2) the impact of myopia on the development of four sight-threatening complications in adulthood. We compared strategies of myopia control with 100% uptake vs. no myopia control from the societal perspective to determine whether myopia control is value for money.

Results

With myopia control, the cumulative prevalence of high myopia was relatively reduced by 44.7% (5.9 vs. 10.7%) and severe visual impairment by 19.2% (2.2 vs. 2.7%) compared to no myopia control. The lifetime cost per quality-adjusted life year gained was 26 407 US dollars (USD) and is considered cost-effective compared to the threshold recommended by the World Health Organization (WHO) of one times annual per capita gross domestic product (48 359 USD). Probabilistic sensitivity analysis showed that myopia control had an 87% likelihood of being cost-effective at the WHO threshold.

Conclusions

Myopia control is cost-effective when provided to all eligible children. Further investigation is required to determine if it is cost-effective for the government to subsidise myopia control in order to maximise access.

Exploring the Effects of Age at Menarche and Pregnancy on Myopia

PURPOSE

Associations between age at menarche and myopia have been observed in studies that included older women. Furthermore, pregnancy-related hormone surges in young women are associated with short-term changes in refractive error, although the long-term effects are less known. This study explored associations of age at menarche and parity with refractive error and ocular biometry in young women, and the relationship between age at menarche and refractive error in middle-aged adults for comparison.

METHODS

Community-based young women underwent eye examinations at 20 and 28 years old. Information on age at menarche and parity were collected prospectively. The older cohort underwent an eye examination and information on age at menarche was self-reported retrospectively. Cross-sectional associations between age at menarche and myopia were explored in both cohorts. Associations between parity and 8-year longitudinal change in refractive error measures were explored in the young cohort.

RESULTS

The cross-sectional analyses comprised 429 young (age 18-22) and 1,818 older (age 46-69) women. No associations were found between age at menarche and myopia or ocular biometry measures in either cohort. The longitudinal analysis (n = 269 women) revealed that for each pregnancy carried to full term, there rate of lens thickening increased by 0.004 mm/year (95% CI = 0.002-0.007). No other associations between parity and refractive error or ocular biometry were found.

CONCLUSION

There is no association between age at menarche and myopia or its related measures. While pregnancy was associated with thicker lens in the long term, there is no lasting effect on refractive error.

Polygenic Prediction of Keratoconus and its Measures: Cross-Sectional and Longitudinal Analyses in Community-Based Young Adults

PURPOSE

This study evaluates the performance of a multitrait polygenic risk score (PRS) in an independent cohort to predict incident or progression of keratoconus.

DESIGN

Prospective cross-sectional and cohort study METHODS: Setting: Single-center; Study population: 1478 community-based young adults (18-30 years; 51% female), including 609 (52% female) who returned for an 8-year follow-up; Observation procedures: Scheimpflug imaging (Pentacam, Oculus), genotyping and development of a multitrait PRS previously validated to predict keratoconus in older adults.; Main outcome measure: Belin/Ambrόsio enhanced ectasia display (BAD-D) score and keratoconus, defined as BAD-D ≥2.6, were each analyzed against the PRS using linear and logistic regression, respectively.

RESULTS

Prevalence of keratoconus was 2.5% (95% confidence interval [CI] = 1.9-3.6) in the cross-sectional cohort. Each z-score increase in PRS was associated with worse BAD-D z-score by 0.13 (95%CI = 0.08-0.18) and 1.6 increased odds of keratoconus. The 8-year keratoconus incidence was 2.6% (95%CI = 1.3-4.0). Participants in the highest PRS decile were more likely to have incident keratoconus compared to the rest of the cohort (odds ratio = 3.85, 95%CI = 1.21-12.22). For each z-score increase in PRS, 8-year change in BAD-D z-score worsened by 0.11 (95%CI = 0.04-0.17).

CONCLUSIONS

A PRS for keratoconus could be useful in predicting incident keratoconus and progression, demonstrating its potential utility in clinical settings to identify patients at high risk of postsurgery ectasia or those who may benefit most from keratoconus intervention.

Mean cycloplegic refractive error in emmetropic adults - The Tehran Eye Study

PURPOSE

In children under 20 years, refractive development targets a cycloplegic refractive error of +0.5 to +1.5D, while presbyopes over 40 years generally have non-cycloplegic errors of ≥ +1D. Some papers suggest these periods are separated by a period of myopic refractive error (i.e., ≤ -0.50D), but this remains unclear. Hence, this work investigates the mean cycloplegic refractive error in adults aged between 20 - 40 years.

METHODS

In 2002 a cross-sectional study with stratified cluster sampling was performed on the population of Tehran, providing cycloplegic and non-cycloplegic refractive error data for the right eyes of 3,576 participants, aged 30.6±18.6 years (range: 1-86 years). After grouping these data into age groups of 5 years, the refractive error histogram of each group was fitted to a Bigaussian function. The mean of the central, emmetropized peak was used to estimate the mean refractive error without the influence of myopia.

RESULTS

The mean cycloplegic refractive error at the emmetropized peak decreased from +1.10±0.11D (95 % confidence interval) to +0.50±0.04D before 20 years and remains stable at that value until the age of 50 years. The non-cycloplegic refractive error also sees a stable phase at 0.00±0.04D between 15 - 45 years. After 45 - 50 years both cycloplegic and non-cycloplegic refractive error become more hypermetropic over time, +1.14±0.12D at 75 years.

CONCLUSIONS

The cycloplegic refractive error in adults is about +0.50D between 20 - 50 years, disproving the existence of the myopic period at those ages.

Myopia management algorithm. Annexe to the article titled Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute

Myopia is becoming increasingly common in young generations all over the world, and it is predicted to become the most common cause of blindness and visual impairment in later life in the near future. Because myopia can cause serious complications and vision loss, it is critical to create and prescribe effective myopia treatment solutions that can help prevent or delay the onset and progression of myopia. The scientific understanding of myopia's causes, genetic background, environmental conditions, and various management techniques, including therapies to prevent or postpone its development and slow its progression, is rapidly expanding. However, some significant information gaps exist on this subject, making it difficult to develop an effective intervention plan. As with the creation of this present algorithm, a compromise is to work on best practices and reach consensus among a wide number of specialists. The quick rise in information regarding myopia management may be difficult for the busy eye care provider, but it necessitates a continuing need to evaluate new research and implement it into daily practice. To assist eye care providers in developing these strategies, an algorithm has been proposed that covers all aspects of myopia mitigation and management. The algorithm aims to provide practical assistance in choosing and developing an effective myopia management strategy tailored to the individual child. It incorporates the latest research findings and covers a wide range of modalities, from primary, secondary, and tertiary myopia prevention to interventions that reduce the progression of myopia.

The optimal atropine concentration for myopia control in Chinese children: a systematic review and network Meta-analysis

AIM

To figure out whether various atropine dosages may slow the progression of myopia in Chinese kids and teenagers and to determine the optimal atropine concentration for effectively slowing the progression of myopia.

METHODS

A systematic search was conducted across the Cochrane Library, PubMed, Web of Science, EMBASE, CNKI, CBM, VIP, and Wanfang database, encompassing literature on slowing progression of myopia with varying atropine concentrations from database inception to January 17, 2024. Data extraction and quality assessment were performed, and a network Meta-analysis was executed using Stata version 14.0 Software. Results were visually represented through graphs.

RESULTS

Fourteen papers comprising 2475 cases were included; five different concentrations of atropine solution were used. The network Meta-analysis, along with the surface under the cumulative ranking curve (SUCRA), showed that 1% atropine (100%)>0.05% atropine (74.9%) >0.025% atropine (51.6%)>0.02% atropine (47.9%)>0.01% atropine (25.6%)>control in refraction change and 1% atropine (98.7%)>0.05% atropine (70.4%)>0.02% atropine (61.4%)>0.025% atropine (42%)>0.01% atropine (27.4%)>control in axial length (AL) change.

CONCLUSION

In Chinese children and teenagers, the five various concentrations of atropine can reduce the progression of myopia. Although the network Meta-analysis showed that 1% atropine is the best one for controlling refraction and AL change, there is a high incidence of adverse effects with the use of 1% atropine. Therefore, we suggest that 0.05% atropine is optimal for Chinese children to slow myopia progression.

An Insight into Knowledge, Perspective, and Practices of Indian Optometrists towards Childhood Myopia

The current understanding of clinical approaches and barriers in managing childhood myopia among Indian optometrists is limited. This research underscores the necessity and relevance of evidence-based practice guidelines by exploring their knowledge, attitude, and practice towards childhood myopia. A self-administered internet-based 26-item survey was circulated online among practicing optometrists in India. The questions assessed the demographics, knowledge, self-reported clinical practice behavior, barriers, source of information guiding their management, and extent of adult caregiver engagement for childhood myopia. Of 393 responses, a significant proportion of respondents (32.6-92.4%) were unaware of the ocular complications associated with high myopia, with less than half (46.5%) routinely performing ocular biometry in clinical practice. Despite the growing awareness of emerging myopia management options, the uptake remains generally poor, with single-vision distance full-correction spectacles (70.3%) being the most common mode of vision correction. Barriers to adopting optimal myopia care are medicolegal concerns, absence of clinical practice guidelines, and inadequate consultation time. Own clinical experience and original research articles were the primary sources of information supporting clinical practice. Most (>70%) respondents considered involving the adult caregiver in their child's clinical decision-making process. While practitioners' awareness and activity of newer myopia management strategies are improving, there is plenty of scope for its enhancement. The importance of evidence-based practice guidelines and continuing education on myopia control might help practitioners enhance their clinical decision-making skills.

Differential Impact of 0.01% and 0.05% Atropine Eyedrops on Ocular Surface in Young Adults

Purpose

To evaluate the effect of low-concentration (0.01% and 0.05%) atropine eyedrops on ocular surface characteristics in young adults.

Methods

Twenty-six myopic students aged 18 to 30 years were randomly assigned to receive either 0.01% or 0.05% atropine once nightly for 14 days, followed by cessation, with a ≥14-day interval between each administration. Assessments were conducted one, two, seven, and 14 days after using atropine with corresponding timepoints after atropine cessation. Tear meniscus height and first and average noninvasive keratograph tear film breakup time (NIKBUT-first, NIKBUT-average) were measured using Keratograph 5M, whereas the objective scatter index (OSI) was measured by OQAS II devices; the ocular surface disease index (OSDI) score was also obtained.

Results

The mean OSI peaked after two days of administration of 0.05% atropine (β = 0.51, P = 0.001), accompanied by significant decreases in NIKBUT-first (β = -7.73, P < 0.001) and NIKBUT-average (β = -8.10, P < 0.001); the OSDI peaked after 14 days (β = 15.41, P < 0.001). The above parameters returned to baseline one week after atropine discontinuation (all P > 0.05). NIKBUT-first and NIKBUT-average reached their lowest points after 14 days of 0.01% atropine administration (NIKBUT-first: β = -4.46, P = 0.005; NIKBUT-average: β = -4.42, P = 0.001), but those significant changes were diminished once atropine treatment stopped.

Conclusions

Young adult myopes experienced a significant but temporary impact on the ocular surface with 0.05% atropine administration, whereas 0.01% atropine had a minimal effect.

Translational Relevance

The investigation of the ocular surface effects of different concentrations of atropine may inform evidence-based clinical decisions regarding myopia control in young adults.

Assessing the rebound phenomenon in different myopia control treatments: A systematic review

PURPOSE

To review the rebound effect after cessation of different myopia control treatments.

METHODS

A systematic review that included full-length randomised controlled studies (RCTs), as well as post-hoc analyses of RCTs reporting new findings on myopia control treatments rebound effect in two databases, PubMed and Web of Science, was performed according to the PRISMA statement. The search period was between 15 June 2023 and 30 June 2023. The Cochrane risk of bias tool was used to analyse the quality of the selected studies.

RESULTS

A total of 11 studies were included in this systematic review. Unifying the rebound effects of all myopia control treatments, the mean rebound effect for axial length (AL) and spherical equivalent refraction (SER) were 0.10 ± 0.07 mm [-0.02 to 0.22] and -0.27 ± 0.2 D [-0.71 to -0.03] after 10.2 ± 7.4 months of washout, respectively. In addition, spectacles with highly aspherical lenslets or defocus incorporated multiple segments technology, soft multifocal contact lenses and orthokeratology showed lower rebound effects compared with atropine and low-level light therapy, with a mean rebound effect for AL and SER of 0.04 ± 0.04 mm [0 to 0.08] and -0.13 ± 0.07 D [-0.05 to -0.2], respectively.

CONCLUSIONS

It appears that the different treatments for myopia control produce a rebound effect after their cessation. Specifically, optical treatments seem to produce less rebound effect than pharmacological or light therapies. However, more studies are required to confirm these results.

Myopia progression patterns among paediatric patients in a clinical setting

PURPOSE

This retrospective analysis of electronic medical record (EMR) data investigated the natural history of myopic progression in children from optometric practices in Ireland.

METHODS

The analysis was of myopic patients aged 7-17 with multiple visits and not prescribed myopia control treatment. Sex- and age-specific population centiles for annual myopic progression were derived by fitting a weighted cubic spline to empirical quantiles. These were compared to progression rates derived from control group data obtained from 17 randomised clinical trials (RCTs) for myopia. Linear mixed models (LMMs) were used to allow comparison of myopia progression rates against outputs from a predictive online calculator. Survival analysis was performed to determine the intervals at which a significant level of myopic progression was predicted to occur.

RESULTS

Myopia progression was highest in children aged 7 years (median: -0.67 D/year) and progressively slowed with increasing age (median: -0.18 D/year at age 17). Female sex (p < 0.001), a more myopic SER at baseline (p < 0.001) and younger age (p < 0.001) were all found to be predictive of faster myopic progression. Every RCT exhibited a mean progression higher than the median centile observed in the EMR data, while clinic-based studies more closely matched the median progression rates. The LMM predicted faster myopia progression for patients with higher baseline myopia levels, in keeping with previous studies, which was in contrast to an online calculator that predicted slower myopia progression for patients with higher baseline myopia. Survival analysis indicated that at a recall period of 12 months, myopia will have progressed in between 10% and 70% of children, depending upon age.

CONCLUSIONS

This study produced progression centiles of untreated myopic children, helping to define the natural history of untreated myopia. This will enable clinicians to better predict both refractive outcomes without treatment and monitor treatment efficacy, particularly in the absence of axial length data.

Ocular Biometry Features and Their Relationship with Anterior and Posterior Segment Lengths among a Myopia Population in Northern China

Objectives: The study aims to explore the ocular biometry of a myopic population in Northern China, focusing specifically on anterior and posterior segment lengths. Methods: This is a cross-sectional study. The medical records of 3458 myopic patients who underwent refractive surgery were evaluated. Axial length (AL), anterior chamber depth (ACD), lens thickness (LT) and other biometric parameters were measured using the IOL Master 700. The study determined the anterior segment length (ASL = ACD + LT), the posterior segment length (PSL = AL - ASL) and the ratio of ASL to PSL (ASL/PSL). Results: This study included 3458 eyes from 3458 myopic patients (1171 men and 2287 women). The mean age was 27.38 ± 6.88, ranging from 16 to 48 years old. The mean ASL was 7.35 ± 0.27 mm, and the mean PSL was 18.39 ± 1.18 mm. The ASL and PSL trends demonstrate an age-related increase for both genders, with notable gender-specific variations. Across most age groups, males typically exhibited higher ASLs and PSLs than females, with the exception of the 35-40 and 40-45 age groups. The ASL and PSL consistently increased with a rising AL. The AL strongly correlates with the PSL and negatively correlates with the ASL/PSL ratio. The ACD and LT moderately correlate with the ASL, but an increased LT does not imply a longer posterior segment. The CCT and SE show little correlation with axial eye parameters. Conclusions: Among Chinese myopic patients, a longer ASL and PSL were correlated with older age and the male gender. The AL strongly correlates positively with the PSL and negatively correlates with the ASL/PSL ratio. An elongation of the posterior segment may primarily account for an eyeball's lengthening.

Lifestyle Factors in Myopic Spanish Children

BACKGROUND

Childhood myopia represents a global concern with increasing prevalence in recent decades. Lifestyle factors significantly impact myopia.

AIM

To evaluate lifestyle factors in myopic children from a metropolitan area in Europe.

METHODS

This was a descriptive study including myopic subjects aged 4-18 years. Patient demographic and clinical data were collected, including cycloplegic refraction in spherical equivalent refraction (SER) and axial length (AL). In addition, a questionnaire on lifestyle factors was conducted between September 2022 and April 2023.

RESULTS

A total of 321 myopic children were included, aged 10.72 ± 3.05 years, of whom 51.4% were boys, with SER -2.25 ± 1.9 D and AL 24.54 ± 0.98 mm. The mean age of myopia onset was 7.69 ± 3.05 years. A total of 59.8% had family history of myopia. Those children who had <2 h/day of screen time (on weekdays) presented SER -2 ± 1.91 D, compared to those who had >2 h/day, SER: -2.50 ±1.88 D (p = 0.009). Children who spent <2 h/day doing near work after school were less myopic compared to those who spent >2 h/day (SER: -1.75 ± 1.83 vs. SER: -2.75 ± 1.82, respectively, p = 0.03). However, no significant association was observed between SER and AL and time spent outdoors nor between SER and AL and academic performance (p > 0.05).

CONCLUSIONS

Screen time and near-work time appear to be lifestyle factors related to myopia.

Eyecare practitioner perspectives and attitudes towards myopia and myopia management in the UK

OBJECTIVE

Many children with progressive myopia are still prescribed single-vision correction. An investigation into UK eyecare practitioners' (ECPs) perceptions of myopia management was carried out to ascertain factors which may be limiting its implementation and uptake within clinical practice.

METHODS AND ANALYSIS

Online focus groups were held with UK ECPs. Participants were encouraged to discuss their knowledge of the available myopia management options, their perception of how myopia management is being delivered in the UK and any barriers limiting ECPs' prescribing of these management options in practice. The discussions were transcribed and analysed thematically.

RESULTS

Focus groups were held with 41 ECPs from primary and secondary eyecare. ECPs felt that provision of myopia management in the UK is variable. Most ECPs believe they have sufficient knowledge, but felt a lack of confidence in decision-making and practical experience. Less experienced ECPs sought more definitive guidance to support their decision-making. ECPs desired clarity on their duty of care obligations and were concerned over possible future litigation if they had not offered, or referred for, myopia management when indicated. The greatest barrier appears to be financial-treatment is expensive and ECPs are uncomfortable communicating this to parents. Many barriers were indicative of systemic problems within UK eyecare, such as commercial pressures, inadequate National Health Service funding and poor public awareness of paediatric eyecare.

CONCLUSION

Myopia management is not implemented consistently across the UK. To improve accessibility, changes are required at multiple levels, from individual ECPs through to wider stakeholders in UK eyecare provision.

Changes in Refractive Error During Young Adulthood: The Effects of Longitudinal Screen Time, Ocular Sun Exposure, and Genetic Predisposition

Purpose

Changes in refractive error during young adulthood is common yet risk factors at this age are largely unexplored. This study explored risk factors for these changes, including gene-environmental interactions.

Methods

Spherical equivalent refraction (SER) and axial length (AL) for 624 community-based adults were measured at 20 (baseline) and 28 years old. Participants were genotyped and their polygenic scores (PGS) for refractive error calculated. Self-reported screen time (computer, television, and mobile devices) from 20 to 28 years old were collected prospectively and longitudinal trajectories were generated. Past sun exposure was quantified using conjunctival ultraviolet autofluorescence (CUVAF) area.

Results

Median change in SER and AL were -0.023 diopters (D)/year (interquartile range [IQR] = -0.062 to -0.008) and +0.01 mm/year (IQR = 0.000 to 0.026), respectively. Sex, baseline myopia, parental myopia, screen time, CUVAF, and PGS were significantly associated with myopic shift. Collectively, these factors accounted for approximately 20% of the variance in refractive error change, with screen time, CUVAF, and PGS each explaining approximately 1% of the variance. Four trajectories for total screen time were found: "consistently low" (n = 148), "consistently high" (n = 250), "consistently very high" (n = 76), and "increasing" (n = 150). Myopic shift was faster in those with "consistently high" or "consistently very high" screen time compared to "consistently-low" (P ≤ 0.031). For each z-score increase in PGS, changes in SER and AL increased by -0.005 D/year and 0.002 mm/year (P ≤ 0.045). Of the three types of screen time, only computer time was associated with myopic shift (P ≤ 0.040). There was no two- or three-way interaction effect between PGS, CUVAF, or screen time (P ≥ 0.26).

Conclusions

Higher total or computer screen time, less sun exposure, and genetic predisposition are each independently associated with greater myopic shifts during young adulthood. Given that these factors explained only a small amount of the variance, there are likely other factors driving refractive error change during young adulthood.

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

Purpose

To objectively quantify near-work gaze behaviors and the visual environment during reading tasks performed on a smartphone and on paper in both indoor and outdoor environments in myopes and emmetropes.

Methods

A novel wearable gaze and viewing distance tracking device was used to quantify near-work gaze behaviors (focusing demand) and the visual environment (20° peripheral scene relative defocus) during a series of reading tasks. Data from nine myopes (mean age, 21 ± 1.4 years) and 10 emmetropes (21 ± 0.8 years) were analyzed. Five-minute reading tasks (matched for font type and size) were performed under four conditions: reading from a smartphone indoors, paper indoors, smartphone outdoors, and paper outdoors.

Results

A significantly greater focusing demand (closer viewing distance) was found with smartphone-based reading (mean, 3.15 ± 0.74 D) compared to paper-based reading (2.67 ± 0.48 D) (P < 0.001), with the differences being greatest for myopic participants (P = 0.04). Smartphone reading was also associated with greater peripheral scene relative myopic defocus (P < 0.001). Although near-work behaviors were similar between environments, significantly more relative myopic defocus was found at the start of the paper-based task when performed outdoors compared to indoors (P = 0.02).

Conclusions

Significant differences in focusing demand and scene relative defocus within a 20° field were found to be associated with reading tasks performed on a smartphone and paper in indoor and outdoor environments.

Translational Relevance

These findings highlight the complex interaction between near-work behaviors and the visual environment and demonstrate that factors of potential importance to myopia development vary between paper-based and smartphone-based near tasks.

Orthokeratology vs. orthokeratology combined with atropine for the control of myopia in children: systematic review

The purpose of this investigation is to determine the efficacy of orthokeratology (OK) compared to orthokeratology combined with atropine (AOK) for the control of myopia in children. A systematic review that included systematic reviews with meta-analyses, as well as randomized and controlled clinical trials, was carried out in the PubMed, Web of Science, Scopus, Cochrane Library, ProQuest, Taylor & Francis, Science Direct databases, as well as a manual search. Of the Q1-Q4 journals of the Scimago Journal & Country Rank, published in the last 5 years in English and Spanish. Eighteen studies that met the eligibility criteria were considered. The articles selected included 6,866 patients for analysis, where orthokeratology combined with 0.01% atropine was found to be more effective due to its ability to reduce the progression of myopia and axial elongation. In our investigation, it was determined that there could be an additive effect in the combination of 0.01% atropine with orthokeratology in a period of 1-2 years of treatment in patients with mild myopia; however, more multiethnic studies should be carried out, in where a correct evaluation of the progression of myopia, genetic and environmental factors that may influence the results is considered.

The underestimated role of myopia in uncorrectable visual impairment in the United States

We estimate the US prevalence of uncorrectable visual impairment in 2050 accounting for the changing distribution of both age and myopia. Age projections of the US population (from an estimated total of 379 million in 2050), were taken from the US census website. The distribution of myopia, by severity, was calculated from literature-derived prevalence estimates of 58.4% (≤ - 0.50 D, 2050 projection) and 33.1% (≤ - 1.00 D, 1999-2004 estimate) to provide predicted and conservative estimates, respectively. Uncorrectable visual impairment as a function of age and refractive error was modelled by multiple linear regression. Finally, the likely number of individuals in the US with visual impairment in 2050 was calculated. For a projected myopia prevalence of 58.4%, 222 million are projected to be myopic and 48 million will have high myopia (- 5 D or worse). The projected total number with uncorrectable visual impairment is 11.4 million of which 4.9 million cases (43%) of visual impairment will be directly attributed to increased risk of eye disease associated with myopia. For a projected myopia prevalence of 33.1%, 8.9 million are projected to have uncorrectable visual impairment of which 2.4 million cases (27%) will be directly attributed to myopia. It is predicted that between 27 and 43% of uncorrectable visual impairment in the US population in 2050 will be directly attributable to myopia. Failure to account for the increasing prevalence of myopia among the aging population leads to a substantial underestimate of the prevalence of visual impairment.

Distribution of Axial Length in Australians of Different Age Groups, Ethnicities, and Refractive Errors

Purpose

Treatments are available to slow myopic axial elongation. Understanding normal axial length (AL) distributions will assist clinicians in choosing appropriate treatment for myopia. We report the distribution of AL in Australians of different age groups and refractive errors.

Methods

Retrospectively collected spherical equivalent refraction (SER) and AL data of 5938 individuals aged 5 to 89 years from 8 Australian studies were included. Based on the SER, participants were classified as emmetropes, myopes, and hyperopes. Two regression model parameterizations (piece-wise and restricted cubic splines [RCS]) were applied to the cross-sectional data to analyze the association between age and AL. These results were compared with longitudinal data from the Raine Study where the AL was measured at age 20 (baseline) and 28 years.

Results

A piece-wise regression model (with 1 knot) showed that myopes had a greater increase in AL before 18 years by 0.119 mm/year (P < 0.001) and after 18 years by 0.011 mm/year (P < 0.001) compared to emmetropes and hyperopes, with the RCS model (with 3 knots) showing similar results. The longitudinal data from the Raine Study revealed that, when compared to emmetropes, only myopes showed a significant change in the AL in young adulthood (by 0.016 mm/year, P < 0.001).

Conclusions

The AL of myopic eyes increases more rapidly in childhood and slightly in early adulthood. Further studies of longitudinal changes in AL, particularly in childhood, are required to guide myopia interventions.

Translational Relevance

The axial length of myopic eyes increases rapidly in childhood, and there is a minimal increase in the axial length in non-myopic eyes after 18 years of age.

Myopia Progression in Adults: A Retrospective Analysis

SIGNIFICANCE

Studies on adult myopia progression are limited. This retrospective analysis of a large data set of young adult myopes characterizes myopia progression during adulthood.

PURPOSE

This study aimed to determine the mean annual progression of myopia and to estimate the proportion of progressors in adult myopes.

METHODS

Longitudinal, noncycloplegic subjective refraction data for young adult myopes (spherical equivalent refractive error, -0.5 D or more), age ranging from 18 to 30 years, were retrospectively analyzed. The mean annual progression, as well as the proportion of progressors (at least -0.50 D shift between visits and annualized progression of -0.25 D or more), was estimated.

RESULTS

A total of 354 myopes (230 females [64.7%]), with a mean (standard deviation) age of 22.2 (3.8) years, were considered. The mean (standard deviation) annualized progression was -0.10 (0.21), -0.08 (0.2), and -0.04 (0.21) D in the 18- to 21-year, 22- to 26-year, and 27- to 30-year age groups, respectively ( P = .003). The difference between 18- to 21- and 27- to 30-year age groups was significant ( P = .05), whereas all other pairwise comparisons were not significant. The proportion (95% confidence interval) of progressors in the 18- to 21-, >21- to 26-, and >26- to 30-year age groups was 18.3% (14.9 to 21.7%), 10.9% (7.1 to 14.7%), and 8.8% (4.4 to 13.1%), respectively. The proportion of progressors working or studying in a higher learning/academic environment was 16.2% with an odds ratio (95% confidence interval) for progression of 2.07 (1.15 to 3.74) compared with those in nonacademic environments ( P = .02), with no significant effect of sex or ethnicity.

CONCLUSIONS

This study is consistent with other studies on myopia in young adults, which show that myopia does not progress by substantial amounts throughout the adult years, particularly after the age of 21 years. Although future studies may be challenged by the small rates of change and the small proportion of progressors, further research is needed to understand the implications of adult myopia progression on clinical management.

IMI 2023 Digest

Myopia is a dynamic and rapidly moving field, with ongoing research providing a better understanding of the etiology leading to novel myopia control strategies. In 2019, the International Myopia Institute (IMI) assembled and published a series of white papers across relevant topics and updated the evidence with a digest in 2021. Here, we summarize findings across key topics from the previous 2 years. Studies in animal models have continued to explore how wavelength and intensity of light influence eye growth and have examined new pharmacologic agents and scleral cross-linking as potential strategies for slowing myopia. In children, the term premyopia is gaining interest with increased attention to early implementation of myopia control. Most studies use the IMI definitions of ≤-0.5 diopters (D) for myopia and ≤-6.0 D for high myopia, although categorization and definitions for structural consequences of high myopia remain an issue. Clinical trials have demonstrated that newer spectacle lens designs incorporating multiple segments, lenslets, or diffusion optics exhibit good efficacy. Clinical considerations and factors influencing efficacy for soft multifocal contact lenses and orthokeratology are discussed. Topical atropine remains the only widely accessible pharmacologic treatment. Rebound observed with higher concentration of atropine is not evident with lower concentrations or optical interventions. Overall, myopia control treatments show little adverse effect on visual function and appear generally safe, with longer wear times and combination therapies maximizing outcomes. An emerging category of light-based therapies for children requires comprehensive safety data to enable risk versus benefit analysis. Given the success of myopia control strategies, the ethics of including a control arm in clinical trials is heavily debated. IMI recommendations for clinical trial protocols are discussed.