Association between whole-grain intake and myopia in chinese children: a cross-sectional epidemiological study

Association between myopia and refined carbohydrate consumption: A cross-sectional study from the Constances cohort

BACKGROUND & AIMS

The effects of refined carbohydrate consumption on the prevalence of myopia have been little studied. The aim of this study is to explore the potential link between this consumption and myopia in individuals aged 40 or under in the population-based Constances cohort, in conjunction with other known risk and confounding factors.

METHODS

The association between the probability of myopia in at least one eye and refined carbohydrate consumption was tested for 5271 participants, aged 40 or younger, in conjunction with education level, physical activity, energy intake, age, sex, fasting blood glucose, Body Mass Index (BMI), and Mediterranean diet quality. Refined carbohydrate intake was estimated by glycemic load. Myopia was assessed by the Monoyer score. Significant sex interactions led to stratified analysis by sex.

RESULTS

The risk of myopia was significantly increased for men with refined carbohydrate consumption (p = 0.012, Odd Ratio (OR) = 1.12, Confidence Interval (CI) = 1.02-1.22) but not for women (p = 0.657, OR = 1.02, CI = 0.94-1.10). Some previously identified myopia risk factors were concurrently observed: a higher level of education increased the probability of myopia in both sexes (men p < 10-11, OR = 1.36, CI = 1.24-1.49; women p = < 10-4, OR = 1.19, CI = 1.09-1.28), while a higher level of physical activity might be protective in men (p = 0.08, OR = 0.93, CI = 0.85-1.01).

CONCLUSION

This research reveals how high refined carbohydrate consumption might influence myopia and confirms recent studies on its risk factors. It also highlights significant sex differences in the prevalence and factors associated with myopia, emphasizing that modifiable risk factors, crucial for public health initiatives, may vary between men and women.

Digital Screen Time and Myopia: A Systematic Review and Dose-Response Meta-Analysis

Importance

The association of digital screen time with myopia has been documented, but the dose-response association and safe exposure threshold remain unclear.

Objective

To evaluate the dose-response association of time spent on digital screens with myopia risk.

Data Sources

PubMed, EMBASE, Cochrane Library databases, CINAHL, and ClinicalTrials.gov were searched for full-length articles from peer-reviewed journals without restrictions on study design, publication date, or language from inception to November 25, 2024.

Study Selection

Primary research articles investigating the association of exposure to digital screen devices (ie, smartphones, tablets, game consoles, computers, or television) with myopia-related outcomes (ie, prevalent or incident myopia and the rate of myopia progression) were identified by reviewers.

Data Extraction and Synthesis

Two independent reviewers extracted data using a standardized procedure in accordance with the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. A random-effects, dose-response meta-analysis (DRMA) was utilized to examine the pattern of the association of screen time with myopia.

Main Outcome and Measures

Increased odds of myopia per hour of daily screen time.

Results

In the linear DRMA of 45 studies with 335 524 participants (mean [SD] age, 9.3 [4.3] years), an additional hour of daily screen time was associated with higher odds of myopia (odds ratio [OR], 1.21; 95% CI, 1.13-1.30). The nonlinear DRMA of 34 studies with 314 910 participants also indicated higher odds of myopia with increasing screen time, ranging from 1 hour of daily exposure (OR, 1.05; 95% CI, 1.01-1.09) to 4 hours (OR, 1.97; 95% CI, 1.56-2.40). The dose-response curve showed myopia risk increasing significantly between 1 to 4 hours of daily screen time, and then rising more gradually after 4 hours.

Conclusions and Relevance

In this systematic review and DRMA, a daily 1-hour increment in digital screen time was associated with 21% higher odds of myopia and the dose-response pattern exhibited a sigmoidal shape, indicating a potential safety threshold of less than 1 hour per day of exposure, with an increase in odds up to 4 hours. These findings can offer guidance to clinicians and researchers regarding myopia risk.

Association of dietary inflammatory index and refractive status in American adolescents: NHANES 1999-2008

Background

Several nutrients have been found to be associated with the prevalence of myopia, and the role of dietary patterns in influencing myopia risk has recently garnered significant attention. We aim to explore the relationship between the Dietary Inflammatory Index (DII) and refractive status in adolescents.

Methods

Data from 7,331 participants were analyzed from the 2005-2008 US National Health and Nutrition Examination Survey (NHANES). Smooth curve fitting and linear regression analysis were used to explore both non-linear and linear relationships between DII and spherical equivalent refraction (SER). The threshold effect of DII on SER was analyzed using a two-piecewise linear regression model.

Results

DII was connected with a lower SER, indicating a shift toward myopia (β: -0.0586; 95% CI: -0.1109 to -0.0063; p < 0.05). Compared to the first quartile, the third quartile (β: -0.2512; 95% CI: -0.4952 to -0.0072; p < 0.05) and the fourth quartile (β: -0.2905; 95% CI: -0.5030 to -0.0780; p < 0.01) were significantly associated with a lower SER. Smooth curve fitting revealed a non-linear relationship between DII and SER, with a turning point at 0.81. For DII values below 0.81, there was no significant association with SER (β: -0.0450; 95% CI: -0.0272 to -0.1173; p > 0.05). However, for DII values ≥0.81, a significant association with lower SER was observed (β: -0.1197; 95% CI: -1.1722 to -0.0672; p < 0.01).

Conclusion

These findings indicate that a higher DII (≥0.81) may contribute to the progression of myopia. This study highlights the potential for dietary recommendations in myopia prevention. Prospective studies are required to validate these findings and establish causal relationships.

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.

The association between macronutrients intake and myopia risk: a systematic review and meta-analysis

BACKGROUND

Dietary factors have been suggested as potential risk factors for myopia, but research findings on this relationship are inconclusive. The potential predisposing or protective role of macronutrient (carbohydrate, protein, fat) intake in the development of myopia was systematically reviewed, followed by data synthesis by meta-analysis.

METHODS

A systematic search was conducted in PubMed, Web of Science, Scopus, and Google Scholar up to the end of June 2023 to identify all relevant studies. All observational studies that assessed the relationship between macronutrient intake with myopia, axial length (AL) of eyes and spherical equivalent refractive error (SE) on individuals younger than 18 years old were included.

RESULTS

After removing duplicates and screening studies, four studies were included in the systematic review and meta-analysis. Pooled odds ratios regarding the association between myopia development and nutritional intake were 1.01 (95% CI: 0.94, 1.08), 0.97 (95% CI: 0.86, 1.08), and 0.99 (95% CI: 0.83, 1.18) for carbohydrates, proteins, and fats, respectively, indicating no significant associations. Intake of carbohydrates, proteins, and fats was not significantly associated with either SE or AL.

CONCLUSIONS

Intake of carbohydrates, fats, or proteins did not influence the risk of myopia. The relationship between the intake of other macronutrients and myopia is suggested to be scrutinized in future studies.

REGISTRATION

The systematic review protocol was registered on PROSPERO (registration number: CRD42024541369).

Interdependence of Nutrition, Physical Activity, and Myopia

Background: Myopia (also known as nearsightedness), a prevalent refractive error, occurs when parallel rays of light converge in front of the retina, resulting in blurry distance vision. Recently, there has been a marked rise in myopia among the global population. The absence of effective methods of controlling the progression of this visual defect prompts the search for new preventive and therapeutic options. The impact of diet and lifestyle on the progression of myopia is still not fully understood. Therefore, our aim was to examine how these factors might affect the advancement of myopia, based on the existing literature. Methods: This manuscript was prepared through an extensive literature review conducted from June 2022 to September 2024. We searched for pertinent research articles using reputable databases, including PubMed, Scopus, and Web of Science. We included all types of publications, with a special focus on the newest ones. Results: Despite far-reaching examination, the relationship between these factors and myopia control remains inconclusive with varying degrees of evidence supporting their roles. Conclusions: However, promoting a healthy lifestyle, particularly increasing physical activity and outdoor time, is essential. Additionally, emerging research suggests that maintaining a balanced diet is important due to the potential impact of certain nutrients on myopia development. Ophthalmologists should also guide parents on the alternative correction methods beyond single vision glasses, especially for rapidly progressing cases. With the rising prevalence of myopia in children, further research is necessary.

Correlation analysis of myopia and dietary factors among primary and secondary school students in Shenyang, China

Currently, the global prevalence of myopia is high and on the rise, seriously affecting the health of students. Studies have suggested that dietary factors may be associated with the occurrence and development of myopia, but the results are inconsistent. This survey aims to analyze the correlation between dietary factors and myopia while controlling for more confounding factors. A multi-stage stratified cluster sampling method was performed to select 10,619 primary and secondary school students in Shenyang for visual examination, and questionnaires were administered to 6974 of them. Logistic regression was performed with myopia as the dependent variable and the variables with p < 0.1 in the univariate analysis as independent variables. Sensitivity analysis was conducted using propensity score matching. The results showed that the overall prevalence of myopia among primary and secondary school students in Shenyang was 59.1%, with mild myopia predominating. Students who ate fresh fruits two or more times a day had a 0.69 times lower risk of myopia compared to those who did not eat fruits (95% CI 0.50-0.97). However, subgroup analysis demonstrated that this protective effect was only significant for male students, with an OR of 0.59 (95% CI 0.38-0.91). Moreover, female students who consumed sugary beverages once or more a day had a 1.8 times higher risk of myopia compared to those who did not consume sugary beverages (95% CI 1.03-3.15). Vegetable consumption, intake of fried foods, and breakfast habits were not significantly associated with myopia. In summary, excessive consumption of sugary beverages could increase the risk of myopia, especially in female students, whereas fruit intake contributed to reducing the risk of myopia, particularly in male students.

Personalizing Nutrition Strategies: Bridging Research and Public Health

In recent years, although life expectancy has increased significantly, non-communicable diseases (NCDs) continue to pose a significant threat to the health of the global population. Therefore, eating habits have been recognized as key modifiable factors that influence people's health and well-being. For this reason, it is interesting to study dietary patterns, since the human diet is a complex mixture of macronutrients, micronutrients, and bioactive compounds, and can modulate multiple physiological processes, including immune function, the metabolism, and inflammation. To ensure that the data we acquired were current and relevant, we searched primary and secondary sources, including scientific journals, bibliographic indexes, and databases in the last 15 years with the most relevant articles. After this search, we observed that all the recent research on NCDs suggests that diet is a critical factor in shaping an individual's health outcomes. Thus, cardiovascular, metabolic, mental, dental, and visual health depends largely on the intake, habits and patterns, and nutritional behaviors. A diet high in processed and refined foods, added sugars, and saturated fats can increase the risk of developing chronic diseases. On the other hand, a diet rich in whole, nutrient-dense foods, such as vegetables, fruits, nuts, legumes, and a high adherence to Mediterranean diet can improve health's people.

Self-supervised pre-training for joint optic disc and cup segmentation via attention-aware network

Image segmentation is a fundamental task in deep learning, which is able to analyse the essence of the images for further development. However, for the supervised learning segmentation method, collecting pixel-level labels is very time-consuming and labour-intensive. In the medical image processing area for optic disc and cup segmentation, we consider there are two challenging problems that remain unsolved. One is how to design an efficient network to capture the global field of the medical image and execute fast in real applications. The other is how to train the deep segmentation network using a few training data due to some medical privacy issues. In this paper, to conquer such issues, we first design a novel attention-aware segmentation model equipped with the multi-scale attention module in the pyramid structure-like encoder-decoder network, which can efficiently learn the global semantics and the long-range dependencies of the input images. Furthermore, we also inject the prior knowledge that the optic cup lies inside the optic disc by a novel loss function. Then, we propose a self-supervised contrastive learning method for optic disc and cup segmentation. The unsupervised feature representation is learned by matching an encoded query to a dictionary of encoded keys using a contrastive technique. Finetuning the pre-trained model using the proposed loss function can help achieve good performance for the task. To validate the effectiveness of the proposed method, extensive systemic evaluations on different public challenging optic disc and cup benchmarks, including DRISHTI-GS and REFUGE datasets demonstrate the superiority of the proposed method, which can achieve new state-of-the-art performance approaching 0.9801 and 0.9087 F1 score respectively while gaining 0.9657 D C disc and 0.8976 D C cup . The code will be made publicly available.

Macular and Optic Disc Perfusion Changes After Silicone Oil Removal Using Optical Coherence Tomography Angiography: A Prospective Study

AIM

The aim of this study was to prospectively evaluate the changes in macular and optic disc microvascular structures in patients who underwent silicone oil (SO) removal.

MATERIALS AND METHODS

A total of 28 patients scheduled for unilateral SO removal were included in the study. Their fellow eyes served as controls. Optical coherence tomography angiography (OCTA) of the retina (6.0 mm) and disc (4.5 mm) was performed one day before SO removal, and then at 1 week and 1, 3, 6, and 12 months postoperatively. All analyses were conducted using the R programming language, with a p-value <0.05 considered statistically significant.

RESULTS

After silicone oil removal, statistically significant changes were observed in the flow in the outer retina and radial peripapillary capillary (RPC) density for small and all vessels inside the disc. Statistically significant differences between the intervention and control groups were noted in vessel density in both the superficial and deep capillary plexuses and RPC density for small and all vessels.

CONCLUSION

Changes in macular vessel density and radial peripapillary capillary density were observed after SO removal. The latter changes appear to improve after the first postoperative month and continue until the first postoperative year. Notably, these changes were significant between the first postoperative week and 6 and 12 postoperative months (p = 0.0263 and p = 0.021, respectively). Best corrected visual acuity (BCVA) is likely associated with these parameters, indicating that improvement may be observed even one year following SO removal.

The influence of the environment and lifestyle on myopia

BACKGROUND

Myopia, commonly known as near-sightedness, has emerged as a global epidemic, impacting almost one in three individuals across the world. The increasing prevalence of myopia during early childhood has heightened the risk of developing high myopia and related sight-threatening eye conditions in adulthood. This surge in myopia rates, occurring within a relatively stable genetic framework, underscores the profound influence of environmental and lifestyle factors on this condition. In this comprehensive narrative review, we shed light on both established and potential environmental and lifestyle contributors that affect the development and progression of myopia.

MAIN BODY

Epidemiological and interventional research has consistently revealed a compelling connection between increased outdoor time and a decreased risk of myopia in children. This protective effect may primarily be attributed to exposure to the characteristics of natural light (i.e., sunlight) and the release of retinal dopamine. Conversely, irrespective of outdoor time, excessive engagement in near work can further worsen the onset of myopia. While the exact mechanisms behind this exacerbation are not fully comprehended, it appears to involve shifts in relative peripheral refraction, the overstimulation of accommodation, or a complex interplay of these factors, leading to issues like retinal image defocus, blur, and chromatic aberration. Other potential factors like the spatial frequency of the visual environment, circadian rhythm, sleep, nutrition, smoking, socio-economic status, and education have debatable independent influences on myopia development.

CONCLUSION

The environment exerts a significant influence on the development and progression of myopia. Improving the modifiable key environmental predictors like time spent outdoors and engagement in near work can prevent or slow the progression of myopia. The intricate connections between lifestyle and environmental factors often obscure research findings, making it challenging to disentangle their individual effects. This complexity underscores the necessity for prospective studies that employ objective assessments, such as quantifying light exposure and near work, among others. These studies are crucial for gaining a more comprehensive understanding of how various environmental factors can be modified to prevent or slow the progression of myopia.

Nutritional intake, environmental factors, and their impact on myopia prevalence in Korean children aged 5-12 years

BACKGROUND

Myopia is a complex condition influenced by numerous factors, including genetic predisposition, environmental factors, and lifestyle choices. Although evidence indicates that certain dietary factors may influence the development of myopia, this relationship is still not completely understood and is a topic of ongoing research.

METHODS

This study analyzed the relationship between dietary habits, environmental factors, and the prevalence of myopia in a sample of 24,345 children aged 5-12 years from the seventh Korea National Health and Nutrition Examination Survey (KNHANES VII). The average daily intake of dietary nutrients associated with the refractive error status of the participants was analyzed using analysis of variance (GLM) and the Scheffe method for post-hoc comparison. Multiple logistic regression analysis was conducted between the participant's refractive error status and daily dietary nutrient intake, while taking into consideration the age, sex, BMI, parental myopia, and near-work hours.

RESULTS

The risk of myopia increased with age, especially notable between ages 11 and 12, and was higher in children with both parents having myopia. Dietary factors played a crucial role; children with myopia had significantly lower intake of fat, omega-3 fatty acids, and retinol but higher intake of other nutrients compared to emmetropic and hyperopic counterparts. High consumption of carbohydrates, protein, phosphorus, iron, potassium, and sodium was associated with increased myopia risk. High sodium intake was particularly associated with a 2.05-fold increased myopia risk.

CONCLUSIONS

This study highlights the significant role of diet and lifestyle choices in the development of myopia in children. Our findings suggest the importance of considering these specific factors in the management and prevention strategies for myopia, underscoring the need for targeted interventions in children's health and vision care.

Association between dietary nutrient intake and prevalence of myopia in Korean adolescents: evidence from the 7th Korea National Health and Nutrition Examination Survey

Background

The rise in myopia prevalence, particularly among adolescents in East Asia, is a cause for concern. While a combination of environmental and genetic factors is understood to contribute to this trend, the role of dietary nutrients is not yet fully clarified.

Objective

To assess the potential association between the intake of specific nutrients and the prevalence of myopia in a large, population-based sample of Korean adolescents.

Methods

Data from 18,077 adolescents (average age: 15.05 ± 1.67 years; 51.7% male, 48.3% female) who participated in the 7th Korea National Health and Nutrition Examination Survey (KNHANES VII, 2016) were analyzed. Refractive error was measured using an auto-refractor-keratometer (KR-8800) without cycloplegia. Dietary intake of 14 nutrients was assessed through a 24-h personalized dietary recall method.

Results

The study revealed a myopia prevalence of 87.6% among the adolescents. Multivariable models adjusted for age, gender, BMI, and other confounding factors indicated that higher intakes of carbohydrates, proteins, cholesterol, sodium, and vitamin B2 were associated with an increased risk of myopia. Conversely, higher intake of vitamin C was found to be associated with a decreased risk.

Conclusion

The findings suggested a potential association between dietary nutrient intake and myopia prevalence in Korean adolescents. While the study did not establish a causal link, the differences in nutrient intake between the myopic and non-myopic groups could indicate that diet plays a role in the development or progression of myopia. Further research is warranted to corroborate these findings and explore the underlying mechanisms.

A Novel CRYBB2 Silent Variant in Autosomal Dominant Congenital Cataracts (ADCC) in Pakistani families

Objective

Congenital Cataract is a type of ophthalmic genetic disorder that appears at birth or in early childhood. Among 30 genes, CRYBB2 is one of the most common and a water-soluble protein of lens's that code for the βB2-crystallin. This study aimed to investigate the novel silent mutation in CRYBB2 of exon six in the Pakistani families of Autosomal Dominant Congenital Cataracts (ADCC).

Methods

It is a family-based study that presents three to five-generations of two Pakistani families. Data and blood samples from the families were collected from January to August 2019 from LRBT (Layton Rahmatullah Benevolent Trust) Hospital, Mansehra, Pakistan. We only included patients >15 years old. Before enrollment in the current study, each patient obtained a thorough optical examination. Samples were moved to the molecular lab using the collection and storage method. The phenol-chloroform technique was used to extract the DNA. The technique of Sanger sequencing was used to find any potential mutation in some of the selected families. Statistical and bioinformatics analysis were carried out.

Results

By using bioinformatics tools, the novel silent mutation was identified. Heterozygous silent mutation of CRYBB2 of exon 6 (c. 495G>A) was detected by the alignment of sequences. Computational prediction program did not predict the silent mutation.

Conclusion

This study investigated a novel important sequence variant in the beta-crystalline protein that causes autosomal dominant congenital cataract (ADCC) in Pakistani families. Thus, our study enlarges the CRYBB2 mutation spectrum and associated phenotypes to help clinical diagnosis of human genetic diseases.

Dietary Patterns and Associations with Myopia in Chinese Children

Dietary shifts in populations undergoing rapid economic transitions have been proposed as partly contributing toward the rapid intergenerational rise in myopia prevalence; however, empirical evidence of the effect of dietary factors on myopia is limited. This study investigated the association between dietary factors and incident myopia in Chinese children aged 10-11 years. We evaluated dietary habits using a 72-item food frequency questionnaire (FFQ) among 7423 children. Myopic status was assessed using the "General Personal Information Questionnaire". Principal component analysis was used to extract dietary patterns and investigate their association with myopia. After adjusting for potential confounders, participants with the highest adherence to dietary pattern A (95% confidence interval (CI): 0.66-0.92, p for trend = 0.007) and dietary pattern C (95% CI: 0.58-0.80, p for trend < 0.001) had a lower risk of myopia than participants with the least adherence. Both of these dietary patterns are characterized by high consumption of meats, aquatic product, dairy and its products, eggs, legumes, vegetables, fruits, grains, and potatoes. Our findings suggest that other environmental factors, such as those related to the dietary environment, may contribute to the development of myopia. These findings can serve as a reference for diet-related primary prevention of myopia.

Emmetropization and nonmyopic eye growth

Most eyes start with a hypermetropic refractive error at birth, but the growth rates of the ocular components, guided by visual cues, will slow in such a way that this refractive error decreases during the first 2 years of life. Once reaching its target, the eye enters a period of stable refractive error as it continues to grow by balancing the loss in corneal and lens power with the axial elongation. Although these basic ideas were first proposed over a century ago by Straub, the exact details on the controlling mechanism and the growth process remained elusive. Thanks to the observations collected in the last 40 years in both animals and humans, we are now beginning to get an understanding how environmental and behavioral factors stabilize or disrupt ocular growth. We survey these efforts to present what is currently known regarding the regulation of ocular growth rates.