Highlights from the 2019 International Myopia Summit on 'controversies in myopia'.

Myopia is an emerging public health issue with potentially significant economic and social impact, especially in East Asia. However, many uncertainties about myopia and its clinical management remain. The International Myopia Summit workgroup was convened by the Singapore Eye Research Institute, the WHO Regional Office for the Western Pacific and the International Agency for the Prevention of Blindness in 2019. The aim of this workgroup was to summarise available evidence, identify gaps or unmet needs and provide consensus on future directions for clinical research in myopia. In this review, among the many 'controversies in myopia' discussed, we highlight three main areas of consensus. First, development of interventions for the prevention of axial elongation and pathologic myopia is needed, which may require a multifaceted approach targeting the Bruch's membrane, choroid and/or sclera. Second, clinical myopia management requires co-operation between optometrists and ophthalmologists to provide patients with holistic care and a tailored approach that balances risks and benefits of treatment by using optical and pharmacological interventions. Third, current diagnostic technologies to detect myopic complications may be improved through collaboration between clinicians, researchers and industry. There is an unmet need to develop new imaging modalities for both structural and functional analyses and to establish normative databases for myopic eyes. In conclusion, the workgroup's call to action advocated for a paradigm shift towards a collaborative approach in the holistic clinical management of myopia.

Macular choroidal thickness in Chinese preschool children: decrease with axial length but no evident change with age.

AIM: To explore the distribution pattern of macular choroidal thickness (ChT) and its association with age as well as refractive status in Chinese preschoolers. METHODS: School-based, cross-sectional study. A total of 550 healthy preschool children aged 3 to 6 years old from 6 kindergartens were enrolled. Comprehensive ocular examinations, including measurement of visual acuity, axial length, intraocular pressure and slit-lamp examination before cycloplegia, as well as refraction measurement and swept-source optical coherence tomography (SS-OCT) examination after cycloplegia, were performed. The macular ChT in each sector of the ETDRS grid was measured by the built-in software of SS-OCT. RESULTS: The mean central ChT of the participants was 312±59 µm. The mean axial length and spherical equivalent refraction were 22.36±0.72 mm and 1.51±0.83 D, respectively. Axial length increased with age (P<0.001), while the spherical equivalent refraction was similar among different age groups. Similarly, no significant difference was observed in ChT in all sectors among different age groups (all P>0.05). The central ChT of 3-4, 5 and 6 years old children was 314±59 µm, 312±60 µm and 312±59 µm, respectively (P=0.920). No difference was observed in ChT in most of the sectors between genders. No statistical significant difference was observed among different refractive groups (all P>0.05), though the ChT of each sector seemed to be smaller in myopic children. Axial length and weight were the independent factors of central ChT. Children with longer axial length (ß=-21.184, P<0.001) and smaller weight (ß=1.502, P=0.041) tended to have thinner choroid. CONCLUSION: In preschool children, the ChT remains relatively stable with age, while a negative association between ChT and axial length existed. This will be helpful to elucidate the characteristics of ChT during the early refractive development.

Half-spaced substrate integrated spoof surface plasmon polaritons based transmission line.

In this paper, a new spoof surface plasmon polaritons (SPPs) based transmission line (TL) with semi-open structure is proposed, which is implemented on a single-layer substrate with metallized via holes planted on a ground plane. The electromagnetic (EM) power propagates along it in the form of controlled slow surface wave, which is the same with its existing counterparts. The proposed TL can adjust the degree of EM energy confinement, and thus balance its performance in every characteristic, in particular attenuation and interference. As the TL is semi-open (i.e., EM energy distributes in the half space above the ground plane), it is less vulnerable to the nearby interference compared with its former counterparts, which are fully-open structure (i.e., EM energy distributes in the full space). Prototypes working at Ka band are fabricated and measured. Bianco-Parodi (BP) method is used to derive the attenuation of the proposed TL from the measured S-parameters. The proposed structure can be easily scaled for THz applications, which opens the door for future high performance THz components and systems.

Three-Dimensional Simultaneous Arbitrary-Way Orbital Angular Momentum Generator Based on Transformation Optics.

In wireless communications, people utilize the technology of diversity against multipath fading, so as to improve the reliability of communication equipment. One of the long-standing problems in diversity antennas is the limited number of diversity in a certain space. In this paper, we provide a solution to this issue by a three-dimensional (3D) simultaneous arbitrary-way orbital angular momentum (OAM) generator (3D SAWOG) based on transformation optics. The proposed 3D SAWOG consists of a metamaterial block and a group of transformation cylinders, by which arbitrary-way planar wavefronts can be converted to helical wavefronts with various topological charges simultaneously. The 2D four-way OAM generator and the 3D SAWOG are analyzed, designed, and simulated. The simulation results validate the performance of a 3D SAWOG successfully, indicating that the proposed model possess a high mode purity and expansibility. The SAWOG can be used as a novel diversity antenna array due to the orthogonal property among different modes, which could provide more degrees of freedom than traditional dual-polarization antennas, further improving the reliability of the communication systems.

Inhibition of proliferation and induction of apoptosis in RB116 retinoblastoma cells by afatinib treatment.

The present study investigates the effect of afatinib on the growth, induction of apoptosis in RB116 cells, and reduction of carcinoma growth in the mice transplanted with RB116 cells. The results from MTT assay revealed that afatinib inhibited the growth of RB116 cells in a dose-dependent manner. Proliferation of RB116 cells was reduced to 64 % on treatment with 200 µM concentration of afatinib after 48 h. Afatinib treatment of RB116 cells at 200 µM concentration induced apoptosis and necrosis in 49.7 and 9.4 %, respectively, after 48 h. In the RB116-transplanted mice, treatment with afatinib at 10-mg/kg doses for 45 days caused a significant (p < 0.005) reduction in the tumor volume compared to the control group. The tissue lysates of the mice containing RB116 transplant showed a significant decrease in the expressions of Ki67 and p53 in the afatinib treatment group after 45 days. However, the expression of caspase-3 was increased and of Bcl-2 remained unaltered on treatment with afatinib. Measurement of the body weight of afatinib-treated animals showed no reduction during the study. Thus, afatinib can be of therapeutic value for the treatment of retinoblastoma.

The control effect of orthokeratology on axial length elongation in Chinese children with myopia.

BACKGROUND: To retrospectively compare axial elongation in children with different degrees of myopia wearing spectacles and undergoing ortho-k treatment. METHODS: The medical records of 128 patients who were fitted with spectacles or orthokeratology (ortho-k) lenses in our clinic between 2008 and 2009 were reviewed. Ortho-k group comprised 65 subjects and 63 subjects wearing spectacles were included in the control group. Subjects were also divided into low-myopia, moderate-myopia and high-myopia groups, based on the basic spherical equivalent refractive error. Axial length periodically measured over 2-year of lens wear and changes in axial length were compared between treatment groups and between subgroups with different degrees of myopia. RESULTS: The control group exhibited more changes in axial length than the ortho-k group at both 12 months (0.39 ± 0.21 mm vs 0.16 ± 0.17 mm, p <0.001) and 24 months (0.70 ± 0.35 mm vs 0.34 ± 0.29 mm, p <0.001). Axial length elongation was estimated to be slower by about 51% in the ortho-k group. Similar results were found for the subgroups (49%, 59% and 46% reductions, respectively). In the group with low and moderate myopia, the annual increases in axial length were significantly different between the ortho-k and control groups during both the first ( Low myopia: 0.19 ± 0.17 mm vs 0.40 ± 0.18 mm, p = 0.001; Moderate myopia: 0.14 ± 0.18 mm vs 0.45 ± 0.22 mm, p <0.001) and second ( Low myopia: 0.18 ± 0.14 mm vs 0.32 ± 0.19 mm, p = 0.012; Moderate myopia: 0.18 ± 0.16 mm vs 0.34 ± 0.30 mm, p = 0.030) years. In the high myopia groups, significant differences were only found between the ortho-k and control groups during the first year (0.16 ± 0.18 mm vs 0.34 ± 0.22 mm, p = 0.004). The 2-year axial elongation was significantly associated with initial age (p <0.001) and treatment (p <0.001), but not with gender, initial refractive error, initial axial length, initial corneal curvature. CONCLUSIONS: This 2-year study indicates that ortho-k contact lens wear is effective for reducing myopia progression in children with low, moderate and high myopia.

[Analysis of cataract surgical rate and its influencing factors in Shanghai, China].

OBJECTIVE: To explore the cataract surgical rate (CSR) of Shanghai from 2006 to 2012 and examine its influencing factors. METHODS: As of 2003, a cataract surgery registration form had been filled by physicians after every cataract surgery in Shanghai. The local eye disease prevention team then entered the relevant information into the Shanghai Cataract Operations Database. Based upon this database, CSR of Shanghai was calculated. And the number of cataract surgeries was compared between Shanghai urban and suburban districts as well as among different medical institutions. RESULTS: The overall CSR in Shanghai increased from 1741 in 2006 to 2313 in 2012. In 2012, CSR in urban districts reached 6013 while it stood at 460 and 584 in inner and outer suburb districts respectively. The number of hospitals performing cataract surgery in urban districts was much more than that in suburbs. And the average number of cataract surgeries per hospital per year in suburbs was only one third of that (748 cases) in urban areas. The number of cataract surgeries at in private hospitals increased rapidly during the past 7 years. The number of 1921 cases was nearly twice as many as that at tertiary hospitals in 2012. Phacoemulsification surgery was the most popular surgical choice for cataract removal, accounting for 98.40% of total cataract surgeries in 2012. CONCLUSION: Until 2012, CSR in Shanghai dropped below the target of World Health Organization (WHO). A low level of CSR in suburbs is a major influencing factor for the overall level of CSR in Shanghai.

Cross-sectional investigation of visual impairing diseases in Shanghai blind children school.

BACKGROUND: The control of blindness in children is a high priority within the VISION 2020 initiative. To determine the causes of severe visual impairment and blindness in children from Shanghai Blind Children School (SBCS) can provide useful information on childhood blindness in Shanghai. METHODS: A cross-sectional investigation of students in SBCS was conducted in May 2010. The World Health Organization/Prevention of Blindness (WHO/PBL) eye examination record system for children with low vision and blindness was used. The results were further compared with the findings of two previous investigation studies conducted in 1986 and 2004, respectively in SBCS. RESULTS: Of the 146 children observed, 80 children (54.8%) were blind (best corrected best visual acuity less than 0.05), 27 children (18.5%) had severe visual impairment (best corrected visual acuity less than 0.1 but better than or equal to 0.05), and 34 children (23.3%) had moderate visual impairment (best corrected visual acuity less than 0.3 but better than or equal to 0.1). The major affected anatomic sites in the 107 children with severe visual impairment and blindness (SVI/BL) were retina (47.7%), whole globe (16.8%), optic nerve (13.1%) and lens (9.3%). The leading causes of SVI/BL were retinopathy of prematurity (ROP, 25.2%), followed by retinal dystrophy (15.9%), optic nerve atrophy (9.3%) and microphthalmos (9.3%). The two leading etiologic categories of SVI/BL were perinatal/neonatal (36.4%) and congenital/hereditary groups (29.0%). The leading cause of moderate visual impairment was aphakia after cataract surgery (congenital cataract, 44.1%). Compared with the findings in two previous investigations in SBCS, the proportion of ROP in visual impairing diseases increased, while the proportion of disorders of the lens (cataract and aphakia) significantly decreased. CONCLUSIONS: The leading cause of childhood blindness in SBCS nowadays is ROP. It is projected that without improvement in perinatal medical care that ROP will continue to be a major cause of childhood blindness.

[Practising appropriate vision check scheme in eye diseases mass screening works].

Vision check is the first step of mass screening works of most blinding diseases. In recent China, the primary childhood vision check is mainly conducted by hygiene teachers in educational institutions, following the Chinese traditional poor vision classification system, which is based on uncorrected distance visual acuity. However, this classification system does not meet childhood vision developmental mechanism, and may lead to massive unnecessary repetitive screening, diagnosis and treatment of corrected ametropia. In some Chinese communities and villages, the vision check is still based on uncorrected distance visual acuity during eye diseases mass screening procedures in adults. The critical point of preschool children vision impairment screening is then suggested to follow novel Chinese amblyopia diagnostic criteria. Combination of uncorrected, presenting and corrected visual acuity indexes may be used for children' vision check. Collaboration of children health care workers, pediatric ophthalmologists and optometrists in children eye diseases screening projects should be realized as soon as possible. In the adult population, presenting vision is suggested to be used in vision impairment screening works, and appropriate vision check scheme should be adopted in specific eye diseases screening works.

[A prevalence investigation of blindness and vision impairment in 2009 in older adults of Dachang Blocks of Baoshan District, Shanghai, China].

OBJECTIVE: To investigate the prevalence of blindness and low vision and the leading causes of blindness in residents aged≥60 years in Dachang Blocks of Baoshan District, Shanghai, China. METHODS: A cross-sectional study was carried out by Shanghai Eye Disease Prevention & Treatment Center and the Center for Disease Control and Prevention in Baoshan District of Shanghai from October to December in 2009. Randomly cluster sampling was used to identify the adults aged≥60 years who had lived in Dachang Blocks of Baoshan District, Shanghai for more than 10 years. Presenting visual acuity (PVA) and best-corrected visual acuity (BCVA) based on autorefraction and subjective refraction were measured separately in each eye. External eye, anterior segment and ocular fundus were examined by the ophthalmologist using slit lamp-microscopes direct ophthalmoscopy and non-mydriatic digital camera. And the leading causes of visual impairment were assured. The Chi square test was used between the groups of rate comparison. RESULTS: Of 5199 enumerated subjects≥60 years of age, 87.42% (4545/5199) were examined. All subjects were urban population who were originally changed from the rural population in nearly 10 years. In this population, with best-corrected visual acuity, 30 persons were diagnosed as blindness, 145 persons were diagnosed as low vision. The prevalence of blindness and low vision were 0.67%, 3.19%, respectively. Low vision was associated with female gender. It was statistically significant difference (χ2=4.88, P<0.05). The leading causes of blindness were cataract, macular degeneration, ocular absence or atrophy, glaucoma, and diabetic retinopathy or corneal diseases. With presenting visual acuity, 39 persons were diagnosed as blindness, 401 persons were diagnosed as low vision. The prevalence of blindness and low vision were 0.86%, 8.82%, respectively. Blindness and low vision were associated with older age. The prevalence of blindness and low vision increased rapidly in aged 75 years or older people. The leading causes of blindness were cataract, uncorrected refractive error, macular degeneration, ocular absence or atrophy, glaucoma. Low vision was associated with female gender. It had statistically significant difference (χ2=13.345, P<0.01). CONCLUSIONS: In rapidly urbanized and aging community of Shanghai, cataract, uncorrected refractive error, macular degeneration were the leading causes of blindness with presenting visual acuity. The prevalence of low vision in females was higher than that of males which had statistically significant difference. These kinds of residents needed more targeted eye health education and services.

Icaritin shows potent anti-leukemia activity on chronic myeloid leukemia in vitro and in vivo by regulating MAPK/ERK/JNK and JAK2/STAT3 /AKT signalings.

PURPOSE: To explore the effects of Icaritin on chronic myeloid leukemia (CML) cells and underlying mechanisms. METHOD: CML cells were incubated with various concentration of Icaritin for 48 hours, the cell proliferation was analyzed by MTT and the apoptosis was assessed with Annexin V and Hoechst 33258 staining. Cell hemoglobinization was determined. Western blotting was used to evaluate the expressions of MAPK/ERK/JNK signal pathway and Jak-2/Phorpho-Stat3/Phorsph-Akt network-related protein. NOD-SCID nude mice were applied to demonstrate the anti-leukemia effect of Icaritin in vivo. RESULTS: Icaritin potently inhibited proliferation of K562 cells (IC50 was 8 µM) and primary CML cells (IC50 was 13.4 µM for CML-CP and 18 µM for CML-BC), induced CML cells apoptosis and promoted the erythroid differentiation of K562 cells with time-dependent manner. Furthermore, Icaritin was able to suppress the growth of primary CD34+ leukemia cells (CML) and Imatinib-resistant cells, and to induce apoptosis. In mouse leukemia model, Icaritin could prolong lifespan of NOD-SCID nude mice inoculated with K562 cells as effective as Imatinib without suppression of bone marrow. Icaritin could up-regulate phospho-JNK or phospho-C-Jun and down-regulate phospho-ERK, phospho-P-38, Jak-2, phospho-Stat3 and phospho-Akt expression with dose- or time-dependent manner. Icaritin had no influence both on c-Abl and phospho-c-Abl protein expression and mRNA levels of Bcr/Abl. CONCLUSION: Icaritin from Chinese herb medicine may be a potential anti-CML agent with low adverse effect. The mechanism of anti-leukemia for Icaritin is involved in the regulation of Bcr/Abl downstream signaling. Icaritin may be useful for an alternative therapeutic choice of Imatinib-resistant forms of CML.

[The frequency of JAK2 V617F mutation, expression level of phosphorylated JAK/STATs proteins and their clinical significance in myeloproliferative disorders patients].

OBJECTIVE: To investigate the frequency of JAK2 V617F mutation in 145 myeloproliferative disorders (MPDs) patients, analyze the correlation between JAK2 V617F mutation and clinical features. METHODS: The JAK2 V617F mutation was detected by direct DNA sequencing of PCR product and allele-specific PCR respectively. The expression of JAK2, phospho-JAK2 and phospho-STAT5 proteins was determined by Western blot. The clinical data of MPDs patients with or without JAK2 V617F mutation was collected and analyzed for evaluating the clinical significance of JAK2 V617F mutation. RESULTS: 1) The frequency of JAK2 V617F mutation for PV, IMF, ET was 92%, 58%, 50% respectively. Compared with conventional DNA sequencing (PV 84%, IMF 44%, ET 39%, respectively), allele-specific PCR exhibited a higher sensitivity in JAK2 V617F mutation detection. 2) The expression levels of phospho-JAK2 and phospho-STAT5 in peripheral blood mononuclear cells (PBMNCs) were upregulated significantly in JAK2 V617F-positive patients than in JAK2 V617F negative patients. 3) Compared with the patients with no JAK2 V617F mutation, the JAK2 V 617F-positive patients' features were as follows: older age of onset, higher mean leukocyte counts, lower platelet counts and smaller spleen volume. Frequency of thrombosis events in PT, ET, IMF was 17%, 32%, 16% respectively for JAK2 V617F positive group, and 0% (PV), 16% (ET), 5% (IMF) for JAK2 V617F negative group. CONCLUSIONS: MPDs patients display higher frequency of JAK2 V617F mutation. JAK2 V617F mutation positive patients predispose to a thrombosis tendency.

[Epidemiology of diabetic macular edema in patients with type 2 diabetes in the Beixinjing District of Shanghai].

OBJECTIVE: To investigate the prevalence of diabetic retinopathy (DR) and diabetic macular edema (DME) in Beixinjing District, and analyze the image characteristics of their Optical coherence tomography (OCT), so as to evaluate the correlation among DME and the grade of DR as well as posterior vitreous detachment (PVD). METHODS: In a prospective study, OCT was performed in 151 eyes of 100 type 2 diabetes patients with DR and 102 normal eyes as control subjects. RESULTS: 795 cases were examined, and 215 of them were diagnosed to have DR. The average thickness of macular fovea was 195.56 microm in 151 eyes from 100 random sampling. 46 eyes had macular thickening. Three characteristics were found in the images of OCT in the patients with DME: sponge-like retinal swelling in 35 eyes (76.1%), macular cystoid edema in 8 eyes (17.4%), and serous retinal detachment in 3 eyes (6.5%). The statistical analysis showed that there was a positive correlation between the thickness of macular fovea and negative correlation with best-corrected visual acuity (r = 0.2869, P = 0.0004). There was statistic significance between the severity of DR and DME (P = 0.0003). But there was no statistic significance between DME and PVD. CONCLUSIONS: The prevalence of DME is 37.1% in this district. Three type images of OCT were demonstrated in DME. The macular thickness is correlated with the severity of DR regardless of PVD.

[Exogenous advanced glycosylation end products induce diabetes-like vascular dysfunction in normal rats: a factor for occurrence of diabetic retinopathy].

OBJECTIVE: To disclose the relationship between the deposition of advanced glycosylation end products (AGE) in the retinal vascular tissues and damage of retinal vessels in diabetic retinopathy. METHODS: Sixteen SD rats aged 2 months were divided into 4 groups, with 4 rats in each group. Rats in normal group received no treatment. Diabetes was induced by AGE in the diabetes group. Rat serum albumin (RSA, 40 mg/kg weight) was administered daily to healthy non-diabetic rats through tail veins for 2 weeks (RSA group). AGE-modified RSA was injected to rats in another group at the same route and dosage (AGE-RSA group). The number of pericytes in retinal capillary vessels was counted 2 weeks later. RESULTS: After two weeks continuous AGE treatment, the average amount of pericytes of capillary vessel per 10 microscope visual field (x 100 magnification) in AGE group (4.31 +/- 0.34) was significantly less than that of RSA group (5.80 +/- 0.48) (P < 0.01). Meanwhile, in the AGE-RSA group, AGE were identified in the retinal vascular tissues by immunohistochemical staining. CONCLUSION: Injection of exogenous AGE into healthy rats induces vascular changes resembling those find in the diabetic retinopathy. AGE might be one of the independent pathogenic factors in the occurrence of diabetic retinopathy.