Predicting the child who will become myopic - can we prevent onset?

Myopia has become a global epidemic with significant public health impacts. Identifying the child at risk of developing myopia, i.e. the pre-myopic child and implementing strategies to prevent the onset of myopia, could significantly reduce the burden of myopia on an individual and society. This paper is a review of publications that have identified ocular characteristics of children at risk of future myopia development including a lower than age normal amount of hyperopia and accelerated axial length elongation. Risk factors associated with increased risk of myopia development such as education exposure and reduced outdoor time, and strategies that could be implemented to prevent myopia onset in children are also explored. The strong causal role of education and outdoor time on myopia development suggests that lifestyle modifications could be implemented as preventative measures to at-risk children and may significantly impact the myopia epidemic by preventing or delaying myopia onset and its associated ocular health consequences.

Visual disturbances during prolonged space missions.

PURPOSE OF REVIEW: During prolonged spaceflight, astronauts often experience ocular changes, due to constant head-ward fluid shifts in space as compared with Earth. This article reviews symptoms, likely causes, and potential solutions, such as lower body negative pressure, to counteract space-associated neuroocular syndrome (SANS). RECENT FINDINGS: Low gravity conditions and other aspects of spaceflight affect the eye detrimentally, causing SANS which is characterized by optic disc edema, choroidal thickening, cotton wool spots, and a hyperopic shift. SANS is probably caused by altered hemodynamic flows in the head and neck as well as mildly elevated intracranial and intraocular pressures. Carbon dioxide and other chemicals in space-craft may influence SANS as well. SANS may be counteracted by using lower body negative pressure, thigh cuffs, spacecraft engineering, and/or artificial gravity by a centrifuge. SUMMARY: Prolonged space missions are associated with optic disc edema, choroidal thickening, cotton wool spots, and a hyperopic shift. Possible causes and countermeasures are currently being researched to reduce the risk of SANS. Although many countermeasures to SANS are under investigation lower body negative pressure exhibits great promise in counteracting the headward fluid shifts in space. Understanding and prevention of SANS is critical to future space exploration, especially to long-duration missions to the moon and Mars.

Using the posterior to anterior corneal curvature radii ratio to minimize the risk of a postoperative hyperopic shift after Descemet membrane endothelial keratoplasty.

PURPOSE: To evaluate different corneal parameters in identifying patients at risk of a hyperopic shift after (DMEK). METHODS: This retrospective study included 92 eyes of patients with FECD after DMEK surgery. Pachymetry parameters, various tomographic parameters and densitometry values before and after DMEK were determined using a rotating Scheimpflug system (Pentacam HR, Oculus). For assessing the posterior to anterior corneal curvature relationship, we calculated the RPA (posterior to anterior corneal curvature radii ratio). RESULTS: The average keratometry reading of the posterior corneal surface (KmB) increased and the total corneal refractive power (TCRP) decreased significantly after surgery (P < .001). There was a significant difference between the preoperative and postoperative RPA (P < .001) and the posterior Q value (P < .001). The strongest correlation was found between the change in the KmB and the preoperative RPA (Spearman's correlation coefficient = 0.872, P < .001). In the receiver operating characteristic (ROC) analysis, the highest AUC values (for ∆KmB) among the different preoperative parameters tested were obtained for RPA and posterior Q value (Asph. QB) with AUROC (area under the ROC) values of 0.95 and 0.89, respectively. CONCLUSIONS: The Q value and the RPA showed the highest correlation with the change in corneal refractive power and the greatest AUC. These parameters could be used as surrogate markers to identify eyes that might be at risk of a greater postoperative hyperopic shift, which would allow more accurate setting of refractive goals.

T2 formula in a highly myopic population, comparison with other methods and description of an improved approach for estimating corneal height.

BACKGROUND: To determine the accuracy of the T2 formula as applied to highly myopic eyes, to compare the T2 formula to the SRK/T and Holladay 1 formulas, and to describe possible ways to improve the estimation of corneal height and prediction error in two settings, the Hadassah Hospital, Ophthalmology Department, Jerusalem, Israel and Clínica Barraquer, Bogotá, Colombia. METHODS: In this retrospective case series, optical biometer measurements were taken for 63 highly myopic patients (> 25 mm) undergoing uneventful crystalline lens phacoemulsification and insertion of an acrylic intraocular lens. Prediction errors were obtained, with estimations of ±0.50 D, ± 1.00 D, and greater than ±2.00 D. A method to improve the corneal height calculation is described. RESULTS: The SRK/T formula (mean absolute error [MAE] = 0.418; median absolute error [MedAE] = 0.352) was the most accurate, followed by the T2 (MAE = 0.435; MedAE = 0.381) and Holladay 1 (MAE = 0.455; MedAE = 0.389) formulas. Both the SRK/T and T2 formulas overestimated corneal height, but values were higher with the T2 formula. Corneal height was more precisely estimated using an alternative method that, when combined with axial length optimization, resulted in lower MAE (0.425) and MedAE (0.365) values than when applying the T2 formula alone. CONCLUSIONS: The T2 formula seems to be less accurate than the SRK/T formula in highly myopic eyes. An improved corneal height estimation method is described for the the T2 formula.

Comparison of intraocular lens power calculation formulas in Chinese eyes with axial myopia.

PURPOSE: To assess the accuracy of intraocular lens (IOL) power calculation formulas in Chinese eyes with axial lengths (ALs) longer than 26.0 mm. SETTING: Department of Cataract Surgery, Shanxi Eye Hospital, China. DESIGN: Prospective case series. METHODS: This study evaluated (1) two new formulas (Barrett Universal II and Hill-RBF 2.0), (2) three vergence formulas (Haigis, Holladay 1, and SRK/T), and (3) the original and modified Wang-Koch AL adjustment formulas with Holladay 1 and SRK/T. The User Group for Laser Interference Biometry lens constants were used for IOL power calculation. The refractive prediction error was calculated by subtracting the predicted refraction from the actual refraction postoperatively. The mean numerical error (MNE), percentage of eyes with hyperopic outcomes, and mean absolute error (MAE) were determined. RESULTS: The study comprised 136 eyes. The Barrett and Hill-RBF formulas had MNEs close to zero (-0.09 D to 0.03 D), the Haigis, Holladay 1, and SRK/T produced hyperopic MNEs (0.25 to 0.70 D), and the original and modified Wang-Koch AL adjustment formulas induced myopic MNEs (-0.48 to -0.22 D). The original Wang-Koch formulas produced significantly lower percentages of eyes with hyperopic outcomes (15% to 18%) than all other formulas (28% to 91%). There were no significant differences in MAEs between the Barrett, Hill-RBF, Haigis, and original and modified Wang-Koch adjustment with the Holladay 1 (0.32 to 0.41 D). CONCLUSION: The performances of the Barrett and Hill-RBF were comparable in long eyes. The incidence of hyperopic outcome with the Wang-Koch AL adjustment formula was significantly lower than other formulas.

Avoiding Hyperopic Surprises After Descemet Membrane Endothelial Keratoplasty in Fuchs Dystrophy Eyes by Assessing Corneal Shape.

PURPOSE: It is unclear which patients unexpectedly have a hyperopic refractive outcome after combined Descemet membrane endothelial keratoplasty and cataract surgery (triple DMEK). We assessed how corneal shape predicts hyperopia after triple DMEK. DESIGN: Retrospective cohort study. METHODS: Patients with Fuchs endothelial corneal dystrophy (FECD) with Scheimpflug examinations before uncomplicated triple DMEK at a tertiary referral center were included. The arithmetic error was calculated (stable postoperative refraction minus predicted refraction). Using multinomial logistic regression, risk ratios of > +0.5 diopter (D) hyperopic and > 0.5 D myopic arithmetic errors were calculated. RESULTS: In 112 eyes, the median predicted refraction was -0.43 D (interquartile range [IQR], -0.47 to -0.17) with an achieved refraction of -0.63 to 0.56 (IQR). The arithmetic error was 0.34 D (IQR, -0.22 to 0.81). A hyperopic arithmetic error was present in 46% of eyes. FECD eyes with an oblate posterior cornea (Q value >0) had a 3.0 times higher risk of hyperopic shift after triple DMEK (95% confidence interval [CI], 1.3-7.0; P = .011), compared to spherical or prolate corneas (Q value ≤ 0). In eyes with posterior Q > 0, the mean prediction error was +0.50 D higher than in eyes with negative Q values (95% CI, 0.19-0.82; P = .002), independent of corneal thickness. CONCLUSIONS: Hyperopic surprises after triple DMEK particularly occur in corneas that are flatter centrally than the periphery because of edematous changes (oblate posterior profile). Eyes with a positive Q value on Scheimpflug imaging should be considered for additional power at the intraocular lens level.

Practical applications to modify and control the development of ametropia.

For many individuals, the developmental trend of lessening hyperopia from birth continues past emmetropia towards myopia during childhood. The global pattern for prevalence of refractive errors indicates that the prevalence of hyperopia is low; in contrast, the burden of myopia is on the rise because of rising prevalence and magnitude of myopia. This review highlights the need to lessen the global burden of myopia by intervening with the development and/or slowing the progression of myopia. Further, outcomes from human clinical trials of pharmaceutical, optical, and environmental approaches to control myopia will be summarised. Pharmaceutical treatments are effective in controlling eye growth but are associated with deleterious side effects. Optical strategies that induce myopic defocus at the retina such as peripheral defocus reducing lenses, simultaneous defocus lenses, bifocals, and orthokeratology as well as environmental influences such as increased outdoor activity show promise and provide a substantially risk-free environment in which to control eye growth.

Can manipulation of orthokeratology lens parameters modify peripheral refraction?

PURPOSE: To investigate changes in peripheral refraction, corneal topography, and aberrations induced by changes in orthokeratology (OK) lens parameters in myopes. METHODS: Subjects were fitted with standard OK lenses that were worn overnight for 2 weeks. Peripheral refraction, corneal topography, and corneal surface aberrations were measured at baseline and after 14 nights of OK lens wear. Subsequent to a 2-week washout period, subjects were refitted with another set of lenses where one eye was randomly assigned to wear an OK lens with a smaller optic zone diameter (OZD) and the other eye with a steeper peripheral tangent. Measurements were taken again at a second baseline and after 14 days of overnight wear of the second OK lens set. RESULTS: Standard OK lenses with a 6-mm OZD and 1/4 peripheral tangent caused significant changes in both peripheral refraction and corneal topography. Significant hyperopic shift occurred in the central visual field (VF) while a myopic shift was found at 35 degrees in the nasal VF. OK induced significant reductions in corneal power at all positions along the horizontal corneal chord except at 2.4 mm nasal where there was no significant change and at 2.8 mm nasal where there was an increase in corneal refractive power. A positive shift in spherical aberration was induced for all investigated lens designs except for the 1/2 tangent design when calculated over a 4-mm pupil. Reducing OZD and steepening the peripheral tangent did not cause significant changes in peripheral refraction or corneal topography profiles across the horizontal meridian. CONCLUSIONS: OK lenses caused significant changes in peripheral refraction, corneal topography, and corneal surface aberrations. Modifying OZD and peripheral tangent made no significant difference to the peripheral refraction or corneal topography profile. Attempting to customize refraction and topography changes through manipulation of OK lens parameters appears to be a difficult task.

Protective effects of taurine against alloxan-induced diabetic cataracts and refraction changes in New Zealand White rabbits.

The present study examined the protective effects of taurine on alloxan-induced diabetic cataracts and lens damage in male New Zealand White rabbits. The animals were randomly divided into three treatment groups: (1) normal control (vehicle administration); (2) diabetes (100 mg/kg alloxan administration); and (3) diabetes + taurine (1% [w/v] taurine dissolved in drinking water and alloxan administration). The results showed that alloxan-induced diabetes caused significant (p < 0.05) hyperglycemia, hyperopic refraction shifts, cataract formation and lens damage compared with the normal control group. In contrast, the administration of taurine for 24 weeks significantly ameliorated the alloxan-induced elevated levels of blood glucose, level of hyperopic refraction error shifts in the eyes and progression of diabetic cataract formation in the lens in rabbits. Moreover, histopathology showed that the taurine supplement reduced the incidence of lens lesions induced by hyperglycemia. Overall, the studies demonstrate that taurine exhibits potent protective effects against alloxan-induced diabetic cataracts and refraction changes in rabbits.

Predictability of intraocular lens calculation and early refractive status: the Infant Aphakia Treatment Study.

OBJECTIVE: To report the accuracy of intraocular lens (IOL) power calculations and the early refractive status in pseudophakic eyes of infants in the Infant Aphakia Treatment Study. METHODS: Eyes randomized to receive primary IOL implantation were targeted for a postoperative refraction of +8.0 diopters (D) for infants 28 to 48 days old at surgery and +6.0 D for those 49 days or older to younger than 7 months at surgery using the Holladay 1 formula. Refraction 1 month after surgery was converted to spherical equivalent, and prediction error (PE; defined as the calculated refraction minus the actual refraction) and absolute PE were calculated. Baseline eye and surgery characteristics and A-scan quality were analyzed to compare their effect on PE. MAIN OUTCOME MEASURES: Prediction error. RESULTS: Fifty-six eyes underwent primary IOL implantation; 7 were excluded for lack of postoperative refraction (n = 5) or incorrect technique in refraction (n = 1) or biometry (n = 1). Overall mean (SD) absolute PE was 1.8 (1.3) D and mean (SD) PE was +1.0 (2.0) D. Absolute PE was less than 1 D in 41% of eyes but greater than 2 D in 41% of eyes. Mean IOL power implanted was 29.9 D (range, 11.5-40.0 D); most eyes (88%) implanted with an IOL of 30.0 D or greater had less postoperative hyperopia than planned. Multivariate analysis revealed that only short axial length (<18 mm) was significant for higher PE. CONCLUSIONS: Short axial length correlates with higher PE after IOL placement in infants. Less hyperopia than anticipated occurs with axial lengths of less than 18 mm or high-power IOLs. Application to Clinical Practice Quality A-scans are essential and higher PE is common, with a tendency for less hyperopia than expected. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00212134.

The effect of daily transient +4 D positive lens wear on the inhibition of myopia in the tree shrew.

PURPOSE: Negative-lens-induced defocus causes accelerated ocular elongation and myopia, whereas positive-lens-induced defocus produces reduced ocular elongation and hyperopia. Short durations of positive lens wear result in markedly stronger temporal effects than do short periods of negative lens wear in the chick model of refractive development. In mammalian and nonhuman primate models, there have been equivocal results in inhibiting myopia by short periods of positive lens wear when compared with data from the chick model. The purpose of the present study was an evaluation of full-time -9.5 D negative lens wear interrupted by short periods of daily +4 D positive lens wear in preventing experimental myopia in the tree shrew. METHODS: One treatment group wore negative lenses (-9.5 D) binocularly for 23 hours a day (10 hours of which were spent in total darkness), interrupted by 1 hour of wearing positive lenses (+4 D) binocularly for 12 days. Another group of animals wore negative lenses (-9.5 D) binocularly for 23 hours a day, interrupted by two 30-minute periods of positive lens (+4 D) wear daily, again for 12 days. The animals were raised on a 14-hour/10-hour light-dark cycle. Animals wearing -9.5 D lenses binocularly, interrupted by 0-powered lenses for either 1 hour or two 30-minute periods daily for 12 days, acted as controls. RESULTS: Continuous wear of -9.5 D lenses binocularly induced a -10.8 D myopic shift in refraction. Full-time wear of -9.5 D lenses binocularly, interrupted by 1 hour of 0-power lens wear binocularly, caused a myopic shift of 3.6 D over 12 days, whereas wearing -9.5 D lenses, interrupted by 1 hour every day of +4.0 D lens wear binocularly, whether it was continuous or divided into two 30-minute periods, caused a myopic shift of only 0.7 D over 12 days. CONCLUSIONS: Daily intermittent +4 D positive lens wear effectively inhibits experimentally induced myopia and may prove a viable approach for preventing myopia progression in children.

Effects of lenses with different power profiles on eye shape in chickens.

PURPOSE: Defocus imposed to the periphery of the visual field can affect the development of foveal/central refractive errors. To make use of this observation, lenses can be designed to reduce myopia progression, but it is important to know which power profiles of the lenses are most effective. We have studied this question in chickens. METHODS: Sixty male white leghorn chickens were used. From day 7 after hatching, they were treated for 5 days either with full field -7D or +7D lenses, with -7D lenses with a 4mm central hole, with hemi-field lenses of the same power, or with two different types of radial refractive gradient (RRG) lenses with increasing positive power from the center to the periphery, which were designed by Rodenstock GmbH, Munich, Germany. A macro file was written for "ImageJ" to trace and average the outlines of several excised eyes after treatment. Shapes of fellow control eyes and lens-treated eyes were compared in the horizontal and vertical meridians. Refractions were determined at -45°, 0°, and 45° over the horizontal visual field, at the beginning and at the end of experiments, using automated infrared photoretinoscopy. RESULTS: (1) Eye length, as determined by the new automated eye shape tracing technique, was well correlated with A-scan ultrasound data. (2) The effects of previously tested lens designs were reproduced with the new tracing technique. Full field lenses were by far the most effective (-7D: external axial length +0.24mm with an increase in eye volume of about 6%, +7D: -0.08 mm, with a decrease in eye volume of about 2%). Hemi-field lenses and negative lenses with a 4mm central hole induced conspicuous local changes in eye shape. (3) The first type of RRG lenses with a plano zone of about 4mm (equivalent to about ± 12.52° in the visual field for a vertex distance of 5mm) had no apparent effect on central refractions but induced small hyperopic shifts in the periphery, more significant in the temporal retina (+1.70 ± 1.70 D, p<0.001, paired t-test to untreated fellow eyes). The second type of RRG lenses with a small plano zone of 2mm (equivalent to ± 6.34°) induced peripheral hyperopia but also changed the central refraction (temporal retina +1.50 ± 1.17D, p<0.001, central retina +0.77 ± 1.15 D, p<0.01, nasal retina +1.47±1.35D, p<0.001, paired t-test to untreated control eyes). CONCLUSIONS: In the afoveate chick, RRG lenses have an effect on central refraction and eye growth only if the central plano zone is small (<4mm). For the second type of RRG lens with a central plano zone of about 2mm, inhibitory effects on eye growth were detected in both the center and periphery even though the optical power of the lenses in the periphery was low.

[How can the shift of refraction due to vitreous substitutes be avoided? Posterior chamber intraocular lens for patients suffering from diabetic retinopathy]. / Wie ist die Refraktionsänderung bei Glaskörpertamponade zu vermeiden? Hinterkammerlinse für Patienten mit diabetischer Retinopathie.

Silicone filling of pseudophakic eyes usually results in strong unilateral hyperopia and binocularity is severely disturbed. This problem can be avoided by designing a concave posterior lens surface with the centre of curvature in the macula (Acri.Lyc 59RET®, haptics in capsular bag, body in vitreous cavity). The prospective study on 40 eyes with idiopathic macular foramen yields a mean refraction difference of 0.22 D with and without oil. The A-constant of the lens was found to be 115.7. Clinically relevant aniseikonia did not occur. The main indication is cataracts combined with diabetic retinopathy.

Prevention of hyperopic surprise after LASIK in patients with refractive multifocal intraocular lenses.

PURPOSE: Three cases of patients who developed a similar hyperopic defect in refraction following laser in situ keratomileusis (LASIK) after multifocal intraocular lens (IOL) implantation are described. METHODS: Ophthalmologic evaluation including refractive status, corrected and uncorrected visual acuity (both at far and near), and corneal topography in patients presenting similar hyperopic refractive surprise in one eye as a result of LASIK refinement of residual ametropia after refractive multifocal IOL implantation. RESULTS: Laser in situ keratomileusis enhancement for residual ametropia of -1.00 to -1.50 D in patients with a prior implantation of refractive multifocal IOL resulted in a refractive surprise of +2.25 to +2.50 D. After excluding other possible sources of error, an explanation for such a refractive surprise is suggested, and a simple method for avoiding this error is presented. CONCLUSIONS: Proper knowledge of the defocus curve and the use of a systematic method for determining subjective refraction in patients implanted with refractive multifocal IOLs will reduce the possibility of refractive surprise after LASIK enhancement in a bioptics procedure.

The effect of pirenzepine on positive- and negative-lens-induced refractive error and ocular growth in chicks.

PURPOSE: The selective muscarinic antagonist pirenzepine inhibits experimentally induced myopia in avian and mammalian species, including nonhuman primates and adolescent humans. Transient positive lens defocus has a potent inhibitory effect on negative-lens-induced myopia in avian and mammalian models. The purpose of the present study was to determine the influence of daily treatment with pirenzepine on ocular growth and refractive error in chicks wearing positive lenses. METHODS: The chicks were allocated to one of eight groups (n = 6 each group) on the basis of whether they wore +10 or -10 D lenses monocularly and whether they received daily intravitreal injections of pirenzepine (700 µg) or vehicle (phosphate-buffered saline) in the lens-defocused eye. In vivo refractive and biometric data were collected, and glycosaminoglycan synthesis in the sclera was assessed. RESULTS: Pirenzepine did not alter the level of positive-lens-induced hyperopia in chicks wearing +10 D lenses compared with that in the vehicle control group (+8.1 ± 0.6 D vs. +8.9 ± 2.4 D, mean ± SEM; P = 0.76). In contrast, pirenzepine caused significant inhibition of negative-lens-induced myopia compared with that in the vehicle group (-1.1 ± 1.5 D vs. -8.8 ± 1.1 D; P = 0.001). Glycosaminoglycan synthesis in the posterior sclera was significantly increased in the negative-lens-treated groups and showed small decreases in the positive-lens-treated groups. CONCLUSIONS: The influence of pirenzepine on ocular growth in chicks differed by sign of lens defocus, with pirenzepine blocking negative-lens effects on ocular growth, but not positive-lens effects. The most likely reason that hyperopia was not enhanced by pirenzepine treatment was that the rapid compensatory eye growth associated with positive lenses eliminated the imposed myopic defocus, and the clear retinal image prevented any additional hyperopia from developing.

Pachymetric ratio no-history method for intraocular lens power adjustment after excimer laser refractive surgery.

OBJECTIVE: To evaluate a new pachymetric method not requiring pre-refractive surgical data for adjusting the intraocular lens (IOL) power in eyes undergoing cataract surgery after excimer laser refractive surgery and comparing final refractive results with previously published formulas or methods. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Thirty-six eyes from 23 patients who had uneventful phacoemulsification cataract surgery after previous myopic (35) or mixed astigmatism (1) excimer laser photoablation. METHODS: A new corneal ratio (Geggel ratio) method was developed to estimate the diopters (D) of previous excimer treatment or change in spherical equivalent (SE) at the corneal plane. A regression formula, 0.40 (|DeltaSE|-1), predicted the correction factor to be added to the SRK/T (Sanders, Retzlaff, Kraff) formula. The IOL results from the Geggel and Geggel-real (modified for mild myopia) method were compared with the Masket, Koch double K table, Ladas, Walter, modified Maloney, clinical history, Feiz standardized and nomogram, Latkany average and flat, Ferrara, Rosa, Savini, Jin, Shammas no-history and regression formula, Seitz, and Awwad methods. The SRK/T, Hoffer, and Holladay formulas were tested in appropriate formulas. All IOL powers were converted to refractive results using IOL(exact) equations. MAIN OUTCOME MEASURES: Mean +/- standard deviation (SD), range, absolute mean +/- SD, and percent within +/-0.5 D, +/-1.0 D, and -1.0/+0.5 D. RESULTS: The pachymetric technique minimizes hyperopic surprises with 92% of eyes within -1.0/+0.5 D and no overcorrections >0.5 D with the Geggel-real modification. Final refractive results with the Geggel, Geggel-real, Masket, Koch double K tables, Latkany average and flat, Savini, Shammas no-history, Seitz Holladay, Seitz Hoffer, and Awwad Hoffer all had >55% SE +/-0.5 D and >85% SE +/-1.0 D of the surgical goal. The best results with fewer hyperopic overcorrections were found in 5 methods that comprise a new consensus group: Geggel-real, Shammas no-history, Savini, Latkany flat, and Seitz Hoffer. The consensus group had 96% of eyes within -1.0/+0.5 D of the surgical goal. CONCLUSIONS: The Geggel-real method is a new approach requiring no historical data to determine IOL power in this ever-enlarging and challenging group of former refractive surgery patients undergoing routine cataract surgery. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Insulin acts as a powerful stimulator of axial myopia in chicks.

PURPOSE: In animal models, it has been shown that the retina can use the defocus of the projected image to control emmetropization. Glucagon may be involved in the sign of defocus detection, at least in chickens. Since glucagon and insulin often have opposite effects in metabolic pathways, the effect of insulin on eye growth was investigated. METHODS: Chicks were treated with either positive or negative spectacle lenses and intravitreally injected with saline or different amounts of insulin. Refraction, axial length, and corneal curvature were measured. Effects of insulin on vitreal glucose concentration, on retinal ZENK and glucagon mRNA levels, and on the number of ZENK-immunoreactive glucagon amacrine cells were studied. RESULTS: Insulin injections (0.3 nmol) caused only a small myopic shift in control chicks. When positive lenses were worn, insulin injections (0.3; 0.03 nmol) not only blocked hyperopia but rather induced high amounts of axial myopia. Insulin also enhanced myopia that was induced by negative lenses. Axial elongation was mostly due to an increase in anterior chamber depth and a thickening of the crystalline lens. Insulin temporarily reduced vitreal glucose levels. Insulin increased retinal ZENK mRNA levels, whereas the number of ZENK-immunoreactive glucagon amacrine cells was reduced, a finding that is typically linked to the development of myopia. CONCLUSIONS: Given that insulin is used in therapy for human metabolic disorders and has been proposed to treat corneal epithelial disease, its powerful myopiagenic effect, which is mostly due to its effects on the optics of the anterior segment of the eye, merits further investigation.

Opposite effects of glucagon and insulin on compensation for spectacle lenses in chicks.

PURPOSE: Chick eyes compensate for the defocus imposed by positive or negative spectacle lenses. Glucagon may signal the sign of defocus. Do insulin (or IGF-1) and glucagon act oppositely in controlling eye growth, as they do in metabolic pathways and in control of retinal neurogenesis? METHODS: Chicks, wearing lenses or diffusers or neither over both eyes, were injected with glucagon, a glucagon antagonist, insulin, or IGF-1 in one eye (saline in the other eye). Alternatively, chicks without lenses received insulin plus glucagon in one eye, and either glucagon or insulin in the fellow eye. Ocular dimensions, refractive errors, and glycosaminoglycan synthesis were measured over 2 to 4 days. RESULTS: Glucagon attenuated the myopic response to negative lenses or diffusers by slowing ocular elongation and thickening the choroid; in contrast, with positive lenses, it increased ocular elongation to normal levels and reduced choroidal thickening, as did a glucagon antagonist. Insulin prevented the hyperopic response to positive lenses by speeding ocular elongation and thinning the choroid. In eyes without lenses, both insulin and IGF-1 speeded, and glucagon slowed, ocular elongation, but glucagon and insulin each increased the rate of thickening of the crystalline lens. When injected together, insulin blocked choroidal thickening by glucagon, at a dose that did not, by itself, thin the choroid. CONCLUSIONS: Glucagon and insulin (or IGF-1) cause generally opposite modulations of eye growth, with glucagon mostly increasing choroidal thickness and insulin mostly increasing ocular elongation. These effects are mutually inhibitory and depend on the visual input.

Corrected and uncorrected near and distance vision with ReSTOR compared to monofocal intraocular lens implantation after cataract surgery: a pooled analysis.

BACKGROUND/AIM: To evaluate distance and near vision-related benefit after implantation of ReSTOR multifocal intraocular lenses (IOLs) following cataract surgery. METHODS: Two prospective open-labeled nonrandomized studies were pooled. Patients' perception of benefit was assessed with the TyPE, administered at baseline and after each eye surgery. RESULTS: A total of 499 patients received ReSTOR IOLs, and 173 received monofocal IOLs. The distance vision of monofocal and ReSTOR patients improved equally with and without glasses. A greater improvement in near vision without glasses was reported by ReSTOR-implanted patients as early as after the 1st eye surgery (p < 0.0001). More ReSTOR patients than monofocal patients reported independence from glasses after the 1st eye surgery (64 vs. 52%; p = 0.0002). This difference had increased after the 2nd eye surgery (85 vs. 51%; p < 0.0001). CONCLUSIONS: The improvement in near vision without glasses was significantly more evident in ReSTOR patients, allowing the majority of them to be free of glasses.