Dual-focus contact lenses for myopia control modify central retinal electrophysiology in humans.

INTRODUCTION: Dual-focus contact lenses create two focal planes, one providing a clear retinal image while the other imposes myopic defocus on the retina to slow myopia progression. This study used global-flash multifocal electroretinogram (gmfERG) response amplitudes to compare central versus peripheral retinal responses under dual-focus conditions and to assess the optimal degree of myopic defocus compared with a single-vision control lens. METHODS: Twenty participants each underwent three gmfERG trials, wearing a spectacle correction over dual-focus contact lenses with plano central power and peripheral secondary focal powers of either +2.00D, +4.00D or a plano single-vision lens. We compared amplitudes and latencies of the gmfERG direct and induced components (DC and IC) within participants, between the three different contact lens powers and at different retinal eccentricities (gmfERG ring). RESULTS: We observed significant differences in the gmfERG responses between the single-vision and dual-focus contact lenses. Overall, DC amplitudes peaked between zero and +2.00D secondary power, while IC amplitudes were maximal between +2.00D and +4.00D. Compared with the single-vision control, the greatest increase in DC and IC amplitudes while wearing dual-focus lenses occurred within the central 10° of the retina. There was no interaction effect between gmfERG ring (eccentricity) and secondary power, and no difference in the latency of the gmfERG responses between different powers. CONCLUSION: We found that dual-focus contact lenses with a +2.00D secondary power are close to that expected to induce the greatest increase in gmfERG responses relative to a single-vision lens. Dual-focus lenses produced the highest DC and IC response amplitudes relative to a single-vision lens in the central 10° of the retina. This suggests that dual-focus contact lenses slow myopia progression by modifying central rather than peripheral retinal activity.

The acute effect of atropine eye drops on the human full-field electroretinogram.

PURPOSE: Atropine eye drops are a common and effective treatment for slowing myopia progression, but the site and mode of action of atropine in controlling myopia are unclear. We investigated the early retinal sites of action of atropine by examining its effects on the human full-field electroretinogram (ffERG). METHOD: Baseline ffERGs were recorded in both eyes of 24 healthy subjects (mean ± SD: 21.0 ± 2.3 years; spherical equivalent refraction, range: + 1.63 to - 0.75 D) using 6 standard ISCEV protocols, 30 min after bilateral pupil dilation with 1% Tropicamide. Atropine (1 drop, 0.1%) was then instilled into the non-dominant eye. 24 h later, ffERGs were again recorded in both eyes. Ratios (post-atropine: pre-atropine) of dark-adapted (DA) and light-adapted (LA) ffERGs were compared between atropine-treated and control eyes using multivariate repeated measures general linear models. RESULTS: Atropine-treated eyes responded with 14% lower DA3.0 OP (oscillatory potential) amplitude (p = 0.003) and 4% delay in the DA10.0 a-wave peak time (p = 0.00099) compared with control eyes. Amplitudes and peak times were not different between atropine-treated and control eyes for DA0.01, LA3.0, and LA3.0 flicker ERGs. While atropine caused a small (1.26 mm2, p = 0.03) extra increase in pupil area in the treated eye, atropine-induced changes in ffERG responses bore no relationship with changes in pupil area (R2 = 2-5%, p > 0.05). CONCLUSIONS: The observed changes in oscillatory potentials corroborate previous findings that atropine affects neural activity in the inner retina. However, observed changes to the a-wave suggest that atropine also affects activity in photoreceptors.

Global-flash mfERG responses to local differences in spherical and astigmatic defocus across the human retina.

PURPOSE: Emmetropisation is essentially a visually guided, within-eye process. We investigated differences in global-flash multifocal electroretinogram (gmfERG) responses to naturally occurring differences in spherical and astigmatic defocus across the retina, which might provide a basis for guiding eye growth. METHODS: Experiment 1: The gmfERG responses (direct, DC, and induced, IC, amplitudes and latencies) recorded simultaneously from six retinal areas (15° eccentricity, spaced at 60°, areas 3.2°2 ) were correlated with the uncorrected retinal defocus measured at the six corresponding retinal locations in 20 adults with foveal refractive errors (-4.75 to +1.25D). No correcting lenses were used to avoid introduction of lens-induced aberrations and magnification. Experiment 2 investigated the effect of superimposing astigmatic defocus (+2.00/-4.00D Jackson Cross Cylinder presented at four orientations) on gmfERG responses. RESULTS: Experiment 1: DC and IC response amplitudes were greater in retinal regions naturally exposed to more hyperopic spherical defocus (DC: rho = 0.26, p = 0.005; IC: rho = 0.29, p = 0.001), but response latencies were unaffected by sign or magnitude of spherical defocus (DC: p = 0.34; IC: p = 0.40). Response amplitudes and latencies were unaffected by astigmatic defocus. Experiment 2: Rotating the JCC axis to four different orientations had no effect on the gmfERG responses (DC amplitude, p = 0.39; DC latency, p = 0.10; IC amplitude, p = 0.51; IC latency, p = 0.64). CONCLUSION: The gmfERG responses from discrete retinal areas varied with the sign and magnitude of local spherical defocus, but we found no evidence that retinal responses were affected by astigmatic defocus. Therefore, local astigmatism is unlikely to provide cues for controlling eye growth, whereas differences in response to spherical defocus between different retinal regions could potentially provide cues for controlling eye growth in emmetropisation.

Repeatability of Arterial Spin Labeling MRI in Measuring Blood Perfusion in the Human Eye.

BACKGROUND: Quantifying blood perfusion in ocular tissues is challenging, partly because the majority of the blood is carried by the choroid, which is difficult to visualize because it is located between the retina and sclera. PURPOSE/HYPOTHESIS: To evaluate the intra- and interday repeatability of MRI measures of chorio-retinal blood perfusion. STUDY TYPE: Prospective, cross-sectional, observational study. POPULATION: Twenty young healthy adults (six male, age: 25 ± 5 years) scanned twice within a single session repeated at the same time of day on 2 days. FIELD STRENGTH/SEQUENCE: Arterial spin labeling (ASL) MRI at 3.0T using pseudocontinuous ASL (PCASL) labeling scheme and a 3D turbo-gradient-spin-echo (TGSE) acquisition, including axial T2 -weighted structural images using a 2D turbo-spin-echo (TSE) sequence. ASSESSMENTS: Region-of-interest analysis for assessment of chorio-retinal blood perfusion. STATISTICAL TESTS: Intra- and interday repeatability of measures analyzed using intraclass correlation coefficients (ICC), Pearson's correlation analysis, paired t-tests, and Bland-Altman plots. RESULTS: The mean chorio-retinal perfusion was 77.86 (standard deviation [SD] = 29.80) ml/100ml/min. Perfusion measurements correlated strongly within a single session (r = 0.95, 95% confidence interval [CI] [0.880-0.980], P < 0.001) and between the two sessions based on a single run (r = 0.80 [0.582-0.913], P < 0.001), and two runs (r = 0.80 [0.479-0.918], P < 0.001). There were mean differences of 2.69 [16.85 to -22.23] ml/100ml/min for intraday measures, -7.44 [27.45 to -42.32] ml/100ml/min for single-run interday measures, and 5.73 [28.71 to -40.17] ml/100ml/min for two-run interday measures, but none were significant (all P > 0.05). DATA CONCLUSION: Quantitative ASL-MRI measurements of chorio-retinal blood perfusion showed high intra- and interday repeatability. The ASL-MRI technique provides reliable measures of chorio-retinal perfusion in vivo. LEVEL OF EVIDENCE: 1 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;49:966-974.

Effect of retinal image defocus on the thickness of the human choroid.

PURPOSE: To describe the time-course and amplitude of changes to sub-foveal choroidal thickness (SFCT) induced by imposed hyperopic and myopic retinal defocus and to compare the responses in emmetropic and myopic subjects. METHODS: Twelve East Asian subjects (age: 18-34 years; six were emmetropic and six had myopia between -2.00 and -5.00 dioptres (D)) viewed a distant target (video movie at 6 m) for 60 min on two separate occasions while optical coherence tomography (OCT) images of the choroid were taken in both eyes every 5 min to monitor SFCT. On each occasion, one eye was optimally corrected for distance with a contact lens while the other eye wore a contact lens imposing either 2.00 D hyperopic or 2.00 D myopic retinal defocus. RESULTS: Baseline SFCT in myopic eyes (mean ± S.D.): 256 ± 42 µm was significantly less than in emmetropic eyes (423 ± 62 µm; p < 0.01) and was correlated with magnitude of myopia (-39 µm per dioptre of myopia, R(2) = 0.67: p < 0.01). Repeated measures anova (General Linear Model) analysis revealed that in both subject groups, 2.00 D of myopic defocus caused a rapid increase in SFCT in the defocussed eye (significant by 10 min, increasing to approximately 20 µm within 60 min: p < 0.01), with little change in the control eye. In contrast, 2.00 D of hyperopic defocus caused a decrease in SFCT in the experimental eye (significant by 20-35 min. SFCT decreased by approximately 20 µm within 60 min: p < 0.01) with little change in the control eye. CONCLUSIONS: Small but significant changes in SFCT (5-8%) were caused by retinal defocus. SFCT increased within 10 min of exposure to 2.00 D of monocular myopic defocus, but decreased more slowly in response to 2.00 D of monocular hyperopic defocus. In our relatively small sample we could detect no difference in the magnitude of changes to SFCT caused by defocus in myopic eyes compared to emmetropic eyes.

Response of the human choroid to short-term changes in eyelid and periocular temperature.

CLINICAL RELEVANCE: Choroidal thickness measurement is gaining popularity in clinical practice and research as an early indicator of myopia progression. Understanding the influence of temperature on choroidal thickness changes will improve the reliability of the measures. BACKGROUND: It has been suggested that environmental temperature may affect choroidal thickness and blood flow, with potential implications for ocular disease and refractive development. This study investigates the effect of changes in eyelid/ocular adnexa temperature on choroidal thickness. METHODS: In a paired-eye study, 20 young, healthy subjects received a warm stimulus (heat pack) over one closed eye and simultaneously a cold stimulus (ice pack) over the other for 10 min. Eyelid temperatures were monitored with thermal probes, and optical coherence tomography scans of the retina and choroid were taken before and after heating and cooling, and then every 5 min during a 15-min recovery period. Retinal and choroidal thicknesses were measured across the macular region (6 mm), including the subfoveal (1 mm), parafoveal (1-3 mm), and perifoveal (3-5 mm) regions, and compared between the cooled and warmed eyes. RESULTS: When the thermal stimuli were applied, eyelid surface temperatures changed predictably and remained significantly different (by approximately 10-15°C) between the eyes after 2 min (p < .001). Relative to the warmed eye, macular choroidal thickness in the cooled eye increased significantly after 10 min of treatment (p = .004). This choroidal thickening response occurred in the subfoveal, parafoveal, and perifoveal regions (all p < .05). Upon removal of the thermal stimuli, choroidal thickness rapidly returned to the baseline and was no longer different between the cooled and warmed eye (p = .641). CONCLUSION: Cooling the anterior eye by application of a cold stimulus directly onto the closed eyelid caused a small but significant increase in choroidal thickness relative to warming the anterior eye, demonstrating that the choroid can modulate its thickness rapidly and transiently in response to local temperature changes.

Influence of periodic vs continuous daily bright light exposure on development of experimental myopia in the chick.

PURPOSE: In children, time spent outdoors has a protective effect against myopia development. In animal models, bright light reduces the development of experimental myopia. This study investigates how an increase in daily light exposure, presented either continuously during the day or periodically at different times of day, influences the development of experimental myopia in the chick. METHODS: Myopia was induced in Cobb Chicks (Gallus domesticus) by monocular deprivation (MD) of form vision with a translucent diffuser for 3 days (from 4 days of age) under a 12:12 light: dark cycle. MD control chicks were exposed to constant 300 lux (n = 11) during the light period. MD treatment groups received either constant 2000 lux (n = 11) during the light period or 300 lux for 10 h with a 2 h period of bright light (10 000 lux), either in the morning (n = 10), midday (n = 10) or evening (n = 10), giving the same total daily light exposure as the 2000 lux group. After 3 days of MD, refractive status, corneal curvature and axial eye dimensions were measured for all eyes under anaesthesia. RESULTS: Myopia in the constant 2000 lux group (-4.94 ± 1.21 D) was significantly less than in the 300 lux control group (-9.73 ± 0.96 D; p = 0.022). However, compared to the 300 lux control group, 2 h periods of 10 000 lux did not produce significant effects on refraction when presented either in the morning (-9.98 ± 0.85; p = 1.00), midday (-8.00 ± 1.26; p = 0.80), or evening (-13.14 ± 1.16 D; p = 0.20), although significantly less myopia was induced in the midday group compared to the evening group (p = 0.018). Orthogonal regression showed that myopia development was matched by changes in vitreous chamber depth (R(2)  = 0.69; p < 0.0001). CONCLUSIONS: In chicks, an increase in daily light exposure continuously during the day is more effective at inhibiting myopia than adding an equivalent dose within a 2 h period of bright light. A weak time-of-day effect also appears to be present in the response to bright light exposure. Our results suggest that future light-based myopia therapies in humans may be more effective if light levels are increased over the whole day, rather than through short periods of bright light exposure.

Peripheral refraction in high myopia with spherical soft contact lenses.

PURPOSE: Previous studies suggest that the refractive status of the peripheral retina may influence the progression of myopia. Our aim was to investigate peripheral refractions in human eyes with high myopia when corrected with a conventional soft spherical contact lens (CL). METHODS: Ten young adults with high myopia (over -6.00 D) were investigated. An open-field auto-refractor was used to measure on- and off-axis refractions in primary gaze, with and without a CL, every 5° out to 20° horizontally in nasal and temporal retina. Results were analyzed as mean sphere (M) and astigmatic (J(0) and J(45)) vector components. Partial coherence interferometry measures of eye size were also made on- and off-axis at 10 and 20° in nasal and temporal retina. RESULTS: Subjects (mean age, 22 years; range, 20 to 26 years) had an average on-axis spherical refractive error of -8.31 ± 2.10 D and an average on-axis eye length of 27.39 ± 1.18 mm. Mean sphere exhibited a significant shift from hyperopic relative peripheral refraction (RPR) in the uncorrected state to myopic RPR on correction, in both nasal and temporal retina. Mean RPR of all subjects across all eccentricities was hyperopic when uncorrected (M = +0.20 ± 0.49 D: mean ± 1 SEM) becoming myopic when corrected (M = -0.45 ± 0.56 D: p = 0.0003, reaching -1.21 ± 0.82 D at 20° in the temporal retina). Peripheral J(0) astigmatism also became significantly more negative on correction (p = 0.002), whereas J(45) astigmatism remained unchanged. On- and off-axis measures of eye length indicated a relatively prolate retinal contour. Uncorrected off-axis mean sphere refractive error reduced with eccentricity, and this was accurately predicted (R > 0.98) by the measured retinal contour. CONCLUSIONS: Correcting the foveal refractive error in high myopia with standard spherical soft CLs can result in significant absolute myopic defocus in the peripheral retina. If peripheral refraction does indeed influence myopia progression, then our results suggest that in high myopia, standard soft CLs may be beneficial in reducing myopia progression.

Peripheral refraction in myopia corrected with spectacles versus contact lenses.

PURPOSE: Previous studies suggest that the refractive status of the peripheral retina can influence the development and progression of myopia. Our aim was to compare peripheral refractions in the same cohort of human eyes corrected with spectacle lenses vs soft contact lenses. METHODS: Ten young adults with moderate to high myopia (-5.00 D to -8.00 D) were investigated. Open-field autorefraction was used to measure on- and off-axis refractions with the eyes in primary gaze, when uncorrected, and when corrected with spectacles and contact lenses. Measures were made every 5° out to 30° horizontally in nasal and temporal retina and analysed as power vectors (M, J(0) , and J(45)). Partial coherence interferometry measures of eye size were also made on-axis and off-axis at 10º and 20º in nasal and temporal retina. RESULTS: Subjects (mean age 24; range 19-29 years) had an average on-axis mean-sphere refraction of -6.33 ± 0.31 D (mean ± 1 S.E.) and an average axial eye length of 25.99 ± 0.20 mm. The average relative peripheral refraction (RPR) for all subjects across all eccentricities was hyperopic when uncorrected (+0.90 ± 0.14 D) and also when corrected with spectacles (+1.01 ± 0.13 D) but changed to a myopic RPR when corrected with contact lenses (-1.84 ± 0.61 D). There was a highly significant effect of correction on peripheral refraction (p < 0.0001). Peripheral J(0) astigmatism also became significantly more negative (less with-the-rule) on correction with contact lenses (p = 0.015), whereas J(45) astigmatism remained unchanged. On- and off- axis eye length measures indicated a relatively prolate eye shape. CONCLUSIONS: Correcting the on-axis refractive error in moderate to high myopia with conventional spherical spectacle lenses results in hyperopic defocus in the peripheral retina. Correcting the same eyes with conventional spherical soft contact lenses results in significant myopic defocus in the peripheral retina. These results corroborate the general findings of earlier studies and the predictions of optical modelling by others. If the refractive status of the peripheral retina does influence myopia progression, then these results suggest that myopia progression should be slower with conventional contact lens wear than with conventional spectacle wear. However, previous studies comparing myopia progression with conventional spectacles and conventional contact lenses have reported no such difference.

Ketogenic diet: rapid onset of selenium deficiency-induced cardiac decompensation.

Selenium-deficiency cardiomyopathy is a known secondary complication from long-term treatment with a ketogenic diet for medical refractory epilepsy. Our patient, a 5-year-old boy on a ketogenic diet for intractable seizures, had a normal selenium level before starting the diet, but he shortly thereafter developed acute reversible cardiomyopathy and ventricular tachycardia, which was unmasked during a hospitalization for an elective operative procedure. His cardiomyopathy was suspected to be secondary to a selenium-deficient state and was confirmed by way of a markedly low serum selenium level and supported by rapid improvement with the initiation of selenium supplementation and cessation of the ketogenic diet. For patients being initiated on a ketogenic diet, current screening guidelines call for baseline and follow-up selenium levels every 3 months during the first year along with RDA selenium supplementation, which is 30 mcg/day. Most of the new ketogenic diet formulas meet this requirement. Our patient underwent elective surgery before his planned 3-month selenium level check and had potentially preventable complications. Secondary to this experience, we suggest that all patients initiated on a ketogenic diet should have a preoperative electrocardiogram (EKG), an echocardiogram, and selenium level determined before any elective surgery. These steps would prevent unnecessary perioperative morbidity and mortality.

Automated external defibrillators in West Virginia schools.

INTRODUCTION: Sudden death, particularly when occurring in children and adolescents, is a traumatic event not only for the victim's family, but for the entire community. It has been shown that school-based automated external defibrillator (AED) programs provide a high survival rate for both students and nonstudents who suffer sudden cardiac arrest (SCA) on school grounds. The use of AEDs is becoming increasingly more common in schools in the United States. In West Virginia middle and high schools, we analyzed the prevalence and use of AEDs, barriers to obtaining a device, and cases of sudden death on school grounds. METHODS: A mailed survey distributed to West Virginia high schools and middle schools collected general demographic data, AED data, and occurrences of sudden death on school grounds. Schools reporting a death were contacted to obtain details regarding the event. For schools with a device, the number of AEDs, length of possession, reasons for and means of obtaining the AED, personnel trained to operate the AED and the number of device uses were determined. For schools without an AED, barriers to and interest in obtaining a device were determined. RESULTS: Two hundred and twenty-five of 312 surveys (72%) were returned. One hundred and fifty-two schools (68%) currently have at least one AED and 73 schools (32%) do not have an AED. Public high schools had the highest prevalence of AEDs (76%) compared to public middle schools (62%) and private schools (67%). Sixty-nine percent of schools obtained their devices by donations or grants and 32% obtained them using school funds. Barriers to obtaining a device included cost (82%), lack of trained personnel (45%), unfamiliarity with AED (22%), and liability issues (19%). There were a total of 23 deaths on school premises reported by 20 schools. There was one reported occurrence of an AED being used to save a life. CONCLUSION: Over two thirds of West Virginia middle schools and high schools currently have at least one AED on their premises. An AED is an effective way of preventing death following sudden cardiac arrest, and has saved at least one life in a West Virginia school. While most schools without AEDs cite cost as the main deterrent, the majority of schools with a device received them via donation or grant. We submit that a number of sudden deaths on West Virginia school grounds could possibly have been averted by use of an AED.

The Revelation of Beauty in Nursing.

A recent insight into the attributes of beauty is used to show its relations to nursing science and its theories and paradigms. It is indicated how insight into beauty came from energyspirit perceptions-experiences of feelings from art objects. Rogers and her science of unitary human beings are viewed from the attributes of beauty. It is recommended nursing consider beauty as a concept for the advancement of nursing science.

A Rogerian Vision of Gender in a Pandimensional Universe.

Rogers' science of unitary human beings is used to present a unitary process in the origin of humans and the evolution of gender. It is suggested that the increasing diversity of gender may be indicative of the future of humankind. Human field image and Barrett's power theory are used to understand gender identity, experience, and expression for wellbecoming.

Effect of dual-focus soft contact lens wear on axial myopia progression in children.

PURPOSE: To test the efficacy of an experimental Dual-Focus (DF) soft contact lens in reducing myopia progression. DESIGN: Prospective, randomized, paired-eye control, investigator-masked trial with cross-over. PARTICIPANTS: Forty children, 11-14 years old, with mean spherical equivalent refraction (SER) of -2.71 ± 1.10 diopters (D). METHODS: Dual-Focus lenses had a central zone that corrected refractive error and concentric treatment zones that created 2.00 D of simultaneous myopic retinal defocus during distance and near viewing. Control was a single vision distance (SVD) lens with the same parameters but without treatment zones. Children wore a DF lens in 1 randomly assigned eye and an SVD lens in the fellow eye for 10 months (period 1). Lens assignment was then swapped between eyes, and lenses were worn for a further 10 months (period 2). MAIN OUTCOME MEASURES: Primary outcome was change in SER measured by cycloplegic autorefraction over 10 months. Secondary outcome was a change in axial eye length (AXL) measured by partial coherence interferometry over 10 months. Accommodation wearing DF lenses was assessed using an open-field autorefractor. RESULTS: In period 1, the mean change in SER with DF lenses (-0.44 ± 0.33 D) was less than with SVD lenses (-0.69 ± 0.38 D; P < 0.001); mean increase in AXL was also less with DF lenses (0.11 ± 0.09 mm) than with SVD lenses (0.22 ± 0.10 mm; P < 0.001). In 70% of the children, myopia progression was reduced by 30% or more in the eye wearing the DF lens relative to that wearing the SVD lens. Similar reductions in myopia progression and axial eye elongation were also observed with DF lens wear during period 2. Visual acuity and contrast sensitivity with DF lenses were not significantly different than with SVD lenses. Accommodation to a target at 40 cm was driven through the central distance-correction zone of the DF lens. CONCLUSIONS: Dual-Focus lenses provided normal acuity and contrast sensitivity and allowed accommodation to near targets. Myopia progression and eye elongation were reduced significantly in eyes wearing DF lenses. The data suggest that sustained myopic defocus, even when presented to the retina simultaneously with a clear image, can act to slow myopia progression without compromising visual function. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Multifocal Orthokeratology versus Conventional Orthokeratology for Myopia Control: A Paired-Eye Study.

We conducted a prospective, paired-eye, investigator masked study in 30 children with myopia (-1.25 D to -4.00 D; age 10 to 14 years) to test the efficacy of a novel multifocal orthokeratology (MOK) lens compared to conventional orthokeratology (OK) in slowing axial eye growth. The MOK lens molded a center-distance, multifocal surface onto the anterior cornea, with a concentric treatment zone power of +2.50 D. Children wore an MOK lens in one eye and a conventional OK lens in the fellow eye nightly for 18 months. Eye growth was monitored with non-contact ocular biometry. Over 18 months, MOK-treated eyes showed significantly less axial expansion than OK-treated eyes (axial length change: MOK 0.173 mm less than OK; p < 0.01), and inner axial length (posterior cornea to anterior sclera change: MOK 0.156 mm less than OK, p < 0.01). The reduced elongation was constant across different baseline progression rates (range -0.50 D/year to -2.00 D/year). Visual acuity was less in MOK vs. OK-treated eyes (e.g., at six months, MOK: 0.09 ± 0.01 vs. OK: 0.02 ± 0.01 logMAR; p = 0.01). We conclude that MOK lenses significantly reduce eye growth compared to conventional OK lenses over 18 months.

Additive effect of atropine eye drops and short-term retinal defocus on choroidal thickness in children with myopia.

Atropine eye drops and myopic retinal defocus each slow progression of myopia (short-sight). They also cause thickening of the choroid, and it has been suggested that the thickening is a precursor for reduced eye growth and slowed myopia progression. We investigated whether choroidal thickening due to optical defocus would add to thickening due to atropine when both were applied simultaneously. Addition would suggest that combining the two clinical treatments may improve efficacy of myopia control. We studied 20 children receiving 0.3% atropine daily for myopia control, over a period of 6 months. We imposed short periods of retinal defocus (1 h of myopic or hyperopic defocus (± 2.00D)) both before, and after 1 week and 3 and 6 months of atropine treatment. Prior to atropine, myopic or hyperopic defocus caused significantly thicker or thinner choroids respectively (± 12 µm, p < 0.001). After one week of atropine alone, thickness had increased (+ 21 µm; SD 17 µm; p < 0.001), and it increased further (by + 13 µm; SD 6 µm; p < 0.001) when exposed to myopic defocus. Atropine abolished choroidal thinning in response to hyperopic defocus. These effects remained the same after 3 and 6 months of atropine treatment. Our results show that additive effects of atropine and optical defocus are present at the level of the choroid, and suggest that combining optical and pharmaceutical treatments is likely to enhance efficacy of clinical myopia control.

National Institutes of Health social and behavioral research in response to the SARS-CoV2 Pandemic.

The COVID-19 pandemic has been mitigated primarily using social and behavioral intervention strategies, and these strategies have social and economic impacts, as well as potential downstream health impacts that require further study. Digital and community-based interventions are being increasingly relied upon to address these health impacts and bridge the gap in health care access despite insufficient research of these interventions as a replacement for, not an adjunct to, in-person clinical care. As SARS-CoV-2 testing expands, research on encouraging uptake and appropriate interpretation of these test results is needed. All of these issues are disproportionately impacting underserved, vulnerable, and health disparities populations. This commentary describes the various initiatives of the National Institutes of Health to address these social, behavioral, economic, and health disparities impacts of the pandemic, the findings from which can improve our response to the current pandemic and prepare us better for future infectious disease outbreaks.

Unitariology and the Changing Frontiers of the Science of Unitary Human Beings.

The evolution of Rogers' use of the word unitary and the changing frontiers of her science are discussed. The author shows how Rogers' science illuminates issues in nursing such as nursing as a basic or applied science, health as wellbecoming, and proposed changes in nursing education and research. The process of the creation of the pandimensional awareness-integral presence theory is presented.

The Effect of Atropine on Human Global Flash mfERG Responses to Retinal Defocus.

Purpose: To investigate the action of atropine on global flash multifocal electroretinogram (gmfERG) responses to retinal defocus. Method: gmfERG recordings were made monocularly in 19 healthy adults under three lens-imposed defocus conditions (2 diopters myopic, 2 diopters hyperopic, and no defocus) before and 24 hours after instillation of 1 drop of 0.1% atropine. Signals reflecting activity from the outer and inner retina (direct [DC] and induced [IC] components respectively) were analyzed. Responses were grouped into either a central (0°-6°) or peripheral (6°-24°) retinal zone. The gmfERG responses were compared relative to the no defocus, no atropine condition. Results: Within the central zone, atropine had no effect on the amplitudes and peak times of DC or IC responses to defocus. For IC responses in the peripheral zone, there was a significant interaction effect of atropine and defocus (F2,36 = 6.050, P = 0.011) with greater post-atropine amplitudes under myopic defocus (mean increase = 15.5%, 95% confidence interval [CI] = 5.6%-25.4%, P = 0.004). Atropine also had a significant main effect of increasing IC peak times (F1,18 = 9.722, P = 0.006). For DC responses, atropine had a significant main effect of increasing DC amplitudes (F1,18 = 7.821, P = 0.012) and peak times (F1,18 = 15.406, P = 0.001) regardless of sign of defocus. Conclusions: Our results imply that atropine acts in the inner layers of the peripheral retina to affect neuronal responses to myopic defocus, raising the possibility that atropine may potentiate the effects of myopic defocus in inhibiting eye growth.