Evolution of the Prevalence of Myopia among Taiwanese Schoolchildren: A Review of Survey Data from 1983 through 2017.

PURPOSE: The aim of this study was to evaluate the changes in the prevalence of myopia in Taiwanese schoolchildren over the past few decades and to analyze the risk factors for myopia. DESIGN: Analysis of 8 consecutive population-based myopia surveys conducted from 1983 through 2017. PARTICIPANTS: An average of 8917 (5019-11 656) schoolchildren 3 to 18 years of age were selected using stratified systematic cluster sampling or by probability proportional to size sampling. METHODS: All participants underwent complete ophthalmic evaluations. Three drops of 0.5% tropicamide were used to obtain the cycloplegic refractive status of each participant. Questionnaires were used to acquire participant data from the 1995, 2005, 2010, and 2016 surveys. MAIN OUTCOME MEASURES: Prevalence of myopia (spherical equivalence of ≤-0.25 diopter [D]) and high myopia (≤-6.0 D) was assessed. Multivariate analyses of risk factors were conducted. RESULTS: The prevalence of myopia among all age groups increased steadily. From 1983 through 2017, the weighted prevalence increased from 5.37% (95% confidence interval [CI], 3.50%-7.23%) to 25.41% (95% CI, 21.27%-29.55%) for 7-year-olds (P = 0.001 for trend) and from 30.66% (95% CI, 26.89%-34.43%) to 76.67% (95% CI, 72.94%-80.40%) for 12-year-olds (P = 0.001 for trend). The prevalence of high myopia also increased from 1.39% (95% CI, 0.43%-2.35%) to 4.26% (95% CI, 3.35%-5.17%) for 12-year-olds (P = 0.008 for trend) and from 4.37% (95% CI, 2.91%-5.82%) to 15.36% (95% CI, 13.78%-16.94%) for 15-year-olds (P = 0.039 for trend). In both the 2005 and 2016 survey samples, children who spent less than 180 minutes daily on near-work activities showed significantly lower risks for myopia developing (<60 minutes: odds ratio [OR], 0.48 and 0.56; 60-180 minutes: OR, 0.69 and 0.67). In the 2016 survey, spending more than 60 minutes daily on electronic devices was associated significantly with both myopia and high myopia (OR, 2.43 and 2.31). CONCLUSIONS: The prevalence of myopia among schoolchildren increased rapidly from 1983 through 2017 in Taiwan. The major risk factors are older age and time spent on near-work activities. Use of electronic devices increased the amount of time spent on near-work and may increase the risk of developing myopia.

Wide-based foveal pit: a predisposition to idiopathic epiretinal membrane.

PURPOSE: To report the anatomical characteristics of wide-based foveal pit and its possible associations with macular diseases. METHODS: Wide-based foveal pit was defined as a foveal base width (FBW) larger than the mean value plus one standard deviation of the normal population. Eyes with a wide-based foveal pit were retrospectively collected as the study group, and age- and sex-matched subjects with a normal FBW were recruited as the control group. FBW, area of foveal avascular zone (FAZ), and retinal artery trajectory (RAT) were compared between the two groups. The characteristics of the fellow eyes in the study group were also described. RESULTS: Fifty-two eyes from 52 patients were identified as having a wide-based foveal pit; 43 (82.7%) were female. Both their FBW (474.7 ± 84.6 µm) and area of FAZ (0.50 ± 0.11 mm2) were significantly larger than in the control group (297.6 ± 42.3 µm and 0.29 ± 0.10 mm2, respectively; p < 0.001 for both), and they also had a wider RAT than the control group (p < 0.001). During follow-up, three eyes had developed idiopathic epiretinal membrane. As for their fellow eyes, they either also had a wide-based foveal pit (11 eyes) or had various macular diseases including idiopathic epiretinal membrane (27 eyes), macular hole (5 eyes), and others (16 eyes). CONCLUSIONS: Eyes with a wide-based foveal pit had a large FAZ and a wide RAT, and they might have a predisposition to idiopathic epiretinal membrane formation. Their fellow eyes also had a predisposition to epiretinal membrane and macular hole.

Clinicopathologic correlation of ocular surface squamous neoplasia from a university hospital in North Taiwan 1994 to 2014.

BACKGROUND/PURPOSE: To describe the clinical and histologic characteristics of ocular surface squamous neoplasia (OSSN) and evaluate factors significant in recurrence at a university hospital in North Taiwan. METHODS: Patient charts, clinical features, and pathology records were retrospectively reviewed in patients with pathology-proved OSSN from January, 1994 to December, 2014. Clinicopathologic correlation was analyzed. RESULTS: Thirty-six patients were recruited. Mean age was 63.4 ± 13.0 (ranging from 23 to 87) years old. OSSN was predominant in men (21/36). Clinical appearances included papilliform in 17 eyes, gelatinous in 11 eyes, leukoplakic in 3 eyes, and 5 eyes in corneal intraepithelial neoplasia (CIN). Of 31 conjunctival OSSN, there were 4 in CIN I, 11 in CIN II, 13 in CIN III, and 3 in squamous cell carcinoma. Superior location was associated with higher-grade OSSN. Although statistical analysis was not significant, papilliform and multifocal lesions showed a trend of high-grade OSSN. The stages of tumor were 4, 5, 26, and 1 eye(s) in T1 to T4, respectively. Recurrence of disease occurred in 9 cases (25%) with mean recurrence time of 20.6 (range: 4 to 65) months. Multifocal lesion has a higher tendency for recurrence. CONCLUSION: Superior location was associated with high-grade OSSN, and papilliform OSSN might have a tendency of severe and invasive lesions. Multifocal lesions might be associated with higher-grade OSSN and higher recurrence rates.

Recurrent corneal erosion caused by retained sutures in blepharoplasty.

PURPOSE: To present recurrent corneal erosion (RCE) caused by late suture exposure after blepharoplasty. METHODS: Four patients who have unilateral RCE were found to have previous blepharoplasty. The RCE was associated with late suture exposure. The clinical courses, characteristics, methods to identify the suture exposure and treatment were presented. RESULTS: The clinical presentations including local erosion of upper bulbar conjunctiva, corneal abrasion lines, local corneal epithelial defects with rough border, and subepithelial opacity were noticed in all four patients. RCE symptoms exaggerated in eye blinking and did not respond to artificial tears treatment. Erosion recurred soon after the removal of therapeutic contact lenses. They underwent blepharoplasty 1-10 years before RCE emerged, and the RCE lasted 1-8 months before suture exposure was found. RCE healed within 1 week after suture removal. CONCLUSIONS: Suture exposure may occur several years after blepharoplasty and could cause RCE. Thorough exploration of the fornix by double eyelid eversion can identify the hidden sutures in such patients.

Gender- and age-related differences in foveal pit morphology.

AIMS: To measure the foveal pit morphology parameters and evaluate their correlations with age and sex. SETTINGS AND DESIGN: A retrospective cross-sectional matched comparison study in a tertiary center. METHODS AND MATERIALS: Forty men and 40 age-matched women who had normal macular structures and foveal contours were enrolled. Foveal pit parameters including top width, base width, nasal width, temporal width, minimal thickness, nasal thickness, temporal thickness, nasal height, temporal height, nasal slope, and temporal slope were measured on horizontal B-scan macular optical coherence tomography and compared between men and women. STATISTICAL ANALYSIS USED: Paired t-tests and Pearson's correlation analysis. RESULTS: The average patient age was 51.4 ± 17.5 (21-84) years. Women had a wider base width (313.1 ± 68.0 µm vs 266.8 ± 70.9 µm, P = 0.006), wider temporal width (1043.1 ± 245.6 µm vs 968.9 ± 261.0 µm, P = 0.006), thinner nasal thickness (345.6 ± 36.2 µm vs 359.7 ± 35.8 µm, P = 0.048), and flatter temporal slope (11.60 ± 2.52° vs 12.98 ± 2.68°, P = 0.016) than men. With age, the base width (r = 0.35, P = 0.025) and temporal width (r = 0.54, P = 0.0003) tended to be wider and the temporal slope was flatter (r = -0.45, P = 0.003) in women but not men. The minimal thickness tended to be thinner in the elderly group (r = 0.038, P = 0.015). CONCLUSIONS: Women had a significantly wider base width, wider temporal width, thinner nasal thickness, and flatter temporal slope of the foveal pit than age-matched men. The base width and temporal width were wider and the temporal slope was flatter with age in women but not men.

Fluid Biomarkers in Optical Coherence Tomography for Visual Outcome in Polypoidal Choroidal Vasculopathy.

Purpose: To investigate the associations between fluid accumulation at different levels in the retina and visual outcome in polypoidal choroidal vasculopathy (PCV). Design: A retrospective observational study. Institutional setting. Study Population: A total of 91 eyes from 91 patients of PCV were included, with 65 receiving intravitreal aflibercept monotherapy and 26 receiving combined intravitreal ranibizumab and photodynamic therapy (PDT). Observation Procedures: Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) examination results were recorded at baseline and 3, 6, and 12 months after treatment. Main Outcome Measures: The correlations between visual outcomes and fluid biomarkers including intraretinal fluid (IRF), subretinal fluid (SRF), serous pigment epithelium detachment (PED), and hemorrhage at fovea were analyzed. Results: No differences in treatment outcomes were noted between patients receiving aflibercept and those receiving combined ranibizumab and PDT. IRF and hemorrhage at baseline predicted poorer vision at 3, 6, and 12 months. The presence of IRF was associated with poorer vision at 6 months and 12 months (p < 0.05 for all). The presence of SRF or PED was not associated with better vision at any time point. No differences in the correlations between fluid markers and visual outcomes were noted between thin and thick subfoveal choroidal thickness groups. Conclusions: For PCV, IRF and hemorrhage at baseline served as surrogates for poor visual prognosis after treatment, and IRF was a biomarker for poor vision during the treatment course. No fluid markers predicted good visual prognosis or had a positive impact on vision at any time point.

Characteristics and response of subretinal hyperreflective material to anti-vascular endothelial growth factor in myopic choroidal neovascularization.

This retrospective study evaluated the characteristics and response of subretinal hyperreflective material (SHRM) to anti-vascular endothelial growth factor (VEGF) treatment in eyes with myopic choroidal neovascularization (CNV). The visual acuity (VA) was assessed at 3, 6, and 12 months after initiating anti-VEGF treatment in 116 patients (119 eyes) with SHRM and myopic CNV. Multimodal imaging, including color fundus photography, fluorescein angiography (FA), and optical coherence tomography angiography (OCT-A), were performed. We compared type 2 neovascularization (NV) (n = 64), subretinal hyperreflective exudation (SHE) (n = 37), NV with hemorrhage (n = 15), and fibrosis (n = 3). The type 2 NV group, and NV with hemorrhage groups showed significant VA improvement after 12 months of treatment (p < 0.05 in both groups); the SHE group failed to show improvement (p = 0.366). All groups showed a significant reduction in central foveal thickness after 12 months of treatment (all p < 0.05). The SHE group had a significantly higher incidence of interrupted ellipsoid zone than the other groups (p < 0.05). Myopic CNV can present as SHRM on OCT-A. Visual prognoses vary in different SHRM types. OCT-A and FA may help predict the outcomes of different subtypes of myopic CNV. SHE is predictive of outer retinal layer atrophy in patients with various SHRM types.

Comparison of Refractive Outcomes in Patients with Highly Myopic Versus Non-highly Myopic Eyes Undergoing Phacovitrectomy.

INTRODUCTION: Combined phacovitrectomy is gaining popularity due to efficiency and immediate visual improvement. However, concerns regarding erroneous intraocular lens (IOL) calculation in combination surgery are increasing, such as myopic shift owing to a thick macula and consequent underestimation of the axial length. Therefore, this study aimed to compare the refractive outcomes of combined phacovitrectomy in patients with highly myopic and non-highly myopic eyes. METHODS: A retrospective chart review was performed on patients who received combined phacoemulsification, intraocular lens implantation, and small gauge pars plana vitrectomy for cataract and macular pathologies in highly myopic and non-highly myopic eyes. Pre- and postoperative evaluation and ocular parameters were recorded, and analyses were performed using the Student's t test and regression analysis. RESULTS: A total of 133 patients with macular pathologies, including myopic tractional maculopathy, macular hole, and epiretinal membrane, were enrolled. SRK II or SRK/T models were used for calculating IOL. The mean absolute error of refraction change was 0.65 D; 83.5% of patients were within 1-D error, 57.9% within 0.5-D error, and 35.3% within 0.25-D error, with SRK/T showing better precision and yielding more myopic shift. Furthermore, the predictive accuracy of SRK II or SRK/T was better in patients with non-highly myopic eyes. Moreover, Barrett's universal II formula was not superior to SRK II or SRK/T in the prediction of postoperative refractive error (p = 0.48). CONCLUSION: Refractive outcomes were satisfactory in the cohort of patients with highly myopic eyes. The combined implementation of SRK II and SRK/T was not inferior to Barrett's universal II formula in predicting satisfactory refractive outcomes. Combination surgery can be an option for patients with both cataract and macular pathologies.

Correlation of Visual Acuity and Outer Retinal Thickness in Myopic Atrophic Maculopathy: A Retrospective Review.

INTRODUCTION: Myopic atrophic maculopathy is prevalent among patients with pathologic myopia and frequently leads to relentless vision loss. Several grading systems were established to facilitate the understanding of myopic atrophic maculopathy. However, the anatomical details in different stages of myopic maculopathy are so far not clearly elucidated. This study aims to investigate the visual acuity and retinal sublayer features in highly myopic eyes with varying severities of myopic atrophic maculopathy (MAM). METHODS: The clinical records of 111 consecutive patients (158 eyes) with high myopia (refractive error ≤ -6.0 D and axial length ≥ 26.0 mm) were reviewed. Fundus photography, optical coherence tomography (OCT), and best-corrected visual acuity (BCVA) were measured. MAM was graded according to the META-analysis for Pathologic Myopia (META-PM) classification system. Myopic choroidal neovascularization (mCNV) and dome-shaped macula (DSM) were also investigated. RESULTS: Among the 158 eyes, 18 (11%), 21(13%), 24 (15%), 25 (16%), 23 (15%), and 24 (15%) had tessellated fundus, diffuse chorioretinal atrophy, diffuse chorioretinal atrophy with DSM, patchy atrophy, patchy atrophy with DSM, and MAM with mCNV, respectively. A total of 23 (15%) eyes had macular atrophy without mCNV. Progressive thinning in the Henle's fiber and outer nuclear layers, myoid and ellipsoid zone (MEZ), outer segment (OS), and interdigitation zone and retinal pigmented epithelium based on the severity of MAM (p-value < 0.001) was found. MEZ and OS were most significantly reduced in thickness (p-value < 0.001). The presence of mCNV demonstrated significant outer retinal layer thinning compared with that of the tessellated fundus (p-value = 0.031). Patchy atrophy with DSM showed statistically poorer BCVA compared with that without (p-value = 0.008). CONCLUSION: Visual acuity and outer retinal sublayer characteristics were correlated with the severity of MAM. Outer retinal sublayer analysis by spectrum-domain OCT shed some light on the mechanisms of MAM progression.

Vitreoretinal Interface Changes After Anti-vascular Endothelial Growth Factor Treatment in Highly Myopic Eyes: A Real-World Study.

INTRODUCTION: To investigate changes in the vitreoretinal interface after anti-vascular endothelial growth factor (anti-VEGF) treatment in highly myopic eyes. METHODS: Eyes with myopic choroidal neovascularization (mCNV) treated with intravitreal injection of anti-VEGF in a single-center were retrospectively reviewed. Fundus abnormalities and features of optical computed tomography were studied. RESULTS: A total of 295 eyes from 254 patients were recruited to the study. Prevalence of myopic macular retinoschisis (MRS) was 25.4%, and the rates of progression and onset of MRS were 75.9% and 16.2%, respectively. Outer retinal schisis (ß = 8.586, p = 0.003) and lamellar macular hole (LMH) (ß = 5.015, p = 0.043) at baseline were identified risk factors for progression and onset of MRS, whereas male sex (ß = 9.000, p = 0.039) and outer retinal schisis at baseline (ß = 5.250, p = 0.010) were risk factors for MRS progression. Progression of MRS was first detected in outer retinal layers in 48.3% of eyes. Thirteen eyes required surgical intervention. Spontaneous improvements of MRS were observed in five eyes (6.3%). CONCLUSION: Changes in the vitreoretinal interface, such as progression, onset, and improvement of MRS, were observed after anti-VEGF treatment. Outer retinal schisis and LMH were risk factors of progression and onset of MRS after anti-VEGF treatment. Intravitreal injection of ranibizumab and retinal hemorrhage were protective factors for surgical intervention for vision-threatening MRS.

The Correlations of Macular Structure Characteristics With Idiopathic Epiretinal Membrane and Its Sexual Preference-A Matched Comparison Study.

Purpose: To measure the anatomical characteristics of the macula in fellow eyes of patients with unilateral idiopathic epiretinal membrane (ERM) and to compare them with normal controls. Methods: A total of 83 fellow eyes with unilateral idiopathic ERM were gathered as the study group, and their age- and sex-matched subjects with no vitreomacular diseases were recruited as the control group. Macular structure parameters including foveal base width (FBW), central foveolar thickness (CFT), central subfield thickness (CST), area of foveal avascular zone (FAZ), and retinal artery trajectory (RAT) were measured using optical coherence tomography (OCT) and OCT angiography and were compared between two groups. Results: For the study group, the FBW (463.8 ± 79.6 µm) and area of FAZ (0.39 ± 0.12 mm2) were significantly larger than those in the control group (334.3 ± 76.5 µm, 0.31 ± 0.13 mm2). Their CST was thinner and their RAT was wider than those of the control group (P < 0.05 for all). In the normal population, females had a wider FBW, a thinner CFT, and a wider RAT than males (P < 0.05 for all). Conclusions: Fellow eyes of the unilateral ERM had a larger FBW, a larger FAZ, a thinner CST, and a wider RAT than the normal population. This implicates that some centrifugal tractional force may exist on their macula, which eventually may result in the formation of idiopathic ERM. Females had a wider FBW, a thinner CFT, and a wider RAT than males, which may explain the higher prevalence of idiopathic ERM in females.

Identification of Sex and Age from Macular Optical Coherence Tomography and Feature Analysis Using Deep Learning.

PURPOSE: To develop deep learning models for identification of sex and age from macular optical coherence tomography (OCT) and to analyze the features for differentiation of sex and age. DESIGN: Algorithm development using database of macular OCT. METHODS: We reviewed 6147 sets of macular OCT images from the healthy eyes of 3134 individuals from a single eye center in Taiwan. Deep learning-based algorithms were used to develop models for the identification of sex and age, and 10-fold cross-validation was applied. Gradient-weighted class activation mapping was used for feature analysis. RESULTS: The accuracy for sex prediction using deep learning from macular OCT was 85.6% ± 2.1% compared with accuracy of 61.9% using macular thickness and 61.4% ± 4.0% using deep learning from infrared fundus photography (P < .001 for both). The mean absolute error for age prediction using deep learning from macular OCT was 5.78 ± 0.29 years. A thorough analysis of the prediction accuracy and the gradient-weighted class activation mapping showed that the cross-sectional foveal contour lead to a better sex distinction than macular thickness or fundus photography, and the age-related characteristics of macula were on the whole layers of retina rather than the choroid. CONCLUSIONS: Sex and age could be identified from macular OCT using deep learning with good accuracy. The main sexual difference of macula lies in the foveal contour, and the whole layers of retina differ with aging. These novel findings provide useful information for further investigation in the pathogenesis of sex- and age-related macular structural diseases.

Real world experience of the treatment outcome between photodynamic therapy combined with ranibizumab and aflibercept monotherapy in polypoidal choroidal vasculopathy.

To provide real-world experiences of treating polypoidal choroidal vasculopathy (PCV) patients with photodynamic therapy (PDT) plus intravitreal injection of ranibizumab or intravitreal injection of aflibercept alone. Retrospective chart review of patients with PCV in a single tertiary referral center in Taiwan. Chart review of PCV patients treated with PDT and injection of ranibizumab or injection of aflibercept. A total of 101 eyes of 101 patients (38 females and 63 males) were reviewed. Of those, 48 and 53 eyes received primary/adjunctive PDT along with injections of ranibizumab or intravitreal injections of aflibercept only, respectively. Initial visual acuity (VA) and central subfield choroidal thickness were similar between the two groups (p > 0.05). In addition, changes in VA at 3, 6, and 12 months post treatment were similar. The central retinal thickness decreased with either treatment (p < 0.01); however, this change did not translate into VA performance (p > 0.05). In the subgroup analysis of pachychoroid and non-pachychoroid patients, better initial VA and post-treatment VA at 3 months and 6 months was noted in the latter group of patients treated with anti-vascular endothelial growth factor monotherapy (p < 0.05). Aflibercept monotherapy is comparable with PDT plus ranibizumab in PCV patients with PCV (pachychoroid and non-pachychoroid patients). In addition, better prognosis regarding VA was observed in non-pachychoroid patients treated with aflibercept monotherapy.

Long-term results and risk factors influencing outcome of gas tamponade for myopic foveoschisis with foveal detachment.

OBJECTIVE: To evaluate the long-term results of gas tamponade without vitrectomy in patients with myopic foveoschisis (FS) and foveal detachment (FD). METHODS: Twenty eyes of 20 patients with myopic foveoschisis and foveal detachment were analysed retrospectively. All patients received an intravitreal injection of 0.2-0.3 mL C3F8 as an initial treatment. The patients were followed up for at least 18 months after the procedure. The refractive status, best-corrected visual acuity (BCVA), and anatomical abnormalities in macular area before and after the treatment were assessed and recorded. RESULTS: After initial gas tamponade, FD resolved completely (defined as responders) in 14 eyes, resolved partially in 2 eyes (defined as partial responders), and worsened in 4 eyes (non-responders) at the 3-month follow-up visit. Vitrectomy was performed in four eyes that showed increased detachment (two cases) or developed macular hole (two cases). Repeated gas injection was performed in two recurrent cases after initial success at the 3-month follow-up, and the foveal detachment once again resolved. Overall, 70% of our cases demonstrated resolution of FD at the 3-month follow-up and the long-term responders to gas injection was 65%. The risk factors for treatment failure were: (1) The presence of optical coherence tomography (OCT)-evident premacular membranes (p = 0.03) and (2) the height of FS measured >588 µm (p = 0.009). CONCLUSION: Our data supported that gas tamponade may be effective as an alternative treatment for selected cases of myopic FS with FD. The procedure may be especially beneficial in patients without OCT-evident premacular membranes and have low height of FS.

Modified Cow-Hitch Suture for Repositioning of Subluxated Scleral-Fixated Rigid Intraocular Lens.

BACKGROUND AND OBJECTIVE: To describe a new technique for repositioning a subluxated scleral-fixated rigid intraocular lens (IOL). PATIENTS AND METHODS: The authors present a modified intraocular threading technique to tie a cow-hitch knot around the eyelet on the dislocated haptic of a scleral-fixated rigid IOL. This technique uses three small corneal incisions to eliminate the need for IOL externalization and minimized the size and number of wounds. RESULTS: Three consecutive cases of subluxated haptics in two patients underwent this procedure. Postoperative IOL centration and alignment were satisfactory without tilt. No surgical-related complication was observed 1 year after surgery. CONCLUSION: A rigid IOL could be repositioned to a desired axis and centration via this modified cow-hitch technique, with better IOL support as compared with a single tie. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:179-182.].

Serum components and clinical efficacies of autologous serum eye drops in dry eye patients with active and inactive Sjogren syndrome.

PURPOSE: Autologous serum eye drops are considered safe and efficient for the treatment of various ocular surface disorders, including dry eye diseases (DED) caused by the primary and secondary Sjogren syndrome (SS). However, the serum components in patients of SS may be different from those of normal patients and can thus lead to unpredictable therapeutic effects. This study divided the SS patients into active and inactive types based on the erythrocyte sedimentation rate and the presence or absence of active rheumatoid arthritis. METHODS: We compared the serum components of these two groups with standard and multiplex enzyme linked immunosorbent assay arrays and predicted the therapeutic effects of topical autologous serum for the treatment of DED with ocular surface disease index (OSDI) and Oxford Schema scale (OSS). RESULTS: Hyaluronic acid and transforming growth factor b1 levels were significantly higher in the active SS group compared to the inactive SS group (P < 0.01), whereas epidermal growth factors, insulin growth factor 1, and fibroblast growth factor b had no significant differences between these two groups. Active SS group had significantly higher expressions of interleukin (IL) 1 beta, IL 6, and tumor necrosis factor alpha compared to inactive SS patients (P < 0.05). There were no statistical differences in therapeutic effects between these two groups, as measured with the OSDI or OSS. CONCLUSION: Dividing the Sjogren dry eye patients into active and inactive groups may appear as a reasonable method to predict the quality of autologous serum eye drops, but there seems to be no significant predictability to the therapeutic effects.