The impact of different postures on acute intraocular pressure and accommodation responses during reading.

INTRODUCTION: To investigate the effects of different reading postures on intraocular pressure (IOP) and near-work-induced transient myopia (NITM) in children with myopia. METHODS: Sixty myopic children were instructed to read a book text placed at 33 cm for 30 min with two different reading postures: head bowed and head upright postures. The participants' IOP and NITM were assessed using a rebound tonometer and an open-field autorefractor. The measurement of IOP was conducted prior to reading, during reading sessions (at 5, 10, 20, and 30-min intervals), and after a 5-min recovery period. RESULTS: For the head bowed posture, the mean baseline IOP was 16.13 ± 2.47 mmHg. A significant rise in IOP was observed after 5 min of reading (17.17 ± 2.97 mmHg; +1.03 ± 2.29 mmHg; p = 0.014). Subsequent measurements revealed a further increase after 20 min (17.87 ± 2.90 mmHg; +1.73 ± 2.58 mmHg; p < 0.001), which continued to persist even after 30 min of reading (17.57 ± 3.46 mmHg; +1.43 ± 2.66 mmHg; p = 0.002). The IOP at different time points measured in the head upright posture did not show any significant difference in comparison to the baseline measurement (all p = 1.000). Compared to reading with the head upright, reading with the head bowed resulted in a greater increase in IOP at each time point (p < 0.05). Furthermore, the NITM was higher for reading with the head bowed than for reading with head upright at 30 min (-0.24 ± 0.53 D vs. -0.12 ± 0.47 D, p = 0.038). CONCLUSION: Reading in a head bowed position resulted in greater increases in IOP and NITM compared to reading in a head upright posture.

The efficacy and safety of combination therapy of repeated low-level red light and defocus-incorporated multiple segments spectacle lenses for myopia control in children: the study protocol for a 12-month, randomized, parallel-controlled, and single-center clinical trial.

BACKGROUND: Myopia is increasing in prevalence worldwide. Combination therapy showed a better effect on myopia control than monotherapy. Repeated low-level red light therapy (RLRL) therapy and defocus-incorporated multiple segment (DIMS) spectacle lenses have been reported to retard myopia progression significantly. However, whether these two therapies are better than one is still unknown. The present study aims to report the study protocol of a trial designed to evaluate the efficacy and safety of combination therapy of RLRL and DIMS versus DIMS alone for reducing the progression of myopia among Chinese school-aged children. METHODS: This study is a 12-month, randomized, parallel-controlled, single-center clinical trial. We will recruit children aged 8-12 years with spherical equivalence (SE) between - 0.50 D and - 6.00 D under cycloplegia in both eyes. We will recruit 66 participants with an allocation ratio of 1:1 from our hospital. Participants in the intervention group will be treated with an RLRL therapy device twice a day from Monday to Friday at home, 3 min per session, with a minimum interval of 4 h, under the supervision of their parents/guardians. They will wear DIMS spectacles for myopia correction during the day. Participants in the control group will not receive the RLRL therapy and will only wear DIMS spectacles to correct myopia. Participants from both groups will attend the hospital every 6 months. The primary outcome is the change in axial length at 12 months. Secondary outcomes include changes in refraction under cycloplegia, optical coherence tomography (OCT), multifocal electroretinogram (mfERG), color vision, and participants' self-reporting of adverse events at 12 months. DISCUSSION: This study will report the efficacy and safety outcome of the combination therapy of RLRL and DIMS versus DIMS for school-aged children with myopia in detail. TRIAL REGISTRATION: ChiCTR2300075398. Registered 4 September 2023. https://www.chictr.org.cn/bin/project/edit?pid=200751 .

Optical coherence tomography angiography of the macula of high myopia in children and adolescents.

BACKGROUND: High myopia represents a health issue and leads to the development of complications that threaten vision. The study of macular changes in high myopia patients has undergone great advances with updated technology via new spectral optical coherence tomography (OCT) and Optical coherence tomography angiography (OCTA). Most of related studies have focused on the adults and additional studies need to investigate macular changes in children and adolescents. This study aimed to evaluate the changes in the macular structure by OCT and the macular vessel density in high myopia in children and adolescents by OCTA. METHODS: A cross-sectional comparative study. The population was divided into two groups: group 1 (4-11 years) and group 2 (12-18 years). The results were comparable to those of control study of the same age group. The two high myopia groups and the control groups were examined by macular OCT and OCTA to evaluate macular thickness and vessel density in the superficial and deep capillary plexuses. RESULTS: OCT measurements of patients in group 1 revealed that central macular thickness was significantly lower in high myopia group than in the control group and measured 220.91 ± 27.87 µm and 258.23 ± 17.26 µm, respectively, (P < 0.0001). However, in group 2 the central macular thickness in the high myopia group and control group was 236.32 ± 27.76 µm and 247.09 ± 16.81 µm respectively, and the difference was not statistically significant (P = 0.09). The parafoveal macular thickness and the perifoveal macular quadrants thickness were significantly lower in high myopic children and high myopic adolescents (P < 0.0001) than age matched controls. The parafoveal and perifoveal vessel densities in the superficial and deep capillary plexuses were lower in the high myopia groups than in the age-matched controls in both groups with a few segment exceptions in group 1. The FAZ was significantly wider in group 1 than in the age-matched emmetropes (P = 0.02). The FAZ was wider in group 2 than controls, but the difference was not statistically significant, (P = 0.75). CONCLUSION: High myopic children and adolescents have thinner macular thickness than comparable age-matched emmetropes and have less vessel density in superficial and deep capillary plexuses with a wider FAZ.

Short-term effects of cyclopentolate and tropicamide eye drops on macular choroidal thickness in myopic children.

BACKGROUND: To investigate the short-term effects of cyclopentolate and tropicamide eyedrops on choroidal thickness (ChT) in myopic children using placebo or low-dose atropine eyedrops. METHODS: The analysis included 242 myopic individuals (7-19 years) enrolled in two randomised placebo-controlled clinical trials of low-dose atropine eyedrops. Cycloplegia was induced using either one drop of 1% cyclopentolate (n = 161), two drops of 1% cyclopentolate (n = 32) or two drops of 1% tropicamide (n = 49). ChT measurements were taken using swept-source optical coherence tomography before and 30 min after administering the cycloplegic eye drops. A subset of 51 participants underwent test-retest measurements prior to cycloplegia. RESULTS: Mean changes in subfoveal ChT after two drops of tropicamide and one and two drops of cyclopentolate were -2.5 µm (p = 0.10), -4.3 µm (p < 0.001) and -9.6 µm (p < 0.001), respectively. Subfoveal ChT changes after one and two drops of cyclopentolate were significantly greater than the test-retest changes (test-retest mean change: -3.1 µm; p < 0.05), while the tropicamide group was not significantly different (p = 0.64). Choroidal thinning post-cyclopentolate was not significantly different between atropine and placebo treatment groups (p > 0.05 for all macular locations). The coefficient of repeatability (CoR) in the tropicamide group (range: 8.2-14.4 µm) was similar to test-retest (range: 7.5-12.2 µm), whereas greater CoR values were observed in the cyclopentolate groups (one drop: range: 10.8-15.3 µm; two drops: range: 12.2-24.6 µm). CONCLUSIONS: Cyclopentolate eye drops caused dose-dependent choroidal thinning and increased variation in pre- to post-cycloplegia measurements compared with test-retest variability, whereas tropicamide did not. These findings have practical implications for ChT measurements when cyclopentolate is used, particularly for successive measurements.

Corneal endothelial morphology of healthy myopic Malaysian children of Chinese ethnicity aged 8-9 years and its association with axial length.

Background: This is a cross-sectional study to further understand the effects of axial length elongation on the corneal endothelial cell's morphology in myopic children. Abnormal changes in the morphology of corneal endothelium are indicators of corneal stress or instability which could be linked to myopia. Methods: 111 school children comprising of 37 emmetropes, 37 mild myopes and 37 moderate myopes aged 8-9 years old were recruited. Visual acuity was measured using the LogMar chart, cycloplegic refraction was determined using an open-field autorefractor (Grand Seiko WAM-5100, Hiroshima, Japan) and refined using subjective refraction. Morphology of corneal endothelial cells [endothelial cell density, coefficient of variation, hexagonality and central corneal thickness] was evaluated using a non-contact specular microscope (Topcon SP-2000P). Axial length was measured with A-scan ultrasound biometry (PacScan Plus, Sonomed Escalon, NY). The correlation between morphology of corneal endothelial cells and axial length were assessed using Pearson Correlation and Linear regression analysis. Results: There was no significant difference in corneal endothelial cells and axial length between gender (p>0.05). Significant reduction in endothelial cells density and hexagonality and increased coefficient of variation was found in eyes of higher myopic power which had longer axial when compared to emmetropes (p<0.001). Except for central corneal thickness, all corneal endothelial cells parameters correlated significantly with axial length (p<0.05). For every 1mm increase in axial length, endothelial cells density decreased by 73.27cells/mm 2, hexagonality decreased by 2.32% and coefficient of variation increased by 1.75%. Conclusions: There were significant changes in morphology of cornea endothelial cells in young moderate myopic children of Chinese ethnicity at 8-9 years of age. This result provides normative data for Malaysian children of Chinese ethnicity that can be used for comparison and reference for clinical procedures, thereby facilitating decision-making with respect to interventions for myopia control, especially in prescribing contact lens for children.

Effect of 0.01% atropine eyedrops on intraocular pressure in schoolchildren: a randomized clinical trial.

AIM: To assess the effect of 0.01% atropine eye drops on intraocular pressure (IOP) in myopic children. METHODS: A placebo-controlled, double-masked, randomized study. Totally 220 children aged 6 to 12y with myopia ranging from -1.00 to -6.00 D in both eyes were enrolled. Children were randomized in a 1:1 ratio to either 0.01% atropine eye drops or a placebo group using generated random numbers. All participants underwent the examination of IOP and cycloplegic refraction at baseline, 6 and 12mo. The change of IOP and the proportion of subjects with increased IOP in atropine and placebo groups were compared. RESULTS: Of 220 children, 117 were boys (53.2%). A total of 159 (72.3%) participants completed the follow-up at the 1-year study. At baseline, the mean IOP was 15.74 mm Hg (95%CI, 15.13 to 16.34 mm Hg) for the 0.01% atropine group and 15.59 mm Hg (95%CI, 15.00 to 16.19 mm Hg) for placebo group (mean difference, 0.14 mm Hg; P=0.743) after adjusting for central corneal thickness at baseline. At one year follow-up, the mean change of IOP was 0.16 mm Hg (95%CI, -0.43 to 0.76 mm Hg) for the 0.01% atropine group and -0.11 mm Hg (95%CI, -0.71 to 0.50 mm Hg) for placebo group (mean difference, 0.27 mm Hg; P=0.525) after adjusting for central corneal thickness. The 51.4% of children have increased IOP in the 0.01% atropine group, compared with 45.9% in the placebo group (P=0.511). CONCLUSION: The 0.01% atropine eye drops do not significantly affect the risk of elevated IOP. It is relatively safer to use in the studies that try to minimize myopia progression. However, a further long-duration study is required to be validated.

Effects of low-concentration atropine eye drops on the optical quality of the eyes in myopic children.

Purpose: The present study was performed to compare the optical quality of the eyes of myopic children before and after treatment with atropine eye drops of different concentrations. Methods: In the study population of 71 patients (131 eyes), 34 patients (63 eyes) were given 0.01% atropine eye drops and 37 patients (68 eyes) were given 0.05% atropine eye drops. The modulation transfer function (MTF) cutoff frequency, Strehl ratio, objective scattering index (OSI), and predicted visual acuities (PVAs 100%, 20%, and 9%) under different lighting conditions were measured before and after two weeks of atropine treatment. Results: After using 0.05% atropine eye drops for two weeks, the Strehl ratio decreased from 0.27 ± 0.07 to 0.23 ± 0.07 (P = 0.0026), PVA 20% decreased from 1.15 ± 0.32 to 1.03 ± 0.36 (P = 0.0344), and PVA 9% decreased from 0.74 ± 0.23 to 0.64 ± 0.23 (P = 0.0073). The OSI was significantly higher after using 0.05% than 0.01% atropine eye drops (P = 0.0396), while both the Strehl ratio and PVA 20% were lower after using 0.05% than 0.01% atropine eye drops (P = 0.0087 and P = 0.0492, respectively). Conclusion: The children's optical quality did not change significantly after using 0.01% atropine eye drops, whereas it decreased after using 0.05% atropine eye drops.

A Cooperative Management App for Parents with Myopic Children Wearing Orthokeratology Lenses: Mixed Methods Pilot Study.

Orthokeratology (OK) lens wear is an effective modality to inhibit axial elongation in myopic children. Willingness for commitment from both parents and children contributes to the success of OK treatment. We aimed to develop and assess the usability of a mobile application on OK lens wear by quantitatively and qualitatively evaluating parents with myopic children and eye care professionals (ECPs). Moreover, the preliminary outcome was also evaluated in this study. The app was developed and tested using a co-design approach involving key stakeholders. Two prototype tests were conducted during the feasibility and utility assessment. The app features include self-reported compliance documentation, analytics, and personalized and generalized messages for compliance behaviors of OK lenses. After the trial period, the full usage of app functions ranged from 40% to 60% among the enrolled parents. After app implementation, the compliance with follow-up visits substantially improved. Qualitative data show that the high-satisfaction app functions reported by parents were the app's reminder and axial length recording, although it was recommended that the number of compliance questions should be reduced to minimize the survey completion time. Additionally, who should complete the recording of the axial length data as well as the management and reminder for the follow-up visit remained controversial. This is the first app developed to improve parents of myopic children's compliance with OK lens wear and to assist ECPs and parents in collaboratively monitoring and managing the use and care of OK lenses among myopic children. This study highlights the importance of interdisciplinary collaboration in the design, development, and validation of such an app.

Compliance with orthokeratology care among parents of young children in Taiwan.

OBJECTIVES: To evaluate compliance with orthokeratology (Ortho-K) care and its influencing factors among parents of 6-13-year-old myopic children in Taiwan. METHODS: Parents who are responsible for the care of the Ortho-K lenses of their myopic children were recruited through a closed Facebook peer support group to answer an online compliance questionnaire, including the wear and care behaviours and follow-up visits of Ortho-K. RESULTS: A total of 253 online questionnaires were analysed after excluding those with wrong information. Most participants (89.7%) were mothers and had university-level or higher education (72.3%); 67.6% of them could achieve a score equal or higher than 60% correct rate on knowledge items. In addition, 39.3% of participants had high myopia (spherical equivalent ≦ 6.0 diopters). The mean age at onset of myopia was 7.75 years for children, and 57.4% wore Ortho-K lenses for less than a year. Full compliance rate was 22.8%, as reported by fathers or mothers. The compliance rate for follow-up visits significantly increased with provision of axial length information in follow-up visits, knowledge of axial length changes as an effect of myopia control, and Ortho-K use for less than 6 months. The compliance rate for wear and care was significantly associated with high myopia in one of parents, high education level, early onset of myopia in children, knowledge of Ortho-K and myopia control, and Ortho-K use for less than 6 months. CONCLUSION: These results indicate the need for a comprehensive education programme for parents with young myopic children to ensure strict adherence to fitting and wear protocols and good follow-up of Ortho-K lenses.

Trajectories of myopia control and orthokeratology compliance among parents with myopic children.

SIGNIFICANCE: This study set out to illustrate the trajectories of myopia control in time sequence and explore orthokeratology compliance for parents with myopic children in the first fitting within one year. Profiling these results is crucial to improving myopia control and orthokeratology care. PURPOSE: To obtain a better understanding of myopia control and orthokeratology care that could promote compliance with orthokeratology (ortho-K) lenses for parents with myopic children. METHODS: We conducted semi-structured qualitative interviews and pre-interview questionnaire surveys of the parent who is mainly responsible for complying to ortho-K lens care for their myopic children aged 7-12 years, including 16 mothers and 4 fathers. A framework analytical approach that involved gaining familiarity with the data to identify a thematic framework was used for data analysis. It was written in line with the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. RESULTS: Five themes and twelve subthemes depicted the parents' trajectory during myopia diagnosis, treatment, and compliance with ortho- K for their children in the first fitting within one year. Myopia control and the convenience of outdoor activities were important reasons for parents to actively ask for ortho-K lenses for their children. Parents have non-compliance behaviors after the children wore the lenses for three months, including not scheduling follow-up visits, simplifying cleaning procedures, not replacing accessories. The degree of parents' non-compliance differed based on the uncomfortable feelings of their child's eyes. In general, clear, unaided vision (visual acuity > 0.9) during the day was an indicator of ortho-K's effectiveness, according to parents. CONCLUSIONS: Although parents play a passive role when a child is diagnosed with myopia, they take on a proactive role when deciding on ortho-K treatment. Myopia treatment for children is a long-term process. Understanding the course of treatment and non-compliance helps eye care professionals provide parents with the necessary assistance and resources, and enables myopia treatment to yield maximum effects.

Effect of 0.01% atropine eye drops on choroidal thickness in myopic children.

PURPOSE: To examine the effects of low-dose atropine on the choroidal thickness (CT) of young children in Shanghai, China, as well as the ocular biometrics of myopic patients. METHODS: A total of 59 eyes of 35 myopic children had subfoveal CT and ocular biometry measurements taken before and after 2weeks, 4weeks, and 8weeks of treatment with 0.01% atropine. All eyes were measured using swept-source optical coherence tomography. CT and changes in it were also recorded. RESULTS: The choroid exhibited significant and continuous thickening under the fovea after patients were treated with 0.01% atropine. The magnitude of change in CT varied with the location and with the duration of treatment. The greatest change was observed in the fovea. There was no significant relationship between changes in subfoveal CT and axial length. CONCLUSIONS: Using 0.01% atropine eye drops significantly increased CT in eyes of young myopic children, by variable magnitude depending upon location.

The Effect of Treatment Zone Decentration on Myopic Progression during Or-thokeratology.

Purpose: To evaluate the relationship between magnitude of orthokeratology (OrthoK) treatment zone decentration and 2-year axial length (AL) elongation in myopic children.Methods: One-hundred and one Chinese children who wore OrthoK contact lenses for 2 years. The magnitude and direction of the OrthoK treatment zone center from the entrance pupil center were recorded after 3 and 24 months of lens wear along with AL measurement. Stepwise multiple linear regression analysis was performed to assess which factors significantly affected an increase in AL.Results: After 3 and 24 months of OrthoK treatment, the mean (± standard deviation [SD]) magnitude of the OrthoK treatment zone decentration was 0.64 ± 0.38 mm and 0.68 ± 0.32 mm, respectively. There were no significant differences between the two time points (P > .05). After 2 years of OrthoK contact lenses wear, the mean (± SD) AL growth was 0.36 ± 0.34 mm. The axial elongation was slightly correlated with baseline age of subjects (r = -0.073, P < .001), baseline spherical equivalent refractive error (r = -0.088, P < .001) and magnitude decentration of treatment zone (r = -0.190, P = .027).Conclusions: The decentration of OrthoK treatment zone stabilizes after 3 months of lens wear and slightly decreases AL growth.

Adverse effects of 0.01％ atropine sulfate eye drops on myopic children / 中华实验眼科杂志

Objective To observe the adverse effects of 0.01％ atropine sulfate eye drops on myopic children.Methods A prospective non-randomized controlled trial was conducted.Ninety-nine myopic children (99 right eyes) were randomly assigned to experimental group(55 cases) and control group(44 cases).Myopic children of experimental group wore completely corrected frame glasses,while 0.01％ atropine sulfate eye drop was dropped into each eye once a day before going to bed.Myopic children in control group only wore completely corrected frame glasses.The follow-up time was 4 months.Best corrected visual acuity (BCVA),intraocular pressure (IOP),change of pupil diameter (PD) and amplitude of accommodation,symptoms of discomfort after medication were observed.This study followed the Helsinki declaration and was approved by Ethic Committee of the First Affiliated Hospital of Zhengzhou University.Informed consent was signed by the parents of each patient.Results No significant differences were found in best corrected distance visual acuity (BCDVA),best corrected near visual acuity(BCNVA) and IOP between the two groups before and 4 months after treatment (BCDVA:Fgroup =3.880,P =0.112;Ftime =27.220,P =0.413;BCNVA:Fgroup =5.200,P =0.311;Ftime =38.200,P =0.116,IOP:Fgroup =12.350,P=0.214;Ftime =22.300,P =0.146).After 4 months treatment,the PD was (6.99 ±0.64) mm in the experimental group,which was significantly higher than that before treatment(P＜0.001).The PD of the experimental group was higher than that of the control group after 4 months treatment,and the difference was statistically significant (P＜0.01).The amplitude of accommodation in the experimental group was 14.01 ±3.98 after 4 months treatment.which was 1.20 D lower than that before treatment,the difference was statistically significant (P＜0.01).The amplitude of accommodation of the experimental group was lower than that of the control group after 4 months treatment,the difference was statistically significant (P ＜ 0.01).Four cases (8％) appeared photophobia symptoms.Two cases and 2 cases appeared photophobia for 1 week or 2 weeks,respectively.However this symptom would relieve after wear sunglasses or sunshade caps in outdoor activities.One case (2％) appeared ocular itching and swelling after 1 month treatment,but disappeared after withdrawal.There were no other uncomfortable symptoms such as near sight blurring.Conclusions In mainland of China,the BCDVA,BCNVA and IOP of myopic children are stable;the PD is dilated and the amplitude of accommodation is decreased slightly after 4 months treatment of 0.01％ atropine,and 10％ children appear photophobia,but do not affect their study and life.

The Effect of Atropine on Myopic Progression in Children

PURPOSE: To examine the effects of atropine therapy on myopic progression in myopic children. METHODS: Fifty myopic patients, aged from 7 to 14 years and less than -5 diopters, visited our clinic for correction of refractive error from August 2001, and were followed up for at least 1 year. Of these 50 patients, the atropine therapy group was 23 and the control group was 27. Right eye cycloplegic refraction and axial length changes of the two groups were compared and analyzed. RESULTS: There was a mean increase of myopia of 0.25+/-0.43 D/yr in the atropine therapy group and of 0.83+/-0.37 D/yr in the control group (P=0.000). There was a mean increase of axial length of 0.12+/-0.19 mm/yr in the atropine therapy group and 0.39+/-0.21 mm/yr in the control group (P=0.000). In refraction and axial length changes according to age, there was no statistically significant difference within the group, aged from 7 to 9 years. However, there was a statistically significant difference within the group, aged from 10 to 14 years. In refraction and axial length changes according to myopic grade, there were a statistically significant differences between the groups. CONCLUSIONS: Atropine therapy is effective in slowing the myopic progression in myopic children with refractive error less than -5 diopters.