Longitudinal changes in optical coherence tomography angiography characteristics in normal-tension glaucoma with or without high myopia.

PURPOSE: To evaluate the structural, microvascular, and functional progression of normal tension glaucoma (NTG) with or without high myopia by examining longitudinal changes in optical coherence tomography angiography (OCTA) and visual field (VF) parameters. METHODS: We evaluated 61 NTG eyes and classified 25 of the eyes with axial lengths (ALs) of ≥26 mm as highly myopic. We assessed the rate of change in OCTA parameters, namely radial peripapillary capillary (RPC) vessel density (VD), parafovea VD, deep parafovea VD, retinal nerve fibre layer (RNFL) thickness, and ganglion cell complex thickness. We evaluated the correlation of the rate of change in OCTA parameters with VF loss and AL. RESULTS: Among the 61 NTG eyes, rates of loss of RPC VD, parafovea VD, deep parafovea VD, and RNFL thickness were significantly different from zero despite the nonsignificant rate of change in VF mean deviation (MD). Changes in these OCTA parameters did not differ significantly in highly myopic NTG eyes. The rate of change in VF MD was significantly correlated with the rate of change in parafovea VD in highly myopic and non-highly myopic NTG eyes. In highly myopic NTG eyes, AL was negatively correlated with the rates of loss of RNFL thickness, VF MD, and VF PSD. CONCLUSION: NTG eyes with a relatively stable VF exhibited loss of VD and RNFL thickness. VF progression in NTG was correlated with decreasing parafovea VD, indicating a structure-function correlation. Greater AL may indicate faster VF loss and RNFL thinning in highly myopic NTG eyes.

Exploring the Location of Corneal Pigmented Arc and Myopia Control Efficacy in Orthokeratology-Treated Children Using Pentacam Measurements.

OBJECTIVES: To determine the location and intensity of the corneal pigmented arc in orthokeratology (ortho-k)-treated children and its relationship with annual axial length (AL) change using Pentacam. METHODS: This retrospective cohort study enrolled children aged 9 to 15 years who had been followed up for at least one year after ortho-k treatment for myopia control. A Pentacam was used to determine the location and intensity of pigmented arc after lens wear. Annual AL changes were further used as the outcome measurement to determine their relationships with the location and intensity of pigmented arc using generalized estimating equations (GEE). RESULTS: In total, 62 eyes from 33 patients (mean age 10.9 years) were included in our final analysis. The mean follow-up time was 30.6 months. The mean annual AL changes were 0.10 mm. Age statistically correlated with annual AL change (GEE, P= 0.033). In addition, the annual AL change was negatively associated with the relative vertical distance of the lowest density of pigmented arc point based on the visual center, pupil center, and corneal thinnest point after adjustment with age ( P =0.005, P =0.004, and P< 0.001, respectively). CONCLUSIONS: Pentacam could be a useful tool for evaluating the location and intensity of the corneal pigmented arc. In addition, there was a negative correlation between the vertical distance of the pigmented arc and annual AL change. These findings may provide important information regarding myopia control, next-generation ortho-k design, and prescription.

Treatment of Myopia with Atropine 0.125% Once Every Night Compared with Atropine 0.125% Every Other Night: A Pilot Study.

(1) Purpose: To investigate the efficacy of myopia treatment in children using atropine 0.125% once every two nights (QON) compared with atropine 0.125% once every night (HS). (2) Methods: This retrospective cohort study reviewed the medical records of two groups of children with myopia. Group 1 comprised children treated with atropine 0.125% QON, while group 2 included children treated with atropine 0.125% HS. The first 6 months of data of outcome measurements were subtracted as washout periods in those children undergoing both atropine QON and HS treatment. The independent t-test and Pearson's chi-square test were used to compare the baseline clinical characteristics between the two groups. A generalized estimating equations (GEE) model was used to determine the factors that influence treatment effects. (3) Results: The average baseline ages of group 1 (38 eyes from 19 patients) and group 2 (130 eyes from 65 patients) were 10.6 and 10.2 years, respectively. There were no significant differences in axial length (AL) or cycloplegic spherical equivalent (SEq) at baseline or changes of them after 16.9 months of follow-up. GEE showed that the frequency of atropine 0.125% use has no association with annual AL (QON vs. HS: 0.16 ± 0.10 vs. 0.18 ± 0.12) and SEq (QON vs. HS: -0.29 ± 0.44 vs. -0.34 ± 0.36) changes in all children with myopia. It also showed that older baseline age (B = -0.020, p < 0.001) was associated with lesser AL elongation. (4) Conclusion: The treatment effects of atropine 0.125% HS and QON were similar in this pilot study. The use of atropine 0.125% QON may be an alternative strategy for children who cannot tolerate the side effects of atropine 0.125% HS. This observation should be confirmed with further large-scale studies.

Retinal Neurodegeneration and Visual Acuity Decline in Patients with Chronic Kidney Disease.

INTRODUCTION: Chronic kidney disease (CKD) has been associated with accelerated retinal neurodegeneration. The purpose of this study is to evaluate the association between retinal neurodegeneration and the best-corrected visual acuity (BCVA) decline in patients with CKD. METHODS: Post hoc analysis of two prospective studies. Patients with CKD stage ≥ 3 were enrolled. Macular thickness, peripapillary retinal nerve fiber layer (pRNFL) thickness, and macular ganglion cell complex (GCC) thickness were measured by optical coherence tomography. Eyes were classified into three groups: Group 1, no GCC defect; Group 2, GCC defect confined to parafoveal area; and Group 3, GCC defects extending beyond the parafoveal area. Each group was matched for age, sex, axial length, lens status, and cataract grading. RESULTS: A total of 120 eyes (40 eyes in each group) from 120 patients (age 63.0 ± 10.3 years) were included. The logMAR BCVA was 0.076 ± 0.101, 0.100 ± 0.127, and 0.196 ± 0.191 in Group 1, 2, and 3, respectively. Group 3, but not Group 2, had a significantly worse BCVA than Group 1. In simple linear regression, parafoveal inner retinal thickness, pRNFL thickness, presence of pRNFL defect, GCC thickness, GCC global loss volume, GCC focal loss volume, and GCC defect extending beyond parafoveal area were associated with BCVA. Central subfield retinal thickness (CRT), parafoveal full retinal thickness, and parafoveal outer retinal thickness were not associated with BCVA. In backward stepwise linear regression, age and GCC defects extending beyond the parafoveal area were factors associated with BCVA. Moreover, GCC defect extending beyond parafoveal area was connected with worse BCVA in both phakic and pseudophakic subgroups. CONCLUSIONS: GCC defect extending beyond parafoveal area could be an independent biomarker associated with decreased BCVA in patients with CKD. However, macular thinning measured by CRT or parafoveal full retinal thickness might have low discriminative power in determining BCVA.

Accelerated Peripapillary Retinal Nerve Fiber Layer Degeneration in Patients With Chronic Kidney Disease: A 2-Year Longitudinal Study.

Purpose: To evaluate the longitudinal changes in the peripapillary retinal nerve fiber layer (pRNFL) in patients with chronic kidney disease (CKD). Methods: In this prospective cohort study, the CKD group consisted of patients with CKD stage ≥ 3. Age-matched healthy controls were enrolled at a 1:4 ratio. Spectral-domain optical coherence tomography was used to measure the pRNFL at baseline, 1 year, and 2 years. Within-group longitudinal changes and between-group comparisons were performed using linear mixed models. Results: Overall, 152 patients with CKD and 40 controls were included (mean ages, 62.8 ± 9.1 years vs. 63.0 ± 9.3 years; P = 0.931). The CKD group showed faster loss of pRNFL than the control group (-0.87 µm/y vs. -0.26 µm/y; P = 0.004). Subgroup analysis found that the rate of pRNFL change was -0.41 µm/y in stage 3a CKD, -0.74 µm/y in stage 3b, -0.98 µm/y in stage 4/5, and -1.38 µm/y in end-stage renal disease. Multiple linear regression analysis revealed that CKD stage (coefficient = -0.549; 95% confidence interval [CI], -0.966 to -0.131; P = 0.010), hypertension (coefficient = -1.557; 95% CI -3.013 to -0.101; P = 0.036), and rim area (coefficient = -1.505; 95% CI, -2.940 to -0.070; P = 0.040) were factors associated with the pRNFL change over 2 years. Conclusions: Patients with CKD experienced faster pRNFL loss than healthy controls did. Severity of CKD, hypertension, and rim area were independent factors associated with the loss of pRNFL. Translational Relevance: This study contributes to our understanding of retinal neurodegeneration in normal aging and in patients with chronic kidney diseases.

Association of Intraocular Pressure and Optical Coherence Tomography Angiography Parameters in Early Glaucoma Treatment.

This prospective study aimed to explore the effect of medical intraocular pressure (IOP) reduction on structural and capillary vessel density (VD) change by optical coherence tomography (OCT) angiography in early glaucoma. Patients with newly diagnosed glaucoma and a follow-up of ≥6 months were enrolled. An ocular examination that included slit-lamp bio-microscopy, pneumatic tonometry, gonioscopy, standard automated perimetry, and OCT angiography was performed. Quantitative OCT angiography parameters were assessed using a linear mixed model that was adjusted for inter-eye correlation. The correlations between IOP changes and OCT angiography parameter changes were analyzed using Spearman's correlation test. In total, 52 eyes of 36 participants, including 33 glaucoma eyes of 17 participants and 19 healthy eyes of 19 participants served as the case and control groups, respectively. The IOP of the case group decreased from a baseline mean of 20.4 ± 0.8 mmHg to 15.7 ± 0.5 mmHg at 3 months (p < 0.001) and to 16.1 ± 0.5 mmHg at 6 months (p < 0.001). For the subgroup with an IOP reduction of >20%, the deep macula VD was negatively correlated with baseline IOP and significantly decreased at 3 months follow-up. Additionally, change in retinal nerve fiber layer (RNFL) was positively correlated with a change in IOP at 6 months. In conclusion, the deep-layer macula VD was correlated with baseline IOP and influenced by the reduction in IOP in the short term. The changes in VD revealed the vulnerability of the deep vascular complex. The OCTA parameters provide in vivo monitoring information during medical treatment for early glaucoma.

Zebrafish (Danio rerio) Is an Economical and Efficient Animal Model for Screening Potential Anti-cataract Compounds.

Purpose: To develop a zebrafish cataract model for screening potential anti-cataract compounds. Methods: Living zebrafish were anesthetized and exposed to ultraviolet-C (UV-C) irradiation at a dosage of 3250 mJ/cm2/d until they developed severe cataracts. These cataracts were graded based on photographs analyzed with ImageQuant TL version 7.0. Fish with severe cataracts were used to evaluate a range of compounds for cataract treatment, including the previously demonstrated hit compound lanosterol. For the initial evaluation, fish were divided into four groups: no treatment, balanced salt solution, ß-cyclodextrin (ß-CD), and lanosterol dissolved in ß-CD. The treatments were performed for 10 days, and the clarity of lenses was evaluated. To assess the persistence of treatment, fish were treated with ß-CD and lanosterol dissolved in ß-CD for seven consecutive days followed by monitoring for three days without treatment. Results: The average time for zebrafish to develop severe cataracts using the present UV-C irradiation protocol was 7.8 days (range 4-15 days). Both study designs required only another 10 days to determine the effect of hit compounds. The total experimental period could be completed within one month, and the entire experiment was economical. Conclusions: We could assay a large number of hit compounds at a reasonable cost and within a short time using this newly developed zebrafish cataract model. These assays may allow development of an efficient platform for screening potential anti-cataract compounds. Translational Relevance: The results may facilitate the development of ani-cataract medication for humans after further experiments and investigations.

An Assessment of Cataract Severity Based on Antioxidant Status and Ascorbic Acid Levels in Aqueous Humor.

Cataract is the leading cause of blindness throughout the world. Currently, the cataract severity evaluation is based on the subjective LOCS III guideline. To ameliorate the evaluation system and develop an objective and quantitative analysis, we investigated the relationships among aqueous humor total antioxidant capacity (AqTAC), ascorbic acid (AqAA) concentration, and cataract severity. In this study, we enrolled 130 cataract patients who underwent phacoemulsification between April 2019 and March 2020. The AqTAC and AqAA were measured by our own developed TAC assay and commercially available kit. Cataract severity was recorded by nuclear opalescence (NO) and cortical cataract (CC) degree according to LOCS III. Cumulative dissipated energy (CDE) during phacoemulsification was recorded to verify the severity of the cataract. As a result, we found a moderate correlation between AqTAC and CDE (p < 0.001). In addition, we found AqTAC independently associated with the CDE when analyzed by multivariate linear regression (p < 0.001). AqTAC also negatively correlated to cataract severity when measured by NO and CC (p = 0.012 in NO grade 3 vs. grade 1; p = 0.012 in CC grade 2 vs. grade 1; p < 0.001 in CC grade 3 vs. grade 1). We further found AqAA provided 71.9 ± 13.5% of AqTAC, and showed a high correlation (rho = 0.79, p < 0.001). In conclusion, we found a significant correlation between AqTAC/AqAA and cataract severity measured by CDE. The correlation was superior to the correlation between LOCS III and CDE. Aqueous humor TAC owns the potential to assess cataracts in an objective and quantitative way.

Refractive Changes Following Premature Posterior Capsulotomy Using Neodymium:Yttrium-Aluminum-Garnet Laser.

We aimed to determine the timing of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy on corrected-distance visual acuity (CDVA), intraocular pressure (IOP), and spherical equivalent (SE) in patients with posterior capsular opacification (PCO). There were 59 patients with unilateral PCO and a history of Nd:YAG laser capsulotomy enrolled and further divided into the early Nd:YAG group (timing < 12 months, n = 25) and late Nd:YAG group (timing > 12 months, n = 34) depending on the elapsed months from phacoemulsification to Nd:YAG laser capsulotomy. The primary outcomes were CDVA, IOP, and SE before (immediately before Nd:YAG laser capsulotomy) and after (weeks one and four after the laser treatment). The independent t test was applied to analyze the difference in CDVA, IOP, and SE between the two groups, while the generalized estimating equation with Bonferroni adjustment was conducted to evaluate the effect of all the parameters on the change in SE with adjusted odds ratio (aOR) and 95% confidence interval (CI). The CDVA showed significant improvement in both the early Nd:YAG group (p = 0.005) and the late Nd:YAG group (p = 0.001), and hyperopic change occurred in both the early Nd:YAG group (p = 0.003) and the late Nd:YAG group (p = 0.017). The early Nd:YAG group revealed more significant hyperopic change compared with the late Nd:YAG group four weeks after Nd:YAG treatment (p < 0.001), which was still significant after multivariable analysis (aOR: 0.899, 95% CI: 0.868-0.930, p = 0.011). In addition, a deeper ACD (aOR: 0.764, 95% CI: 0.671-0.869, p = 0.019) was significantly correlated with hyperopic change. In conclusion, Nd:YAG laser capsulotomy performed within one year after cataract surgery may lead to significant hyperopic change, in which the ACD alteration affects the hyperopic shift significantly.

Efficacy of Myopia Control and Distribution of Corneal Epithelial Thickness in Children Treated with Orthokeratology Assessed Using Optical Coherence Tomography.

The association between myopia control efficacy in children treated with orthokeratology and corneal epithelial thickness is still unknown. The aim of this study was to explore the corneal epithelial thickness and its association with axial length changes in children treated with orthokeratology. This retrospective cohort study enrolled children aged from 9 to 15 years who had received orthokeratology for myopia control and had been followed up for at least 1 year. Anterior segment optical coherence tomography was performed to generate wide epithelial thickness maps of the patients. Annual axial length changes were calculated from the axial length at 6 months after the initiation of orthokeratology lens wear and at final measurements. Corneal epithelial thickness data were obtained from 24 sectors and a central 2 mm zone of the wide epithelial thickness map. Associations between annual axial length changes and corneal epithelial thickness for each sector/zone of the wide epithelial thickness map, and orthokeratology treatment data were determined by generalized estimating equations. Finally, a total of 83 eyes of 43 patients (mean age 11.2 years) were included in the analysis. The mean annual axial length change was 0.169 mm; when regressing demographic and ortho-k parameters to mean annual axial length changes, age and target power were both negatively associated with them (ß = -14.43, p = 0.008; ß = -0.26, p = 0.008, respectively). After adjusting for age and target power, the annual axial length changes were positively associated with the corneal epithelium thickness of IT1, I1, SN2, and S2 sectors of the wide epithelial thickness map, and negatively with that of the I3 sector. In conclusion, we identified associations between annual axial length changes and the corneal epithelium thickness of certain sectors in children treated with orthokeratology. This may facilitate the design of orthokeratology lenses with enhanced efficacy for myopia control.

Corneal Endothelial Changes Following Early Capsulotomy Using Neodymium:Yttrium-Aluminum-Garnet Laser.

We aimed to survey whether the timing of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy would alter the corneal endothelial morphology and density. A retrospective cohort study was conducted, and 48 patients with unilateral posterior capsular opacity (PCO) and Nd:YAG laser capsulotomy performance were enrolled. The participants were divided into the early Nd:YAG group (timing ≤ 12 months, n = 20) and late Nd:YAG group (timing > 12 months, n= 28) depending on elapsed months between phacoemulsification and Nd:YAG laser capsulotomy. Endothelial cell density (ECD), coefficient of variant (CV), hexagonality (HEX), and central corneal thickness (CCT) between the two groups were collected. A generalized estimate equation was conducted to evaluate the corneal endothelial parameters between the two groups with an adjusted odds ratio (aOR) and 95% confidence interval (CI). The CDVA was improved after treatment in both groups (both p < 0.001). Chronically, ECD in the early group was significantly decreased one week after treatment (2221.50 ± 327.73/mm2 vs. 2441.55 ± 321.80/mm2, p < 0.001), which recovered to 2369.95 ± 76.37/mm2 four weeks after the treatment but was still lower than the preoperative status (p < 0.001). In addition, the HEX percentage showed a significant reduction at four weeks after treatment (p = 0.028). The ECD in the early group was significantly lower than that in the late group (aOR: 0.167, 95% CI: 0.079-0.356, p = 0.003) in both week 1 (p < 0.001) and week 4 (p = 0.004) after laser treatment. In conclusion, the early application of Nd:YAG laser capsulotomy within one year after cataract surgery may be the reason for postoperative ECD decrement without known etiology.

Investigation of Possible Correlation Between Retinal Neurovascular Biomarkers and Early Cognitive Impairment in Patients With Chronic Kidney Disease.

Purpose: To investigate the association between retinal neurovascular biomarkers and early cognitive impairment among patients with chronic kidney disease (CKD). Methods: Patients with CKD stage ≥3 were evaluated using the standardized Mini-Mental State Examination (MMSE). Patients were classified as having a low (<24), middle (24 to 27), and high (>27) MMSE level. Retinal nerve fiber layer thickness, ganglion cell complex (GCC) thickness, GCC global loss volume, and GCC focal loss volume were measured using optical coherence tomography (OCT). Superficial vascular plexus vessel density, deep vascular plexus vessel density (DVP-VD), and size of the foveal avascular zone were obtained by OCT angiography. Results: The study enrolled 177 patients with a mean ± SD age of 64.7 ± 6.6 years. The mean ± SD MMSE score was 27.25 ± 2.30. Thirteen, 65, and 99 patients were classified as having a low, middle, and high MMSE level, respectively. The patients with a high MMSE level were younger, had more years of education, had less severe CKD, and had higher DVP-VD than patients with a low MMSE level. The multivariable regression revealed that age (coefficient, 0.294; 95% confidence interval [CI], 0.195-0.393; P = 0.041), years of education (coefficient, 0.294; 95% CI, 0.195-0.393; P < 0.001), estimated glomerular filtration rate (coefficient, 0.019; 95% CI, 0.004-0.035; P = 0.016), and DVP-VD (coefficient, 0.109; 95% CI, 0.007-0.212; P = 0.037) were independent factors associated with MMSE score. Conclusions: Retinal DVP-VD was associated with early cognitive impairment among patients with CKD. Translational Relevance: DVP-VD measured by OCT angiography may facilitate early detection of cognitive impairment.

Evaluation of axial length to identify the effects of monocular 0.125% atropine treatment for pediatric anisometropia.

The aim of the study is to determine the effects of monocular 0.125% atropine daily treatment on the longer axial length (AL) eyes in children with pediatric anisometropia. This was a retrospective cohort study. The charts of children with anisometropia (aged 6-15 years) who had a > 0.2-mm difference in AL between the two eyes were reviewed. Children who received monocular treatment of 0.125% atropine in the eye with longer AL were included for final analysis. The main outcome measure was the difference in AL between the two eyes after treatment. Regression analysis was used to model the changes in AL according to the time of treatment in both eyes. Finally, forty eyes in 20 patients (mean age 10.2 years) were included in the analyses. During the treatment period, AL was controlled in the treated eyes (p = 0.389) but elongated significantly in the untreated eyes (p < 0.001). The difference in AL between the treated and untreated eyes decreased from 0.57 to 0.22 mm (p < 0.001) after the 1-year treatment period. In the regression model, the best fit for the relationship between changes in AL and time during the treatment period in the treated eyes was the quadratic regression model with a concave function. In conclusion, these data suggest that 0.125% atropine daily is an effective treatment to reduce the interocular difference of AL in eyes with axial anisometropia. This pilot study provides useful information for future prospective and larger studies of atropine for the treatment of pediatric axial anisometropia.

Higher HbA1c may reduce axial length elongation in myopic children: a comparison cohort study.

AIMS: To compare the annual axial length (AL) changes in myopic children with type 1 diabetes mellitus (T1DM) and those without diabetes. METHODS: There are two groups of myopic children in this retrospective cohort study. Group 1 consisted of myopic children with T1DM (44 eyes of 22 patients). Group 2 comprised age-matched myopic children without diabetes (44 eyes of 22 children). These two groups were compared with regard to their baseline clinical characteristics. A generalized estimating equations (GEE) model was also used to determine the most likely factor that contributed to the results. RESULTS: The average ages of group 1 and group 2 were 14.8 and 14.6 years, respectively. Children in group 1 had significantly slower annual AL changes (0.051 mm/year vs 0.103 mm/year; 50.5% slower, P = 0.011) and shorter baseline AL (23.97 vs 25.19 mm, P < 0.001) than those in group 2. GEE also showed that serum glycated hemoglobin (HbA1c) level (B = -0.023, P = 0.039) was the most important factor in reducing AL elongation in group 1 myopic children. CONCLUSIONS: Long-term higher HbA1c level may reduce AL elongation. A strict blood sugar control strategy in clinical practice is warranted to axial myopia progression in T1DM children.

Impact of blood pressure control on retinal microvasculature in patients with chronic kidney disease.

Chronic kidney disease (CKD) is an emerging disease worldwide. We investigated the relationship between blood pressure (BP) control and parafoveal retinal microvascular changes in patients with CKD. This case-control study enrolled 256 patients with CKD (stage 3-5) and 70 age-matched healthy controls. Optical coherence tomography angiography showed lower superficial vascular plexus (SVP) vessel density, lower deep vascular plexus (DVP) vessel density, and larger SVP flow void area in the CKD group. The BP parameters at enrollment and during the year before enrollment were collected in patients with CKD. Partial correlation was used to determine the relationship between BP parameters and microvascular parameters after controlling for age, sex, diabetes mellitus, axial length, and intraocular pressure. The maximum systolic blood pressure (SBP) (p = 0.003) and within-patient standard deviation (SD) of SBP (p = 0.006) in 1 year were negatively correlated with SVP vessel density. The average SBP (p = 0.040), maximum SBP (p = 0.001), within-patient SD of SBP (p < 0.001) and proportion of high BP measurement (p = 0.011) in 1 year were positively correlated with the SVP flow void area. We concluded that long-term SBP was correlated with SVP microvascular injury in patients with CKD. Superficial retinal microvascular changes may be a potential biomarker for prior long-term BP control in these patients.

Correlation of corneal pigmented arc with wide epithelial thickness map in orthokeratology-treated children using optical coherence tomography measurements.

PURPOSE: To determine the intensity of corneal pigmented arc in orthokeratology (ortho-k)-treated children and its correlation with wide epithelial thickness map (ETM) obtained through anterior segment optical coherent tomography (AS-OCT). METHODS: This retrospective case series reviews medical records of children who received ortho-k treatment for myopia control. Intensity of ortho-k-associated pigmented arc after wearing ortho-k lens more than 12 months and its correlation with each sector/zone of wide ETM obtained by AS-OCT was explored. Pigmented arcs were further divided into apparent and unapparent groups, and the clinical differences between groups were determined. RESULTS: This study included 57 eyes of 29 children (mean age, 11.4 years, range 9-15); after initiating ortho-k treatment, the incidence of the corneal pigmented arc was 91.2% with mean lens wear duration of 26.1 months. Intensity of pigmented arc was significantly correlated with lens wear duration, target power, baseline degree of myopia, C zone and sectors I2, I3 and IT3 on wide ETM. Comparison between apparent and unapparent groups showed the same significant results except for C zone. After adjusting for lens wear duration and target power, sector I2 has the highest association with pigmented arc severity. CONCLUSION: Children treated with ortho-k are likely to develop ortho-k-associated pigmented arcs. The new wide ETM of AS-OCT can provide important information regarding the intensity of pigmented arc in these children. This can support customized pigmented arc-free ortho-k treatment for children in the future.

Retinal neurovascular changes in chronic kidney disease.

PURPOSE: To examine retinal neurovascular changes in patients with chronic kidney disease (CKD). METHODS: Case-control study. A total of 171 CKD cases and 40 controls were recruited (mean age 62.9 ± 10.3 versus 60.8 ± 9.2, p = 0.257). Retinal neural parameters, including parafoveal retinal thickness (PfRT), macular ganglion cell complex thickness (GCCt), global loss volume (GLV), focal loss volume (FLV) and peripapillary retinal nerve fibre layer thickness (RNFLt), were measured using optical coherence tomography (OCT). Microvascular parameters, including foveal avascular zone size, vessel density over the parafoveal superficial vascular plexus (SVP-VD), parafoveal deep vascular plexus (DVP-VD) and radial peripapillary capillary (RPC-VD), were measured using OCT angiography. RESULTS: Chronic kidney disease (CKD) patients showed reduced PfRT, GCCt and RNFLt and increased GLV and FLV compared with the controls (all p < 0.005). Among patients with CKD, estimated glomerular filtration rate was an independent factor associated with PfRT (coefficient 0.19, p = 0.015), GCCt (coefficient 0.10, p = 0.006), GLV (coefficient - 0.08, p = 0.001), FLV (coefficient - 0.02, p = 0.006) and RNFLt (coefficient 0.15, p = 0.002). Parafoveal retinal thickness (PfRT), GCCt, GLV, FLV and RNFLt were correlated with SVP-VD (all p < 0.001) but not with DVP-VD (all p > 0.1). CONCLUSIONS: Chronic kidney disease (CKD) patients demonstrated a significant reduction in macular thickness and changes in retinal neural parameters. These changes were associated with the severity of CKD and correlated with the microvascular rarefaction in the parafoveal SVP.

Correlation between higher-order aberrations and visual acuity recovery (CoHORT) after spectacles treatment for pediatric refractive amblyopia: A pilot study using iDesign measurement.

PURPOSE: To determine the correlation between higher-order aberrations (HOAs) and best-corrected visual acuity (BCVA) recovery speed after spectacles treatment using iDesign measurements in refractive amblyopic children. METHODS: This is a prospective case series. Children aged from 3 to 7 years with refractive amblyopia (Landolt C equivalent < 0.8) were recruited. All participants were followed for at least 6 months after full correction of the refraction error by spectacles. The HOAs were measured using iDesign before and after cycloplegia at first visit and at 3-month intervals. Then correlation between BCVA recovery after treatment for 6 months and HOAs was determined. RESULTS: We analyzed 24 eyes of 12 children (mean age, 4.5 years). Baseline mean BCVA was logarithm of minimal angle of resolution (logMAR) 0.335 (Landolt C equivalent 0.46), which improved to logMAR 0.193 (Landolt C equivalent 0.64) after treatment with full-correction spectacles for 6 months. The amblyopic eye BCVA recovery was negatively correlated with tetrafoil with/without cycloplegia (P = 0.006 and 0.022, respectively) and trefoil with cycloplegia (P = 0.049). CONCLUSIONS: trefoil and tetrafoil measured with iDesign negatively correlates with the BCVA recovery speed of refractive amblyopic eyes after spectacles treatment in this pilot study. The current study results may aid in further investigation for diagnosis and treatment of refractory refractive and idiopathic amblyopia.

Correlation between pigmented arc and epithelial thickness (COPE) study in orthokeratology-treated patients using OCT measurements.

PURPOSE: To determine the intensity of corneal pigmented arc in orthokeratology (ortho-k)-treated children, and its correlation with key epithelial thickness measurements obtained by anterior segment optical coherence tomography (AS-OCT). METHODS: This study is a retrospective case series. Medical records of children who received ortho-k treatment for myopia control in our hospital were reviewed. Intensity of ortho-k-associated pigmented arc and its correlation with key epithelial thickness parameters in the central 7-mm-diameter zone obtained by AS-OCT was examined. The subjects were further divided into apparent and unapparent pigmented arc groups for severity comparison. RESULTS: The mean age of children was 11.4 years, and the incidence of corneal pigmented arc was 92.2% after lens wear for a mean duration of 21.2 months. Intensity of pigmented arc was found to be significantly correlated with key epithelial thickness parameters, including maximum and minimum epithelial thickness (Spearman's rank correlation coefficient (rs) = 0.404, P = 0.003; rs = - 0.426, P = 0.002, respectively), the difference between them (Min-Max) (rs = -0.624, P < 0.001) and standard deviation (rs = 0.659, P < 0.001). Significant correlation between intensity of pigmented arc and ortho-k target power (rs = 0.454, P = 0.001) was found. Comparison between the two groups showed significant difference in the same key epithelial thickness parameters. CONCLUSIONS: Children receiving ortho-k treatment tended to develop pigmented arcs. Significant correlation between intensity of pigmented arc and key epithelial thickness parameters was observed. AS-OCT can be a useful tool for predicting intensity of pigmented arc in ortho-k-treated children.