Effects of orthokeratology and spectacle lenses with highly aspherical lenslets on unilateral myopic anisometropia control.

PURPOSE: To evaluate the 1-year effects of orthokeratology (OK) lenses and spectacle lenses with highly aspherical lenslets (HALs) on axial length (AL) elongation in children with unilateral myopic anisometropia. METHODS: This ambispective cohort study recruited 81 children aged 8-14 years with unilateral myopic anisometropia. Of these, 42 participants (mean age 11.07 ± 1.54 years; 23 males) were treated with monocular OK lenses (OK group), and 39 (mean age 10.64 ± 1.72 years; 22 males) with binocular HALs (HAL group). Changes in AL and spherical equivalent refraction (SER) from baseline at 3, 6 and 12 months were compared between eyes and groups. Kaplan-Meier estimation and Cox proportional hazard regression were performed to analyse the risk of myopia onset in the initially non-myopic eyes. RESULTS: Mean axial elongation in the myopic and non-myopic eyes at the 12-month follow-up visit were 0.17 ± 0.20 and 0.41 ± 0.26 mm in the OK group (p < 0.001) and 0.10 ± 0.15 and 0.12 ± 0.12 mm in the HAL group (p = 0.32), respectively. Compared with the OK group, the non-myopic eyes in the HAL group had less axial elongation, lower cumulative myopia incidence and percentage of participants with rapid myopic shift at the 6- and 12 month follow-up (all p < 0.05). Cox regression analysis showed that a higher initial SER decreased the risk of myopia onset significantly in the initially non-myopic eyes (B = -2.06; 95% CI, 0.03-0.49; p = 0.003). CONCLUSIONS: Monocular OK lenses suppressed axial elongation in the myopic eye and minimised anisometropia; however, the non-treated contralateral eye may experience faster myopia onset and myopic shift. Binocular HALs can effectively reduce axial elongation in both eyes of children with unilateral myopic anisometropia.

Refractive features and amblyopia in Duane's Retraction Syndrome: A review of the 582 patients / Características refractivas y ambliopía en el síndrome de retracción de Duane: una revisión de los 582 pacientes

Purpose: To report the visual and refractive characteristics and the prevalence of amblyopia in patients with different types of Duane's Retraction Syndrome (DRS). Method: This retrospective study was performed on hospital records of 582 DRS patients at Farabi Hospital, Iran, from 2012 to March 2022. Results: The mean age of patients was 19.4 ± 11.9 (range, 3–70) years [335 (57.6 %) females and 247 (42.4 %) males (P < .001)]. DRS type I, II, III, and IV were presented in 347 (59.6 %), 148 (25.4 %), 82 (14.1 %), and 5 (0.9 %) patients, respectively. There were 530 (91.1 %) patients with unilateral and 52 (8.9 %) with bilateral involvement. In the unilateral patients, the DRS eyes' corrected distance visual acuity (CDVA) and astigmatism were significantly worse than the Non-DRS Eyes (P < .001). The mean amount of all refractive and visual parameters in bilateral patients' right or left eyes was significantly lower than in unilateral patients' non-DRS eyes (all P < .05). Anisometropia was observed in 75(12.9 %) of the patients. Amblyopia was observed in 18.5 % (98 patients) and 36.5 % (19 patients) of unilateral and bilateral DRS patients, respectively (P < .001). In unilateral patients, amblyopia was found in 57 (16.4 %) patients with Type I, 22 (14.9 %) patients with Type II, 16 (19.5 %) patients with Type III, and 3 (60 %) patients with Type IV. Forty-four (37.6 %) of patients with amblyopia had anisometropia. Conclusion: This large-scale study indicates that DRS types differ in terms of refractive error, visual acuity, and the prevalence of amblyopia and anisometropia. Clinicians should be aware of the clinical features associated with different types of DRS.(AU)

Reconnecting Anisometropic Amblyopic Eyes to the Cortex: VEP-Based Auditory Biofeedback.

OBJECTIVE: This study aimed to evaluate the effectiveness of a visual rehabilitation method for anisometropic amblyopia that uses visual evoked potential (VEP) parameters and sound biofeedback to increase objectiveness. DESIGN: an observational, case-controlled trial. SETTING: Ophthalmology Clinic, Emergency County Hospital, Cluj-Napoca, Romania. PARTICIPANTS: Sixteen subjects with amblyopic anisometropia, aged 15-57, and sixteen controls, aged 24-33, were included. INTERVENTIONS: Subjects were divided into two groups. The control group, composed of normal-vision subjects, and the amblyopic group received 10 training sessions. The rehabilitation program lasted 10 min, took place twice a week, and ran over five consecutive weeks. During each session, the subjects were asked to fixate on a target on the computer screen and were instructed to keep the fixation and maintain the sound of the biofeedback at high frequency. MAIN MEASURES: The study assessed the main visual parameters at baseline, after 10 sessions, and 1, 3, 6, and 12 months after treatment. Performance was evaluated by measuring visual acuity, contrast sensitivity, and reading velocity (words/minute). RESULTS: In the experimental group, mean BCVA improved with two rows, which means an improvement in the LogMARLogMAR scale with an average of nine letters. These values tended to be maintained over time. Both groups showed better reading velocities after training, but this parameter has undergone large variability during follow-ups. Contrast sensitivity was also improved and stable. CONCLUSIONS: Visual rehabilitation with the Retimax Vision Trainer can improve visual performance in patients with amblyopia after the critical period, an improvement that is maintained in most cases for at least one year after treatment.

Baseline characteristics of children in the early glasses study.

PURPOSE: The relationship between refractive error at age 1 and the risk of developing amblyopia or accommodative esotropia, and the protection offered by early glasses, is unknown. These are determined in the Early Glasses Study, a prospective, population-based, longitudinal, randomized controlled study. We report baseline findings. METHODS: Healthy children aged 12-18 months were recruited at Children's Healthcare Centres (CHCs) and received an entry orthoptic examination followed by cycloplegic retinoscopy. Children with amblyopia, strabismus, ophthalmic disease or very high refractive error were excluded. Those exceeding the AAPOS 2003 Criteria (> + 3.5D spherical equivalent (SE), > 1.5D astigmatism, > 1.5D anisometropia) were randomized into wearing glasses or not, and are followed-up by research orthoptists. Other children are followed-up by regular vision screening at CHCs and visual acuity is measured in all children at age 4. RESULTS: Parents of 865 children were called, 123 were excluded. Of 742 children enrolled, 601 underwent the entry orthoptic examination at age 14.5 ± 1.7 months. Mean SE was + 1.73 ± 1.18D, astigmatism -0.70 ± 0.44D, anisometropia 0.21D (IQR: 0-0.25). Of 62 (10.3%) children exceeding the Criteria, 52 were randomized into wearing glasses or not. Of 539 other children, 522 are followed up at CHCs. In total, 31 were excluded: 2 had strabismus and amblyopia, 7 strabismus, 2 amblyopia suspect, 1 strabismus suspect, 1 squinting during sinusitis, 4 excessive refractive error, 9 myopia, 2 ptosis, 1 oculomotor apraxia, 1 Duane syndrome, 1 congenital nystagmus. CONCLUSION: Prevalence of strabismus (10/601) was as expected, but prevalence of amblyopia (2/601) was low, suggesting that common amblyopia develops later than generally thought. KEY MESSAGES: What is known High refractive errors cause amblyopia, but no study has determined the exact relationship between the kind and size of refractive error at age 1 and the risk to develop amblyopia, and assessed the protective effect of glasses in a controlled, population-based, longitudinal study. What is new At baseline, 601 children received a full orthoptic examination followed by retinoscopy in cycloplegia at the age of 14.5 ± 1.7 months; 10.3% had high refractive error exceeding spherical equivalent > + 3.5D, > 1.5D astigmatism, > 1D oblique astigmatism or > 1.5D anisometropia. The prevalence of amblyopia was lower (0.3%) than expected, suggesting that most amblyopia develops after the first year of life. The prevalence of anisometropia, associated with amblyopia in older children, was low (0.8%).

Prevalence of Amblyogenic Risk Factors Among School Children in India Using the Spot Vision Screener.

INTRODUCTION: Amblyopia is a common cause of preventable visual impairment in children, affecting 1% to 6% globally. This study assesses amblyopia prevalence and risk factors among school children in rural Telangana, India, using the Spot Vision Screener (Welch Allyn, Inc., Skaneateles Falls, New York, USA), a portable, noninvasive device recommended for automated vision screening. METHODS: A cross-sectional study was conducted on 714 schoolchildren aged 5-10 years. Screening was performed using the Spot Vision Screener, evaluating refractive errors, ocular alignment, and other amblyopia risk factors. Children identified with potential amblyogenic factors were referred for comprehensive ophthalmological evaluation to confirm diagnosis. RESULTS: Out of 714 children screened, 84 were referred by the Spot Vision Screener for further evaluation. Subsequent examination by ophthalmologists confirmed amblyopia in 65 children, resulting in a prevalence of 9.10%. Myopic refractive error was the most prevalent (69.23%), followed by astigmatism (21.53%) and hypermetropia (9.23%) among amblyopia cases. CONCLUSION: The Spot Vision Screener proved to be a reliable tool for identifying amblyopia risk factors in school children, facilitating early detection and referral for appropriate management. This study underscores the importance of implementing effective vision screening programs in rural settings to mitigate preventable childhood blindness.

Spectacle correction may affect refractive progression in children with unilateral myopic anisometropia: A retrospective study.

OBJECTIVE: To investigate the effect of spectacle correction on refractive progression in children with unilateral myopic anisometropia (UMA). METHODS: In this retrospective study, 153 children with UMA (aged 8-12 years) were recruited and classified into an uncorrected (UC) group (n = 47) and a spectacle (SP) group (n = 106). The spherical equivalent refraction (SER) of the myopic eyes ranged from -0.75 to -4.00 D; the SER of the emmetropic eyes ranged from +1.00 to -0.25 D; anisometropia was ≥1.00 D and the follow-up duration was 1 year. Nineteen subjects from the SP group with follow-up records spanning at least 6 months before and after wearing spectacles were selected as a subgroup. Changes in the SER and axial length (AL), the degree of anisometropia and interocular AL differences of the two groups and the subgroup were analysed. RESULTS: During the 1-year follow-up period, AL and SER changes in myopic eyes were significantly greater than those in emmetropic eyes in the UC group (p < 0.001). For the UC group, the degree of anisometropia and AL change increased (all p < 0.001). For the SP group, there were no significant differences in the degree of anisometropia or AL change (all p > 0.05). When comparing the groups, AL elongation of the myopic eyes in the UC group occurred significantly faster than in the SP group (p = 0.02), and AL elongation for the emmetropic eyes in the UC group occurred significantly slower than in the SP group (p = 0.04). For the subgroup, the AL and SER changes in the myopic eyes 6 months before wearing spectacles occurred significantly faster than those after correction (p < 0.001). CONCLUSIONS: Spectacle correction could prevent increased anisometropia in uncorrected children with UMA by slowing myopia progression in the myopic eyes and accelerating the myopic shift in the contralateral eye.

Visual Performance of Children with Amblyopia after 6 Weeks of Home-Based Dichoptic Visual Training.

OBJECTIVES: This study was aimed at analyzing the efficacy on the improvement of the visual function of a dichoptic online cloud-based platform for the treatment of amblyopia in anisometropic children. METHODS: A quasi-experimental (pretest-post-test) study was conducted in 23 subjects with ages from 5 to 15 years old with anisometropic amblyopia combined with additional presence (2 subjects) or not (21 subjects) of microtropia. A total of 30 home-based training sessions of 30 min per session with Bynocs® platform were prescribed for 6 weeks. RESULTS: Amblyopic eye logMAR visual acuity (VA) significantly improved from 0.28 ± 0.24 to 0.13 ± 0.20 after the 6-week treatment (p < 0.001). At baseline, 60.9% of participants had VA in amblyopic eye of 0.20 logMAR or worse, whereas this percentage decreased to 21.7% after treatment. Binocular function (BF) significantly improved from 2.82 ± 1.11 to 2.32 ± 0.94 (p < 0.001). Mean compliance was 92%, 87% and 93% at 2, 4 and 6 weeks of treatment, respectively. CONCLUSIONS: In conclusion, home-based dichoptic training with the digital platform evaluated is an effective method to improve amblyopic VA and stereoacuity in children with anisometropic amblyopia combined or not with microtropia.

How does the Surgical Repair of Ptosis Impact Refractive Error?

PURPOSE: To identify a correlation between the degree of congenital ptosis and levels of refractive error, visual stimulus deprivation and anisometropic amblyopia, and any improvement with surgical intervention. METHODS: A prospective investigation of 30 patients aged 3 months to 8 years, with a diagnosis of unilateral or bilateral congenital ptosis. A full orthoptic assessment and cycloplegic refraction were performed and patients requiring surgical intervention for ptosis were at surgeon discretion. RESULTS: The mean age at presentation was 27.1 months. The prevalence of amblyopia ranged from 19 to 29%. There was no significant difference in the levels of astigmatism throughout the follow-up period between patients who underwent surgical intervention and who did not. There was a significant improvement in the visual acuity of the affected eye (p = .03) and both eyes open (p = .02), in patients who did not undergo surgery. This was then repeated on patients who underwent surgical intervention which showed no significant difference in the affected eye or both eyes open; p = .27, p = .32, respectively. CONCLUSION: There is no significant change in the levels of astigmatism in both patients who underwent surgery and those who did not. Conservative management of congenital ptosis, while counterintuitive, proves not to deleteriously affect the visual potential of these patients.

Anisometropia and its correction in children in northwest China: A study based on autorefraction data.

BACKGROUND: To investigate the prevalence and correction of anisometropia among primary school children in northwestern China. METHODS: A cross-sectional school-based study was conducted in Shaanxi Province. Visual acuity (VA) and autorefraction without cycloplegia were assessed in all participants, and some received axial length (AL) measurements. Anisometropia was categorised based on spherical equivalent (SE), cylindrical (CYL), and AL. The prevalence of anisometropia and refractive correction across different ages and sexes, and correlations between ocular parameters, were analysed. RESULTS: The study included 29 153 children aged 6-12 (mean age 9.52 ± 1.73 years) for VA and autorefraction measurements, and 1176 children for AL measurements. The prevalence of myopia (SE ≤ -0.50 D), hyperopia (SE ≥ +0.50 D), and anisometropia (interocular SE difference ≥1.00 D) was 65.26%, 15.09%, and 16.50%, respectively. Anisometropia severity, based on SE (χ2 = 443.758, p < 0.001), CYL (χ2 = 41.669, p < 0.001), and AL (χ2 = 95.505, p < 0.001), increased with age, with no significant differences between sexes. Interocular SE difference correlated with interocular spherical power (r = 0.806, p < 0.001), CYL (r = 0.21, p < 0.001), and AL (r = 0.365, p < 0.001). Additionally, interocular CYL difference was positively correlated with interocular AL difference (r = 0.16, p < 0.001). Despite the high prevalence of anisometropia, less than 30% of affected children received refractive correction. CONCLUSIONS: Anisometropia of SE, CYL, and AL increased progressively with age. Despite the elevated prevalence of anisometropia, the utilisation of refractive correction remained strikingly low.

Association of choroidal thickness and blood flow features with asymmetric axial lengths in children with unilateral myopic anisometropia.

BACKGROUND: Considering that changes in the choroidal thickness are closely related to ocular growth, we studied the choroidal thickness (CT) and the blood flow features in children with unilateral myopic anisometropia (UMA) as well as investigating the relationship between choroidal changes and myopia. METHODS: Subjective refractive, axial length (AL), and biometric parameters were measured in 98 UMA children (age: 8-15 years). CT and choroidal blood-flow features, including the choroidal vessel volume (CVV), choroidal vascularity index (CVI), and choriocapillaris perfusion area (CCPA), were measured through swept-source optical coherence tomography angiography. The macular region was categorized into four concentric circles of diameters 0-1 mm (central fovea), 1-3 mm (parafovea), 3-6 mm (perifovea), and 6-9 mm (extended), and further categorized into superior (S), inferior (I), temporal (T), and nasal (N) quadrants. RESULTS: The aforementioned four regions of myopic eyes displayed significantly lower CT, CVV, and CVI than those of non-myopic eyes. CCPA changes differed across different regions of both the eyes (parts of N and T quadrants). There was an inverse association between CT and the interocular AL difference (central and other regions S, T quadrant). No correlation was noted between CVV and CVI with interocular AL difference. CT and CVV were positively correlated in the 0-6-mm macular region of myopic eyes (Spearman correlation coefficient = 0.763, P < 0.001). CONCLUSIONS: In UMA children, CCT and blood flow may be related to myopia progression. A robust correlation between CT and CVV in the 0-6-mm macular region and reduced CT and diminished blood flow indicated an association with myopia.

Refractive Outcomes Following Combined Cataract and Microinvasive Glaucoma Surgery.

PURPOSE: To compare refractive outcomes in eyes undergoing cataract extraction (CE) alone, CE with goniotomy (CE/goniotomy), and CE with Schlemm's canal stent (CE/SCS) insertion. DESIGN: Retrospective cohort study. PARTICIPANTS: Eyes from the Bascom Palmer Glaucoma Repository undergoing CE/goniotomy, CE/SCS insertion, or uncomplicated CE alone between July 2014 and February 2022 were identified. METHODS: Refraction data were analyzed at postoperative month (POM) 1 and 6 with Kruskal-Wallis and Dunn's tests. Anisometropia was defined as a spherical equivalent (SE) difference of ≥2D. MAIN OUTCOME MEASURES: The primary outcome was mean refraction at POM1 and POM6 across the 3 surgical groups. Secondary outcomes were comparisons of refraction and visual acuity (VA) among different goniotomy and Schlemm's canal stent (SCS) devices, as well as incidence of anisometropia. RESULTS: A total of 8360 eyes (150 CE/goniotomy, 395 CE/SCS, and 7815 CE alone) from 6059 patients were analyzed. At POM1, mean SE in the CE/goniotomy, CE/SCS, and CE alone groups was -0.36 ± 0.91D, -0.31 ± 0.85D, and -0.39 ± 0.88D respectively (P = 0.019). Mean logarithm of the minimum angle of resolution VA was 0.10 ± 0.20, 0.08 ± 0.19, and 0.14 ± 0.26 respectively (P = 0.002, CE/SCS vs. CE alone). No statistically significant differences were noted at POM6. Anisometropia occurred at POM1 in 2 patients (13.3%) in the CE/goniotomy-CE group, 1 patient (3.2%) in the CE/SCS-CE group, and 184 patients (4.9%) in the CE-CE group (P = 0.217). At POM6, mean SEs were -0.38 ± 0.97D (CE/goniotomy), -0.35 ± 0.81D (CE/SCS), and -0.40 ± 0.91D (CE alone; P = 0.473). No significant differences in overall refractive outcomes were observed with different SCS or goniotomy devices. Among primary open-angle glaucoma/normal-tension glaucoma eyes, mean SE at POM1 was -0.36 ± 0.73D (CE/goniotomy), -0.24 ± 0.84D (CE/SCS), and -0.45 ± 0.81D (CE alone; P < 0.001). CONCLUSIONS: Concurrent SCS insertion or goniotomy with CE was associated with some statistically significant differences in postoperative refraction and VA, although these small magnitude differences were unlikely to be clinically meaningful. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article.

A Possible Reciprocal Relationship Between Myopia and Dry Eye Disease in Japanese Teenagers.

Purpose: To investigate the relationship between dry eye disease (DED) and myopia in Japanese teenagers. Methods: This clinic-based, retrospective, cross-sectional study assessed DED condition in 10- to 19-year-old teenagers presenting at Japanese eye clinics. They included 106 high myopic patients (HM; mean age, 16.4 ± 2.2 years), 494 mild myopic patients (15.0 ± 2.6 years) and 82 non-myopic teenagers (NM; 13.8 ± 2.6 years). Subjective refraction and anisometropia were measured. Myopia grade was classified as HM (≤ -6.00 D), MM (> -6.00 D, < -0.50 D), or NM (≥ -0.5 D). The presence of DED-related symptoms including dryness, irritation, pain, fatigue, blurring and photophobia were assessed through a questionnaire. Tear film break-up time (BUT) and fluorescein corneal staining were investigated. Comparison among three groups and regression analysis of myopic error and other variables were conducted. Results: Anisometropia and astigmatic error were greatest in the HM group compared with the other groups (p < 0.001). The HM group reported less photophobia (p < 0.001) and less pain (p = 0.039) compared with the NM group. Regression analysis revealed that myopic error was correlated with astigmatic error (ß = -0.231, p <0.001), anisometropia (ß = -0.191, p <0.001), short BUT (ß = -0.086, p = 0.028) and the presence of diagnosed DED (ß = -0.112, p = 0.003). Dryness (ß = -0.127 p = 0.004), photophobia (ß = 0.117, p = 0.002) and pain (ß = 0.084, p = 0.034) correlated with myopic error. Conclusion: This study associated clinical findings of DED in HM teenagers. The present results suggest DED might be associated with myopia, possibly in a reciprocal relationship.

Visual and Ocular Characteristics of Anisometropic Children.

Purpose: To compare the demographic and ocular characteristics of patients with low and high levels of anisometropia compared with non-anisometropic individuals. Methods: This cross-sectional study was conducted on 1803 individuals (age range, 1 to 30 years) examined at strabismus clinics between January 2019 and December 2020. Of these, 203 subjects had anisometropia (11.2%); 66 cases were excluded due to the history of prior ocular surgery except from strabismus surgery. Finally, data from 137 subjects were analyzed. Spherical or cylindrical differences of 1.50 or 3.00D between the two eyes were defined as low or high anisometropia, respectively, and isometropic subjects (n = 1600) served as controls. Results: No significant difference was observed between cases and controls regarding age (10.25 ± 8.41 vs. 9.2 ± 1.7 years; P = 0.133) and sex (P = 0.051). History of ocular surgery was present in 33% of anisometropic patients versus 0.8 % of isometropic cases. The rate of amblyopia was 83% and 2.3% in anisometropic and non-anisometropic groups, respectively. Best corrected visual acuity (BCVA) was comparable in amblyopic eyes in both study groups, while BCVA of non-amblyopic eyes of non-anisometropic subjects was better (non-anisometropic: 0.01 ± 0.01 vs. anisometropic: 0.06 ± 0.17 LogMAR; P = 0.001). Eye deviation was significantly more prevalent among anisometropic patients (36.5% vs. 3.25%, P < 0.001) and exotropia was the common type of deviation. Anisohyperopia and anisomyopia were the most common refractive errors under low and high anisometropia categories, respectively. Simultaneous manifestation of amblyopia and strabismus were observed in 30.6% of anisometropic cases, while only 0.7% of subjects with isometropia had a similar status (P < 0.001). Conclusion: High rates of amblyopia and strabismus in anisometropic subjects, especially with higher degrees of anomaly, indicate the necessity of early visual acuity and refractive error screening to improve detection and enhance the outcomes of treatment.

Characteristics of peripheral refractive errors in eyes of patients with non-amblyopic myopic anisometropia.

BACKGROUND: This study aims to investigate relative peripheral refractive (RPR) characteristics in children with non-amblyopic myopic anisometropia and explore potential associations between relative peripheral refractive errors (RPRE) and myopia. METHODS: Relative peripheral refractive errors were assessed in 64 children diagnosed with non-amblyopic myopic anisometropia utilizing multispectral refraction topography (MRT). Two eyes of each patient were divided into into the more myopia eyes group (ME) and the fellow eyes group (FE). Evaluated parameters encompassed total defocus values (TRDV), defocus values at eccentricities spanning 0 to 15 degrees (RDV-15), 0 to 30 degrees (RDV-30), 0 to 45 degrees (RDV-45), as well as superior (RDV-S), inferior (RDV-I), temporal (RDV-T), and nasal (RDV-N) positions. RESULTS: The study revealed a noteworthy contrast in TRDV values between Group ME (0.52 ± 0.36) and Group FE (0.17 ± 0.41), with a substantial significance (P < 0.0001). While no significant RDV-15 difference emerged between Group ME (0.01 ± 0.05) and Group FE (-0.01 ± 0.07) (P > 0.05), a meaningful RDV-30 difference existed between Group ME (0.11 ± 0.14) and Group FE (0.03 ± 0.19) (P = 0.0017). A significant discrepancy in RDV-45 was also observed between Group ME (0.39 ± 0.29) and Group FE (0.13 ± 0.34) (P < 0.001). Notably, RDV-I and RDV-T positions demonstrated marked differences between Group ME and Group FE (P < 0.0001), whereas no significant disparity was noted in RDV-S and RDV-N positions (P > 0.05). CONCLUSION: Eyes exhibiting greater myopia manifested more hyperopic peripheral defocus in the context of anisometropia. MRT as a novel ophthalmic evaluation technique, holds promising potential for broader clinical applications in the future.

Comparative analysis of corneal parameters in simple myopic anisometropia using Scheimpflug technology.

Purpose: This study aims to investigate the differences in binocular corneal parameters and their interrelation with binocular biometric parameters asymmetry in patients with simple myopic anisometropia, thereby elucidating the influence of myopia process on various corneal parameters. Methods: In this cross-sectional study, 65 patients with anisometropia in monocular myopia were included. They were divided into low anisometropia group: 3.00D<Δ spherical equivalent (SE)≤-1.00D (Δ represents the difference between the two eyes, i.e., myopic data minus emmetropic data) and high anisometropia group: ΔSE ≤ -3.00D. Corneal and ocular biometric parameters were measured using Pentacam, Corvis ST, and IOL Master 700. Statistical analyses focused on the binocular corneal parameters asymmetry, using the contralateral emmetropia as a control. Results: The mean age of participants was 18.5 ± 1.3 years, with the average SE for myopia and emmetropia being -2.93 ± 1.09D and -0.16 ± 0.41D, respectively. The central corneal thickness (CCT), flat keratometry (Kf), keratometry astigmatism (Ka), total corneal aberration (6 mm) (TOA), surface variance index (ISV), vertical asymmetry index (IVA), stress-strain index (SSI), and first applanation stiffness parameter (SPA1) and ambrosia relational thickness-horizontal (ARTh) showed significant differences between anisometropic fellow eyes (p < 0.05). There were significant differences in ΔIVA, Δ the difference between the mean refractive power of the inferior and superior corneas (I-S), Δ deviation value of Belin/Ambrósio enhanced ectasia display (BAD-D), Δ deformation amplitude ratio max (2 mm) (DAR)and Δ tomographic biomechanical index (TBI) (p < 0.05) in two groups. Asymmetry of corneal parameters was correlated with asymmetry of ocular biometric parameters. Anisometropia (ΔSE) was positively correlated with ΔIVA (r = 0.255, p = 0.040), ΔBAD-D (r = 0.360, p = 0.006), and ΔSSI (r = 0.276, p = 0.039) and negatively correlated with ΔDAR (r = -0.329, p = 0.013) in multiple regression analysis. Δ mean keratometry (Km), Δ anterior chamber depth (ACD), and Δ biomechanically corrected intraocular pressure (bIOP) were also associated with binocular corneal differences. Conclusion: Compared to contralateral emmetropia, myopic eyes have thinner corneas and smaller corneal astigmatism. Myopic corneas exhibit relatively more regular surface morphology but are more susceptible to deformation and possess marginally inferior biomechanical properties. In addition, there is a certain correlation between anisometropia and corneal parameter asymmetry, which would be instrumental in predicting the development of myopia.

Bilateral axial length growth patterns of myopic anisometropes undergoing sequential monocular to binocular orthokeratology treatment.

PURPOSE: To investigate bilateral axial length (AL) growth patterns and interactions of myopic eyes in anisometropic children during unilateral orthokeratology (OK) treatment in their singularly myopic eyes (Eyes1), followed by bilateral treatment when their second eyes (Eyes2) developed myopia. METHODS: This study enrolled 94 eyes from 47 anisometropes (20 males). All patients had undergone monocular OK treatment for > 1 year followed by binocular treatment for > 1 year. Axial growth of Eyes1 and Eyes2 during the first year of monocular treatment (Stage 1), average annual axial elongation during the monocular treatment period, and axial elongation during the first year of binocular treatment (Stage 2) were respectively termed: S1E1 and S1E2, Annual E1 and Annual E2, and S2E1 and S2E2. Associations between AL growth and age, sex, interval time, and ocular parameters were analysed using correlation and generalised estimating equation (GEE) analysis. RESULTS: During the monocular period, Eyes1 showed less AL growth (S1E1: 0.05 ± 0.18 mm; Annual E1: 0.05 ± 0.21 mm) than Eyes2 (S1E2: 0.51 ± 0.24 mm; Annual E2: 0.52 ± 0.25 mm) (all p < 0.001). During the binocular period, there was no significant difference between S2E1 and S2E2(0.21 ± 0.14 mm v. 0.19 ± 0.17 mm, p = 0.951). Between monocular and binocular periods, Eyes1 had significantly higher S2E1 compared to S1E1 and Annual E1 (both p < 0.001), and Eyes2 had significantly lower S2E2 than S1E2 and Annual E2 (both p < 0.001). In the GEE model, spherical equivalent refraction (SER) and between periods interval time showed independently significant associations with AL growth after adjusting for age and sex. CONCLUSION: Orthokeratology can significantly control AL growth in unilateral myopia. AL growth of the initial myopic OK-treated eyes accelerated relative to the monocular period when contralateral eyes developed myopia and assumed OK treatment. During the binocular treatment phase, OK lenses showed moderate and comparable effects on AL retardation across both eyes.

Outcomes of Corneal Compound Myopic Astigmatism with Presbyopia by Zeiss PRESBYOND® Laser Blended Vision LASIK Using Default CRS-Master® Target Refractions for Reduced Anisometropia.

Background/Objectives: Presbyopia, a common age-related refractive error, affects over a billion people globally and significantly impacts daily life. Methods: This retrospective study analyzed 288 eyes of 144 patients undergoing LBV PRESBYOND® treatment for myopic presbyopia with astigmatism, aiming to evaluate precision, efficacy, safety, and stability over six months. Results: Key findings include high efficacy, with 99% of distance-eyes achieving uncorrected distance visual acuity (UDVA) of 20/25 or better, and 85% of near-eyes achieving UDVA of 20/32 or better. The results show excellent refractive outcomes, with 99% of long-sighted eyes and 97% of near-sighted eyes having a postoperative spherical equivalent within ±1.00 D. Safety was demonstrated by no loss of two or more Snellen lines after treatment, with 94% of patients maintaining corrected distance visual acuity (CDVA) before and after surgery. Conclusions: Overall, LBV PRESBYOND® proved effective, safe, and well tolerated for myopic presbyopia correction, offering satisfactory visual outcomes and potential spectacle independence for various distances. This study underscores the importance of individualized treatment based on patient age, highlighting the positive impact of binocular summation on visual function. This study contributes to the growing body of evidence supporting LBV PRESBYOND® as a viable option for addressing presbyopic myopia, offering insights into its efficacy and safety profile. Further research could explore postoperative stereopsis and long-term outcomes to enhance understanding and refine treatment protocols.

A case of reverse amblyopia in a myopic anisometropic patient: an atypical presentation.

We herein report a case of a 4-year-old female patient who presented with anisometropic amblyopia with initial visual acuity recorded at 20/400 OD and 20/100 OS. The patient was recommended for patching. Eighteen months later, the patient presented with visual acuity of 20/60 OD and 20/80 and reverse amblyopia was noted. In settings of amblyopia, where alternate patching may be used, it is most likely that reverse amblyopia, if present, will affect the more myopic eye. However, unexpectedly, in this case, reverse amblyopia occurred in the less myopic eye. With discontinuation of occlusion therapy and continued use of optical correction, the patients reverse amblyopia resolved and the visual equity equalized. To our knowledge, this is the first case described in the literature demonstrating such an occurrence. Awareness of this rare presentation by clinicians is of great importance to aid in correctly diagnosing and treating such patients.

Assessment of the effects of myopic and hyperopic anisometropia on choroidal vascular structure in children using SS-OCTA.

OBJECTIVE: To compare large- and medium-sized choroidal vascularity and the choriocapillaris (CC) flow area in children with different refractive errors using swept-source optical coherence tomography angiography (SS-OCTA). METHODS: Forty-two anisometropic children were enrolled and divided into hyperopic anisometropia (HA) and myopic anisometropia (MA) groups. SS-OCTA was performed to analyse choroidal vascularity. Mean choroidal thickness (CT), choroidal vascularity volume (CVV), choroidal vascularity index (CVI) and CC flow area were compared between the two eyes. The inter-ocular differences between the two groups were also determined. RESULTS: Mean CT and CVV were highest in eyes with shorter axial lengths in both refractive groups, and the difference between the two eyes was positively correlated with the difference in axial length at the foveal region. Significant differences in the CVI in the MA group were only found in the parafoveal region. Inter-ocular differences in the CC were significantly reduced in eyes with longer axial lengths in the foveal and parafoveal regions of the HA and MA groups, respectively. Comparing inter-ocular differences, CC was significantly greater in the parafoveal region of the MA group than the HA group. CONCLUSIONS: All layers of choroidal vasculature were thinner in eyes with longer axial lengths in all groups. The inter-ocular CC difference was greater in the MA than in the HA group, with similar differences in axial length. This suggests that both medium-to-large choroidal vascular and choroidal capillaries may play a role in myopia development.

Temporal trend of anisometropia incidence in Chinese school-aged children before and during the COVID-19 pandemic.

Objective: To analyze and compare the temporal trends in the incidence of anisometropia among Chinese school-aged children both before and during the COVID-19 pandemic, and to investigate the impact of the pandemic on the incidence of anisometropia. Methods: We conducted a retrospective study comprising six distinct and independent longitudinal cohorts, each including children aged 6 to 13 years who visited the Joint Shantou International Eye Center between January 2010 and December 2021. Children were grouped into cohorts based on the year of their first eye clinic visit: 2010, 2012, 2014, 2016, 2018, or 2020. Only children without anisometropia at initial visits, followed for 18 ± 6 months, were included. The cumulative incidence and risk factors of anisometropia were analyzed using Kaplan-Meier estimation and Cox proportional hazards regression models. Subgroup analyses were performed based on sex, age groups, initial refractive error status, and initial interocular SE difference. Anisometropic children were further categorized into myopic and non-myopic, with subsequent subgroup analyses conducted. Results: Of 11,235 children were recruited from six cohorts (2010: n = 1,366; 2012: n = 1,708; 2014: n = 1,896; 2016: n = 2,354; 2018: n = 2,514; 2020: n = 1,397), 869 children developed anisometropia during a mean follow-up of 17.5 ± 3.7 months. After adjustment of confounding factors, we found that the risk of anisometropia remained relatively stable before 2020 but significantly increased in the 2020 cohort (adjusted HR 2.93, 95% CI 2.23 to 3.86; p < 0.001). This trend persisted in studies of spherical anisometropia (adjusted HR 2.52, 95% CI 1.60 to 3.97; p < 0.001) and cylindrical anisometropia (adjusted HR 2.91, 95% CI 1.69 to 3.62; p < 0.001). Older age and a greater initial difference in SE between the two eyes were also significantly associated with a higher risk of developing anisometropia (p < 0.001). Subgroup analyses consistently showed increased risk in the 2020 cohort. Conclusion: This study reveals a concerning rise in anisometropia incidence among Chinese school-aged children during the period of the COVID-19 pandemic. These findings highlight the worrisome rise in anisometropia risk during the COVID-19 pandemic and emphasize the importance of early detection and management to safeguard children's visual health.