The CroMyop study: myopia progression in Croatian children and adolescents-a 15-year retrospective analysis.

Purpose: Myopia is a major global health issue, especially among children and adolescents. Understanding its traits and progression is vital for proper management and prevention. This study aimed to fill a gap in research by analyzing demographic and refractive data concerning myopia among children and adolescents in Croatia, with the goal of providing insights into myopia prevalence, progression rates, and associated risk factors within the Croatian population. Design: This retrospective study utilized a comprehensive dataset from pediatric ophthalmology clinics at the University Eye Department, University Hospital "Sveti Duh," Zagreb, Croatia. The dataset included electronic medical records spanning from January 2008 to July 2023, encompassing demographic and refractive data. Methods: Data analysis focused on individuals aged 4 to 18 years who were diagnosed with primary myopia and/or compound myopic astigmatism. Ophthalmic examinations, including visual acuity tests, cycloplegic refraction, and assessments for eye comorbidities, were conducted by experienced pediatric ophthalmologists. Statistical analysis, including t-tests, survival analysis, and logistic regression, was performed to assess myopia prevalence, progression rates, and associated factors. These analyses were adjusted for covariates such as age, parental myopia, and gender. Results: The study included 895 individuals, 51 premyopes, 813 low myopes, and 31 high myopes. The average age of diagnosis was 11.37 ± 3.59 years for premyopes, 11.18 ± 3.53 years for low myopes, and 11.44 ± 4.35 years for high myopes. The fastest progression occurred in 2021 and 2022, -0.5 ± 0.12 D/y for premyopes and - 0.45 ± 0.1 D/y for low myopes. Premyopic progression to low myopia was associated with age 7-9 years (HR 2.42, 1.53 to 3.21) and both parents being myopic (HR 920.27. 850.16 to 950.53). Low myopic individuals with both myopic parents displayed the fastest 11-24 months after first visit progression rates, -0.69 (-0.52 to -0.87) D/y, while the 7-9 age group demonstrated -0.36 (-0.24 to -0.45) D/y. Low myopes aged 7-9 years with baseline SE between -6 D and -4 D were more strongly associated with ≤ - 0.5 D progression (OR = 2.0, 95% CI -1.00 to 2.39). Conclusion: This study highlights the importance of environmental factors, genetics, and age in addressing myopia progression among Croatian youth, urging further research for effective local intervention strategies.

Development and validation of predictive models for myopia onset and progression using extensive 15-year refractive data in children and adolescents.

BACKGROUND: Global myopia prevalence poses a substantial public health burden with vision-threatening complications, necessitating effective prevention and control strategies. Precise prediction of spherical equivalent (SE), myopia, and high myopia onset is vital for proactive clinical interventions. METHODS: We reviewed electronic medical records of pediatric and adolescent patients who underwent cycloplegic refraction measurements at the Eye & Ear, Nose, and Throat Hospital of Fudan University between January 2005 and December 2019. Patients aged 3-18 years who met the inclusion criteria were enrolled in this study. To predict the SE and onset of myopia and high myopia in a specific year, two distinct models, random forest (RF) and the gradient boosted tree algorithm (XGBoost), were trained and validated based on variables such as age at baseline, and SE at various intervals. Outputs included SE, the onset of myopia, and high myopia up to 15 years post-initial examination. Age-stratified analyses and feature importance assessments were conducted to augment the clinical significance of the models. RESULTS: The study enrolled 88,250 individuals with 408,255 refraction records. The XGBoost-based SE prediction model consistently demonstrated robust and better performance than RF over 15 years, maintaining an R2 exceeding 0.729, and a Mean Absolute Error ranging from 0.078 to 1.802 in the test set. Myopia onset prediction exhibited strong area under the curve (AUC) values between 0.845 and 0.953 over 15 years, and high myopia onset prediction showed robust AUC values (0.807-0.997 over 13 years, with the 14th year at 0.765), emphasizing the models' effectiveness across age groups and temporal dimensions on the test set. Additionally, our classification models exhibited excellent calibration, as evidenced by consistently low brier score values, all falling below 0.25. Moreover, our findings underscore the importance of commencing regular examinations at an early age to predict high myopia. CONCLUSIONS: The XGBoost predictive models exhibited high accuracy in predicting SE, onset of myopia, and high myopia among children and adolescents aged 3-18 years. Our findings emphasize the importance of early and regular examinations at a young age for predicting high myopia, thereby providing valuable insights for clinical practice.

Examination under anesthesia: Preferred Practice.

Pediatric ocular examinations are often a challenge in the outpatient setting due to limited cooperation of the child. Hence an evaluation under anesthesia (EUA) or sedation is important for a holistic ophthalmic examination. It can be combined with short procedures, such as suture removal and corneal scrappings, both for diagnosis and for the management of several ophthalmic disorders. It can also be performed before planning a surgical intervention to record the baseline characters and formulate or refine a surgical plan. Every EUA must be used as a chance to perform a complete ophthalmic examination rather than perform a single task such as recording the intraocular pressure. This article aims to provide a protocol that can be followed for a complete EUA.

Analysis of 2-year spherical equivalent progression in emmetropic children with non-cycloplegic refraction: a retrospective chart review.

BACKGROUND: We aimed to investigate children with an emmetropic non-cycloplegic refraction (NCR) to compare the difference in progression of NC spherical equivalent (SE) over 2 years between the children with emmetropic and hyperopic cycloplegic refraction (CR) values. METHODS: Through a retrospective medical record review, 59 children aged under 10 years were evaluated. Refractive error was calculated as the average of the SE values of both eyes. According to the CR results, children with emmetropia (-0.50 to 1.00 diopter [D]) were assigned to group 1 (n = 29), and those with hyperopia (≥ 1.00 D) were assigned to group 2 (n = 30). The prevalence of myopia and SE progression were compared over 2 years. Correlations between final SE progression and baseline age and refractive error were analyzed and multiple regression analysis was conducted. Receiver operating characteristic curves that achieved the best cutoff points to distinguish between the groups were calculated. RESULTS: Group 1 showed significantly myopic SE changes compared to baseline at the 1-year follow-up, and group 1 was significantly myopic compared with group 2 at the 2-year follow-up. Myopia prevalence was 51.7% in group 1 and 6.7% in group 2 after 1 year, and 61.1% and 16.7% after 2 years, respectively. In the correlation analysis, baseline age, baseline CR, and difference between CR and NCR showed significant correlations with the 2-year SE progression (r = -0.359, p = 0.005; r = 0.450, p < 0.001; r = -0.562, p < 0.001, respectively). However, NCR refractive error showed no significant correlation (r = -0.097, p = 0.468). In multiple regression analysis, baseline age (ß= -0.082), and CR-NCR difference (ß= -0.214) showed a significant effect on SE progression for 2 years. When an NCR value of 0.20 D was set as the cut-off value to distinguish between the groups, a sensitivity of 70% and specificity of 92% were obtained. CONCLUSION: Even if NCR showed emmetropia, children with baseline CR values of emmetropia showed greater SE progression compared with those with hyperopia. Cycloplegia is essential to confirm the correct refractive status in children. It may be useful for predicting prognosis of SE progression.

Identification of ocular refraction based on deep learning algorithm as a novel retinoscopy method.

BACKGROUND: The evaluation of refraction is indispensable in ophthalmic clinics, generally requiring a refractor or retinoscopy under cycloplegia. Retinal fundus photographs (RFPs) supply a wealth of information related to the human eye and might provide a promising approach that is more convenient and objective. Here, we aimed to develop and validate a fusion model-based deep learning system (FMDLS) to identify ocular refraction via RFPs and compare with the cycloplegic refraction. In this population-based comparative study, we retrospectively collected 11,973 RFPs from May 1, 2020 to November 20, 2021. The performance of the regression models for sphere and cylinder was evaluated using mean absolute error (MAE). The accuracy, sensitivity, specificity, area under the receiver operating characteristic curve, and F1-score were used to evaluate the classification model of the cylinder axis. RESULTS: Overall, 7873 RFPs were retained for analysis. For sphere and cylinder, the MAE values between the FMDLS and cycloplegic refraction were 0.50 D and 0.31 D, representing an increase of 29.41% and 26.67%, respectively, when compared with the single models. The correlation coefficients (r) were 0.949 and 0.807, respectively. For axis analysis, the accuracy, specificity, sensitivity, and area under the curve value of the classification model were 0.89, 0.941, 0.882, and 0.814, respectively, and the F1-score was 0.88. CONCLUSIONS: The FMDLS successfully identified the ocular refraction in sphere, cylinder, and axis, and showed good agreement with the cycloplegic refraction. The RFPs can provide not only comprehensive fundus information but also the refractive state of the eye, highlighting their potential clinical value.

Time for effective cycloplegia in patients with brown iris.

We aimed to evaluate the time needed for effective cycloplegia after instillation of cyclopentolate 1% in patients with brown irides. A prospective analytical study involving 161 patients (322 eyes) with a mean (SD) age of 9.0 (3.1) years (range: 3-16 years), who attended outpatient eye clinic. All had brown irides, cyclopentolate 1% was instilled two times, 10 minutes apart, spherical equivalent (SE) was calculated using readings taken by Nidek AR-1000 autorefractometer before the first drop and at 15, 30, 45 and 60 minutes after the first drop. The time for effective cycloplegia was determined from the time point at which the 95% confidence interval of the differences between the average spherical equivalent (SE) at each point and its final value at 60 minutes was reached and remained within ±0.25 D. We found that maximum cycloplegia was reached 30 minutes after the instillation of first drop of cyclopentolate 1% in all refractive error categories (emmetropia, hyperopia and myopia) with the exception of high hyperopia subgroup (SE ≥ +6.0D) where at least 45 minutes were needed to achieve cycloplegia. Additionally no clinically significant difference in the minimum time required to achieve maximum cycloplegia was noticed in subjects under 10 years old and those aged 10 years or older with both groups needed at least 30 minutes to achieve maximum cycloplegia after the instillation of first drop of cyclopentolate 1%. In this group of patients with brown irides, most children reached maximum cycloplegia after 30 minutes of instillation of cyclopentolate 1% eye drops.

Agreement of wavefront-based refraction, dry and cycloplegic autorefraction with subjective refraction

Purpose: To evaluate the agreement of dry, and cycloplegic autorefraction and wavefront-based refraction with subjective refraction.Method: 83 subjects aged 19–57 years were included in this cross-sectional study. Refractive status was determined using four methods including subjective refraction, wavefront-based refraction, dry and cycloplegic autorefraction. Refractive data were recorded as sphere, cylinder and spherical equivalent (SE). Power vector components were used to compare the astigmatism obtained using the different methods of refraction.Results: The more negative spherical, cylindrical and SE components were obtained using dry autorefraction, wavefront-based refraction and dry autorefraction, respectively. The less negative spherical, cylindrical and SE components were obtained using cycloplegic autorefraction, subjective refraction and cycloplegic autorefraction, respectively. Considering the spherical component, there was a statistically significant hyperopic shift (0.12 ± 0.29 D, p = 0.001) with cycloplegic autorefraction and a significant myopic shift (−0.17 ± 0.32 D, p < 0.001) with dry autorefraction compared to subjective refraction, while the difference between wavefront-based and subjective refraction was not significant statistically (p = 0.145). The calculated cylindrical component using subjective refraction showed statistically significant difference with dry auto-refraction (p < 0.001), cycloplegic auto-refraction (p = 0.041) and wavefront refraction (p < 0.001). The highest correlation with subjective refraction in sphere, cylinder and SE was observed for cycloplegic auto-refraction (rs = 0.967), dry auto-refraction (rs = 0.983) and cycloplegic auto-refraction (rs = 0.982), respectively.Conclusions: As subjective refraction is gold standard in our study, sphere in cycloplegic auto-refraction and astigmatism in dry auto-refraction showed better agreement and correlation. (AU)

Agreement of wavefront-based refraction, dry and cycloplegic autorefraction with subjective refraction.

PURPOSE: To evaluate the agreement of dry, and cycloplegic autorefraction and wavefront-based refraction with subjective refraction. METHOD: 83 subjects aged 19-57 years were included in this cross-sectional study. Refractive status was determined using four methods including subjective refraction, wavefront-based refraction, dry and cycloplegic autorefraction. Refractive data were recorded as sphere, cylinder and spherical equivalent (SE). Power vector components were used to compare the astigmatism obtained using the different methods of refraction. RESULTS: The more negative spherical, cylindrical and SE components were obtained using dry autorefraction, wavefront-based refraction and dry autorefraction, respectively. The less negative spherical, cylindrical and SE components were obtained using cycloplegic autorefraction, subjective refraction and cycloplegic autorefraction, respectively. Considering the spherical component, there was a statistically significant hyperopic shift (0.12 ±â€¯0.29 D, p = 0.001) with cycloplegic autorefraction and a significant myopic shift (-0.17 ±â€¯0.32 D, p < 0.001) with dry autorefraction compared to subjective refraction, while the difference between wavefront-based and subjective refraction was not significant statistically (p = 0.145). The calculated cylindrical component using subjective refraction showed statistically significant difference with dry auto-refraction (p < 0.001), cycloplegic auto-refraction (p = 0.041) and wavefront refraction (p < 0.001). The highest correlation with subjective refraction in sphere, cylinder and SE was observed for cycloplegic auto-refraction (rs = 0.967), dry auto-refraction (rs = 0.983) and cycloplegic auto-refraction (rs = 0.982), respectively. CONCLUSIONS: As subjective refraction is gold standard in our study, sphere in cycloplegic auto-refraction and astigmatism in dry auto-refraction showed better agreement and correlation.

Comparison between Plusoptix A09 and gold standard cycloplegic refraction in preschool children and agreement to detect refractive amblyogenic risk factors.

BACKGROUND: The preschool children hardly complain about their vision problems. It is of paramount importance to screen them with an objective tool and compare with the gold standard technique. AIM: To compare the values obtained with Plusoptix A09 and cycloplegic refraction in 3-6 years children and agreement to detect refractive amblyogenic risk factors. SUBJECTS AND METHODS: A cross-sectional study was conducted in the Outpatient Department of Ophthalmology in a tertiary care hospital. Informed consent from parents and verbal assent from children were obtained. Each subject had monocular vision assessment with Lea symbol chart, stereo acuity measurement with Frisby, refractive screening with Plusoptix A09, squint assessment, and anterior segment evaluation before administering Homatropine hydrobromide (homide) 2% eye drops. Cycloplegic refraction and posterior segment evaluation were performed for final diagnosis. STATISTICAL ANALYSIS: Descriptive statistics were used to summarize the data. Spearman correlation coefficient and kappa statistics were also employed. RESULTS: In total, data of 94 children were analyzed. The correlation values obtained between plusoptix and cyclorefraction values for spherical, cylindrical, spherical equivalent were 0.508 (P < 0.0001), 0.779 (P < 0.0001), and 0.407 (P < 0.0001), respectively. Refractive errors were seen in 32% and amblyopia in 17% of eyes. Kappa value was κ = 0.974 in detecting refractive amblyogenic risk factors. CONCLUSION: Good correlation was found between the plusoptix and cyclorefraction values. Cylindrical values showed a better correlation. Refractive errors and amblyopia were the major ocular disorders observed. There was significant agreement between the refractive techniques in detecting amblyogenic risk factors.

The Sankara Nethralaya Tamil Nadu Essilor Myopia (STEM) Study-Defining a Threshold for Non-Cycloplegic Myopia Prevalence in Children.

The aim of this study was to investigate the agreement between cycloplegic and non-cycloplegic autorefraction with an open-field auto refractor in a school vision screening set up, and to define a threshold for myopia that agrees with the standard cycloplegic refraction threshold. The study was conducted as part of the Sankara Nethralaya Tamil Nadu Essilor Myopia (STEM) study, which investigated the prevalence, incidence, and risk factors for myopia among children in South India. Children from two schools aged 5 to 15 years, with no ocular abnormalities and whose parents gave informed consent for cycloplegic refraction were included in the study. All the children underwent visual acuity assessment (Pocket Vision Screener, Elite school of Optometry, India), followed by non-cycloplegic and cycloplegic (1% tropicamide) open-field autorefraction (Grand Seiko, WAM-5500). A total of 387 children were included in the study, of whom 201 were boys. The mean (SD) age of the children was 12.2 (±2.1) years. Overall, the mean difference between cycloplegic and non-cycloplegic spherical equivalent (SE) open-field autorefraction measures was 0.34 D (limits of agreement (LOA), 1.06 D to -0.38 D). For myopes, the mean difference between cycloplegic and non-cycloplegic SE was 0.13 D (LOA, 0.63D to -0.36D). The prevalence of myopia was 12% (95% CI, 8% to 15%) using the threshold of cycloplegic SE ≤ -0.50 D, and was 14% (95% CI, 11% to 17%) with SE ≤ -0.50 D using non-cycloplegic refraction. When myopia was defined as SE of ≤-0.75 D under non-cycloplegic conditions, there was no difference between cycloplegic and non-cycloplegic open-field autorefraction prevalence estimates (12%; 95% CI, 8% to 15%; p = 1.00). Overall, non-cycloplegic refraction underestimates hyperopia and overestimates myopia; but for subjects with myopia, this difference is minimal and not clinically significant. A threshold of SE ≤ -0.75 D agrees well for the estimation of myopia prevalence among children when using non-cycloplegic refraction and is comparable with the standard definition of cycloplegic myopic refraction of SE ≤ -0.50 D.

Distribution of ocular biometry in young Chinese eyes: The Anyang University Students Eye Study.

PURPOSE: To investigate the distribution of ocular biometric parameters and its association to refraction in university students in central China. METHODS: Ocular biometric parameters including axial length (AL), central corneal thickness (CCT), keratometry power (K), anterior chamber depth (AQD) and lens thickness (LT) were measured by an optical biometry in a cohort of university students. Corneal radius of curvature (CR), lens position (LP), lens power (PBennett ), vitreous chamber depth (VCD) and AL to corneal radius ratio (AL/CR) were calculated. Cycloplegic refraction was measured using an autorefractor. RESULTS: A total of 7650 undergraduate students participated in this study, with a mean age of 20.0 ± 1.4 years. The following ocular biometric parameters were measured: AL (24.78 ± 1.21 mm), CCT (539.83 ± 33.03 µm), AQD (3.23 ± 0.25 mm), LT (3.47 ± 0.18 mm), CR (7.79 ± 0.27 mm), LP (4.97 ± 0.23 mm), VCD (17.55 ± 1.15 mm), PBennett (25.00 ± 1.07 dioptres) and AL/CR (3.18 ± 0.15). Male subjects were found to have longer AL, thicker CCT, flatter CR, thinner lens, deeper AQD and VCD than female ones. Myopic subjects were found to have longer AL, thinner CCT, steeper CR, thinner and posterior lens, deeper AQD and VCD, lower PBennett and larger AL/CR than emmetropes and hyperopes. Spherical equivalent (SE) showed a negative correlation with AL/CR (r = -0.914), AL (r = -0.755) and VCD (r = -0.751). CONCLUSIONS: This study provided a range of reference values for the main ocular biometric parameters in young adults and reported their distributions based on gender and refractive status. Our study indicates that SE has a strong correlation with AL/CR ratio, AL and VCD.

Adverse reactions to 1% cyclopentolate eye drops in children: an analysis using logistic regression models.

PURPOSE: To determine the frequency, symptoms and risk factors for adverse reactions to two-times instillation of 1% cyclopentolate in children. STUDY DESIGN: Prospective, observational study. METHODS: The subjects were 646 patients who underwent cycloplegic refraction with cyclopentolate (mean age; 7.0 ± 3.5 years, age range; 0-15 years). Five minutes after instillation of 0.4% oxybuprocaine hydrochloride, a 1% cyclopentolate eye drop was instilled twice, with an interval of 10 min. Fifty minutes later, two certified orthoptists evaluated adverse reactions using a questionnaire and interviewed the patients' guardians. The relationship between the adverse reaction rates and age, gender, additional instillation, complications of the central nervous system (CNS), time of day and season were analysed using binominal and polytomous logistic regression models. RESULTS: The overall frequency of adverse reactions was 18.3% (118/646 patients). The main symptoms included conjunctival injection (10.5%, 68/646), drowsiness (6.8%, 44/646) and facial flush (2.2%, 14/646). The odds ratio (OR) of conjunctival injection increased with patient's age (p < 0.05), in boys (p < 0.01) and in winter (p < 0.001). In contrast, the OR of drowsiness decreased with age (p < 0.001). Facial flush was observed mostly in children younger than 4 years. CNS complications were not a significant risk factor for any of the symptoms. CONCLUSIONS: Adverse reactions to 1% cyclopentolate eye drops were more frequent than previously expected, but all were mild and transient. The probability of each symptom was associated with a clear age-specific trend.

Meta-analysis of the effect and safety of Cyclopentolate and Atropine on ciliary muscle paralysis in myopic children / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To systematically evaluate the effect and safety of cyclopentolate and atropine on ciliary muscle paralysis before optometry in myopic children. <p>METHODS: Relevant references published before April 2020, which concerned about cyclopentolate compared with atropine for ciliary muscle palsy in children with myopia, were obtained by searching PubMed, EMBASE, Web of Science, The Cochrane Library, CNKI and WanFang Database. For the selected studies, after data extraction and methodological quality evaluation of the included study, RevMan5.3 software was used for Meta-analysis. <p>RESULTS: Nine articles were finally included, containing 588 eyes using atropine and 592 eyes using cyclopentolate. Meta-analysis results indicated: comparing of cyclopentolate and atropine for cycloplegia in children with myopia before optometry, the diopter difference between the two is <i>WMD</i>: -0.01, 95%<i>CI</i>(-0.30, 0.27), <i>P</i>=0.93; the difference in residual accommodation power between the two is <i>WMD</i>: 0.22, 95%<i>CI</i>(-0.13, 0.58), <i>P</i>=0.22. In addition, the cyclopentolate is safer and has a lower incidence of adverse reactions.<p>CONCLUSION: Compared with atropine, cyclopentolate has equivalent effects on ciliary muscle paralysis in myopic children, and has higher security. Cyclopentolate could replace atropine for myopic children before optometry.

Do all children need a cycloplegic refraction? A comparison of Mohindra's versus cycloplegic refraction.

PURPOSE: In 1-12 years old children, we assessed correlation, regression, and agreement between spherical equivalents (SE) obtained on Mohindra's near retinoscopy (MNR) and the post cycloplegic refraction (PCRef), performed 72 h after a cycloplegic refraction (CRef) using cyclopentolate 1% drops. METHODS: In this prospective comparative study, Mohindra's near retinoscopy (MNR) was performed on 202 eyes of 101 children, from 50 cm with a streak retinoscope, in a dimly lit room, subtracting 1.25 from the trial lens used for neutralization, to obtain the final refraction. Subsequently we undertook CRef, half-hour after instilling 1% cyclopentolate, with a PCRef 72 h later. All refractive data were converted to SE for evaluation. We compared the SEs using correlation, linear regression, and agreement (Bland-Altman graphic analysis) and paired t-test. Significance was set at P ≤ 0.05. RESULTS: The mean SE on MNR was 1.71 ± 2.49 D compared to 1.43 ± 2.42 D on PCRef. A significant correlation with r = 0.97 (r2= 0.94, P < 0.001) existed. Agreement analysis suggested that MNR overestimates hypermetropia and underestimates myopia each by 0.3 D than the standard procedure of CRef-PCRef. The regression analysis suggested that SE on PCRef is 95% of that on MNR, less 0.20. CONCLUSION: Our study suggests that MNR offers single point refraction very similar to CRef-PCRef, and may be considered as a viable option more often.

Deep Learning-Based Prediction of Refractive Error Using Photorefraction Images Captured by a Smartphone: Model Development and Validation Study.

BACKGROUND: Accurately predicting refractive error in children is crucial for detecting amblyopia, which can lead to permanent visual impairment, but is potentially curable if detected early. Various tools have been adopted to more easily screen a large number of patients for amblyopia risk. OBJECTIVE: For efficient screening, easy access to screening tools and an accurate prediction algorithm are the most important factors. In this study, we developed an automated deep learning-based system to predict the range of refractive error in children (mean age 4.32 years, SD 1.87 years) using 305 eccentric photorefraction images captured with a smartphone. METHODS: Photorefraction images were divided into seven classes according to their spherical values as measured by cycloplegic refraction. RESULTS: The trained deep learning model had an overall accuracy of 81.6%, with the following accuracies for each refractive error class: 80.0% for ≤-5.0 diopters (D), 77.8% for >-5.0 D and ≤-3.0 D, 82.0% for >-3.0 D and ≤-0.5 D, 83.3% for >-0.5 D and <+0.5 D, 82.8% for ≥+0.5 D and <+3.0 D, 79.3% for ≥+3.0 D and <+5.0 D, and 75.0% for ≥+5.0 D. These results indicate that our deep learning-based system performed sufficiently accurately. CONCLUSIONS: This study demonstrated the potential of precise smartphone-based prediction systems for refractive error using deep learning and further yielded a robust collection of pediatric photorefraction images.

Prevalence of myopia among secondary school students in Welkite town: South-Western Ethiopia.

BACKGROUND: Refractive error, especially myopia, is the most common eye disorder in the world and a significant cause of correctable visual impairment. The aim of this study was to assess the prevalence of myopia among secondary school students in Welkite town, South-Western Ethiopia. METHODS: A school based cross sectional study was carried out among secondary school students of 13 to 26 years of age. The students were selected using a multi stage-stratified cluster sampling technique from four secondary schools. The students' socioeconomic background, usage of eyeglasses and parental myopia was assessed by a questionnaire before visual acuity assessment. Students with visual acuity of less than or equal to 6/12 in the worse eye, who showed vision improvement with pinhole, underwent non-cycloplegic retinoscopy and subjective refraction. Myopia was defined as a spherical equivalent of less than or equal to - 0.50 diopters. Logistic regression was used to see the association of myopia with age, sex, grade level, ethnicity, parental history of myopia and severity. RESULTS: A total of 1271 students with a response rate of 89.4% were evaluated. The mean age was 16.56+ 1.51 years. Eighty three students were identified to have myopic refractive error making the prevalence of 6.5% (95% CI: 5.30, 8.02). Of 648 females, 50 (7.7%) had myopia while 33 (5.3%) of 623 males had myopia making females relative risk to be 1.5 times that of males. From the total students diagnosed to have refractive error (n = 92), myopia constituted 83/92 (90.2%) of the students indicating that it is the commonest type of refractive error found amongst secondary school students. Only 36.1% of students with myopia wore eyeglasses when they attended the survey. Myopia was more common among older age group 17-21 years (OR: 1.54 95% CI 0.986-2.415) and higher grade level 11-12 (OR: 1.14 95% CI 0.706-1.847). CONCLUSIONS: The prevalence of myopia is high in our study. Attention to the correction of myopia in secondary schools students of Welkite town using eyeglasses can prevent a major proportion of visual impairment.

Cylinder Axis Agreement: Unexpected Scenarios.

BACKGROUND: The purpose of this retrospective study was to evaluate cylinder axis agreement between manifest refraction (MR), cycloplegic refraction (CR), Allegro Oculyzer ІІ and Allegro Topolyzer-Vario. METHODS: We included 82 patients (32 males and 50 females, 28.1 ± 8.7 years old), with 156 eyes scheduled for wavefront optimized laser refractive surgery, photorefractive keratectomy (PRK) in 50 eyes and laser-assisted in situ keratomileusis (LASIK) in 106 eyes, for correction of simple, myopic, hyperopic or mixed astigmatism. Cylinder axis was determined under manifest and cycloplegic refractions and using Allegro Occulyzer ІІ and Allegro Topolyzer-Vario platforms. Cylinder axis agreement was assessed by intraclass correlation coefficient, Pearson correlation coefficient and by the method described by Bland and Altman. RESULTS: Intraclass correlation coefficient and Pearson correlation coefficient showed statistically significant cylinder axis agreement between manifest refraction, cycloplegic refraction, Allegro Oculyzer ІІ and Allegro Topolyzer-Vario (p <0.001). Despite statistically significant cylinder axis agreement between the four measuring tools, 4 of 156 eyes (2.5%) showed unexpected discrepancy between Allegro Oculyzer ІІ and Allegro Topolyzer-Vario cylinder axis. CONCLUSION: Although cylinder axis shows statistically significant agreement between manifest refraction, cycloplegic refraction, Allegro Oculyzer ІІ and Allegro Topolyzer-Vario, unexpected discrepancies occur.

Availability of Cycloplegic Refraction in Children and Adolescents

PURPOSE: To compare non-cycloplegic and cycloplegic refractive errors and evaluate the utility of cycloplegia in Korean children and young adolescents.METHODS: An anterospective study including 406 outpatients was conducted from September 2015 to December 2017. Pre and post-cycloplegic refractive errors for both eyes were measured using Ocucyclo® and Mydrin P® with an auto-refractor. Patients were divided into different groups according to age: group 1 (< 4 years), group 2 (4–6 years), group 3 (6–8 years), group 4 (8–10 years) and group 5 (< 20 years).RESULTS: A total of 203 patients were studied. Standard deviation (sphere post-pre) was 1.26 ± 1.02 diopters significant in all age groups (p < 0.05). The mean difference decreased with increasing age (r = 0.207, p < 0.05), however, 9% of group with age greater than 10 years old still had manifest refraction-cycloplegic refraction (MR-CR) difference greater than 2 diopters. There were no significant cylindrical or axial component value difference before and after cycloplegia (p = 0.071). Significantly greater MR-CR differences were observed in hypermetropes ≥ 6 years old and myopes ≤8 years old (p < 0.05). The prevalence of pre-cycloplegic eyes with anisometria was 22.6% and 32.6%, a total of 7.39% regressed after cycloplegia (p > 0.05).CONCLUSIONS: After CR hyperopic shift was observed in all age groups. In patients with age greater than 10 years old, although statistically not significant, anisometropia and pseudomyopia still existed. Thus cycloplegic refraction should be performed in young adolescent to precisely measure and correct refractive error and avoid overcorrection.

Cycloplegic refraction by 1% cyclopentolate in young adults: is it the gold standard? The Anyang University Students Eye Study (AUSES).

AIMS: To document the difference between non-cycloplegic and cycloplegic refraction and explore its associated factors in Chinese young adults. METHODS: A school-based study including 7971 undergraduates was conducted in Anyang, Henan Province, China. Cycloplegia was achieved with two drops of 1% cyclopentolate and 1 drop of Mydrin P (Tropicamide 0.5%, phenylephrine HCl 0.5%) with a 5 min interval. Non-cycloplegic and cycloplegic refractions were measured by an autorefractor. A paired-sample t-test and Spearman correlation analysis were used for analysis with data from only the right eyes included.  RESULTS: Of the 7971 students examined, 7793 (97.8%) with complete data were included, aging 20.2±1.5 years. Male students accounted for 36.8%. Overall, there was a significant difference between non-cycloplegic and cycloplegic SE (spherical equivalent) of 0.83±0.81D (p<0.01). The difference was 1.80±1.11D, 1.26±0.93D and 0.69±0.69D for those with cycloplegic hyperopia, emmetropia and myopia, respectively (p<0.01 for all). Those with a hyperopic shift less than 0.25D and 0.5D accounted for 11.1% and 34.1%, respectively. A significant relationship was found between difference in SE and cycloplegic refraction (r=0.33, b=0.11, p<0.01). Without cycloplegia, prevalence of hyperopia and emmetropia would be underestimated by 6.2% (1.0% vs 7.2%) and 5.7% (3.8% vs 9.5%), respectively, with prevalence of myopia and high myopia overestimated by 12.1% (95.3% vs 83.2%) and 6.1% (17.2% vs 11.1%).  CONCLUSION: Lack of cycloplegia will lead to significant misclassification of myopia, emmetropia and hyperopia in Chinese young adults. Cycloplegia is therefore essential for this age-group in epidemiological studies.

Variant myopia: A new presentation?

Purpose: Variant myopia (VM) presents as a discrepancy of >1 diopter (D) between subjective and objective refraction, without the presence of any accommodative dysfunction. The purpose of this study is to create a clinical profile of VM. Methods: Fourteen eyes of 12 VM patients who had a discrepancy of >1D between retinoscopy and subjective acceptance under both cycloplegic and noncycloplegic conditions were included in the study. Fourteen eyes of 14 age- and refractive error-matched participants served as controls. Potential participants underwent a comprehensive orthoptic examination followed by retinoscopy (Ret), closed-field autorefractor (CA), subjective acceptance (SA), choroidal and retinal thickness, ocular biometry, and higher order spherical aberrations measurements. Results: In the VM eyes, a statistically and clinically significant difference was noted between the Ret and CA and Ret and SA under both cycloplegic and noncycloplegic conditions (multivariate repeated measures analysis of variance, P < 0.0001). A statistically significant difference was observed between the VM eyes, non-VM eyes, and controls for choroidal thickness in all the quadrants (Univariate ANOVA P < 0.05). The VM eyes had thinner choroids (197.21 ± 13.04 µ) compared to the non-VM eyes (249.25 ± 53.70 µ) and refractive error-matched controls (264.62 ± 12.53 µ). No statistically significant differences between groups in root mean square of total higher order aberrations and spherical aberration were observed. Conclusion: Accommodative etiology does not play a role in the refractive discrepancy seen in individuals with the variant myopic presentation. These individuals have thinner choroids in the eye with variant myopic presentation compared to the fellow eyes and controls. Hypotheses and clinical implications of variant myopia are discussed.