Intraocular Pressure and Myopia Progression, Axial Length Elongation in Rural Chinese Children.

SIGNIFICANCE: This study reported the relationship between intraocular pressure (IOP) and myopia progression, which helps to understand more comprehensively whether IOP can be an important reference factor to intervene in the progression of myopia. PURPOSE: This study aimed to investigate the association between IOP and myopia progression as well as axial length elongation in rural Chinese children. METHODS: A total of 598 (598 of 878 [68.1%]) children (6 to 17 years) from the baseline Handan Offspring Myopia Study who completed a 3.5-year follow-up vision examination were included. Ocular examinations at both visits included cycloplegic autorefraction, IOP, and axial length measurements. RESULTS: Children with myopia had the highest baseline IOP of the three refractive groups (14.13 ± 1.31, 13.78 ± 1.71, and 13.59 ± 1.64 mmHg in myopes, emmetropes, and hyperopes, respectively, P = .002). However, IOPs showed no significant difference between eyes with or without newly developed myopia (13.63 ± 1.68 vs. 13.89 ± 1.68, P = .16), with or without faster myopia progression (13.75 ± 1.61 vs. 13.86 ± 1.63, P = .46), or with axial length elongation (13.80 ± 1.61 vs. 13.76 ± 1.64, P = .80). The multivariate regression analysis demonstrated that neither baseline refractive error ( ß = -0.082, P = .13) nor baseline axial length ( ß = -0.156, P = .08) was associated with baseline IOP. CONCLUSIONS: Myopic eyes have slightly higher IOP compared with emmetropic and hyperopic eyes, although it was not clinically significant. However, IOP was not found to be associated with either myopia progression or axial length elongation in this cohort sample of rural Chinese children.

A comparative study of the prevalence of myopia and behavioral changes in primary school students.

OBJECTIVE: To analyze the changes in the prevalence of myopia and its relation to ocular biological parameters, and behaviors among primary school students in China, and understand the prevention and control of myopia. METHODS: Cross-sectional surveys were performed on 7-9-year-old children in the yrs. 2012 and 2019. In addition, spherical equivalent refraction (SER), axial length (AL), and AL/corneal radius ratio (AL/CR ratio) were collected without cycloplegia. Participants completed detailed questionnaires on behavior related to myopia. RESULTS: Data was collected on 623 children (8.02 ± 0.57 years old) in 2012 and 536 students in 2019 (8.09 ± 0.65 years old). The prevalence of myopia was 37.7% in 2012 and 39.9% in 2019. The SER was -0.25 (0.92) D in 2012 and -0.25 (1.25) in 2019. There was no statistical difference in the prevalence of myopia and SER over the 7 years (all P > 0.05). In 2019, the prevalence of myopia among girls demonstrated an increasing trend (33.8% vs. 37.8%), but there was no statistical difference (P > 0.05). The mean AL and AL/CR ratio of boys were decreasing (all P < 0.05). The proportion of children reading more than 2 h and using digital devices for more than 2 h per day after their classes in the 2019 group both decreased (all P < 0.05). However, the proportion of activities performed outdoors for more than 2 h./day decreased significantly (P = 0.001). CONCLUSION: Compared with 2012, the prevalence of myopia in primary school students in 2019 was under control, which may be related to the improvement of children's near-work behavior, but there was the problem of insufficient outdoor activity time. In terms of ocular biological parameters, the risk of myopia for boys in 2019 was lower.

Comparing habitual and i. Scription refractions.

BACKGROUND: Many patients voice concerns regarding poor night vision, even when they see 20/20 or better in the exam room. During mesopic and scotopic conditions the pupil size increases, increasing the effects on visual performance of uncorrected (residual) refractive errors. The i.Scription refraction method claims to optimize traditional refractions for mesopic and scotopic conditions, by using the information that the Zeiss i.Profilerplus gathers of ocular aberrations (low and high order). The aim of this study was to investigate any differences between habitual and i.Scription refractions and their relationship to night vision complaints. METHODS: Habitual, subjective, and i.Scription refractions were obtained from both eyes of eighteen subjects. Low and high order aberrations of the subjects were recorded with the Zeiss i.Profilerplus. The root mean square (RMS) metric was calculated for small (3 mm) and maximum pupil sizes. Subjects rated their difficulty with driving at night on a scale of 1-10. RESULTS: There was a statistically significant difference between the habitual and i.Scription refractions on both the sphere and cylinder values [(t = 3.12, p < 0.01), (t = 5.39, p < 0.01)]. The same was found when comparing the subjective and i.Scription refractions [(t = 2.31, p = 0.03), (t = 2.54, p = 0.02)]. There were no significant differences found when comparing the sphere and cylinder values between the habitual and subjective refractions or on any combination of spherical equivalent refraction. The maximum pupil size of the subject population on this study, measured with the i.Profilerplus, was 4.8 ± 1.04 mm. Ten out of the eighteen subjects had discomfort at night with an average magnitude of 4 ± 2.7. Ratings of difficulty with night vision correlated with the change in spherical equivalent correction between the habitual and i.Scription refractions (p = 0.01). A sub-analysis of myopic subjects (n = 15) showed an increase in the significance of this relationship (p = 0.002). CONCLUSIONS: The i.Scription method improves night vision by correcting the sphere and cylinder more precisely. There was a correlation between the amount of change in the cylinder value between habitual and i.Scription prescriptions and the magnitude of the reported visual discomfort at night.

Near work, outdoor activity, and myopia in children in rural China: the Handan offspring myopia study.

BACKGROUND: The near work and outdoor activity are the most important environmental risk factors for myopia. However, data from Chinese rural children are relatively rare and remain controversial. Therefore, the purpose of this study was to evaluate the relationship of both near work and outdoor activities with refractive error in rural children in China. METHODS: In this cross-sectional study, 572 (65.1%) of 878 children (6-18 years of age) were included from the Handan Offspring Myopia Study (HOMS). Information from the parents on these children, as well as the parent's non-cycloplegic refraction, were obtained from the database of the Handan Eye Study conducted in the years 2006-2007. A comprehensive vision examination, including cycloplegic refraction, and a related questionnaire, were assessed on all children. RESULTS: The overall time spent on near work and outdoor activity in the children was 4.8 ± 1.6 and 2.9 ± 1.4 h per day, respectively. Myopic children spent more time on near work (5.0 ± 1.7 h vs.4.7 ± 1.6 h, p = 0.049), while no significant difference was found in outdoor activity hours (2.8 ± 1.3 h vs. 3.0 ± 1.4 h, p = 0.38), as compared to non-myopic children. In the multiple logistic analysis, in general, no association between near work and myopia was found after adjusting for the children's age, gender, parental refractive error, parental educational level, and daily outdoor activity hours [odds ratio (OR), 95% confidence interval (CI): 1.10, 0.94-1.27]. However, a weak protective effect of the outdoor activity on myopia was found (OR, 95% CI: 0.82, 0.70-0.96), after adjusting for similar confounders. CONCLUSIONS: In general, no association between near work and myopia was found, except for the high near work subgroup with moderate outdoor activity levels. A weak protective effect of outdoor activity on myopia in Chinese rural children was observed.

The difference between cycloplegic and non-cycloplegic autorefraction and its association with progression of refractive error in Beijing urban children.

PURPOSE: To investigate the difference between cycloplegic and non-cycloplegic autorefraction and its association with the progression of refractive error in Beijing urban children. METHODS: A total of 386 children aged 6-17 years were enrolled in the baseline investigation of the Beijing Myopia Progression Study in 2010. They were invited for follow-up vision examinations in the years 2011, 2012, and 2013, including cycloplegic (cyclopentolate 1%, three times) autorefraction. We investigated the difference between the cycloplegic spherical equivalent (SE) and the non-cycloplegic SE (DSE) provided by autorefraction and its association with refractive error progression. The progression of refractive error was defined as the difference between the cycloplegic SE at follow-up and at baseline. RESULTS: Two hundred and nineteen children (57%) with completed refractive data (mean ± standard deviation: -1.36 ± 2.44 D at baseline) were ultimately enrolled. The DSE reduced from 0.51 ± 0.72 D at baseline to 0.19 ± 0.43 D in the third year of follow-up (p = 0.01). The baseline DSE was positively associated with the children's baseline cycloplegic refraction (ß = 0.193 dioptre dioptre-1 , p < 0.001). After further divided by refractive status, the DSE was consistently higher in the hyperopic group than in either the emmetropic or myopic groups at each follow-up (all p < 0.001). In the multivariate regression analysis, the myopic children with larger baseline DSE (ß = -0.404 dioptre dioptre-1 , p = 0.01) exhibited more myopic refractive change. However, baseline DSE was not found to be a significant risk factor (relative risk, 95% confidence interval: 1.06, 0.79-1.41) for those with newly developed myopia. CONCLUSION: In this sample, the children's DSE was found to be increased as the hyperopic refraction increased. Furthermore, greater the DSE was associated with the progression of refractive error among the myopic children, but not with the onset of myopia.

The influence of near work on myopic refractive change in urban students in Beijing: a three-year follow-up report.

PURPOSE: To investigate the influence of daily activities on myopic refractive change and myopic onset in Chinese urban students. METHODS: The Beijing Myopia Progression Study was a 3-year cohort study. Cycloplegic refraction and a daily activity questionnaire were assessed at baseline and at follow-up examinations. Refractive change was defined as the difference in cycloplegic spherical equivalent (SE) between the final follow-up and baseline. 386 students were initially enrolled in the baseline study. RESULTS: At the final follow-up, 222 students (57.5 %) with completed refractive error and daily activity data were analyzed. These students spent 0.32 ± 2.33 h/day more on near work (p = 0.04), and 0.21 ± 1.31 h/day less on outdoor leisure (p = 0.02), than they did at baseline. In the multivariate analysis, the younger among the secondary students (ß = 0.06, p < 0.001), and those with more near work hours at baseline (ß = -0.028, p = 0.033), exhibited more myopic refractive change. However, myopic refractive change was not found to be significantly associated with near work hours in the primary students, or with time spent outdoors, in either school level. After stratifying the activity hours into quartile groups, students with a greater near work load at baseline (trend P = 0.03) exhibited a greater myopic refractive change and had a higher risk to develop myopia (hazard ratio, 95 % confidence interval: 5.19, 1.49-18.13), after adjusting for the confounders. However, no significant association was found related to outdoor activity. CONCLUSIONS: In this cohort, children with a greater near work load at baseline exhibited more myopic refractive change and were also more likely to develop myopia. The protective effect of outdoor activity on myopic refractive change was not observed.

Eye exercises of acupoints: their impact on myopia and visual symptoms in Chinese rural children.

BACKGROUND: Chinese traditional "eye exercises of acupoints" have been advocated as a compulsory measure to reduce visual symptoms, as well as to retard the development of refractive error, among Chinese students for decades. The exercises are comprised of a 5-min, bilateral eye acupoint self-massage. This study evaluated the possible effect of these eye exercises among Chinese rural students. METHODS: Eight hundred thirty-six students (437 males, 52.3 %), aged 10.6 ± 2.5 (range 6-17) years from the Handan Offspring Myopia Study (HOMS) who completed the eye exercises and vision questionnaire, the convergence insufficiency symptom survey (CISS) questionnaire, and had a cycloplegic refraction were included in this study. RESULTS: 121 (14.5 %) students (64 males, 52.9 %) performed the eye exercises of acupoints in school. The multiple odds ratio (OR) and 95 % confidence interval (CI) for those having a "serious attitude" towards performing the eye exercises (0.12, 0.03-0.49) demonstrated a protective effect for myopia, after adjusting for the children's age, gender, average parental refractive error, and the time spent on near work and outdoor activity. The more frequently, and the more seriously, the students performed the eye exercises each week, the less likely was their chance of being myopic (OR, 95 % CI: 0.17, 0.03-0.99), after adjusting for the same confounders. However, neither the "seriousness of attitude" of performing the eye exercises (multiple ß coefficients: -1.58, p = 0.23), nor other related aspects of these eye exercises, were found to be associated with the CISS score in this sample. CONCLUSIONS: The traditional eye exercises of acupoints appeared to have a modest protective effect on myopia among these Chinese rural students aged 6-17 years. However, no association between the eye exercises and near vision symptoms was found.

Progression of lower and higher-order aberrations: a longitudinal study.

BACKGROUND: The aim of the present study was to investigate the effect of near-work on lower and higher-order aberrations, and its progression over a 9-month period during the school year. METHODS: Data from 24 young-adult myopic eyes, and 24 non-myopic eyes were used in this investigation. The lower-order aberrations, coma, spherical aberration (SA), and total root mean square (RMS) of higher order aberrations (total HOA) were measured using an open-field iTrace aberrometer, at both the initial baseline evaluation, and then at the follow-up visits over a 9-month period. Pupil size of 4 mm was used for the aberration measurements. RESULTS: The group mean (SD) of the subjects (mean age: 23.6 +/- 3.4 years) at the initial and follow-up visit was 0.47D (0.47D) and 0.31D (0.41D), in the non-myopes and -3.58D (2.08D) and -3.86D (2.14D) in the myopes, respectively. Significant increases in myopic refraction were observed. The group mean (SD) total HOA at the initial and final visit was 0.12 (0.08) and 0.11 (0.06) microns, in the non-myopes, and 0.15 (0.08) and 0.15 (0.08) microns, in the myopes, respectively. The group mean RMS of the coma at the initial and final visit was 0.06 (0.04) and 0.07 (0.05), in the non-myopes, and 0.08 (0.06) and 0.09 (0.06) microns, in the myopes, respectively. The group mean SA of the subjects at the initial and last visit was 0.04 (0.04) and 0.03 (0.03), in the non-myopes, and 0.04 (0.04) and 0.04 (0.04) microns, in the myopes, respectively. CONCLUSIONS: There was a significant difference in myopic refraction, over the 9-month assessment period. However, no significant difference in total HOA, SA, and coma between the initial and follow-up visits in both the myopes and the non-myopes was observed.

Near work, outdoor activity, and their association with refractive error.

PURPOSE: To assess the relationship between near work, outdoor activity, and refractive error in schoolchildren in Beijing. METHODS: The Beijing Myopia Progression Study is a hospital-based myopia study, in which 386 students from primary (aged 6 to 12 years) and secondary (aged 13 to 17 years) schools in the inner city of Beijing were enrolled. Cycloplegic refraction and a detailed questionnaire probing near, intermediate, and distance visual activities were completed. RESULTS: Three hundred seventy (95.9%) of 386 students with complete cycloplegic autorefraction and myopia questionnaire data were enrolled in this study. Children with more near work time did not exhibit a significantly more myopic refraction in both the primary and secondary school levels after adjusting for the children's gender, outdoor activity time, and average parental refractive error. A significant association between outdoor activity time (in hours per day) and the children's spherical equivalent (in diopters) was found in the primary school students (ß = 0.27, p = 0.03) but not in the secondary school students (ß = 0.04, p = 0.70) after adjusting for similar confounders. The time spent on outdoor sports and outdoor leisure in the primary school students was also significantly associated with the children's spherical equivalent (ß = 0.46, p = 0.04 and ß = 0.31, p = 0.02, respectively). Primary school students with more time outdoors exhibited relatively less myopic refraction than their peers (ptrend = 0.0003), but this relation was not demonstrated in the secondary school children (ptrend = 0.53) after adjusting for similar confounders. CONCLUSIONS: Higher levels of outdoor activity were associated with less myopic refraction in primary school students in the inner city of Beijing. Near work activity was not found to be associated with refraction at either school level.

Effect of Lipiflow (Thermal Pulsation) on Ocular Surface Disease Management After Cataract Surgery.

Purpose: The aim of the current study was to investigate the efficacy of Thermal pulsation treatment, completed one month prior to cataract surgery, as a means of eliminating or significantly mitigating the exacerbating effects of cataract surgery on dry eye patients. Setting: Glendale, Arizona. Design: Prospective, longitudinal, non-masked, randomized clinical investigation. Methods: The treatment group received Thermal pulsation therapy approximately 1 month prior to undergoing immediate sequential, same-day bilateral cataract surgery. The control group did not receive pre-operative Thermal pulsation but had cataract surgery performed in the same way, approximately 1 month after their baseline visit. Subjective questionnaires and objective clinical findings were evaluated at baseline, 1, 3, and 6 months after cataract surgery in the treatment group and control group. Results: A total of 62 patients were randomized into two groups of 31 representing 124 eyes. Subjective improvement was observed in the treatment group with OSDI and SPEED II scores. Mean (SD) of the OSDI improved significantly (p<0.01) from 56.98 (18.30) from visit 1 to 14.73 (12.22) at visit 4, and the mean (SD) of the SPEED II scores improved significantly (p=0.01) from 13.84 (6.12) during visit 1 to 7.1 (5.00) at visit 4 in the treatment group. Conclusion: Pre-operative Thermal pulsation treatment in patients with dry eye secondary to MGD appears to reduce dry eye symptoms after cataract surgery. Expectations should be moderated by the fact that the reduction in symptoms appears to reduce prior to 3 months post-op after cataract surgery.

Nearwork-induced transient myopia and parental refractive error.

PURPOSE: To investigate the relationship between parental refractive error and the nearwork-induced transient myopia (NITM) characteristics of their children. METHODS: Three hundred sixty children (173 boys and 187 girls) aged 6 to 17 years were tested. Initial NITM and its decay time (DT) were assessed objectively (WAM-5500, Grand-Seiko) immediately after binocularly viewing and performing a sustained near task (5 diopters [D]) for 5 minutes, incorporating a cognitive demand with full distance refractive correction in place. The NITM was classified into three categories: low (< 0.15 D), moderate (0.15 to 0.30 D), or high (≥0.30 D), whereas its decay was classified into two categories, namely, complete or incomplete. In addition, the children were divided into three groups based on the number of myopic parents (none, one, or two) and into four groups based on the level of parental myopia (no, low, moderate, or high). RESULTS: Neither paternal nor maternal refractive error was associated with either their children's initial NITM magnitude or its DT in the myopic, emmetropic, or hyperopic groups or the combined group. No significant differences (p > 0.05) in the NITM magnitude, DT, or decay time constant were found as related to the number of myopic parents or level of parental myopia. Multiple odds ratio for incomplete decay of NITM did not change significantly (p > 0.05) with either an increase in number of myopic parents or level of parental myopia. CONCLUSIONS: There was no association between parental refractive error and their children's NITM characteristics. This suggests a primary environmental basis for the NITM characteristics in the children.

Nearwork-induced transient myopia (NITM) in anisometropia.

OBJECTIVE: To assess the magnitude of nearwork-induced transient myopia (NITM) under binocular viewing conditions separately in each eye of individuals with mild to moderate anisometropia to determine the relationship between NITM and their interocular refractive error. METHODS: Forty-three children and young adults with anisometropia [cycloplegic spherical equivalent (SE) difference >1.00 D] were tested (ages 9-28 years). NITM was measured with binocular viewing separately in each eye after binocularly performing a sustained near task (5 D) for 5 min incorporating a cognitive demand using an open-field, infrared autorefractor (Grand-Seiko, WAM-5500). Data were averaged over 10 s bins for 3 min in each eye. Initial NITM, its decay time (DT), and its decay area (DA) were determined. A-scan ultrasound ocular biometry was also performed to determine the axial length of each eye. RESULTS: The more myopic eye exhibited increased initial NITM, DT, and DA as compared to the less myopic eye (0.21 ± 0.16 D vs 0.15 ± 0.13 D, p = 0.026; 108.4 ± 64.3 secs vs 87.0 ± 65.2 secs, p = 0.04; and 17.6 ± 18.7 D*secs vs 12.3 ± 15.7 D*secs, p = 0.064), respectively. The difference in DA and the difference in SE between the more versus less myopic eye were significantly correlated (r = 0.31, p = 0.044). Furthermore, 63% (27/43), 56% (24/43), and 70% (30/43) of the more myopic eyes exhibited increased initial NITM, longer DT, and larger DA, respectively, than found in the less myopic eye. CONCLUSIONS: In approximately two-thirds of the anisometropic individuals, the initial NITM and its decay area were significantly increased in the more myopic eye as compared to the less myopic eye. NITM may play an important role in the development of interocular differences in myopia, although a causal relationship is yet to be established. Furthermore, the findings have potentially important implications regarding accommodative control and interocular accommodative responsitivity in anisometropia, in particular for anisomyopia.

Eye exercises of acupoints: their impact on refractive error and visual symptoms in Chinese urban children.

BACKGROUND: Traditional Chinese eye exercises of acupoints involve acupoint self-massage. These have been advocated as a compulsory measure to reduce ocular fatigue, as well as to retard the development of myopia, among Chinese school children. This study evaluated the impact of these eye exercises among Chinese urban children. METHODS: 409 children (195 males, 47.7%), aged 11.1 ± 3.2 (range 6-17) years, from the Beijing Myopia Progression Study (BMPS) were recruited. All had completed the eye exercise questionnaire, the convergence insufficiency symptom survey (CISS), and a cycloplegic autorefraction. Among these, 395 (96.6%) performed the eye exercises of acupoints. Multiple logistic regressions for myopia and multiple linear regressions for the CISS score (after adjusting for age, gender, average parental refractive error, and time spent doing near work and outdoor activity) for the different items of the eye exercises questionnaire were performed. RESULTS: Only the univariate odds ratio (95% confidence interval) for "seriousness of attitude" towards performing the eye exercises of acupoints (0.51, 0.33-0.78) showed a protective effect towards myopia. However, none of the odds ratios were significant after adjusting for the confounding factors. The univariate and multiple ß coefficients for the CISS score were -2.47 (p = 0.002) and -1.65 (p = 0.039), -3.57 (p = 0.002) and -2.35 (p = 0.042), and -2.40 (p = 0.003) and -2.29 (p = 0.004), for attitude, speed of exercise, and acquaintance with acupoints, respectively, which were all significant. CONCLUSIONS: The traditional Chinese eye exercises of acupoints appeared to have a modest effect on relieving near vision symptoms among Chinese urban children aged 6 to 17 years. However, no remarkable effect on reducing myopia was observed.

Reproducibility of nearwork-induced transient myopia measurements using the WAM-5500 autorefractor in its dynamic mode.

PURPOSE: To evaluate the reproducibility of nearwork-induced transient myopia (NITM) measurements obtained objectively using an open-field autorefractor (WAM-5500) in its dynamic mode. METHODS: NITM was assessed in 22, visually-normal, teen-aged and young-adult subjects using an infrared autorefractor (WAM-5500) in the dynamic mode. Measurements were obtained from the right eye in two test sessions separated by either 30 minutes or 2 days. Initial NITM and its decay were assessed monocularly by the same experimenter immediately after binocularly viewing and performing a detailed near task (5D) for 5 minutes incorporating a cognitive demand, with habitual distance refractive correction in place. Data were averaged over 10-second bins for 3 minutes (180 seconds; 18 bins) for the decay analysis. The NITM post- minus pre-task difference and its limits of agreement (LOA), as well as intraclass correlation coefficient (ICC), were calculated to evaluate reproducibility over the two test sessions for the initial NITM magnitude and its decay. RESULTS: The group mean (±SE) initial NITM and its decay duration were 0.33 ± 0.09 D and 0.28 ± 0.08 D, and 118.6 ± 14.3 seconds and 132.3 ± 12.2 seconds respectively, for each test session, which were not significantly different (p > 0.05). The difference (range), LOA, and ICC (95% confidence interval [CI]) were 0.06D (-0.15, 0.64), -0.29 to 0.40D, and 0.90D (0.77, 0.96) for the initial NITM; they were -13.6 (-150.0, 140.0) seconds, -174.5 to 147.3 seconds, and 0.14 (0.00, 0.52) for decay duration, respectively, for each test session. The ICC range for the first 50 secs of the NITM response/decay was 0.90 to 0.96. CONCLUSIONS: The initial NITM was highly repeatable. The initial decay phase was moderately repeatable, with the later decay phase being more variable, yet still yielding acceptable reproducibility in many cases. Both of these key parameters, namely initial NITM and its early decay, can be assessed reliably and with good reproducibility. This is important in future longitudinal studies of NITM, and its possible relation to refractive development.

Baseline characteristics of nearwork-induced transient myopia.

PURPOSE: The purpose of the present study was to describe the baseline refractive and nearwork-induced transient myopia (NITM) characteristics of the Beijing Myopia Progression Study, a 3-year cohort study, that has three overall specific aims: to investigate the natural history of NITM in schoolchildren living in the inner city of Beijing aged between 7 and 17 years; to investigate the possible relation between NITM and permanent myopia; and to determine the possible associations with NITM (eg, parental history). METHODS: Three hundred eighty-six students (187 males and 199 females) were enrolled. The mean ages were 8.4 ± 1.1 years and 14.2 ± 1.6 years for the primary school and secondary school students, respectively. Baseline refractive aspects were determined clinically. Initial NITM and its decay were assessed objectively immediately after binocularly viewing and performing a sustained near task (5 minutes; 5 diopters [D]), incorporating a cognitive demand with full distance refractive correction in place. RESULTS: Initial NITM (mean ± SD) / decay time (median, first quartile, and third quartile) was 0.18 ± 0.16 D / 50 (20, 90) seconds, 0.09 ± 0.13 D / 30 (10, 40) seconds, and 0.10 ± 0.19 D / 20 (10, 40) seconds among the myopic, emmetropic, and hyperopic students, respectively, for the combined school levels. Initial NITM and decay time were significantly larger/longer in the myopic versus the other two refractive groups. CONCLUSIONS: The present findings demonstrate that in a large sample of school-aged children with myopia, the initial NITM magnitude was significantly larger and the decay duration was significantly longer than that observed in age-matched children with either emmetropia or hyperopia. Follow-up for the next 3 years will provide insight into the possible role of NITM in the development of permanent myopia.

Analysis of the Reliability and Repeatability of Distance Visual Acuity Measurement with EyeSpy 20/20.

Background: Visual acuity is a critical component of visual function assessment for all ages. Standardized vision testing protocols may help prevent testing inconsistencies resulting from variations in test administration and interpretation of different examiners. However, most vision assessments outside of research settings, including in doctor's offices, rarely employ standardized protocols. Validated protocols such as the Early Treatment for Diabetic Retinopathy Study (ETDRS) are frequently employed by vision researchers to ensure accurate and repeatable visual acuity measurements. Methods: This study evaluates a desktop-based standardized vision testing algorithm (EyeSpy 20/20) specifically designed for use on mobile electronic platforms. Subjects were tested on a desktop version of the EyeSpy software for both the accuracy and duration of measurement of visual acuity and compared to a e-ETDRS chart in a randomized sequence. Children were recruited for this study and tested between two different visual acuity measurement systems. Bland-Altman analysis and correlation tests were done. Results: Hundred and ten children were recruited for the study. The EyeSpy 20/20 visual acuity testing algorithm as tested with the desktop version was non-inferior to the gold standard e-ETDRS testing algorithm on a desktop platform, but statistically faster to implement when administered on the same electronic testing platform. Conclusion: EyeSpy 20/20 is a promising tool for vision screening and visual acuity evaluation in children.

Refractive change and incidence of myopia among rural Chinese children: the Handan Offspring Myopia Study.

PURPOSE: To assess the refractive change and incidence of myopia, as well as their risk factors, among Chinese rural children aged 6-17 years. METHODS: Children who completed the baseline vision examination of the Handan Offspring Myopia Study were re-examined, including both cycloplegic and non-cyloplegic autorefraction, with a mean follow-up time of 42.4±1.47 months. RESULTS: A total of 601 children (68.5%) who completed both baseline and the follow-up examinations were enrolled. The cumulative refractive change and axial length change were -0.53±1.03 diopter and 0.39±0.46 mm (-0.15 diopter/year and 0.11 mm/year), respectively. A hundred and five out of the 469 non-myopic children at baseline become myopic at the follow-up, yielding a cumulative myopia incidence of 22.4% (95% CI: 18.6% to 26.2%), or annual myopia incidence of 6.3%. After adjustment, younger age (ß=0.08, p<0.001), more myopic baseline refraction (ß=0.31, p<0.001), larger difference between cycloplegic and non-cycloplegic refraction (ß=-0.20, p=0.007) and more myopic paternal refraction (ß=0.09, p=0.007) were found to be associated with more rapid myopic refractive change. More myopic baseline refraction (relative risk (RR), 95% CI: 0.19, 0.13-0.28, p<0.001) and more myopic paternal refraction (RR, 95% CI: 0.92, 0.84-1.00, p=0.039) were also associated with myopia incidence. CONCLUSION: Relatively low myopic refractive change and myopia incidence were found in this study cohort. Children's refraction and paternal refraction were associated with both myopic refractive change and myopia incidence. Such information will be helpful for further comparisons in other rural versus urban areas of China, and other countries.

Elementary school comprehensive intervention and myopia development: the Wenzhou Epidemiology of Refraction Error Study.

AIM: To investigate the effects of school-based comprehensive intervention on myopia development in elementary school children. METHODS: As a part of the Wenzhou Epidemiology of Refraction Error Study, there were 1524 participating elementary students (730 girls, 47.9%) in grades 1 to 3 from three campuses of one school, aged 7.3±0.9y, who were examined twice every year for a 2.5y follow up period. Comprehensive intervention and other reminders were given at school every semester for the intervention group. The control group did not receive comprehensive intervention and did not have reminders of it. RESULTS: There were 651 students in the intervention group [mean age 7.3±0.9y; 294 (45.2%) girls] and 737 students in the control group [mean age 7.2±0.9y; 346 (46.9%) girls]. Overall mean myopia progression during the 2.5y follow-up was -0.49±1.04 diopters (D) in the intervention group and -0.65±1.08 D in the control group (P=0.004). The majority that not get myopia at baseline spherical equivalent (SE≤-1.0 D). Their mean myopia progression during the 2.5y follow-up was -0.37±0.89 D in the intervention group and -0.51±0.93 D in the control group (27.5% reduction, P=0.009); Overall, mean axial length elongation was less in the intervention group (0.56±0.32 mm) than in the control group (0.61±0.38 mm, 10.5% reduction, P=0.009). The percentage of close reading distance (<30 cm) in the intervention group was less than in the control group (73.4% vs 76.2%, P<0.001), the percentage of everyday perform eye exercises in the intervention group was more than in the control group (27.8% vs 20.7%, P<0.001) 30mo later. CONCLUSION: The comprehensive intervention program at elementary school has a significant alleviating effect on myopia progression for children during the 2.5y follow-up, especially for those non-myopia at baseline.

Reading Eye Movements Performance on iPad vs Print Using a Visagraph.

This study investigated reading comprehension, reading speed, and the quality of eye movements while reading on an iPad, as compared to printed text. 31 visually-normal subjects were enrolled. Two of the passages were read from the Visagraph standardized text on iPad and Print. Eye movement characteristics and comprehension were evaluated. Mean (SD) fixation duration was significantly longer with the iPad at 270 ms (40) compared to the printed text (p=0.04) at 260 ms (40). Subjects' mean reading rates were significantly lower on the iPad at 294 words per minute (wpm) than the printed text at 318 wpm (p=0.03). The mean (SD) overall reading duration was significantly (p=0.02) slower on the iPad that took 31 s (9.3) than the printed text at 28 s (8.0). Overall reading performance is lower with an iPad than printed text in normal individuals. These findings might be more consequential in children and adult slower readers when they read using iPads.

The association between nearwork-induced transient myopia and progression of refractive error: A 3-year cohort report from Beijing Myopia Progression Study.

PURPOSE: To investigate the natural change of nearwork-induced transient myopia (NITM), and its association with the progression of refractive error. METHODS: Students of the Beijing Myopia Progression Study were examined at baseline and follow-up examinations, which included cycloplegic autorefraction. Initial NITM and its decay were assessed objectively immediately after binocularly-viewing and performing a sustained 5-minute near task (20 cm). RESULTS: There were 223 students with both NITM and cycloplegic refractive data enrolled. There were 142 myopic (63.7%), 32 emmetropic (14.4%), and 49 hyperopic (22.0%) students according to their baseline cycloplegic refraction. The annual refractive change was -0.45 (-0.73, -0.21) D. From the baseline to the one-year and two-year follow-up periods, the initial NITM (median) increased significantly in the myopic students (0.16, 0.21, and 0.20D, p = 0.01, respectively). The overall proportion of NITM decay types shifted significantly from none being induced at baseline (non-induced: 17.0%, complete decay 57.4%, incomplete decay 25.6%) to incomplete decay at the 2-year follow-up (non-induced: 6.7%, complete decay 65.0%, incomplete decay 28.3%, p = 0.01). For the hyperopic students, after adjusting for risk factors, for every 1 diopter increase in the initial NITM at baseline, there was approximately a -1.48 diopter more relative myopic refractive progression (p = 0.01). No significant association was found between refractive change and the NITM parameters for either the myopic or emmetropic students after adjusting for the same confounders. However, this relation was significant in the hyperopes (p = 0.01). CONCLUSION: NITM was only found to be significantly associated with the progression of a myopic refractive shift among the hyperopes.