Noncycloplegic Compared with Cycloplegic Refraction in a Chicago School-Aged Population.

PURPOSE: To evaluate differences between autorefraction measurements with and without cycloplegia among school-aged individuals and to explore factors associated with significant differences. DESIGN: Cross-sectional, retrospective study. PARTICIPANTS: Individuals between 3 and 22 years of age evaluated at the Illinois College of Optometry from September 2016 through June 2019 who underwent same-day noncycloplegic and cycloplegic autorefraction of the right eye. METHODS: Demographic information including age, sex, and race or ethnicity were collected during the eye examination. Autorefraction was performed before and after cycloplegia. Myopia, defined as at least -0.50 diopter (D) spherical equivalent (SE), hyperopia, defined as at least +0.50 D SE, and astigmatism of at least 1.00 D cylinder were determined using noncycloplegic and cycloplegic autorefractions. Factors associated with at least 1.00 D more myopic SE or at least 0.75 D cylindrical difference by noncycloplegic autorefraction were assessed using logistic regression models. MAIN OUTCOME MEASURES: Differences between noncycloplegic and cycloplegic autorefraction measurements. RESULTS: The mean age was 10.8 ± 4.0 years for the 11 119 individuals; 52.4% of participants were female. Noncycloplegic SE measured 0.65 ± 1.04 D more myopic than cycloplegic SE. After adjusting for demographic factors and refractive error, individuals with at least 1.00 D of more myopic SE refraction by noncycloplegic autorefraction (25.9%) were more likely to be younger than 5 years (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.18-1.79) and 5 to younger than 10 years (OR, 1.32; 95% CI, 1.18-1.48) than those 10 to younger than 15 years. This difference of at least 1.00 D of more myopic SE was more likely to be observed in Hispanic people (OR, 1.23; 95% CI, 1.10-1.36) and those with hyperopia (OR range, 4.20-13.31). Individuals with 0.75 D or more of cylindrical difference (5.1%) between refractions were more likely to be younger than 5 years, to be male, and to have mild-moderate-high myopia or moderate-high hyperopia. CONCLUSIONS: Three quarters of school-aged individuals had < 1 D of myopic SE difference using noncycloplegic compared with cycloplegic autorefraction. Understanding measurement differences obtained for refractive error and associated factors may provide useful information for future studies or programs involving refraction in school-aged children.

CHARACTERISTICS OF PERIPAPILLARY INTRACHOROIDAL CAVITATION IN HIGHLY MYOPIC EYES: The Zhongshan Ophthalmic Center-Brien Holden Vision Institute High Myopia Cohort Study.

PURPOSE: To characterize peripapillary intrachoroidal cavitation (PICC) in highly myopic participants and its associated risk factors. METHODS: This observational, cross-sectional study recruited 890 Chinese participants with bilateral high myopia, defined as ≤-6.00 diopters spherical power. Fundus photography and spectral-domain optical coherence tomography were used to determine the presence of PICC, defined as a yellow-orange lesion adjacent to the disc border with a corresponding intrachoroidal hyporeflective space. RESULTS: Among 890 participants, 884 right eyes were included for analysis. The rate of PICC was 3.6% (32 eyes). Peripapillary intrachoroidal cavitation was observed in two eyes without myopic retinal lesions, nine eyes with tessellated fundus only, 16 eyes with diffuse chorioretinal atrophy, and five eyes with patchy chorioretinal atrophy. The most commonly affected area was inferior disc border (87.5%), followed by multiple (9.4%) and superior (3.1%) disc borders. The multiple linear logistic regression model showed that older age, more myopic spherical equivalent, and longer axial length were associated with the presence of PICC. CONCLUSION: Peripapillary intrachoroidal cavitation was present in 3.6% of highly myopic eyes. It was more common in eyes with a higher myopic maculopathy category. Older age, more myopic spherical equivalent, and longer axial length were risk factors for the presence of PICC.

Determinants of macular ganglion cell-inner plexiform layer thickness in normal Chinese adults.

BACKGROUND: Demographic, systemic and ocular factors may impact macular ganglion cell-inner plexiform layer (GCIPL) thickness measurements. This study aimed to investigate the influences of multiple potential determinants of macular GCIPL thickness in normal Chinese adults. METHODS: This was a retrospective study conducted on 225 normal eyes from 225 healthy Chinese adults. GCIPL thickness were obtained using Cirrus high-definition optical coherence tomography (OCT). The age, gender, laterality, spherical equivalent (SE) refractive error, intraocular pressure (IOP), axial length (AL), central cornea thickness (CCT), circumpapillary retinal nerve fibre layer (pRNFL) thickness and OCT signal strength were recorded and their respective effect on GCIPL thickness parameters were evaluated. RESULTS: The mean (± SD) average, minimum, superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal GCIPL thickness was 84.56 ± 5.36, 81.32 ± 5.58, 83.08 ± 5.37, 85.70 ± 5.95, 87.15 ± 6.26, 85.07 ± 6.11, 82.46 ± 5.76, and 83.88 ± 5.59 µm, respectively. Determinants of thinner GCIPL thickness were older age (P = 0.001-0.117; effects enhanced if age over 40 years), thinner pRNFL (all P < 0.001), and weaker signal strength (all P < 0.001). No significant difference was found between males and females (P = 0.069-0.842), and between right eyes and the left eyes (P = 0.160-0.875) except that of superonasal GCIPL thickness (P < 0.001). There was no significant correlation between GCIPL thickness and SE, IOP, CCT, and AL (P = 0.135-0.968). CONCLUSIONS: Individual determinants associated with thinner GCIPL thickness were older age (particularly over 40 years of age), thinner pRNFL, and weaker OCT signal strength. This is relevant in comprehensively understanding the normative data and differentiating normal aging from abnormalities.

DIFFUSE CHORIORETINAL ATROPHY IN CHINESE HIGH MYOPIA: The ZOC-BHVI High Myopia Cohort Study.

PURPOSE: To explore the associations between diffuse chorioretinal atrophy (DCA) and age, sex, axial length, spherical equivalent, and best-corrected visual acuity (BCVA) among highly myopic eyes. METHODS: This study included right eyes of 857 bilaterally highly myopic individuals from the ZOC-BHVI Cohort Study. Participants underwent examinations, including BCVA, ocular biometry, autorefraction, and color fundus photography. An Early Treatment Diabetic Retinopathy Study grid was applied on the fundus photographs to evaluate the location of DCA, which was graded into four categories (D0-D3). The characteristics and ocular biometry were compared between participants' eyes with and without DCA. RESULTS: Diffuse chorioretinal atrophy was found in 177 (20.6%) eyes. The proportion of participants with DCA in age groups of 7 to 11, 12 to 18, 19 to 39, and ≥ 40 years old was 20.9%, 9.2%, 23.1%, and 52.9%, respectively. The proportion of DCA significantly increased with longer axial length and worse myopic spherical equivalent. Eyes with DCA had poorer BCVA (Snellen visual acuity 20/36, logarithm of minimal angle of resolution 0.26 ± 0.25) than those without DCA (Snellen visual acuity 20/23, logarithm of minimal angle of resolution 0.06 ± 0.14) (P < 0.001). The BCVA gradually declined as the lesion got closer to the fovea (P for trend < 0.001). CONCLUSION: The proportion of DCA increased with older age, longer axial length, and more myopic spherical equivalent. Diffuse chorioretinal atrophy is a vision-threatening complication of high myopia where BCVA gradually worsens with foveal involvement.

Spike encoding and storage properties in mutually coupled vertical-cavity surface-emitting lasers subject to optical pulse injection.

The generation and storage properties of different spike codes in vertical-cavity surface-emitting lasers with an embedded saturable absorber (VCSELs-SA) are investigated numerically. The results show that different spike codes are generated by injecting an optical pulse into one single VCSEL-SA and can be stored in two mutually coupled VCSELs-SA. In particular, in the case of the generation of spike codes, the effects of the input strength and the temporal duration of the input optical pulse are studied; in the case of the storage of spike codes, the roles of the coupling weight and the coupling delay between the two mutually coupled VCSELs-SA are examined. Simulations reveal that spikes can be triggered if the input strength and the temporal duration exceed the threshold values, and higher values of the input strength and the temporal duration are beneficial for generating more spikes. Moreover, successful storage of a perfectly formed train of spike codes in two mutually coupled VCSELs-SA can also be realized provided that the coupling weight and the coupling delay are larger than the corresponding threshold values.

Optic Disc Features in Highly Myopic Eyes: The ZOC-BHVI High Myopia Cohort Study.

SIGNIFICANCE: Some studies reported that optic disc tilt and rotation might be risk factors for the susceptibility of high myopic eyes to develop glaucoma. However, data regarding optic disc manifestations in high myopia participants are few. It is crucial to characterize the features of optic disc manifestations among high myopes. PURPOSE: To describe optic disc characteristics of Chinese highly myopic eyes and to investigate associated factors. METHODS: This cross-sectional, observational study included 890 Chinese with bilateral high myopia (defined as ≤-6.00 diopters spherical power) in 2012. All subjects underwent cycloplegic autorefraction, ocular biometry, and fundus photography. The optic disc tilt ratio, degree of rotation, and ß-zone peripapillary atrophy area were measured from the 45°optic disc-centered fundus photographs. Optic disc tilt was defined as optic disc tilt ratio, the ratio of maximum to minimum diameter of optic disc, exceeding 1.3. The definition of optic disc rotation was using optic disc rotation degree, the angle from long diameter and the vertical meridian, of >15°. RESULTS: Among 890 participants, 2 were excluded by ungradable optic disc-centered fundus photographs. In the 888 studied right eyes, the mean spherical power was -9.36 ± 3.46 diopters with a mean axial length of 27.51 ± 1.63 mm. The proportion of optic disc tilting, rotation, and ß-zone peripapillary atrophy were 81.2%, 48.3%, and 92.8%, respectively. The mean ratio of optic disc tilting and rotation degree was 1.78 ± 0.53 and 21.08 ± 19.91°; the mean area of ß-zone peripapillary atrophy/optic disc head was 1.11 ± 1.22. A multiple linear regression showed that older age (P < .001), female (P = .02), and more myopic spherical equivalent (P = .005) were related to the greater optic disc tilting ratio. CONCLUSIONS: Beta-zone peripapillary atrophy, optic disc tilting, and rotation are very common in highly myopic eyes in Chinese population. Older age, female, and more myopic spherical equivalent are risk factors of higher degree of optic disc tilting.

Is Thicker Choroid a Risk Factor for Malignant Glaucoma?

PURPOSE: The aim of this study was to evaluate the choroidal thickness (CT) and its determinants in primary angle closure glaucoma (PACG) eyes with and without malignant glaucoma (MG). METHODS: In this cross-sectional study, we enrolled 25 patients with bilateral primary angle closure (PAC) diseases; 1 eye of each patient was diagnosed with PACG initially and later with MG after trabeculectomy, and the fellow eyes were diagnosed with PACG, PAC, or PAC suspect. Thirty-seven eyes from 37 PACG patients were recruited as controls. CT was measured at different locations (sub-fovea, 1 and 3 mm from the fovea) using spectral-domain optical coherence tomography. Comparisons of CT were made among MG, the fellow eyes, and the controls. The associations between the determinants and MG were analyzed by univariate and multiple logistic regression analysis. RESULTS: Macular CT in the eyes with MG was thicker than that of the controls (p < 0.001) but not the fellow eyes. Thicker foveal CT was associated with an increased risk of MG (odds ratio 1.141). CONCLUSIONS: Thicker foveal CT is an anatomic risk factor for MG. The results of our study were consistent with the hypothesis that choroidal expansion may play a significant role for the development of MG.

Progression of Near Vision Loss and Incidence of Near Vision Impairment in an Adult Chinese Population.

PURPOSE: To investigate the progression of near vision loss and the cumulative incidence of near vision impairment (NVI) 6 years after initial examination of an urban Chinese cohort. DESIGN: Population-based, prospective cohort study. PARTICIPANTS: People aged ≥35 years examined at baseline in the Yuexiu District of Guangzhou, China. METHODS: Participants examined at baseline were invited for 2-year and 6-year follow-up examinations in 2010 and 2014, respectively. Examinations included noncycloplegic autorefraction and binocular near visual acuity (NVA) with and without current near correction measured at 40 cm using a LogMAR ETDRS near vision tumbling E chart. Those with uncorrected binocular NVA (UCNVA) ≤20/40 underwent subjective refraction to obtain best-corrected binocular NVA (BCNVA). MAIN OUTCOME MEASURES: Change in UCNVA between baseline and 2014 follow-up examinations and the 6-year cumulative incidence of vision impairment based on 3 definitions: NVA ≤20/40, ≤20/50, and ≤20/63. RESULTS: Among the 1817 baseline participants, 1595 (87.8%) were reexamined in 2010 and 1427 (78.5%) in 2014. Mean vision loss between baseline and the 2014 follow-up was 1.54 (±1.74) lines of UCNVA. Vision loss was associated with age 80 years or older, less education, and better baseline UCNVA. The 6-year cumulative incidence of uncorrected binocular NVI (UCNVI) across the 3 vision impairment definitions was 55.2% (95% confidence interval [CI], 46.1%-64.3%), 51.3% (95% CI, 44.0%-58.7%), and 42.4% (95% CI, 35.5%-49.3%), respectively. With best-corrected binocular NVI (BCNVI), incidence was 6.89% (95% CI, 4.28%-9.50%), 5.17% (95% CI, 2.89%-7.44%), and 2.62% (95% CI, 1.11%-4.12%), respectively. A higher incidence of UCNVI was associated with worse baseline UCNVA for all 3 impairment definitions. Similarly, incidence of BCNVI was associated with worse baseline BCNVA, but also with older age and education at the primary level or less. Gender was not significant for either UCNVI or BCNVI. CONCLUSIONS: Approximately half of those aged 35 years or older develop UCNVI in 6 years, the overwhelming majority of whom can be corrected with spectacles. Cost-effective strategies to provide spectacles to this at-risk population remains an issue requiring further study.

Significant Axial Elongation with Minimal Change in Refraction in 3- to 6-Year-Old Chinese Preschoolers: The Shenzhen Kindergarten Eye Study.

PURPOSE: To document the distribution of ocular biometry and to evaluate its associations with refraction in a group of Chinese preschoolers. DESIGN: Population-based cross-sectional study. PARTICIPANTS: A total of 1133 preschoolers 3 to 6 years of age from 8 representative kindergartens. METHODS: Biometric measurements including axial length (AL), anterior chamber depth (ACD), and corneal radius of curvature (CR) were obtained from partial-coherence laser interferometry (IOL Master; Carl Zeiss Meditec, Oberkochen, Germany) before cycloplegia. Lens power (LP) and AL-to-CR ratio were calculated. Cycloplegic refraction (3 drops of 1% cyclopentolate) was measured using an autorefractor (KR8800; Topcon Corp., Tokyo, Japan), and spherical equivalent refraction (SER) was calculated. Biometric and refractive parameters were assessed as a function of age and gender. Multiple regression analysis was performed to explore the associations between refraction and ocular biometry. MAIN OUTCOME MEASURES: Ocular biometric distributions and their relationships to refraction. RESULTS: Among the 1127 children (99.5%) with successful cycloplegic refraction, mean SER was 1.37±0.63 diopters (D). Prevalence of myopia increased from 0% at 3 years of age to 3.7% (95% confidence interval, 1.0%-6.5%) at 6 years of age. Biometric parameters followed Gaussian distributions with means of 22.39±0.68 mm for AL, 7.79±0.25 mm for CR, and 24.61±1.42 D for calculated LP; and non-Gaussian distributions with means of 3.34±0.24 mm for ACD and 2.88±0.06 for AL-to-CR ratio. Axial length, ACD, and AL-to-CR ratio increased from 3 to 6 years of age, CR remained stable, whereas LP declined. Overall, SER declined slightly. For the SER variance, AL explained 18.6% and AL-to-CR ratio explained 39.8%, whereas AL, CR, and LP accounted for 80.0% after adjusting for age and gender. CONCLUSIONS: Young Chinese children are predominantly mildly hyperopic, with a low prevalence of myopia by the age of 6 years. An increase of 1 mm in AL was associated with only 0.45 D of myopic change. Decreases in LP reduce the myopic shifts that normally would be associated with increases in AL, and thus play a key role in refractive development in this age group.

Three-Dimensional Eye Shape, Myopic Maculopathy, and Visual Acuity: The Zhongshan Ophthalmic Center-Brien Holden Vision Institute High Myopia Cohort Study.

PURPOSE: To investigate the relationship among eye shape, myopic maculopathy, and visual acuity in highly myopic eyes using 3-dimensional (3D) magnetic resonance imaging (MRI). DESIGN: Observational case series. PARTICIPANTS: The study included 190 eyes of 95 participants with bilateral high myopia from the Zhongshan Ophthalmic Center-Brien Holden Vision Institute High Myopia Cohort Study, with spherical power ≤-6.00 diopters (D) in both eyes. METHODS: The participants underwent best-corrected visual acuity (BCVA), fundus photography, cycloplegic refraction, and ocular biometry. Posterior staphyloma was identified with 3D MRI, and ocular shapes were categorized into spheroidal, ellipsoidal, conical, nasally distorted, temporally distorted, and barrel shapes according to the inferior view from T2-weighted 3D MRI (Achieva 3.0T; Philips Medical Systems, Best, the Netherlands). Myopic maculopathy was graded as C0 to C4 according to the International Photographic Classification and Grading System using fundus photography. The statistical significance of the differences in distribution of myopic maculopathy and BCVA in eyes with different ocular shapes was determined using Pearson's chi-square tests. MAIN OUTCOME MEASURES: Distributions of myopic maculopathy and BCVA in relation to different eye shapes. RESULTS: The mean spherical equivalent and axial length were -11.74±4.10 D and 28.18±1.73 mm in the right eyes, respectively. The same ocular shapes were observed in both eyes in 69 participants (72.6%). The predominant shape was spheroidal (53.7%), followed by nasally distorted and conical types (both 14.7%). C2 and above myopic maculopathy was observed in all barrel-shaped eyes, in 75% temporally distorted eyes, and in 71.4% nasally distorted and conical eyes. In eyes with posterior staphyloma (n = 22), 18 (81.8%) had C2 and above myopic maculopathy compared with 40 eyes (54.8%) without posterior staphyloma (n = 73). Eyes with temporal and nasal distortion, and eyes with staphyloma were more likely to have BCVA <20/40. CONCLUSIONS: Not all highly myopic eyes are deformed. Spheroid was the predominant ocular shape in this series of young patients with high myopia bilaterally. Barrel-shaped and temporally distorted eyes present significant myopic maculopathy, whereas eyes with posterior staphyloma display more severe chorioretinal atrophy. Eyes of more deformed shapes tend to have more severe myopic maculopathy and worse BCVA.

Reproducibility of macular ganglion cell-inner plexiform layer thickness in normal eyes determined by two different OCT scanning protocols.

BACKGROUND: To investigate the reproducibility of macular ganglion cell-inner plexiform layer (GCIPL) thickness measurement in normal eyes determined by different operators and two different raster scanning protocols of Cirrus high-definition optical coherence tomography (HD-OCT). METHODS: One hundred and two eyes of 102 normal subjects were scanned three times using Cirrus HD-OCT with Macular Cube 512 × 128 protocol by two operators, respectively. Three extra scans were obtained using Macular Cube 200 × 200 protocol. The average, minimum, superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal GCIPL thickness was measured. The reproducibility of the measurements was evaluated with intraclass correlation coefficients (ICC) and coefficients of variation (CoV). RESULTS: The intra-operator ICCs of macular GCIPL thickness were >0.875; and the inter-operator ICCs were 0.882 to 0.991. The intra-protocol ICCs of Macular Cube 512 × 128 and 200 × 200 protocol were 0.953 to 0.987 and 0.953 to 0.991, respectively; and the inter-protocol ICCs were 0.876 to 0.991. All CoVs were <1.5%. CONCLUSIONS: Cirrus HD-OCT can measure macular GCIPL thickness in normal eyes with excellent reproducibility. The measurements determined by Macular Cube 512 × 128 and 200 × 200 protocol were highly consistent and both protocols were eligible for macular GCIPL thickness measurement.

Damage to the Blood-Aqueous Barrier in Ocular Blunt Trauma and Its Association with Intraocular Pressure Elevation.

BACKGROUND: The aim of this study is to provide a quantitative evaluation of the blood-aqueous barrier (BAB) in patients with ocular blunt trauma and evaluate its association with intraocular pressure (IOP) elevation. METHODS: This is a prospective case-control study, and the following 3 groups were included: elevated IOP (45 patients with an elevated IOP secondary to ocular blunt trauma), normal IOP (27 patients with a normal IOP after ocular blunt trauma), and healthy controls. The main outcome measures were IOP and BAB function evaluated using a laser flare-cell meter (LFCM). RESULTS: Patients had significantly higher flare intensities and cell counts than the normal controls (both p < 0.001), and the elevated-IOP group displayed even higher LFCM readings than the normal-IOP group. Aqueous flare and cell readings were positively correlated with IOP (r = 0.529 and 0.590, respectively, p < 0.001). LFCM readings in the elevated-IOP group were still significantly high even on postraumatic day 120 following anti-inflammatory treatment. CONCLUSION: BAB dysfunction occurred following ocular blunt trauma. Eyes with an elevated IOP displayed a more seriously disturbed BAB and a longer recovery course. Examination with a LFCM provides insight into the pathophysiology of IOP elevation and assists in making decisions concerning anti-inflammatory treatment during follow-up.

RETINAL AND CHOROIDAL CHANGES OF NANOPHTHALMIC EYES WITH AND WITHOUT SECONDARY GLAUCOMA.

PURPOSE: To analyze the retinal and choroidal changes and their relationship in nanophthalmic eyes quantitatively and to evaluate the influence of axial length (AL) and secondary glaucoma on the retina and choroid in these eyes. METHODS: Thirty-seven eyes of 19 nanophthalmic patients (23 eyes with secondary glaucoma, SG group; 14 eyes without secondary glaucoma, NG group) and 38 eyes of 38 age/sex-matched controls were recruited. The retinal and choroidal changes, the foveal retinal thickness (FRT), and the subfoveal choroidal thickness (SFCT) were measured by enhanced depth imaging optical coherence tomography (EDI-OCT, Heidelberg). The parameters were compared between nanophthalmic eyes and controls, as well as between the NG and SG group. The relationship between AL and FRT, AL and SFCT, and FRT and SFCT were analyzed. RESULTS: The optical coherence tomography images revealed broadened outer nuclear layer, and aberrant preservation of the inner retinal layer to different extents existed in the fovea in all nanophthalmic cases. The ganglion cell layer was found much thinner in the SG group than that of the NG group. The low-reflective areas near the outer border of the choroid in nanophthalmic eyes seemed larger than that of controls. The average FRT and SFCT of the total nanophthalmic cases were significantly thicker than those of controls (P < 0.001, P < 0.001, respectively). The FRT of the SG group was thinner than that of the NG group (P < 0.001). No significant difference was found between the SG group and NG group in SFCT (P = 0.83). Axial length was negatively related to FRT and SFCT (P < 0.001, P < 0.001, respectively). The foveal retinal thickness and SFCT were positively related (P = 0.02). CONCLUSION: Retina and choroid are thickened accordantly in nanophthalmic eyes and are negatively related to AL. Secondary glaucoma could affect the FRT but would do nothing to the SFCT. The combined measurement of retina and choroid by enhanced depth imaging optical coherence tomography provides valuable information to facilitate comprehensive understanding of the pathology of nanophthalmos and its complications in vivo.

Four-Year Progression of Myopic Maculopathy in Children and Adolescents With High Myopia.

Importance: Individuals with high myopia younger than 18 years are at relatively high risk of progressively worsening myopic maculopathy. Additional studies are needed to investigate the progression of myopic maculopathy in this age group, as well as the risk factors associated with progression. Objective: To investigate the 4-year progression of myopic maculopathy in children and adolescents with high myopia, and to explore potential risk factors. Design, Setting, and Participants: This hospital-based observational study with 4-year follow-up included a total of 548 high myopic eyes (spherical power -6.00 or less diopters) of 274 participants aged 7 to 17 years. Participants underwent comprehensive ophthalmic examination at baseline and 4-year follow-up. Myopic maculopathy was accessed by the International Photographic Classification and Grading System. The data analysis was performed from August 1 to 15, 2023. Main Outcomes and Measures: The progression of myopic maculopathy progression over 4 years and associated risk factors. Results: The 4-year progression of myopic maculopathy was found in 67 of 548 eyes (12.2%) of 274 participants (138 girls [50.4%] at baseline and 4-year follow-up) with 88 lesion changes, including new signs of the tessellated fundus in 16 eyes (18.2%), diffuse atrophy in 12 eyes (13.6%), patchy atrophy in 2 eyes (2.3%), lacquer cracks in 9 eyes (10.2%), and enlargement of diffuse atrophy in 49 eyes (55.7%). By multivariable analysis, worse best-corrected visual acuity (odds ratio [OR], 6.68; 95% CI, 1.15-38.99; P = .04), longer axial length (AL) (OR, 1.73; 95% CI, 1.34-2.24; P < .001), faster AL elongation (OR, 302.83; 95% CI, 28.61-3205.64; P < .001), and more severe myopic maculopathy (diffuse atrophy; OR, 4.52; 95% CI, 1.98-10.30; P < .001 and patchy atrophy; OR, 3.82; 95% CI, 1.66-8.80; P = .002) were associated with myopic maculopathy progression. Conclusions and Relevance: In this observational study, the progression of myopic maculopathy was observed in approximately 12% of pediatric high myopes for 4 years. The major type of progression was the enlargement of diffuse atrophy. Risk factors for myopic maculopathy progression were worse best-corrected visual acuity, longer AL, faster AL elongation, and more severe myopic maculopathy. These findings support consideration of follow-up in these individuals and trying to identify those at higher risk for progression.

Using choroidal thickness to detect myopic macular degeneration.

AIM: To explore the usage of choroidal thickness measured by swept-source optical coherence tomography (SS-OCT) to detect myopic macular degeneration (MMD) in high myopic participants. METHODS: Participants with bilateral high myopia (≤-6 diopters) were recruited from a subset of the Guangzhou Zhongshan Ophthalmic Center-Brien Holden Vision Institute High Myopia Cohort Study. SS-OCT was performed to determine the choroidal thickness, and myopic maculopathy was graded by the International Meta-Analysis for Pathologic Myopia (META-PM) Classification. Presence of MMD was defined as META-PM category 2 or above. RESULTS: A total of 568 right eyes were included for analysis. Eyes with MMD (n=106, 18.7%) were found to have older age, longer axial lengths (AL), higher myopic spherical equivalents (SE), and reduced choroidal thickness in each Early Treatment Diabetic Retinopathy Study (ETDRS) grid sector (P<0.001). The area under the receiver operating characteristic (ROC) curves (AUC) for subfoveal choroidal thickness (0.907) was greater than that of the model, including age, AL, and SE at 0.6249, 0.8208, and 0.8205, respectively. The choroidal thickness of the inner and outer nasal sectors was the most accurate indicator of MMD (AUC of 0.928 and 0.923, respectively). An outer nasal sector choroidal thickness of less than 74 µm demonstrated the highest odds of predicting MMD (OR=33.8). CONCLUSION: Choroidal thickness detects the presence of MMD with high agreement, particularly of the inner and outer nasal sectors of the posterior pole, which appears to be a biometric parameter more precise than age, AL, or SE.

[Detection of the anterior segment configuration of primary angle-closure glaucoma by anterior segment optical coherence tomography].

OBJECTIVE: To quantitatively measure and evaluate the ocular anterior segment parameters in different subtypes of primary angle-closure glaucoma (PACG) using anterior segment optical coherence tomography (AS-OCT). METHODS: This retrospective study collected Fifty-five subjects (55 eyes) with APACG, 63 (63 eyes) with chronic primary angle-closure glaucoma (CPACG) and 90 (90 eyes) normal controls from December 2009 to December 2010 in Zhongshan Ophthalmic Center. AS-OCT examination was performed on all patients and the anterior segment parameters were recorded including: central anterior chamber depth (ACD), anterior chamber width (ACW), anterior chamber volume (ACV), angle opening distance (AOD), trabecular iris area (TISA), angle recess area (ARA), lens thickness (LT) and crystalline lens rise (CLR). The differences of parameters between APACG, CPACG and normal controls were compared. RESULTS: The anterior segment parameters of APACG and CPACG were significantly (P ≤ 0.001) smaller, respectively, than those of normal controls (PACG: ACD 1.81 ± 0.25 mm, ACW 11.30 ± 0.43 mm, AOD 0.039 mm, ARA 0.038 mm(2), ACV 72.8 ± 16.04 mm(3), TISA 0.017 mm(2), Mean ± SD, and CPACG: ACD 2.02 ± 0.25, ACW 11.49 ± 0.45, AOD 0.042, ARA 0.053, ACV 83.60 ± 19.49, TISA 0.022 vs. normal: ACD 2.70 ± 0.35, ACW 11.81 ± 0.47, AOD 0.260, ARA 0.197, ACV 148.52 ± 31.89, TISA 0.100). The LT and CLR of PACG were significantly (P < 0.001) larger, respectively, than that of normal controls (LT: APACG 5.22 ± 0.38, CPACG 5.06 ± 0.36 mm, CLR: APACG 1.07 ± 0.26, CPACG 0.94 ± 0.21 mm vs. normal: LT 4.57 ± 0.42, CLR 0.39 ± 0.33 mm). Compared with CPACG, the anterior segment parameters of APACG were significantly (P < 0.001 - 0.015) decreased, but the LT (P = 0.003) and CLR were significantly (P < 0.001) increased. Compared with APACG-fellow eyes, the anterior segment parameters of APACG-attacked eyes were significantly (P < 0.001 - 0.041) decreased (Fellow-eye: ACD 1.90 ± 0.23 mm, AOD 0.045 mm, TISA 0.037 mm(2), ARA 0.047 mm(2) vs. attached-eye: ACD 1.81 ± 0.25, AOD 0.039, TISA 0.017 and ARA 0.038), while CLR was significantly (t = 1.349, P = 0.043) increased (fellow-eye: 1.01 ± 0.23 mm vs. Attached-eye: 1.07 ± 0.26). There was no significant difference in the other AS-OCT parameters between APACG-attacked eyes and fellow eyes (t = 0.574 - 1.147, P = 0.257 - 0.567). CONCLUSIONS: Our results indicated a more crowding anterior segment configuration in PACG than that in normal controls and a more anterior located and thicker lensing APACG than that in CPACG, which constitute a morphological basis of acute attack.

[Fundus features of nanophthalmos analyzed by optical coherence tomography].

OBJECTIVE: To observe the fundus features of nanophthalmos with or without secondary glaucoma using spectral domain optical coherence tomography (SD-OCT). METHODS: It was a retrospective case-series study. Twenty-three eyes of 12 patients (6 female, 6 male) who were clinically identified to be nanophthalmos (axial length ≤ 20.0 mm) in Zhongshan Ophthalmic Center from June 2008 to December 2010 and twenty-three eyes of 23 age and sex matched normal controls were included in this study. All patients underwent ophthalmological examinations including best-corrected visual acuity, refraction, slit-lamp biomicroscopy and fundus examination, Goldmann applanation tonometry, A-scan and B-scan ultrasound examinations, ultrasound biomicroscopy, fundus photography and spectral domain optical coherence tomography (SD-OCT). All examinations were carried out with natural pupil. The fundus features detected by OCT were compared between nanophthalmos and normal controls, and among nanophthalmos with or without secondary glaucoma.Independent-samples t test was used to analyze the difference of retinal thickness between nanophthalmoic eyes and controls and also between nanophthalmoic eyes with and without secondary glaucoma. Pearson correlation analysis was used to analyze the correlation between axial length and macular retinal thickness. RESULTS: The average age of 12 patients was (25.0 ± 13.1) years, and the mean axial length was (17.30 ± 1.66) mm. Thirteen eyes suffered from secondary glaucoma because of angle closure with average intraocular pressure (IOP) of (28.62 ± 9.18) mm Hg (1 mm Hg = 0.133 kPa). The average IOP of the other 10 eyes without secondary glaucoma was (14.96 ± 3.21) mm Hg.OCT images revealed thickening of the retina in macular fovea, with residual retinal nerve fiber layer, ganglion cell layer, inner plexiform layer, inner nuclear layer, outer plexiform layer, and broadened outer nuclear layer in 23 eyes with nanophthalmos. Pre-retinal folds were seen in 5 eyes with macular cysts.Shallow serous retinal detachment was found in 3 eyes, 2 of which showed focal thickening of retinal pigment epithelium as leopard spots. The cup were not obvious and retina around optic nerve head was thickened in 10 eyes without secondary glaucoma and 4 eyes with secondary early glaucoma, which seemed to be pseudopapilloedema. The other 9 eyes with secondary late glaucoma revealed enlarged cup . The mean macular foveal thickness of nanophthalmic eyes[ (335.65 ± 91.45) µm] was significantly thickened than normal control group [(192.72 ± 11.18) µm] (t = 10.50, P = 0.000) . The mean macular foveal thickness of nanophthalmos with glaucoma [(323.70 ± 104.09) µm] was thinner than those without glaucoma [(403.50 ± 130.24) µm] (t = 3.50, P = 0.002). Macular foveal thickness were negatively related with axial length in both nanophthalmos with and without secondary glaucoma (R = -0.797, P = 0.001). CONCLUSIONS: Macular hypoplasia and crowded optic nerve head are two important characteristic of fundus appearances in nanophthamos.SD-OCT can clearly reveal the changes of macular retina and optic nerve head. SD-OCT will be a very useful tool to help diagnose nanophthamos and evaluate its possible complications.

[Protection effect of sodium hyaluronate on ocular surface toxicity induced by Benzalkonium chloride-preserved brimonidine in rabbits].

OBJECTIVE: To investigate the protective effects of sodium hyaluronate on ocular surface toxicity induced by a prolonged use of benzalkonium chloride-preserved Brimonidine eye drops. METHODS: Experimental study. Thirty adult female New Zealand rabbits were divided into three groups with randomized numbers design. Ten rabbits were treated with 0.2% Brimonidine eye drops and PBS (PBS group), the other ten rabbits with 0.2% Brimonidine combined with sodium hyaluronate eye drops (SH group), and control group received no treatment for 60 days. Schirmer test, fluorescein (FL) and Rose Bengal (RB) staining, conjunctival impression cytology specimens collecting were performed on day 0, 31, and 61. Apoptosis of conjunctival epithelium was detected by in situ terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay on day 61. Conjunctival inflammation was observed by hematoxylin eosin staining. Histomorphological changes of cornea and conjunctiva were observed by light microscopy, and scanning and transmission electron microscopy at day 61. Fluorescein and Rose Bengal scores were analysed by Kruskal-Wallis test. Schirmer scores, goblet cell density and inflammatory cells infiltration were analysed by repeated measures analysis of variance. RESULTS: There were significant differences in fluorescein and Rose bengal (H = 22.031, 15.303, P < 0.01) staining among the groups on day 61. Compared with the control group (FL: 0, 0-1, RB: 0, 0-1), fluorescein and Rose Bengal scores were significantly (P < 0.001) increased in PBS group (FL: 1.5, 1-2, RB: 1, 1-2), whereas was significantly (P < 0.001) decreased in SH group (FL:0, 0-1 RB:1, 0-1) when compared to PBS group. There were significant differences in aqueous tear production and goblet cell density (F = 7.980, 14.545, both P < 0.01) among the groups on day 61. Compared with the control group [(9.43 ± 0.57) mm, (87.73 ± 2.34/HP)], Schirmer scores and goblet cell density were significantly (P < 0.01) reduced in PBS-treated group [(6.61 ± 0.38) mm, (68.06 ± 3.61)/HP], but significantly (P < 0.05) increased in SH-treated group [(8.75 ± 0.57) mm, (82.31 ± 1.64)/HP] compared with PBS-treated group. The number of inflammatory cells was significant difference (F = 56.306, P < 0.001) among the groups on day 61. Compared with the control group [(39.89 ± 2.03)/HP], inflammatory cells infiltration was significantly (P < 0.01) increased in both PBS [(73.18 ± 2.17)/HP] and SH groups [(48.79 ± 2.64)/HP], however, SH-treated group was significantly lowered when compared with PBS-treated group. In addition, decrease in apoptosis, complete microvilli and cell organelles were found in the corneal and conjunctival epithelial cells in SH-treated group. CONCLUSIONS: Our results demonstrate that topical application of SH reduces the ocular toxicity and protect the ocular surface in the long term anti-glaucomatous medical therapies and may be considered as a vehicles or neutralizing material for future ocular application.

Low Vision Rehabilitation Service Utilization Before and After Implementation of a Clinical Decision Support System in Ophthalmology.

Importance: Electronic clinical decision support systems apply clinical guidelines in real time and offer a new approach to improve referral and utilization of low vision rehabilitation (LVR) care. Objective: To characterize patients and factors associated with LVR service utilization with and without the use of an electronic health record (EHR) clinical decision support system (CDSS) alert. Design, Setting, and Participants: Quality improvement study using EHR data to compare patients who did and did not utilize LVR service after referral between November 6, 2017, and October 5, 2019, (primary) and to assess overall service utilization rate from September 1, 2016, to April 2, 2021, regardless of referral status (secondary). Participants in the primary analysis were patients at a large ophthalmology department in an academic medical center in the US who received an LVR referral recommendation from their ophthalmologist according to the CDSS alert. The secondary analysis included patients with best documented visual acuity (BDVA) worse than 20/40 before, during, and after the CDSS implementation. Data were analyzed from August 2021 to April 2022. Exposures: Number and locations of referral recommendations for LVR service according to the CDSS alert in the primary analysis; active CDSS implementation in the secondary analysis. Main Outcomes and Measures: LVR service utilization rate was defined as the number of patients who accessed service among those who were referred (primary) and among those with BDVA worse than 20/40 (secondary). EHR data on patient demographics (age, sex, race, ethnicity) and ophthalmology encounter characteristics (numbers of referral recommendations, encounter location, and BDVA) were extracted. Results: Of the 429 patients (median [IQR] age, 71 [53 to 83] years; 233 female [54%]) who received a CDSS-based referral recommendation, 184 (42.9%) utilized LVR service. Compared with nonusers of LVR, users were more likely to have received at least 2 referral recommendations (12.5% vs 6.1%; χ21 = 5.29; P = .02) and at an ophthalmology location with onsite LVR service (87.5% vs 78.0%; χ21 = 6.50; P = .01). Onsite LVR service (odds ratio, 2.06; 95% CI, 1.18-3.61) persisted as the only statistically significant factor after adjusting for patient demographics and other referral characteristics. Among patients whose BDVA was worse than 20/40 before, during, and after the CDSS implementation regardless of referral status, the LVR service utilization rate was 6.1%, 13.8%, and 7.5%, respectively. Conclusions and Relevance: In this quality improvement study, ophthalmologist referral recommendations and onsite LVR services at the location where patients receive other ophthalmic care were significantly associated with service utilization. Ophthalmology CDSSs are promising tools to apply clinical guidelines in real time to improve connection to care.