Visual efficiency among teenaged athletes and non-athletes

AIM: To compare visual efficiency, specifically accom-modation, vergence, and oculomotor functions among athletes and non-athletes. METHODS: A cross-sectional study on sports vision screening was used to evaluate the visual skills of 214 elementary students (107 athletes, 107 non-athletes), aged between 13 and 16y. The visual screening assessed visual parameters such as ocular motor alignment, accommodation, and vergence functions. RESULTS: Mean visual parameters were compared between age-group matched athletes (mean age 14.82±0.98y) and non-athletes (mean age 15.00±1.04y). The refractive errors of all participants were corrected to maximal attainable best corrected visual acuity of logMAR 0.0. Accommodation function assessment evaluated amplitude of accommodation and accommodation facility. Vergence functions measured the near point of convergence, vergence facility, and distance fusional vergence at break and recovery point. Ocular motor alignment was not statistically significant between both groups. Athletes had a statistically significant amplitude of accommodation for both the right eye (t=2.30, P=0.02) and the left eye (t=1.99, P=0.05). Conversely, non-athletes had better accommodation facility (t=-2.54, P=0.01) and near point of convergence (t=4.39, P<0.001) when compared to athletes. Vergence facility was found to be better among athletes (t=2.47, P=0.01). Nevertheless, non-athletes were significantly better for both distance negative and positive fusional vergence. CONCLUSION: Although the findings are still inconclusive as to whether athletes had superior visual skills as compared to non-athletes, it remains important to identify and elucidate the key visual skills needed by athletes in order for them to achieve higher performance in their sports.     

儿童青少年配戴多焦软性角膜接触镜对调节聚散功能的影响

目的：:比较儿童青少年近视患者配戴单光框架眼镜和多焦软性角膜接触镜（简称多焦软镜）对调节和聚散功能的影响。方法：:系列病例研究。选取2017年7─10月在温州医科大学附属眼视光医院视光门诊就诊的46例近视患者参加本研究,分别在配戴单光框架眼镜和多焦软镜时测量其调节参数和聚散参数,包括调节幅度、调节反应、调节微波动、相对...     

[In Press] Evaluation of the iridocorneal angle with accommodation using optical coherence tomography

The changes in the iridocorneal angle structure during accommodation are assessed by means of Anterior Segment Optical Coherence Tomography. Thirteen right eyes were included in the study. The device used for the measurement was the Visante® omni system. The stimuli were set up at different vergences (0.0 D, -1.5 D, and -3.0 D). The Angle Opening Distance 500 and 750, the Trabecular Iris Space Area 500 and 750, and the Scleral Spur Angle parameters were assessed at the nasal and temporal regions. The results in the iridotrabecular angle comparing the three accommodative states of the eye did not yield any statistically significant difference at nasal or temporal angle sections. In light of our results and in the conditions of our study, the structures of the iridocorneal angle are not significantly changed with accommodation.     

计算法和梯度法测量AC/A在不同眼位中的应用比较

目的:讨论分析计算法和梯度法测量调节性集合与调节的比值(AC/A)在不同眼位中的临床应用。方法:收集就诊于眼科门诊的127例近视患者,采用近远距隐斜眼位得到计算法AC/A和近距附加+1.00D得到梯度法AC/A,比较计算法和梯度法AC/A在不同眼位中的差异。结果:计算法AC/A值高于近距+1.00D梯度法AC/A值(P<0.01);对同一种方法在不同眼位组中比较发现,计算法AC/A和梯度法AC/A在不同眼位组中均有差异,内隐斜组AC/A最高,外隐斜组AC/A最低;对同一眼位组中的两种方法比较发现,在内隐斜组和正视组中计算法AC/A高于梯度法(均P<0.01),外隐斜组中两种方法测得AC/A值无差异(P>0.05)。结论:计算法AC/A高于梯度法AC/A,特别是在内隐斜患者和正视患者中使用计算法易得到高AC/A值,造成错误诊断,更推荐使用梯度法。     

Comparing sports vision among three groups of soft tennis adolescent athletes: Normal vision,refractive errors with and without correction

Background:The effect of correcting static vision on sports vision is still not clear.Aim:To examine whether sports vision (depth perception [DP], dynamic visual acuity [DVA], eye movement [EM], peripheral vision [PV], and momentary vision [MV],) were different among soft tennis adolescent athletes with normal vision (Group A), with refractive error and corrected with (Group B) and without eyeglasses (Group C).Results:A total of 73 athletes (37 in Group A, 8 in Group B, 28 in Group C) were enrolled in this study. All four items of DP showed significant difference among the three study groups (P = 0.0051, 0.0004, 0.0095, 0.0021). PV displayed significant difference among the three study groups (P = 0.0044). There was no significant difference in DVA, EM, and MV among the three study groups.Conclusions:Significant better DP and PV were seen among soft tennis adolescent athletes with normal vision than those with refractive error regardless whether they had eyeglasses corrected. On the other hand, DVA, EM, and MV were similar among the three study groups.     

[In Press] Paediatric retinal detachment: a review

Paediatric retinal detachment (PRD) is an uncommon and challenging disease; it differs from adult detachments in etiology, anatomical characteristics, management and prognosis. PRDs can be particularly challenging, even for the most expert paediatric surgeons due to the higher prevalence of total retinal detachments, late diagnosis and bilateral involvement with respect to those which occur in adulthood. Moreover, the anatomical success, when achieved, is frequently not related to a functional recover. Postsurgical adverse events, refractive errors and amblyopia may additionally undermine the final outcome. Up to date there are few reviews regarding the approach of retinal detachment in children, mainly dealing with rhegmatogenous retinal detachment. In this review, rhegmatogenous, ROP-related and Coats’-related PRDs were considered. The available literature from the last decades werereviewed and summarized. Epidemiology, etiology and clinical presentation, together with therapeutic approaches and outcomes have been reviewed and discussed.     

[In Press] Understanding practice patterns of Glaucoma sub-specialists in India

AIM: To obtain information on the prevailing practice patterns of glaucoma specialists in India METHODS: Glaucoma specialists attending the annual conference of the Glaucoma Society of India (GSI) were polled. This poll, conducted in 2013, was based on an interactive audience response system. RESULTS: The information was obtained from 146 glaucoma specialists. Approximately half (n=83; 57%) had ≥10y of experience in managing glaucoma and were in institutional practice (n=74, 51%). Goldmann applanation tonometry was preferred by 103 (72%) specialists whilst n=25 (17.4%) used non-contact tonometer. Indentation gonioscopy was favoured by two-thirds (n=90, 66%) whereas stereoscopic optic disc examination and visual fields using Humphrey perimeter was performed by a majority of the specialists polled (n=115, 86% and n=114; 83% respectively). Nearly three quarter specialists (n=96; 72%) preferred optical coherence tomography for imaging. The primary choice for treatment of angle closure disease and primary open angle glaucoma was laser (iridotomy, n=117; 93%) and medical management (prostaglandin analogue, n=104; 78%), respectively. Approximately only a third of the specialists polled (n=37; 28%) were performing both trabeculectomy and implantation of a glaucoma drainage device and about half (n=64; 47%) were not operating on congenital glaucoma at all. CONCLUSION: This poll has found conformance with preferred practice patterns in several areas of diagnosis and management of glaucoma, but there was diversity in a few areas. The information is a significant step towards improvement of glaucoma care in India, including planning for future strategies.     

【In Press】 Expression of multidrug resistance proteins in retinoblastoma

AIM: To elucidate the mechanism of multidrug resistance in retinoblastoma (RB), and to acquire more insights into in vivo drug resistance. METHODS: Three anticancer drug resistant Y79 human RBcells were generated against vincristine, etoposide or carboplatin, which are used for conventional chemotherapy in RB. Primary cultures from enucleated eyes after chemotherapy (PCNC) were also prepared. Their chemosensitivity to chemotherapeutic agents (vincristine, etoposide and carboplatin) were measured using MTT assay. Western blot analysis was performed to evaluate the expression of p53, Bcl-2 and various multidrug resistant proteins in RB cells. RESULTS: Following exposure to chemotherapeutic drugs, PCNC showed less sensitivity to drugs. No significant changes observed in the p53 expression, whereas Bcl-2 expression was found to be increased in the drug resistant cells as well as in PCNC. Increased expression of P-glycoprotein (P-gp) was observed in drug resistant Y79 cells; however there was no significant change in the expression of P-gp found between primary cultures of primarily enucleated eyes and PCNC. Multidrug resistance protein 1 (Mrp-1) expression was found to be elevated in the drug resistant Y79 cells as well as in PCNC. No significant change in the expression of lung resistance associated protein (Lrp) was observed in the drug resistant Y79 cells as well as in PCNC. CONCLUSION: Our results suggest that multidrug resistant proteins are intrinsically present in RB which causes treatment failure in managingRB with chemotherapy.     

[In Press] Development of new test to diagnose color vision disturbance

AIM: To develop a new test for the diagnosis of color vision deficiency. METHODS: Cross-sectional study with 203 subjects (121 females and 82 males) who performed detection tests of color vision disturbance using Ishihara''s original test images and the images created for the new test in print and electronic version. Images of the new test were created in computer with a tool to control the three colors, which formed the central number, and the seven colors, that compose the background of the image. RESULTS: Eight males demonstrated color vision deficiency (prevalence of 3.94% in the total sample and 9.75% in the male sample). There were no identified dyschromatopsia carriers in females. The comparative analysis between the images of the original Ishihara test with the new test (eletronic version and printed) demonstrated, in both cases, a high correlation (96%) between the results of the tests. Although the high correlation between the results, the cutoff point for defining the existence of color vision deficiency was higher than the original Ishihara test, to obtain 100% sensitivity and 100% specificity. CONCLUSION: The new developed test is able to identify subjects with dyschromatopsia similar to the original Ishihara test. The test will also provide an option to create images with geometric elements or simple figures for the test in children.     

[In Press] The role of elastic fibers in pathogenesis of conjunctivochalasis

AIM: To hypothesize the role of elastic fibers in the pathogenesis of conjunctivochalasis (CCh). METHODS: The PubMed, MEDLINE databases and China National Knowledge Infrastructure (CNKI) were searched for information regarding the etiology and pathogenesis of CCh and the synthesis and degradation of elastic fibers. After analysis of the literature, the role of elastic fibers in the pathogenesis of CCh was presented. RESULTS: Elastic fibers was a complex protein molecule from the structure and composition. The degradation of elastic fibers was one of the histopathological features of the disease. By reasonably speculating, we considered that abnormal elastic fibers cause the conjunctival relaxation. The vast majority of the factors related to the pathogenesis of CCh ultimately pointed to abnormal elastic fibers. CONCLUSION: Elastic fibers play an important role in the pathogenesis of CCh. Studies on the mechanism of synthesis, degradation of elastic fibers are helpful to clarify the pathogenesis of the disease and to find effective treatment methods.     

[In Press] Expressions of nestin and GFAP in rat retina afteroptic nerve transection

AIM: To assess the expression of nestin and glial fibrillary acidic protein (GFAP) in rat retina afteroptic nerve transection. METHODS: Rats were randomly divided into normal control group, sham group and operation group, and used for establishing an animal model of optic nerve transection. Retinal specimen of each group was collected at 3h, 48h, 7d and 14d postoperative, nestin and GFAP expressionson sagittal sections were analyzed by immunohistochemical staining, and protein extraction was analyzed by Western blot. RESULTS: Immunohistochemical analysis showed that nestin positive staining was rarely detected in normal control group and sham group, while sham group showed weak positive staining at 3h postoperative, the reaction gradually increased at 48h postoperative, and reached its maximum at 7d postoperative, and then decreased at 14d postoperative. Compared to the expression of GFAP, there was obvious difference among three groups (P>0.05). Result of Western blot method was consistent with that of immunohistochemical method. CONCLUSION: The expression of nestin increased in a time dependent fashion in Müller cells of retina following optic nerve transection, which was statistically significant, but there was no obvious difference in GFAP expression. The results indicate that an increase in colloid synthesis in retina following optic nerve transection can improve the retinal neurons’ environment.     

[In Press] The ocular toxicity and pharmacokinetics of simvastatin following intravitreal injection in mice

AIM: To investigate the retinal toxicity and pharmacokinetics of simvastatin intravitreally injected into mice. METHODS: Forty-eight 6-8-week-old C57BL/6J mice were used in this study. Simvastatin was intravitreally injected into the right eye of each mouse; the left eye was injected with vehicle and was used as a control. Bilateral dark-adapted electroretinography (ERG) was performed 1 and 7d following injection. Histology was examined using a combination of light, fluorescence and electron microscopy. High-performance liquid chromatography (HPLC) was used to determine the decay in the retinal simvastatin concentration. RESULTS: ERG revealed no significant changes in the simvastatin-injected eyes compared to control. Histologic studies showed normal retinal morphology in eyes injected with simvastatin up to a final vitreal concentration of 200 μmol/L. No significant changes in the number of photoreceptors, bipolar cells or ganglion cells were found. The retinal simvastatin concentration decayed exponentially, with a half-life of 1.92-2.41h. CONCLUSION: Intravitreal injection of up to 200 μmol/L simvastatin produced no signs of adverse effects in the mouse retina. Simvastatin reaches the retina shortly after intravitreal injectionand has a short half-life.     

[In Press] Above-average defocus curvesin photopic and mesopic visionwith Multifocal Intraocular Lenses after LASIK

Letter to the editor     

[In Press] Systematic review and Meta-analysis comparing modified cross-linking and standard cross-linking for progressive keratoconus

AIM: To compare the effectiveness and safety between modified cross-linking (MC) and standard cross-linking (SC) in mild or moderate progressive keratoconus. METHODS: Eligible studies were retrieved from four electronic databases, including CENTRAL, Clinical Trials gov, PUBMED and OVID MEDLINE. We set post-surgical maximum K value (Kmax) as the primary outcome. In addition, uncorrected and corrected distant visual acuity (UDVA and UDVA), spherical equivalent (SE), endothelial cell density (ECD), central cornea thickness (CCT) and depth of demarcation line (DDL) were Meta-analyzed as secondary outcomes. Mean differences for these outcomes were pooled through either a random-effect model or fixed-effect model according to data heterogeneity. RESULTS: Twenty-four comparative studies either on accelerated cross-linking (AC) compared with SC or on trans-epithelial cross-linking (TC) compared with SC were included and pooled for analysis. The results indicated that MC was significantly inferior to SC at delaying Kmax deterioration [AC vs SC 0.49 (95% CI: 0.04-0.94, I2=75%, P=0.03); TC vs SC 1.15 (95% CI: 0.54-1.75, I2=50%, P=0.0002)]. SE decreased significantly for SC when compared to AC [0.62 (95% CI: 0.38-0.86, I2=22%, P<0.00001)]. DDL of SC was more significantly deeper than that of TC [-133.49 (95% CI: -145.94--121.04, I2=33%, P<0.00001)]. Other outcomes demonstrated comparable results between MC and SC. CONCLUSION: SC is more favorable at halting the progression of keratoconus, but visual acuity improvement showed comparable results between MCs and SC.     

[In Press] Comparison of FDA safety and efficacy data for KAMRA and Raindrop corneal inlays

AIM: To provide a side-by-side analysis of the summary of safety and effectiveness data (SSED) submitted to the FDA for the KAMRA (Acufocus Inc., Irvine, CA, USA) and Raindrop (ReVision Optics, Lake Forest, CA, USA) corneal inlays for the correction of presbyopia. METHODS: SSED reports submitted to the FDA for KAMRA and Raindrop were compared with respect to loss of corrected distance visual acuity (CDVA), adverse event rates, induction of astigmatism, retention of contrast sensitivity, stability of manifest refractive spherical equivalent (MRSE), and achieved monocular uncorrected near visual acuity (UNVA) at 24mo. RESULTS: Totally 442/508 of KAMRA patients and 344/373 Raindrop patients remained enrolled in the clinical trials at 24mo. The proportion of KAMRA and Raindrop patients who lost ≥2 lines of CDVA at 24mo was 3.4% and 1%, respectively. The adverse event rate was comparable between the devices. No significant inductions of astigmatism were noted. Both technologies induced a transient myopic shift in MRSE followed by a hyperopic shift and subsequent stabilization. Totally 87% of KAMRA and 98% of Raindrop patients attained a monocular UNVA of J5 (20/40) or better at 24mo. 28% of KAMRA and 67% of Raindrop patients attained a monocular UNVA of J1 (20/20) or better at 24mo. CONCLUSION: Both devices can be considered safe and effective, however, the results of corneal inlay implantation are mixed, and long-term patient satisfaction will likely depend on subjective expectations about the capabilities of the inlays. Variability in surgical technique and postoperative care within and between the two clinical trials diminishes the comparative power of this article.     

[In Press] Validity of automated refraction after segmented refractive multifocal intraocular lens implantation

AIM: To evaluate the clinical utility of automated refraction (AR) and keratometry (KR) compared with subjective or manifest refraction (MR) after cataract or refractive lens exchange surgery with implantation of LentisMplusX (Oculentis GmbH) refractive multifocal intraocular lens (IOL). METHODS: Eighty-six eyes implanted with the LentisMplusX multifocal IOL were included. Manifest refraction was performed in all patients followed by three consecutive AR measurements using the Topcon KR-8000 autorefractor. Assessment of repeatability of consecutive AR before and after dilation with phenylephrine 10%, and comparison of the AR and KR with MR using vector analysis were performed at 3mo follow-up. RESULTS: Analysis showed excellent repeatability of the AR measurements. Linear regression of AR versus MR showed good correlation for sphere and spherical equivalent, whereas the correlation for astigmatism was low. The mean difference AR-MR was -1.28±0.29 diopters (D) for sphere. Astigmatism showed better correlation between KR and MR. CONCLUSIONS: We suggest AR sphere plus 1.25 D and the KR cylinder as the starting point for MR in eyes with a LentisMplusX multifocal IOL. If AR measurements are equal to MR, decentration of the IOL should be suspected.     

[In Press] Protective effect of hydrogen-rich saline against N-methyl-N-nitrosourea-induced retinitis pigmentosa in rats

AIM: To investigate the effects of hydrogen-rich saline (HRS) on microglia activation and Sirtuin type 1 (Sirt1) in rats with N-methyl-N-nitrosourea(MNU)-induced retinitis pigmentosa (RP). METHODS: Rats were divided into Norm (N) group, Model (M) group and HRS (H) group. Rats in M and H groups were given saline and HRS respectively prior to and after administration of MNU. At one day (d1) and d3 afterwards, electroretinogram and histological examination were performed to confirm the effects of HRS on retinal function and structure of MNU-induced RP. Immunofluorescence staining of anti-ionized calcium-binding adapter molecule 1 (Iba1), a maker of microglia cells, was performed, with qRT-PCR for its mRNA quantification. Moreover, Sirt1 mRNA and protein expression in the retinas were detected by Western blot and qRT-PCR. RESULTS: HRS preserved the retinal function and mitigated the reduction of photoreceptor degeneration in MNU-treated retinas. The presence of microglia cells was somewhat more obvious in H group than that in M group at d1. HRS suppressed the further activation of microglia cells, with the number of microglia cells less than that of M group at d3. Results of qRT-PCR of Iba1 were consistent with those of immunofluorescence staining, with the mRNA expression of Iba1 in H group more intensive than that of M group at d1 (P<0.05), while less than that of M group at d3 (P<0.05). Furthermore, the Sirt1 mRNA and protein expression decreased after MNU administration, while HRS mitigated the MNU-induced downregulation of Sirt1. CONCLUSION: HRS can effectively keep microglia activation induced by MNU to an appropriate extent, while upregulate Sirt1 in MNU-induced RP.     

[In Press] The association of lumican polymorphisms and high myopia in the southern Chinese population

AIM: To investigate the correlation between lumican (LUM) gene and high myopia in a southern Chinese population. METHODS: The studycomprised of 95 high myopia patients with a spherical equivalent ≤?6.5 diopters (D). The control group recruited 95 individuals with a spherical equivalent ranging from ?0.5 D to +0.5 D. Direct sequencing was used to detect the single nucleotide polymorphisms (SNPs) of LUM gene in coding region. Genotype distributions were tested for Hardy-Weinberg disequilibrium. Genotypic and allelic frequencies were analyzed through Chi-square test or Fisher’s exact test. RESULTS: We identified 3 SNPs of the LUM gene:LUMc.32 (rs577456426), LUM c.507 (rs17853500)and LUM c.849 (rs181915277). Among the three SNPs, the genotype and allele frequencies of rs17853500 showed a significant difference between patients and control subjects (P<0.05). However, there were no significant differences in rs181915277 and rs577456426 between the two groups (P>0.05). CONCLUSION: LUM c.507 polymorphism may be a risk factor for the pathogenesis of high myopia in the southern Chinese population.     

[In Press] Long-term efficacy and safety of ExPress implantation for treatment of open angle glaucoma

AIM: To compare the long-term efficacy and safety of ExPress implantation and standard trabeculectomy in patients with primary open angle glaucoma (POAG). METHODS: In this retrospective study, we compared 17 eyes treated by ExPress implantation with 23 eyes treated by trabeculectomy. Efficacy was assessed according to the relevant intraocular pressure (IOP) values and success rates during the first year of follow up. Postoperative corneal endothelial cell loss was also compared. RESULTS: The number of antiglaucoma medications and the IOP reduction were similar between the 2 groups during the follow-up period. Although the mean IOP was similar, the IOP-fluctuation rate during the early postoperative period was significantly lower in the ExPress group than in the trabeculectomy group (P=0.038). A Kaplan-Meier survival curve analysis showed no significant success-rate difference between the groups (P=0.810). The corneal endothelial cell loss rate, moreover, was significantly lower in the ExPress group (P=0.05). CONCLUSION: ExPress implantation compared with trabeculectomy showed similar IOP-reduction and success rates along with lower IOP fluctuation and endothelial cell loss rates. For this reason, it can be considered to be the treatment of choice for patients with advanced glaucoma or low corneal endothelial cell density.