The Treatment of Myopia with Atropine and Bifocals: A Long-term Prospective Study

Two hundred fifty-three patients were followed for up to nine years (mean, 4 1/4 years). They were on a regimen of atropine 1 % once a day in an attempt to retard myopic progression. Their rate of myopic progression prior to atropine treatment was compared with 146 controls. The rates of myopic progression during and after treatment were also compared to those of the controls. The results from several analyses showed a marked flattening in the rate of myopic progression during treatment, and the rate of myopic progression after treatment ran parallel to those in the control group. Age in relation to myopic progression was evaluated in subgroups. A variation existed in the rate of myopic progression in the controls. The fastest rate of myopic progression occurred between eight and 12 years of age, and the slowest rate of myopic progression developed in those patients over 18 years of age.     

近十年阿托品延缓近视的文献计量可视化分析

目的：基于Web of Science数据库的收录情况,运用文献计量的方法分析阿托品在近视防控领域中应用的现状以及研究热点。方法：文献研究。以近十年（2011—2021年）Web of Science（WOS）中的核心数据库收录的关于阿托品在近视防控领域研究的文献为分析对象,利用CiteSpace软件,运用文献计量学方法,从文献的年发文量、国家及机构来源、刊文期刊分布及关键词突现、共被引文献分析等角度对其进行可视化分析。结果：共检索到290篇文献,发文量最多的国家是中国,其次是美国;发文量最多的研究机构是新加坡国立眼科中心,其次是新加坡国立大学和香港理工大学;发文最多的期刊为《Ophthalmic and Physiological Optics》以及《Investigative Ophthalmology and Visual Science》;研究的趋势从早期以动物实验为主来研究阿托品类药物的药理学及安全性到中期的临床随机对照试验及基于这些对照试验进行的一系列Meta分析,目前的研究热点为阿托品对脉络膜厚度的影响。结论：应用CiteSpace分析阿托品在近视防控领域运用的相关文献,展示出了该领域目前的主要研究及彼此合作的国家和机构,揭示了该领域的研究趋势。阿托品在近视防控中的应用潜力巨大,仍具有较高的研究价值。     

低浓度阿托品滴眼液在儿童青少年近视防控中的应用专家共识（2022）

当前全球近视患病率呈快速增长趋势,预计至2050年全球将有47.58亿近视人口,占总人口的49.8%[1]。中华人民共和国国家卫生健康委员会公布,2020年中国儿童青少年近视患病率为52.7%,其中小学生为35.6%,初中生为71.1%,高中生为80.5%[2]。由于近视呈现低龄化、高度化和患病率持续升高趋势,病理性近视患病率也显著增高。病理性近视可因脉络膜新生血管,视网膜变性、裂孔和脱离等眼底改变,造成不可逆的视觉损害,严重者可致盲,给个人、家庭和社会带来沉重负担。因此,预防近视发生、延缓近视进展、防止病理性近视发生刻不容缓。 阿托品药物在近视防控中的应用由来已久,近年来低浓度阿托品滴眼液的应用逐渐受到关注。尽管目前关于低浓度阿托品滴眼液的近视防控应用在中国未获得国家药监部门正式批准应用于临床,但在部分省份已经以院内制剂方式经省级药监部门批准在院内有条件的情况下使用,同时部分患儿亦可凭医师开具的处方通过互联网医院获得,但关于阿托品滴眼液的浓度选择,其有效性、安全性以及使用规范,国内尚无统一的指导性意见。从临床用药规范以及近视防控重要意义的双重角度考虑,有必要形成低浓度阿托品滴眼液的临床使用专家共识,以期为广大一线眼科工作者提供指导,推动我国近视防控工作的健康发展。 本专家共识由中华医学会眼科学分会眼视光学组、中国医师协会眼科分会眼视光专业委员会的组长和执笔团队在文献查阅、临床实践性研究的基础上酝酿而成,并由2个学组牵头组织近百名专家经过文献研究、初稿开放讨论、多轮修改和循证、审稿及定稿等程序,形成最终版本共识。 1? 阿托品的有效性 2? 机制 3? 安全性及不良反应处理 3.1 安全性和不良反应 3.1.1 瞳孔散大、畏光反应和眼压升高 3.1.2 调节能力和近视力下降 3.1.3 过敏反应 3.1.4 刺激性反应 3.2 不良反应的处理 4? 适应证和禁忌证 4.1 适应证 4.1.1 年龄 4.1.2 近视屈光度和增长量 4.1.3 依从性 4.2 禁忌证 5? 使用规范 5.1 基线评估 5.1.1 临床检查 5.1.2 近视快速进展危险因素评估 5.2 用药前宣教 5.3 用药过程和随访 5.4 停药 5.4.1 常规停药 5.4.1.1 停药时机选择 5.4.1.2 反弹效应 5.4.1.3 停药后重新再用药 5.4.2 异常停药 5.4.2.1 用药防控近视效果不佳 5.4.2.2 不良反应 6? 注意事项     

Rationale,Design, and Demographic Characteristics of the Handan Offspring Myopia Study

Abstract

Purpose: The Handan Offspring Myopia Study (HOMS) aims to investigate the familial associations of myopia between parents and their offspring.

Methods: Children aged 6–18 years, residing in 6 villages where all people aged ≥30 years had participated in The Handan Eye Study in 2006–2007, were selected for the current eye study between March and June 2010. A mobile clinic was set up in the 6 villages for comprehensive eye examinations, including visual acuity, ocular biometry, cycloplegic autorefraction and retinal photography.

Results: Of 1238 eligible individuals, 878 children (70.2%; 52.6% male) from 541 families were recruited. Mean age of the children was 10.5?±?2.5 years. The prevalence of myopia (spherical equivalent refraction <?0.5 diopter) was 23.5% (males 16.8%, females 30.8%). The prevalence of low vision (presenting visual acuity ≥20/400 but <20/60) in the better eye was 7.1%. A higher number of females had low vision at the time of presentation (9.2%) compared to males (5.2%, p?=?0.02). The prevalence of low vision in the worse eye was 10.6% (males 6.7%, females 14.9%, p?<?0.001). The majority of visual impairment in the better-seeing (56/62, 90.3%) as well as the worse-seeing (84/93, 90.3%) eye was correctable.

Conclusions: The HOMS examined about 70% of eligible Han Chinese offspring of Handan Eye Study participants in a rural region of northern China. Results from the HOMS will provide key information about the prevalence of refractive errors and eye diseases in rural Chinese children.     

Variation of Orthokeratology Lens Treatment Zone (VOLTZ) Study: A 2-year randomised clinical trial

Purpose

To compare axial elongation (AE) and treatment zone (TZ) characteristics in children wearing 6 mm or 5 mm back optic zone diameter (BOZD) orthokeratology (ortho-k) lenses over 2 years.

Methods

Forty-five (6 to <11 years of age) myopic (−4.00 to −0.75 D) children of Chinese ethnicity were randomly assigned to use the two different lens designs (23 and 22 wore the 6 and 5 mm lenses, respectively). Data collection was performed at baseline and every 6-months after commencing lens wear.

Results

After 24 months, subjects wearing lenses with a 5 mm BOZD achieved smaller TZ diameter (horizontal: 2.69 ± 0.28 vs. 3.84 ± 0.39 mm; vertical: 2.65 ± 0.22 vs. 3.42 ± 0.34 mm, p < 0.001) and less AE (0.15 ± 0.21 vs. 0.35 ± 0.23, p = 0.005) compared to those using the 6 mm design, with no difference in choroidal thickness (ChT) changes (p = 0.93). A significant increase in ChT, using pooled data analysis, was noted at the 6-month (11.8 ± 19.77 μm, p < 0.001) and 12-month (12.0 ± 23.7 μm, p = 0.004) visits, compared to baseline, indicating a transient change in ChT. Significant associations were noted, using linear mixed models, between AE and the TZ diameters (p < 0.003) after adjusting for baseline data. A very weak association was found between ChT changes and AE, with the effect size close to zero.

Conclusions

Smaller BOZD ortho-k lenses resulted in a smaller TZ diameter, which was associated with less AE after 2 years of treatment. The changes in ChT played a very weak role, suggesting that other factors may contribute more to the reduced AE in subjects wearing lenses having a smaller BOZD.     

Sports and Myopia: An Investigation on the Prevalence and Risk Factors of Myopia in Young Sports-Related Groups in Tianjin,China

ObjectiveTo explore the relationship between sports and the prevalence of myopia in young sports-related groups in Tianjin, China.MethodsIn this cross-sectional study, a cluster sampling method was used to survey professional athletes in Tianjin, students at Tianjin University of Sport, and Tianjin Vocational College of Sports. All participants completed epidemiological questionnaires and ophthalmic examinations. Multivariable logistic regression models were used to explore the potential risk factors of myopia.ResultsThis study recruited 1401 participants. The prevalence of myopia was 50.18%. The prevalence of low, moderate, and high myopia were 52.63%, 37.41%, and 9.96%, respectively. There were no sex-related differences in the prevalence of myopia. The odds of having myopia was 1.788 times higher in the indoor sports group than the outdoor sports group (the adjusted odds ratio [OR], 95% confidence interval [CI], 1.391–2.297). Training time of more than 4 h/d (4–6 h/d: OR, 0.539; 95% CI, 0.310–0.938; >6 h/d: OR, 0.466; 95% CI, 0.257–0.844) resulted in a lower risk of myopia. Participants who often used the electronic screen (OR, 1.406; 95% CI, 1.028–1.923) and/or had a family history of myopia (OR, 2.022; 95% CI, 1.480–2.763) were more likely to suffer from myopia.ConclusionsOutdoor sports do not necessarily guarantee to insulate against myopia. Youngsters engaged in outdoor sports had a lower prevalence of myopia than those participating in indoor sports. Electronic screen use, training time, and family history of myopia were also associated with the prevalence of myopia in young sports-related groups.     

Rationale and methodology for a population-based study of eye diseases in Malay people: The Singapore Malay eye study (SiMES)

PURPOSE: Although there are approximately 200 million people of Malay ethnicity living in Asia, the burden and risk factors of blinding eye diseases in this ethnic group are unknown. This study summarizes the rationale and study design of a population-based study of eye diseases among adult Malays in Singapore. METHODS: A population-based cross-sectional study of Malays was designed in Singapore. The sampling frame consisted of all Malays aged 40-79 living in designated study areas in southwestern Singapore. From a list of 16,069 names provided by the Ministry of Home Affairs, age-stratified random sampling was used to select 5,600 names (1,400 people from each decade of 40-49, 50-59, 60-69, and 70-79 years). The target sample size for this study was 3,150 persons. Selected individuals were invited to a centralized clinic by letters, telephone calls, and home visits. Participants underwent standardized interview and assessment of blood pressure, anthropometry, presenting and best-corrected visual acuity, subjective refraction, ocular biometry, Goldmann tonometry, slit-lamp biomicroscopy, optic disc imaging, digital lens, and retinal photography. Blood and urine samples were collected for biochemical analyses and further stored for future studies. Selected participants also had gonioscopic examination, visual fields test, and assessment of ankle and brachial blood pressure to detect presence of peripheral vascular disease. CONCLUSIONS: This study provides population-based data on the prevalence of and risk factors for age-related eye diseases in people of Malay ethnicity in Singapore. Data from this study allow further understanding of the etiology and impact of eye diseases in this ethnic group.     

Nearwork‐induced transient myopia (NITM) following marked and sustained,but interrupted,accommodation at near

Purpose: The purpose of the present investigation was to determine objectively the initial magnitude and decay of nearwork‐induced transient myopia (NITM), and its potential additivity, following successive but interrupted periods of marked, sustained accommodation at near in asymptomatic young‐adult myopic subjects. Methods: Fifteen visually‐normal, asymptomatic young adults (ages 18–28 years) were tested with full distance refractive correction. They included nine early‐onset (EOM) and six late‐onset (LOM) myopic subjects. Accommodation was assessed objectively with a Canon R‐1, open‐field, infrared auto‐refractor under monocular viewing conditions (RE). The distance refractive state was measured immediately before and after a 10 min period of focusing upon a moderate contrast (50%), very near target (12 cm; 8 D) subtending a visual angle of 1°. The task was repeated twice with a 5‐min inter‐trial rest period of imposed far viewing. NITM was defined as the post‐task minus pre‐task change in distance refractive state and was determined for each of the three trials. Results: Significant amounts of NITM were generated following nearly each trial in each subject. These ranged from 0.11 to 0.71 D, with a mean of 0.31 D. The group mean NITM was 0.32, 0.29, and 0.31 D for trials 1, 2, and 3, respectively. For the EOMs subgroup, NITM was 0.28, 0.30, and 0.34 D, while for the LOMs subgroup, it was 0.38, 0.29, and 0.26 D, for trials 1, 2, and 3, respectively. Decay of NITM was prolonged in many of the subjects (67%). However, additivity of NITM was not found following the sequences of interrupted near tasks. Conclusions: There was no evidence of NITM additivity following a marked and sustained, but interrupted, near task. Although NITM has been reported to be additive following long periods of uninterrupted and sustained reading at lower dioptric levels, providing rest periods between each near task trial appears to prevent a cumulative effect (i.e. additivity effect).