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JAMA Ophthalmology Aug 2023Controlling myopia progression is of interest worldwide. Low-dose atropine eye drops have slowed progression in children in East Asia.
IMPORTANCE
Controlling myopia progression is of interest worldwide. Low-dose atropine eye drops have slowed progression in children in East Asia.
OBJECTIVE
To compare atropine, 0.01%, eye drops with placebo for slowing myopia progression in US children.
DESIGN, SETTING, AND PARTICIPANTS
This was a randomized placebo-controlled, double-masked, clinical trial conducted from June 2018 to September 2022. Children aged 5 to 12 years were recruited from 12 community- and institution-based practices in the US. Participating children had low to moderate bilateral myopia (-1.00 diopters [D] to -6.00 D spherical equivalent refractive error [SER]).
INTERVENTION
Eligible children were randomly assigned 2:1 to 1 eye drop of atropine, 0.01%, nightly or 1 drop of placebo. Treatment was for 24 months followed by 6 months of observation.
MAIN OUTCOME AND MEASURES
Automated cycloplegic refraction was performed by masked examiners. The primary outcome was change in SER (mean of both eyes) from baseline to 24 months (receiving treatment); other outcomes included change in SER from baseline to 30 months (not receiving treatment) and change in axial length at both time points. Differences were calculated as atropine minus placebo.
RESULTS
A total of 187 children (mean [SD] age, 10.1 [1.8] years; age range, 5.1-12.9 years; 101 female [54%]; 34 Black [18%], 20 East Asian [11%], 30 Hispanic or Latino [16%], 11 multiracial [6%], 6 West/South Asian [3%], 86 White [46%]) were included in the study. A total of 125 children (67%) received atropine, 0.01%, and 62 children (33%) received placebo. Follow-up was completed at 24 months by 119 of 125 children (95%) in the atropine group and 58 of 62 children (94%) in the placebo group. At 30 months, follow-up was completed by 118 of 125 children (94%) in the atropine group and 57 of 62 children (92%) in the placebo group. At the 24-month primary outcome visit, the adjusted mean (95% CI) change in SER from baseline was -0.82 (-0.96 to -0.68) D and -0.80 (-0.98 to -0.62) D in the atropine and placebo groups, respectively (adjusted difference = -0.02 D; 95% CI, -0.19 to +0.15 D; P = .83). At 30 months (6 months not receiving treatment), the adjusted difference in mean SER change from baseline was -0.04 D (95% CI, -0.25 to +0.17 D). Adjusted mean (95% CI) changes in axial length from baseline to 24 months were 0.44 (0.39-0.50) mm and 0.45 (0.37-0.52) mm in the atropine and placebo groups, respectively (adjusted difference = -0.002 mm; 95% CI, -0.106 to 0.102 mm). Adjusted difference in mean axial elongation from baseline to 30 months was +0.009 mm (95% CI, -0.115 to 0.134 mm).
CONCLUSIONS AND RELEVANCE
In this randomized clinical trial of school-aged children in the US with low to moderate myopia, atropine, 0.01%, eye drops administered nightly when compared with placebo did not slow myopia progression or axial elongation. These results do not support use of atropine, 0.01%, eye drops to slow myopia progression or axial elongation in US children.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03334253.
Topics: Child; Humans; Female; Child, Preschool; Atropine; Ophthalmic Solutions; Refraction, Ocular; Myopia; Vision Tests; Disease Progression
PubMed: 37440213
DOI: 10.1001/jamaophthalmol.2023.2855 -
American Journal of Ophthalmology Jul 2023To compare the extended depth of focus (EDOF) vs trifocal intraocular lenses (IOLs) in patients undergoing IOL implantation. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To compare the extended depth of focus (EDOF) vs trifocal intraocular lenses (IOLs) in patients undergoing IOL implantation.
DESIGN
Systematic review and meta-analysis.
METHODS
An electronic search was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to include studies comparing EDOF vs trifocal IOLs. Refraction and visual acuity were primary outcomes. Secondary outcomes included defocus curves, intraocular aberrations, contrast sensitivity (CS), quality of vision (QoV) questionnaire score, haloes and glare, spectacle independence, and patient satisfaction.
RESULTS
A total of 22 studies enrolling 2200 eyes were identified. Trifocal IOL showed a significant improvement in sphere (mean difference [MD] = -0.23; P = .001) and spherical equivalence (MD = -0.11, P = .0001) compared to EDOF IOL. No difference was observed in cylinder (MD = -0.03, P = .25) or astigmatism. Trifocal IOL had superior near visual acuity outcomes, namely uncorrected near visual acuity (MD = 0.12, P < .00001) and distance-corrected near visual acuity (MD = 0.12, P = .002). Postoperative corrected distance visual acuity (MD = -0.01, P = .01) was significantly improved for the EDOF group, although no difference was noted in postoperative uncorrected distance visual acuity (MD = 0.00, P = .84), uncorrected intermediate visual acuity (MD = 0.01, P = .68) or distance-corrected intermediate visual acuity (MD = -0.01, P = .39). Defocus curve favored trifocal IOLs at near vision and EDOF IOLs at intermediate vision. Ocular aberration, CS, haloes (odds ratio = 0.64, P = .10), glare, and patient satisfaction were not statistically significant between the groups. The trifocal IOL was associated with an improved QoV questionnaire score (MD = 1.24, P = 0.03) and spectacle independence (odds ratio = 0.26, P = .02).
CONCLUSIONS
Trifocal IOLs improved uncorrected near visual acuity compared to EDOF IOLs. Uncorrected distance and intermediate visual acuity, halos, and glare were not statistically different between both groups.
Topics: Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Visual Acuity; Refraction, Ocular; Cataract Extraction; Patient Satisfaction; Prosthesis Design; Phacoemulsification; Pseudophakia
PubMed: 36736751
DOI: 10.1016/j.ajo.2023.01.024 -
Acta Ophthalmologica Sep 2023To evaluate the 1-year myopia control efficacy of a spectacle lens with annular cylindrical microstructures. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To evaluate the 1-year myopia control efficacy of a spectacle lens with annular cylindrical microstructures.
METHODS
A total of 118 consecutive eligible children aged 8-12 years with -1.00 D to -4.00 D of spherical component myopia and <1.50 D astigmatism were enrolled between August 2020 and November 2020 at the Eye Hospital of Wenzhou Medical University. Participants were randomly assigned to wear cylindrical annular refractive element (CARE) (n = 61) or single-vision (n = 57) spectacle lenses. Cycloplegic autorefraction (spherical equivalent refraction [SER]) and axial length (AL) were measured at baseline and 6-month intervals. Adaptation and compliance questionnaires were administered during all visits.
RESULTS
Among 118 randomized participants, 96 (81.4%) were included in the analyses (mean [SE] age, 10.4 [0.6] years; 49 [51.0%] were female; mean [SE] spherical equivalent refractive error, -2.67 [0.66] D; mean [SE] axial length, 24.75 [0.77] mm). Adjusted 1-year myopia progression was -0.56 D for CARE and -0.71 D for single-vision spectacle lenses. The difference in progression was 0.14 D (95% CI, -0.04 to 0.32) for CARE vs single vision. Adjusted 1-year eye growth was 0.27 mm for CARE and 0.35 mm for single vision. The difference in eye growth was 0.09 mm (95% CI, -0.15 to -0.02) for CARE vs single vision. All groups adapted to their lenses with no reported adverse events, complaints, or discomfort.
CONCLUSIONS
Among children with myopia, treatment with cylindrical annular refractive element spectacle lenses significantly reduced the rate of axial elongation over 1 year compared with single-vision spectacle lenses.
Topics: Child; Humans; Female; Male; Eyeglasses; Refraction, Ocular; Myopia; Vision Tests; Astigmatism; Disease Progression
PubMed: 36779428
DOI: 10.1111/aos.15649 -
COMPLEMENT INHIBITION FOR GEOGRAPHIC ATROPHY: Review of Salient Functional Outcomes and Perspective.Retina (Philadelphia, Pa.) Jul 2023To evaluate available rationale and outcomes of randomized trial results for complement inhibition for geographic atrophy. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To evaluate available rationale and outcomes of randomized trial results for complement inhibition for geographic atrophy.
METHODS
Data from recently completed randomized trials of complement inhibition, particularly for pegcetacoplan and avacincaptad pegol, were evaluated for both the outcome, area of autofluorescence loss, and functional vision tests.
RESULTS
Pegcetacoplan 2 mg showed statistically significant reduction in expansion of the area of autofluorescence loss with monthly, but not every-other-month dosing, in a 12-month phase two trial. Nearly 40% of patients recruited for the monthly arm did not complete the treatment. In two parallel phase 3 studies there was a statistically significant reduction in the area of atrophy in one but not both studies as compared with untreated controls. Data released at 24 months follow-up showed statistically significant reduction in the area of autofluorescence-detected atrophy in both studies compared with sham. Patients did not show functional difference in best-corrected visual acuity, maximum reading speed, Functional Reading Independence Index, and mean microperimetry threshold sensitivities in the treatment versus sham arms. Avacincaptad pegol was evaluated in two randomized pivotal studies and showed a statistically significant reduction in the expansion of autofluorescence loss at 12 months. Patients in the treatment arms did not show any difference as compared with sham in the best-corrected visual acuity or low luminance visual acuity, the only functional outcomes mentioned. Both drugs increased the risk of macular neovascularization.
CONCLUSION
Both avacincaptad pegol and pegcetacoplan show significant differences compared with sham in autofluorescence imaging but no benefit in visual function at 12 and 24 months, respectively.
Topics: Humans; Atrophy; Geographic Atrophy; Macular Degeneration; Visual Acuity
PubMed: 36996460
DOI: 10.1097/IAE.0000000000003796 -
The British Journal of Ophthalmology Nov 2023Mutations in the L/M cone opsin gene array cause abnormally high perceived retinal contrast and the development of myopia. Environmental factors may also lead to high... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Mutations in the L/M cone opsin gene array cause abnormally high perceived retinal contrast and the development of myopia. Environmental factors may also lead to high visual contrast and cause myopia. Diffusion optics technology (DOT) lenses are designed to reduce contrast signalling in the retina and slow myopia progression.
METHODS
The ontrol of Mopia Using eripheal Diffusion Lenses fficacy and afety tudy (CYPRESS, NCT03623074) is a 36-month, multicentre, randomised, controlled, double-masked trial evaluating two investigational spectacle lenses versus control lenses in myopic children aged 6-10, with a planned interim analysis at 12 months. The primary endpoints are change from baseline in axial length (AL) and spherical equivalent refraction (SER).
RESULTS
256 children (58% female; mean age at screening, 8.1 years) were dispensed spectacles. Across all groups, baseline averages were AL 24.02 mm (SD±0.77 mm), SER -2.01 D (SD±0.9 D) using manifest refraction, and SER -1.94 D (SD±1.0 D) using cycloplegic autorefraction. At 12 months, mean difference in SER progression for test 1 versus control was -0.40 D (p<0.0001), representing a 74% reduction and -0.32 D for Test 2 (p<0.0001), representing a 59% reduction. The difference in AL progression for test 1 versus control was 0.15 mm (p<0.0001) and test 2 versus control was 0.10 mm (p=0.0018).
CONCLUSION
12-month results from this ongoing trial demonstrate the safety and effectiveness of DOT spectacles for reducing myopic progression.
Topics: Child; Humans; Female; Male; Cupressus; Eyeglasses; Myopia; Refraction, Ocular; Retina
PubMed: 36126105
DOI: 10.1136/bjo-2021-321005 -
Journal of Ocular Pharmacology and... Oct 2023
Topics: Vision, Ocular; Visual Field Tests; Regeneration
PubMed: 37861411
DOI: 10.1089/jop.2023.29111.mve -
Survey of Ophthalmology 2024Keratoconus is an ectatic corneal disorder that causes severe vision loss. Surgical options allow us to correct, partially or totally, the induced refractive error.... (Review)
Review
Keratoconus is an ectatic corneal disorder that causes severe vision loss. Surgical options allow us to correct, partially or totally, the induced refractive error. Intracorneal ring segments (ICRS) implantation represents a minimally invasive surgical option that improves visual acuity, with a high success rate and a low overall complication rate. Corneal allogenic ICRS consists of ring segments derived from allogenic eye bank-processed donor corneas. Selective topography-guided transepithelial photorefractive or phototherapeutic keratectomy combined with CXL is another way in selected cases to improve spectacles corrected distance visual acuity. The microphotoablative remodeling of the central corneal profile is generally planned by optimizing the optical zones and minimizing tissue consumption. Phakic intraocular lens (PIOL) implant is considered in patients with stable disease and acceptable anatomical requirements. The two types of pIOLs, depending on their implantation inside the eye, are anterior chamber-pIOLs, which fixate to the anterior surface of the iris by using a polymethomethacrolate claw at the two haptics, and posterior chamber-pIOLs. In patients with both cataracts and keratoconus, the correct IOL power is difficult to obtain due to the irregular corneal shape and K values. Toric IOL is recommended, but carefully judging the topography and the possible need of subsequent keratoplasties.
Topics: Humans; Prosthesis Implantation; Keratoconus; Photosensitizing Agents; Corneal Stroma; Visual Acuity; Corneal Topography; Cross-Linking Reagents; Refraction, Ocular
PubMed: 37774800
DOI: 10.1016/j.survophthal.2023.09.005 -
Journal of Vision Apr 2024The perceived slant of a stereoscopic surface is altered by the presence of a surrounding surface, a phenomenon termed stereo slant contrast. Previous studies have shown...
The perceived slant of a stereoscopic surface is altered by the presence of a surrounding surface, a phenomenon termed stereo slant contrast. Previous studies have shown that a slanted surround causes a fronto-parallel surface to appear slanted in the opposite direction, an instance of "bidirectional" contrast. A few studies have examined slant contrast using slanted as opposed to fronto-parallel test surfaces, and these also have shown slant contrast. Here, we use a matching method to examine slant contrast over a wide range of combinations of surround and test slants, one aim being to determine whether stereo slant contrast transfers across opposite directions of test and surround slant. We also examine the effect of the test on the perceived slant of the surround. Test slant contrast was found to be bidirectional in virtually all test-surround combinations and transferred across opposite test and surround slants, with little or no decline in magnitude as the test-surround slant difference approached the limit. There was a weak bidirectional effect of the test slant on the perceived slant of the surround. We consider how our results might be explained by four mechanisms: (a) normalization of stereo slant to vertical; (b) divisive normalization of stereo slant channels in a manner analogous to the tilt illusion; (c) interactions between center and surround disparity-gradient detectors; and (d) uncertainty in slant estimation. We conclude that the third of these (interactions between center and surround disparity-gradient detectors) is the most likely cause of stereo slant contrast.
Topics: Humans; Depth Perception; Contrast Sensitivity; Photic Stimulation; Vision, Binocular
PubMed: 38683571
DOI: 10.1167/jov.24.4.24 -
Telemedicine Journal and E-health : the... Jun 2024(Review)
Review
Topics: Humans; Visual Acuity; Telemedicine; Vision Tests; Mobile Applications; Internet; Male
PubMed: 38564179
DOI: 10.1089/tmj.2023.0368 -
European Journal of Ophthalmology Jul 2023Multifocal and toric intraocular lenses (IOLs) or the so-called premium IOLs are currently widely used in adult patients as a one-step refractive solution following... (Review)
Review
Multifocal and toric intraocular lenses (IOLs) or the so-called premium IOLs are currently widely used in adult patients as a one-step refractive solution following cataract surgery. However, the decision to implant a premium IOL in a pediatric patient involves multiple factors affecting the child's visual development and is associated with several dilemmas and surgical challenges. The purpose of this review is to summarize these factors and analyse the influence of each of them on the visual outcomes following premium IOL implantation. A review of literature was conducted using the relevant keywords from various databases until 31 January 2022. All pertinent studies with multifocal or toric IOL implantation in children were reviewed, and relevant articles were studied in detail for age, IOL power calculation, visual outcomes (refractive outcomes, contrast sensitivity and stereopsis) and complications such as dysphotic phenomena and others. A total of 17 relevant studies (10 case series/interventional studies and 7 case reports) on the subject were included. All studies showed a favourable refractive outcome; however, the data available was significantly less. Studies with earlier models of multifocal IOLs showed a higher incidence of IOL decentration and posterior capsule opacification; however, more recent studies with newer IOL models showed much better safety profiles. Toric IOLs showed promising results in all the studies evaluated. Premium IOLs have shown promising results in the pediatric age group. However, their long-term outcomes specifically concerning refractive shift, capsular contraction and role in the management of amblyopia needs to be explored further.
Topics: Adult; Humans; Child; Lens Implantation, Intraocular; Visual Acuity; Lenses, Intraocular; Cataract Extraction; Multifocal Intraocular Lenses; Refraction, Ocular; Astigmatism; Phacoemulsification
PubMed: 36124376
DOI: 10.1177/11206721221126301