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Ophthalmic & Physiological Optics : the... Nov 2022To determine the efficacy of two myopia control contact lenses (CL) compared with a single-vision (SV) CL. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To determine the efficacy of two myopia control contact lenses (CL) compared with a single-vision (SV) CL.
METHODS
Ninety-five Chinese children with myopia, aged 7-13 years in a 1-year prospective, randomised, contralateral, cross-over clinical trial with 3 groups; bilateral SVCL (Group I); randomised, contralateral wear of an extended depth of focus (EDOF) CL and SVCL (Group II) and MiSight® CL and SVCL (Group III). In Groups II and III, CL were crossed over at the 6-month point (Stage 1) and worn for a further 6 months (Stage 2). Group I wore SVCL during both stages. At baseline and the end of each stage, cycloplegic spherical equivalent refractive error (SE) and axial length (AL) were measured. Six-monthly ΔSE/ΔAL across groups was analysed using a linear mixed model (CL type, stage, eye and eye* stage included as factors). Intra-group paired differences between eyes were determined.
RESULTS
In Group I, mean (SD) ΔSE/ΔAL with SVCL was -0.41 (0.28) D/0.13 (0.09) mm and -0.25 (0.27) D/0.16 (0.09) mm for stages 1 and 2, with a mean paired difference between eyes of 0.01 D/0.01 mm and 0.05 D/-0.01 mm, respectively. ΔSE/ΔAL with SVCL was similar across Groups I to III (Stage 1: p = 0.89/0.44, Stage 2: p = 0.70/ 0.64). In Groups II and III, ΔSE/ΔAL was lower with the EDOF and MiSight® CL than the contralateral SVCL in 68% to 94% of participants, and adjusted 6-month ΔSE/ΔAL with EDOF was similar to MiSight® (p = 0.49/0.56 for ΔSE/ΔAL, respectively). Discontinuations across the three groups were high, but not different between the groups (33.3%, 48.4% and 50% for Groups I to III, respectively [p = 0.19]) and most discontinuations occurred immediately after baseline.
CONCLUSIONS
Extended depth of focus and MiSight® CL demonstrated similar efficacy in slowing myopia. When switched from a myopia control CL to SVCL, myopia progression was similar to that observed with age-matched wearers in SVCL and not suggestive of rebound.
Topics: Child; Contact Lenses, Hydrophilic; Disease Progression; Eyeglasses; Humans; Mydriatics; Myopia; Prospective Studies; Refraction, Ocular
PubMed: 36006761
DOI: 10.1111/opo.13042 -
Cornea Jun 2022The aim of this study was to evaluate the clinical and topographic features of posterior polymorphous corneal dystrophy (PPCD) in children aged 15 years or younger with...
PURPOSE
The aim of this study was to evaluate the clinical and topographic features of posterior polymorphous corneal dystrophy (PPCD) in children aged 15 years or younger with a long-term follow-up. Retrospective case series.
METHODS
A retrospective chart review of patients who were diagnosed with PPCD at Boston Children's Hospital from 1999 to 2020 was performed. Data collected included age at the time of diagnosis, slit lamp findings, cycloplegic refraction, best-corrected visual acuity, central corneal thickness, specular microscopy, and corneal topography findings whenever available.
RESULTS
Twenty-seven eyes of 19 patients were included (11 unilateral and 8 bilateral cases). Ten patients were girls (52.6%). Left eye was affected in 14 eyes. The mean age at the time of diagnosis was 8.5 ± 3.3 years, with a mean follow-up of 5.3 years. In unilateral cases, there was a statistically significant difference in the endothelial cell density (P = 0.01), coefficient variation (P = 0.03), and hexagonality (P = 0.01) between the affected and the contralateral unaffected eyes. The mean best-corrected visual acuity at initial presentation was 0.8 ± 0.2 compared with 0.9 ± 0.08 in unaffected eyes (P = 0.04). The mean astigmatism was higher in the affected eye (+1.7 diopters) compared with (+1.00) the unaffected eye (P = 0.07). At initial presentation, 7 of 27 eyes had amblyopia, which resolved, either partially or completely, in 5 eyes after treatment.
CONCLUSIONS
PPCD can present early in children with astigmatism and anisometropic amblyopia. A careful slit lamp examination for children presenting with anisoastigmatism is necessary to diagnose PPCD. Contrary to adults, presentation is often unilateral. Such patients should be followed up regularly with cycloplegic retinoscopy to prevent and treat refractive amblyopia if present.
Topics: Adult; Amblyopia; Astigmatism; Child; Cornea; Corneal Dystrophies, Hereditary; Corneal Topography; Female; Humans; Male; Mydriatics; Retrospective Studies
PubMed: 34469341
DOI: 10.1097/ICO.0000000000002847 -
Optometry and Vision Science : Official... May 2022Identifying children at highest risk for rapid myopia progression and/or rapid axial elongation could help prioritize who should receive clinical treatment or be...
SIGNIFICANCE
Identifying children at highest risk for rapid myopia progression and/or rapid axial elongation could help prioritize who should receive clinical treatment or be enrolled in randomized clinical trials. Our models suggest that these goals are difficult to accomplish.
PURPOSE
This study aimed to develop models predicting future refractive error and axial length using children's baseline data and history of myopia progression and axial elongation.
METHODS
Models predicting refractive error and axial length were created using randomly assigned training and test data sets from 916 myopic participants in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study. Subjects were 7 to 14 years of age at study entry with three consecutive annual visits that included cycloplegic A-scan ultrasound and autorefraction. The effect of adding prior change in axial length and refractive error was evaluated for each model.
RESULTS
Age, ethnicity, and greater myopia were significant predictors of future refractive error and axial length, whereas prior progression or elongation, near work, time outdoors, and parental myopia were not. The 95% limits for the difference between actual and predicted change were ±0.22 D and ±0.14 mm without prior change data compared with ±0.26 D and ±0.16 mm with prior change data. Sensitivity and specificity for identifying fast progressors were between 60.8 and 63.2%, respectively, when the cut points were close to the sample average. Positive predictive value and sample yield were even lower when the cut points were more extreme.
CONCLUSIONS
Young, more myopic Asian American children in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study were the most likely to progress rapidly. Clinical trials should expect average progression rates that reflect sample demographics and may have difficulty recruiting generalizable samples that progress faster than that average. Knowing progression or elongation history does not seem to help the clinical decision regarding initiating myopia control.
Topics: Child; Disease Progression; Ethnicity; Humans; Mydriatics; Myopia; Refraction, Ocular; Refractive Errors
PubMed: 35511119
DOI: 10.1097/OPX.0000000000001883 -
Annals of Allergy, Asthma & Immunology... Sep 2020
Topics: Aircraft; Epinephrine; Humans; Injections, Intramuscular
PubMed: 32553776
DOI: 10.1016/j.anai.2020.06.021 -
European Journal of Ophthalmology May 2023To compare Mydrane®, mydriatic eye drops, and Mydriasert® in terms of pupil site stability, surgical time, visual field, and anterior chamber configuration...
PURPOSE
To compare Mydrane®, mydriatic eye drops, and Mydriasert® in terms of pupil site stability, surgical time, visual field, and anterior chamber configuration modifications among patients with primary open-angle glaucoma (POAG) during cataract extraction surgery.
METHODS
Retrospective analysis of sixty patients with POAG and cataract who underwent elective cataract extraction. All patients underwent routine ophthalmic examinations, including automatic visual field examination, anterior chamber configuration, specular microscopy, and arterial blood pressure measurement prior to surgery, and 24 h and 30 days postoperatively. All cataract surgeries were video-recorded and all measurements were performed using a media player. Patients divided into groups 1, 2, and 3 (n = 20 in each group) received topical mydriatic eye drops, Mydriasert®, and an intracameral injection of Mydrane®, respectively, immediately after the first incision.
RESULTS
The mean change in pupil size from just before capsulorhexis to the end of surgery was 0.43 ± 0.09, 0.42 ± 0.08, and 0.36 ± 0.02 mm in groups 1, 2, and 3, respectively. The mean surgery duration was similar among all the groups. The baseline main cell density slightly decreased at 24 h and remained stable for 30 days postoperatively. The mean deviation and pattern standard deviation remained stable at 1 month after surgery. At 24 h after surgery, the nasal irido-corneal angle, temporal-iridocorneal angle, and anterior chamber depth increased compared with the baseline, remaining stable for 30 days after surgery.
CONCLUSIONS
Mydrane® produced adequate and stable mydriasis as effectively as produced by Mydriasert® and topical eye drops.
Topics: Humans; Mydriatics; Glaucoma, Open-Angle; Retrospective Studies; Phenylephrine; Lidocaine; Cataract Extraction; Pupil; Cataract; Ophthalmic Solutions; Phacoemulsification
PubMed: 36579807
DOI: 10.1177/11206721221146676 -
Nature Sep 2020Tropane alkaloids from nightshade plants are neurotransmitter inhibitors that are used for treating neuromuscular disorders and are classified as essential medicines by...
Tropane alkaloids from nightshade plants are neurotransmitter inhibitors that are used for treating neuromuscular disorders and are classified as essential medicines by the World Health Organization. Challenges in global supplies have resulted in frequent shortages of these drugs. Further vulnerabilities in supply chains have been revealed by events such as the Australian wildfires and the COVID-19 pandemic. Rapidly deployable production strategies that are robust to environmental and socioeconomic upheaval are needed. Here we engineered baker's yeast to produce the medicinal alkaloids hyoscyamine and scopolamine, starting from simple sugars and amino acids. We combined functional genomics to identify a missing pathway enzyme, protein engineering to enable the functional expression of an acyltransferase via trafficking to the vacuole, heterologous transporters to facilitate intracellular routing, and strain optimization to improve titres. Our integrated system positions more than twenty proteins adapted from yeast, bacteria, plants and animals across six sub-cellular locations to recapitulate the spatial organization of tropane alkaloid biosynthesis in plants. Microbial biosynthesis platforms can facilitate the discovery of tropane alkaloid derivatives as new therapeutic agents for neurological disease and, once scaled, enable robust and agile supply of these essential medicines.
Topics: Acyltransferases; Alkaloids; Animals; Atropa belladonna; Atropine Derivatives; Biological Transport; Datura; Glucosides; Hyoscyamine; Lactates; Ligases; Models, Molecular; Nervous System Diseases; Oxidoreductases; Protein Engineering; Saccharomyces cerevisiae; Scopolamine; Vacuoles
PubMed: 32879484
DOI: 10.1038/s41586-020-2650-9 -
Scientific Reports Nov 2022The study is to evaluate the performance of ocular biometric measures and uncorrected visual acuity (UCVA) for detecting myopia among Chinese students. Among 5- to...
The study is to evaluate the performance of ocular biometric measures and uncorrected visual acuity (UCVA) for detecting myopia among Chinese students. Among 5- to 18-year-old Chinese students from two cities of China, trained eye-care professionals performed assessment of ocular biometrics (axial length (AL), corneal curvature radius (CR), anterior chamber depth) under noncycloplegic conditions using NIDEK Optical Biometer AL-Scan, distance visual acuity using retro-illuminated logMAR chart with tumbling-E optotypes, and cycloplegic refractive error using NIDEK autorefractor with administration of 0.5% tropicamide. Spherical equivalent (SER) in diopters (D) was calculated as sphere plus half cylinder, and myopia was defined as SER ≤ - 0.5 D. Performances of ocular biometrics and UCVA (individually and in combination) for detecting myopia were evaluated using sensitivity and specificity, predictive values, and area under ROC curve (AUC) in both development dataset and validation dataset. Among 3436 students (mean age 9.7 years, 51% female), the mean (SD) cycloplegic SER was - 0.20 (2.18) D, and 1269 (36.9%) had myopia. Cycloplegic SER was significantly correlated with AL (Pearson Correlation coefficient r = - 0.82), AL/CR ratio (r = - 0.90), and UCVA (r = 0.79), but was not correlated with CR (r = 0.02, p = 0.15). The AL/CR ratio detected myopia with AUC 0.963 (95% CI 0.957-0.969) and combination with UCVA improved the AUC to 0.976 (95% CI 0.971-0.981). Using age-specific AL/CR cutoff (> 3.00 for age < 10 years, > 3.06 for 10-14 years, > 3.08 for ≥ 15 years) as myopia positive, the sensitivity and specificity were 87.0% (95% CI 84.4-89.6%) and 87.8% (86.0-89.6%), respectively, in the development dataset and 86.4% (95% CI 83.7-89.1%) and 89.4% (95% CI 87.3-91.4%), respectively, in the validation dataset. Combining AL/CR and UCVA (worse than 20/32 for age < 10 years, and 20/25 for ≥ 10 years) provided 91.9% (95% CI 90.4-93.4%) sensitivity and 87.0% (95% CI 85.6-88.4%) specificity, positive value of 80.6% (95% CI 78.5-82.6%) and negative value of 94.8% (95% CI 93.8-95.8%). These results suggest that AL/CR ratio is highly correlated with cycloplegic refractive error and detects myopia with high sensitivity and specificity, AL/CR ratio alone or in combination with UCVA can be used as a tool for myopia screening or for estimating myopia prevalence in large epidemiological studies with limited resources for cycloplegic refraction.
Topics: Humans; Female; Child; Child, Preschool; Adolescent; Male; Mydriatics; Myopia; Refraction, Ocular; Visual Acuity; Biometry; Refractive Errors; Cornea; Students; China
PubMed: 36333404
DOI: 10.1038/s41598-022-23409-0 -
Indian Journal of Ophthalmology Sep 2019Amblyopia is the most common cause of monocular visual impairment affecting 2-5% of the general population. Amblyopia is a developmental cortical disorder of the visual... (Review)
Review
Amblyopia is the most common cause of monocular visual impairment affecting 2-5% of the general population. Amblyopia is a developmental cortical disorder of the visual pathway essentially due to abnormal visual stimulus, reaching the binocular cortical cells, which may be multivariate. Ganglion cells are of two types: parvocellular (P cells) and magnocellular (M cells); they are the first step where the light energy is converted in to neural impulse. P cells are involved in fine visual acuity, fine stereopsis, and color vision and M cells are involved in gross stereopsis and movement recognition. Strabismus, refractive error, cataract, and ptosis, occurring during critical period are highly amblyogenic. The critical period extends from birth to 7--8 years. The earlier the clinically significant refractive error and strabismus are detected and treated, the greater the likelihood of preventing amblyopia. Treatment for amblyopia in children includes: optical correction of significant refractive errors, patching, pharmacological treatment, and alternative therapies which include: vision therapy, binocular therapy, and liquid crystal display eyeglasses are newer treatment modalities for amblyopia. Age of starting the treatment is not predictive of outcome, instituting treatment on detection and early detection plays a role in achieving better outcomes. This review aims to give a simplified update on amblyopia, which will be of use to a clinician, in understanding the pathophysiology of the complex condition. We also share the cortical aspects of amblyopia and give recent developments in the treatment of amblyopia.
Topics: Amblyopia; Atropine; Eyeglasses; Humans; Mydriatics; Ophthalmic Solutions; Sensory Deprivation; Visual Acuity
PubMed: 31436180
DOI: 10.4103/ijo.IJO_11_19 -
Eye (London, England) Jun 2023To evaluate the risk of AAC and intraocular pressure (IOP) changes in diabetic patients after pupil dilation.
BACKGROUND
To evaluate the risk of AAC and intraocular pressure (IOP) changes in diabetic patients after pupil dilation.
METHODS
This cross-sectional study enrolled 2,287 diabetic patients among community residents in Guangzhou, China. All participants underwent routine pupil dilation unless they had a history of glaucoma. IOP was measured using a non-contact tonometer before and one hour after pupil dilation with tropicamide 0.5% and phenylephrine 0.5% eye drop. The proportion of AAC and changes in IOP after pupil dilation were evaluated.
RESULTS
Only one of the 2,287 participants (0.04%) with diabetes developed post-dilation AAC. The mean pre and post-dilation IOP in the right was 16.1 ± 2.7 and 16.5 ± 2.8 mmHg (P < 0.001); mean pre and post-dilation IOP in the left was 16.5 ± 2.7 and 16.8 ± 2.8 mmHg (P < 0.001). Sixty-one participants (2.7%) showed an increase in IOP ≥ 5 mmHg and 25 participants (1.1%) showed a post-dilation IOP > 25 mmHg, including 11 participants (0.5%) who had both an increase in IOP ≥ 5 mmHg and post-dilation IOP > 25 mmHg. Lower pre-dilation IOP (OR = 0.827; 95% CI, 0.742-0.922; P = 0.001) and shallower anterior chamber depth (ACD) (OR = 0.226; 95% CI, 0.088-0.585; P = 0.002) were significant risk factors for an increase in IOP ≥ 5 mmHg in multivariate logistic regression analysis.
CONCLUSIONS
The risk of developing AAC after pupil dilation in diabetic patients was very low. Lower pre-dilation IOP and shallower ACD are risk factors for increased post-dilation IOP.
Topics: Humans; Intraocular Pressure; Mydriatics; Pupil; Cross-Sectional Studies; Dilatation; Diabetes Mellitus; Exfoliation Syndrome; Glaucoma, Angle-Closure
PubMed: 36008530
DOI: 10.1038/s41433-022-02215-y -
Eye (London, England) Jan 2021The global burden of diabetes has resulted in an increase in the prevalence of diabetic retinopathy (DR), a microvascular complication of diabetes. Lifelong repetitive... (Review)
Review
The global burden of diabetes has resulted in an increase in the prevalence of diabetic retinopathy (DR), a microvascular complication of diabetes. Lifelong repetitive screening for DR is essential for early detection and timely management to prevent visual impairment due to the silent sight-threatening disorder. Colour fundus photography (CFP) is helpful for documentation of the retinopathy as well as for counselling the patient. CFP has established roles in DR screening, detection, progression and monitoring of treatment response. DR screening programmes use validated mydriatic or non-mydriatic fundus cameras for retinal imaging and trained image graders identify referable DR. Smartphone-based fundus cameras and handheld fundus cameras that are cost-effective, portable and easy to handle in remote places are gaining popularity in recent years. The images captured with these low-cost devices can be immediately sent to trained ophthalmologists for grading of DR. Recent increase in numbers of telemedicine programmes based on imaging with digital fundus cameras and remote interpretation has facilitated larger population coverage of DR screening and timely referral of those with sight-threatening DR to ophthalmologists. Good-quality retinal imaging and accurate diagnosis are essential to reduce inappropriate referrals. Advances in digital imaging such as ultra-wide field imaging and multi-modal imaging have opened new avenues for assessing DR. Fundus cameras with integrated artificial intelligence (AI)-based automated algorithms can also provide instant DR diagnosis and reduce the burden of healthcare systems. We review the different types of fundus cameras currently used in DR screening and management around the world.
Topics: Artificial Intelligence; Diabetes Mellitus; Diabetic Retinopathy; Humans; Mass Screening; Photography; Retina
PubMed: 33168977
DOI: 10.1038/s41433-020-01262-7