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Scientific Reports Nov 2021To evaluate the efficacy and safety of atropine 0.01% eye drops for myopia control in a multicentric pediatric Spanish cohort. An interventional, prospective,... (Clinical Trial)
Clinical Trial
To evaluate the efficacy and safety of atropine 0.01% eye drops for myopia control in a multicentric pediatric Spanish cohort. An interventional, prospective, multicenter study was designed. Children aged between 6 and 14 years, with myopia between - 2.00 D to - 6.00 D, astigmatism < 1.50 D and documented previous annual progression greater than - 0.5 D (cycloplegic spherical equivalent, SE) were included. Once nightly atropine 0.01% eye drops in each eye were prescribed to all participants for 12 months. Age, gender, ethnicity and iris color were registered. All patients underwent the same follow-up protocol in every center: baseline visit, telephone consultation 2 weeks later and office controls at 4, 8 and 12 months. At each visit, best-corrected visual acuity, and cycloplegic autorefraction were assessed. Axial length (AL), anterior chamber depth and pupil diameter were measured on an IOL Master (Carl Zeiss Meditec, Inc, Dublin, CA). Adverse effects were registered in a specific questionnaire. Mean changes in cycloplegic SE and AL in the 12 months follow-up were analyzed. SE progression during treatment was compared with the SE progression in the year before enrollment for each patient. Correlation between SE and AL, and annual progression distribution were evaluated. Progression risk factors were analyzed by multivariate logistic regression analyses. Of the 105 recruited children, 92 completed the treatment. Mean SE and AL changes were - 0.44 ± 0.41 D and 0.27 ± 0.20 mm respectively. Mean SE progression was lower than the year before treatment (- 0.44 ± 0.41 D versus - 1.01 ± 0.38 D; p < 0.0001). An inverse correlation between SE progression and AL progression (r: - 0.42; p < 0.0001) was found. Fifty-seven patients (62%) had a SE progression less than - 0.50 D. No risk factors associated with progression could be identified in multivariate analyses. Mean pupil diameter increment at 12-months visit was 0.74 ± 1.76 mm. The adverse effects were mild and infrequent, and decreased over the time. Atropine 0.01% is effective and safe for myopia progression control in a multicentric Spanish children cohort. We believe this efficacy might be extensible to the myopic pediatric population from Western countries with similar social and demographic features. More studies about myopia progression risk factors among atropine treated patients are needed.
Topics: Adolescent; Atropine; Child; Disease Progression; Female; Humans; Male; Mydriatics; Myopia; Prospective Studies
PubMed: 34741059
DOI: 10.1038/s41598-021-00923-1 -
Eye (London, England) Mar 2021To evaluate choroidal vasculature changes after the instillation of mydriatic parasympatholytic and sympathomimetic agents in healthy subjects. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To evaluate choroidal vasculature changes after the instillation of mydriatic parasympatholytic and sympathomimetic agents in healthy subjects.
METHODS
A total of 95 healthy subjects were enrolled in this prospective, randomized comparative study. Study participants were divided into three different groups depending on the drug to be administered: tropicamide (1%) group (n = 31), tropicamide (0.5%) + phenylephrine (10%) group (n = 30) and control group receiving artificial tears (n = 34). All participants underwent a complete ophthalmological examination including best corrected visual acuity, refractive status and axial length. Subfoveal choroidal thickness (CT), total choroidal area (TCA), luminal and stromal choroidal area (LCA and SCA) and choroidal vascularity index (CVI) were measured before and after eye drops instillation.
RESULTS
All the baseline characteristics were matched between the three groups (all P > 0.05). Before the mydriatic instillation, there were no significant differences of CT, TCA, LA, SCA, and CVI among the three groups (all P > 0.05). After drug administration, CT, TCA, LCA, SCA, and CVI did not show any significant change as well (respectively, P = 0.265; P = 0.483; 0.573; P = 0.405 and P = 0.708).
CONCLUSIONS
Instillation of mydriatic eye drops did not induce significant changes of the choroidal vasculature, suggesting that their use do not alter CT and CVI evaluation.
Topics: Choroid; Healthy Volunteers; Humans; Mydriatics; Prospective Studies; Tomography, Optical Coherence
PubMed: 32467635
DOI: 10.1038/s41433-020-0995-9 -
Archivos de La Sociedad Espanola de... Jan 2022As an objective technique to assess refractive status, retinoscopy is particularly useful in children. The Mohindra technique (RM) is an alternative for those patients...
PURPOSE
As an objective technique to assess refractive status, retinoscopy is particularly useful in children. The Mohindra technique (RM) is an alternative for those patients not good candidates for cycloplegic retinoscopy (RC). The aim of the present research was to compare both techniques and to determine the correlation and agreement of their measurements.
MATERIAL AND METHODS
A total of 47 boys and girls of ages ranging from 3 to 11 years old were included in the study. Cycloplegic (cyclopentolate 1%) and Mohindra retinoscopy were conducted in both eyes, and refraction was also assessed with an autorefractometre (AR). The results from the three techniques were compared and a correction factor between RM and RC was calculated.
RESULTS
Statistically significant differences were found between RM and RC (median of -0.42 D; p < 0.001) and between RM and AR (median of -0.42 D; p = 0.008), but not between RC and AR (median of 0.00 D; p = 0.758). A strong correlation was found between RM and RC (rho = 0.846; p < 0.001), although the Bland-Altman test revealed a larger difference between these techniques in patients with larger hyperopic refractive errors, with a correction factor of RC = 1.15 RM + 0.42.
CONCLUSIONS
The Mohindra technique may be considered a valid alternative to cycloplegic retinoscopy in patients of young age, with a good correlation between both techniques, albeit less agreement in patients with high hyperopic refractions.
Topics: Child; Child, Preschool; Cyclopentolate; Female; Humans; Male; Mydriatics; Refraction, Ocular; Refractive Errors; Retinoscopy
PubMed: 35027148
DOI: 10.1016/j.oftale.2021.01.011 -
Eye (London, England) Feb 2024The risk of eye diseases such as myopic macular degeneration increases with the level of myopia, but there is no safe level of myopia and the burden of lower degrees of... (Review)
Review
The risk of eye diseases such as myopic macular degeneration increases with the level of myopia, but there is no safe level of myopia and the burden of lower degrees of myopia remains considerable. Effective treatments are available that slow progression and thus limit the final degree of myopia. In this review, the rationale for slowing progression is summarized, and a case made for treating all myopic children. Measurement of refractive error and axial length is reviewed, stressing the precision of optical biometry, but also the need for cycloplegic autorefraction. The factors influencing progression are considered and the available tools for interpretation of progression rate are discussed. Finally, the need to set attainable treatment goals is emphasized.
Topics: Child; Humans; Refraction, Ocular; Mydriatics; Treatment Outcome; Myopia, Degenerative; Macular Degeneration; Disease Progression
PubMed: 37709925
DOI: 10.1038/s41433-023-02722-6 -
Optometry and Vision Science : Official... Aug 2021Cycloplegia is often restricted in screening settings. Previous studies have evaluated noncycloplegic refraction for screening, but their data are not fully applicable...
SIGNIFICANCE
Cycloplegia is often restricted in screening settings. Previous studies have evaluated noncycloplegic refraction for screening, but their data are not fully applicable to school-aged African children. This article adds to the literature by investigating this in school-aged African children.
PURPOSE
The purpose of this study was to evaluate the ability of noncycloplegic autorefraction (NCA) and noncycloplegic retinoscopy (NCR) to detect refractive errors in school-aged African children and quantify differences between noncycloplegic and cycloplegic refraction measures.
METHODS
Autorefraction and retinoscopy were performed on 150 children aged 6 to 15 years before and after cyclopentolate cycloplegia. Subjective refraction was performed by the same examiner after cycloplegia. Noncycloplegic and cycloplegic measurements were compared, and the data were assessed with receiver operating characteristic curves and Bland-Altman plots.
RESULTS
With the exception of cylindrical vector J0 (P = .17) and J45 (P = .08) obtained with NCR, all mean measures of NCA and NCR significantly differed from mean cycloplegic subjective refraction measurements by -0.71 ± 0.67 (P ≤ .001; 95% confidence interval, -2.02 to +0.60) and -0.75 ± 0.68 (P ≤ .001; 95% confidence interval, -2.08 to +0.58), respectively. Mean spherical power between the two tests did not differ (NCA -NCR, mean bias of -0.037 ± 0.675 and 95% limits of agreement of -1.36 to 1.286; P = .51). The sensitivities for detecting any refractive error for NCR and NCA were 86.8 and 82.9%, respectively, and the specificities were 82.0% for NCR and 82.4% for NCA. Performance of both tests was excellent for myopia (area under the curve, >0.90; sensitivity, ≥90%) and similar (P = .13), but the specificities for detecting hyperopia were 78.0% for NCR and 80.0% for NCA.
CONCLUSIONS
Noncycloplegic refraction may accurately detect astigmatism and myopia in this population but may elicit higher myopic values and lower hyperopic values than using cycloplegic refraction.
Topics: Child; Cyclopentolate; Humans; Mydriatics; Refraction, Ocular; Refractive Errors; Schools; Vision Tests
PubMed: 34460453
DOI: 10.1097/OPX.0000000000001742 -
BMJ Open Ophthalmology Apr 2023Self-refracting spectacles (SRSs) have different optical and mechanical designs, which may affect the refractive outcome, depending on the experience of the end user....
OBJECTIVE
Self-refracting spectacles (SRSs) have different optical and mechanical designs, which may affect the refractive outcome, depending on the experience of the end user. This study compared the performance of two SRS among children in Ghana.
METHODS AND ANALYSIS
A cross-sectional study of two Alvarez variable-focus SRS designs was conducted. A total of 167 children (mean age 13.6±1.6 years) identified as having refractive error were recruited from 2465 students who underwent screening. Subjects completed self-refraction using FocusSpecs, and Adlens, autorefraction and cycloplegic subjective refraction (CSR) (gold standard). Wilcoxon signed-rank test was used to compare visual outcomes and accuracy of refraction and graphically illustrated using Bland-Altman plots.
RESULTS
Eighty (47.9%) urban and 87 (52.1%) rural children were analysed and only about one-quarter 40 (24.0%) wore spectacles. The proportion who achieved visual acuity of ≥6/7.5 with FocusSpec, Adlens, autorefraction and CSR among urban schools were 92.6%, 92.4%, 60% and 92.6%, while those in rural schools were 81.6%, 86.2%, 54.0% and 95.4%, respectively. The mean±SD spherical equivalent errors for urban and rural schools using FocusSpec, Adlens and CSR were -1.05±0.61 D, -0.97±0.58 D and -0.78±0.53 D; and -0.47±0.51 D, -0.55±0.43 D and -0.27±0.11 D, respectively. The mean differences between the two self-refraction spectacles for urban and rural schools were not statistically different (p>0.00) but differed significantly when both were compared with the gold standard (CSR) (p<0.05).
CONCLUSION
Background and refraction experience of school children did not significantly affect self-refraction.
Topics: Humans; Child; Adolescent; Eyeglasses; Cross-Sectional Studies; Refractive Errors; Refraction, Ocular; Visual Acuity; Mydriatics
PubMed: 37278415
DOI: 10.1136/bmjophth-2022-001202 -
Ophthalmology Sep 2020The purpose of this assessment is to evaluate the accuracy of autorefraction compared with cycloplegic retinoscopy in children. (Review)
Review
PURPOSE
The purpose of this assessment is to evaluate the accuracy of autorefraction compared with cycloplegic retinoscopy in children.
METHODS
Literature searches were last conducted in October 2019 in the PubMed and the Cochrane Library databases for studies published in English. The combined searches yielded 118 citations, of which 53 were reviewed in full text. Of these, 31 articles were deemed appropriate for inclusion in this assessment and subsequently assigned a level of evidence rating by the panel methodologists. Four articles were rated level I, 11 were rated level II, and 16 were rated level III articles. The 16 level III articles were excluded from this review.
RESULTS
Thirteen of the 15 studies comparing cycloplegic autorefraction with cycloplegic retinoscopy found a mean difference in spherical equivalent or sphere of less than 0.5 diopters (D); most were less than 0.25 D. Even lower mean differences were found when evaluating the cylindrical component of cycloplegic autorefraction versus cycloplegic retinoscopy. Despite low mean variability, there was significant individual measurement variability; the 95% limits of agreement were wide and included clinically relevant differences. Comparisons of noncycloplegic with cycloplegic autorefractions found that noncyloplegic refraction tends to over minus by 1 to 2 D.
CONCLUSIONS
Cycloplegic autorefraction is appropriate to use in pediatric population-based studies. Cycloplegic retinoscopy can be valuable in individual clinical cases to confirm the accuracy of cycloplegic autorefraction, particularly when corrected visual acuity is worse than expected or the autorefraction results are not consistent with expected findings.
Topics: Academies and Institutes; Adolescent; Child; Child, Preschool; Female; Humans; Infant; Male; Mydriatics; Ophthalmology; Refraction, Ocular; Reproducibility of Results; Retinoscopy; Technology Assessment, Biomedical; United States
PubMed: 32317177
DOI: 10.1016/j.ophtha.2020.03.004 -
Journal of Pediatric Ophthalmology and... 2024To ascertain the effectiveness of 0.01% atropine treatment to inhibit myopia progression and the possible additive potency with peripheral defocus contact lenses over 3...
PURPOSE
To ascertain the effectiveness of 0.01% atropine treatment to inhibit myopia progression and the possible additive potency with peripheral defocus contact lenses over 3 years and the rebound effect 1 year after cessation of treatment.
METHODS
This prospective study included 127 children aged 8 to 5 years, divided into three treatment groups: 0.01% atropine and single-vision spectacles (At+SV, n = 36), 0.01% atropine and peripheral defocus contact lens (At+PDCL, n = 30), and 0.01% atropine and dual-focus contact lens (At+DF, n = 25). A control group was prescribed single-vision spectacles (n = 36). Cycloplegic spherical equivalence refraction was measured every 6 months during 3 years of treatment and 1 year after cessation.
RESULTS
Myopia progression decreased over 3 years of treatment, more during the second and third years than the first year, to a statistically significant degree in the atropine groups ( < .01): in the first, second, and third years, respectively, -0.42 ± 0.34, -0.19 ± 0.18, -0.22 ± 0.19 diopters (D) in the At+SV group, -0.26 ± 0.21, -0.14 ± 0.37, and -0.15 ± 0.31 D in the At+PDCL group, and -0.22 ± 0.15, -0.15 ± 0.22, and -0.11 ± 0.14 D in the At+DF group. Myopia progressed 1 year after cessation of treatment: -0.29 ± 0.28 D in the At+SV group, -0.13 ± 0.28 D in the At+PDCL group, and -0.09 ± 0.18 D in the At+DF group. After 3 years, there was no statistically significant difference in myopia progression between the At+SV and At+PDCL or At+DF groups ( < .05).
CONCLUSIONS
Low-dose atropine has been substantiated in this cohort as an effective treatment to decelerate myopia progression over 3 years, more effective in the second and third years of treatment. The combination treatment did not exhibit a statistically significant advantage over monotherapy in this cohort. The At+DF group exhibited a statistically lower rebound effect than the At+SV group. .
Topics: Humans; Atropine; Prospective Studies; Child; Disease Progression; Male; Refraction, Ocular; Female; Eyeglasses; Mydriatics; Follow-Up Studies; Myopia; Ophthalmic Solutions; Child, Preschool; Treatment Outcome; Contact Lenses
PubMed: 38112389
DOI: 10.3928/01913913-20231120-01 -
The British Journal of Ophthalmology May 2022To assess the refractive change and incidence of myopia, as well as their risk factors, among Chinese rural children aged 6-17 years.
PURPOSE
To assess the refractive change and incidence of myopia, as well as their risk factors, among Chinese rural children aged 6-17 years.
METHODS
Children who completed the baseline vision examination of the Handan Offspring Myopia Study were re-examined, including both cycloplegic and non-cyloplegic autorefraction, with a mean follow-up time of 42.4±1.47 months.
RESULTS
A total of 601 children (68.5%) who completed both baseline and the follow-up examinations were enrolled. The cumulative refractive change and axial length change were -0.53±1.03 diopter and 0.39±0.46 mm (-0.15 diopter/year and 0.11 mm/year), respectively. A hundred and five out of the 469 non-myopic children at baseline become myopic at the follow-up, yielding a cumulative myopia incidence of 22.4% (95% CI: 18.6% to 26.2%), or annual myopia incidence of 6.3%. After adjustment, younger age (β=0.08, p<0.001), more myopic baseline refraction (β=0.31, p<0.001), larger difference between cycloplegic and non-cycloplegic refraction (β=-0.20, p=0.007) and more myopic paternal refraction (β=0.09, p=0.007) were found to be associated with more rapid myopic refractive change. More myopic baseline refraction (relative risk (RR), 95% CI: 0.19, 0.13-0.28, p<0.001) and more myopic paternal refraction (RR, 95% CI: 0.92, 0.84-1.00, p=0.039) were also associated with myopia incidence.
CONCLUSION
Relatively low myopic refractive change and myopia incidence were found in this study cohort. Children's refraction and paternal refraction were associated with both myopic refractive change and myopia incidence. Such information will be helpful for further comparisons in other rural versus urban areas of China, and other countries.
Topics: Child; China; Disease Progression; Humans; Incidence; Mydriatics; Myopia; Refraction, Ocular
PubMed: 33441318
DOI: 10.1136/bjophthalmol-2020-317811 -
British Journal of Neurosurgery Sep 2021One of the most feared and devastating complications of carotid revascularization procedures is hyperperfusion hemorrhage. The acute onset of an ipsilateral mydriatic...
BACKGROUND AND IMPORTANCE
One of the most feared and devastating complications of carotid revascularization procedures is hyperperfusion hemorrhage. The acute onset of an ipsilateral mydriatic pupil following carotid endarterectomy (CEA) or carotid artery stenting (CAS) should prompt immediate neurosurgical evaluation to rule out hyperperfusion injury.
CLINICAL PRESENTATION
We describe a case of benign, transient ipsilateral mydriasis following CAS. After undergoing right common and internal carotid artery (ICA) angioplasty and stenting with distal embolic protection, the patient developed anisocoria with a right-sided 5 mm minimally reactive pupil. Imaging demonstrated no acute pathology, and the mydriasis resolved spontaneously within 48 hours. We hypothesise that the pathophysiologic mechanism is secondary to transient ischemia of parasympathetic structures within the petrous/cavernous ICA from arterial ostium occlusion that occurred during device placement. Alternatively, sympathetic stimulation during angioplasty is also plausible.
CONCLUSIONS
Although an ipsilateral mydriatic pupil following carotid revascularization necessitates evaluation, it may represent a self-limiting process especially in the absence of other focal neurologic deficits.
PubMed: 34553660
DOI: 10.1080/02688697.2021.1981241