Optometry Commons^™

Childhood Myopia Part I: Contemporary Treatment Options., Safal Khanal Dr, Erin S. Tomiyama Dr, Síofra Harrington Dr

Articles

Abstract

Childhood myopia is a growing global public health concern. Treatments to control myopia are a priority because myopia, particularly high myopia, poses significant lifelong risks of vision loss from myopia-associated ocular pathologies. Intensive research efforts over the past two decades have led to the development of several effective strategies for controlling myopia in children: increased time outdoors, atropine eye drops, dual-focus and multifocal contact lenses, orthokeratology lenses, and specialized spectacle lenses. While the efficacy of these strategies is variable, evidence is growing regarding the potential benefits of applying these interventions in children with myopia, although none completely halt myopia …

Childhood Myopia Part Ii: Treatment Mechanisms, Emerging Options, And Considerations, Safal Khanal Dr, Erin S. Tomiyama Dr, Síofra Harrington Dr

Articles

Abstract

The rapidly increasing prevalence of myopia and its association with vision-threatening complications in later life has intensified efforts to identify treatments that can prevent the onset and slow the progression of myopia in children. These efforts have led to the development of several optical, environmental, and pharmacological myopia control treatments. Investigations of additional treatment options are ongoing and have shown great promise for clinical translation. Although significant progress has been made in identifying potential pathways and modes of action of these treatments, a complete mechanistic understanding is still lacking. This critical review article explores the potential mechanisms underlying the …

Optimising Non-Cycloplegic Screening Strategies For Early Detection Of Pre-Myopia And Myopia In Young Children, Síofra Harrington, Michael Moore, James Loughman, Ian Flitcroft, Veronica O'Dwyer

Articles

Purpose: Early detection of myopia is essential to delay its onset and progression. Pre-myopia, defined by an inadequate hyperopic reserve, increases myopia risk in childhood. However, effective screening methods remain limited. This study aimed to develop practical non-cycloplegic screening methods for pre-myopia and myopia in 6- to 7-year-olds to support earlier interventions.

Methods: This cross-sectional study of 621 Irish schoolchildren (mean age: 7.12 ± 0.45 years; 51.8% boys) assessed uncorrected distance visual acuity (UDVA). Cycloplegic spherical equivalent refraction (SER) classified refractive status (myopia: SER ≤ −0.50D; pre-myopia: SER > −0.50 ≤ 0.75D). Pre- and post-cycloplegic SER were measured using the Welch …

Refractive Error And Axial Length (Real) Study: Feasibility Of A Population Study In The United States, Sarah E. Singh Dr, Lisa A. Ostrin, Kristen Kerber Dr, Concepcion Cayle, Celia Gong Dr, Lal Barsha Dr, Ian Flitcroft, Síofra Harrington, James Loughman, Kathryn Saunders Prof, Fuensanta Vera-Diaz Dr

Articles

Myopia is the most common eye disease and a leading cause of blindness. A contemporary, large, and ethnically and geographically diverse study of ocular biometry and refractive error in children in the United States is needed to help better describe differences between myopic and nonmyopic eyes.

This is an initial cross-sectional report from the Refractive Error and Axial Length Growth Curve Study that includes ocular component data as a function of age, gender, and geographic location. This feasibility report will inform a planned larger longitudinal ocular growth study in children in the United States.

Cross-sectional data on children, ages 3 …

Accuracy And Repeatability Of Autorefraction In Young Adults: A Comparison Of Cycloplegic And Non-Cycloplegic Methods, Megan Doyle, Veronica O'Dwyer O'Dwyer, Michael Moore, Síofra Harrington

Articles

Clinical Relevance: Cycloplegic refraction remains crucial in young adults, where accommodative activity can obscure accurate refractive status. Autorefractor repeatabil­ity is essential for precise optical correction and refractive error categorisation in clinical and research settings.

Background: Cycloplegic autorefraction is recommended for individuals up to 20 years to prevent hyperopia underestimation and myopia overestimation. This study evaluated differences between non-cycloplegic and cycloplegic spherical equivalent refraction following cyclopentolate hydrochloride (cycloplegic agent) administration in young adults. This study also explored whether this difference varied by refractive status (hyperopia (≥1.00D), emmetropia ( >−0.50, < 1.00D), myopia (≤-0.50D)) or pre- instillation of proxymetacaine hydrochloride and whether cycloplegia improved autorefractor repeatability.

Methods: Participants were 182 young adults (17–30 years) (mean (standard deviation): 21.66 …

Impact Of Proxymetacaine On The Dynamics Of Cyclopentolate In White 6- To 7-Year-Olds, Megan Doyle, Veronica O'Dwyer, Siofra Harrington

Articles

Purpose

This study compared the efficacy of cyclopentolate hydrochloride at 10-, 20- and 30-min post-instillation in White 6- to 7-year-olds, with and without prior instillation of proxymetacaine hydrochloride. The primary aim was to determine if accurate autorefraction values can be obtained sooner than the current standard of 30-min post-cycloplegia. The secondary aim was to investigate whether proxymetacaine hydrochloride enhances the efficiency of cyclopentolate.

Methods

Participants were 112 White 6- to 7-year-olds from the Child Eye Health Study. The right eye received 0.5% proxymetacaine hydrochloride and 1.0% cyclopentolate hydrochloride, and the left eye received only 1.0% cyclopentolate hydrochloride. Non-cycloplegic and cycloplegic …

The Self-Fitting Of Contact Lenses, Claire E. Mcdonnell

Articles

In this article Claire Mc Donnell discusses the phenomenon of first time contact lens wearers fitting themselves with contact lenses without any input from an eyecare professional.

Counterfeit Contact Lenses, Claire E. Mcdonnell

Articles

This article covers how counterfeit cosmetic and corrective contact lenses potentially reach the end user and the dangers of counterfeit lenses.

The Ocular Sequelae Of Eyelash And Eyebrow Fashions, Claire E. Mcdonnell

Articles

This is an article on the possible adverse side effects of eyelash and eyebrow fashions e.g. fake eyelashes, eyelash tinting, eyebrow lamination, microblading. Advice is given to eyecare practitioners discussing these treatments with patients.

Myopia Progression Patterns Among Paediatric Patients In A Clinical Setting, Michael Moore, Gareth Lingham, Daniel Ian Flitcroft, James Loughman

Articles

Purpose

This retrospective analysis of electronic medical record (EMR) data investigated the natural history of myopic progression in children from optometric practices in Ireland.

Methods

The analysis was of myopic patients aged 7–17 with multiple visits and not prescribed myopia control treatment. Sex- and age-specific population centiles for annual myopic progression were derived by fitting a weighted cubic spline to empirical quantiles. These were compared to progression rates derived from control group data obtained from 17 randomised clinical trials (RCTs) for myopia. Linear mixed models (LMMs) were used to allow comparison of myopia progression rates against outputs from a predictive …

Optical Characterisation Of Holographic Diffusers And Bangerter Foils For Treatment Of Amblyopia, Matthew Hellis, Suzanne Martin, Matthew Sheehan, Kevin Murphy

Articles

Amblyopia is a significant issue for children worldwide, and current treatment methods have drawbacks that can hinder treatment effectiveness and/or patient experience. This study proposes a new treatment method using holographic diffusers while also comparing their optical characteristics to a current treatment method (Bangerter foils). Holographic diffusers were developed by optically patterning thin polymer layers on a micron scale. Two compositions of photopolymer (acrylamide and diacetone acrylamide based) are analysed herein. Characterisation shows that holographic diffusers of either composition can achieve a wide range of on-axis intensity reductions, allowing for precise and customisable treatment levels by altering recording exposure time …

The Association Between Time Spent On Screens And Reading With Myopia, Premyopia And Ocular Biometric And Anthropometric Measures In 6- To 7-Year-Old Schoolchildren In Ireland, Síofra Harrington, Veronica O'Dwyer

Articles

Purpose More time spent on near tasks has consistently been associated with the promotion of myopia. The World Health Organization advises limiting daily screentime to less than 2 h for children aged five and over. This study explored the relationship between time spent on screens and reading/writing with refractive status, ocular biometric and anthropometric factors in 6-to 7-year- olds in Ireland.

Methods Participants were 723 schoolchildren (377 boys [51.8%]), mean age 7.08 (0.45) years. The examination included cycloplegic autorefraction (1% cyclopentolate hydrochloride), ocular biometry (Zeiss IOLMaster), height (cm) and weight (kg). Screentime and reading/writing time were reported by parents/legal guardians …

Comparison Of Cycloplegia At 20- And 30-Minutes Following Proxymetacaine And Cyclopentolate Instillation In White 12-13-Year-Olds, Megan Doyle, Veronica O'Dwyer, Siofra Harrington

Articles

Clinical Relevance

Reducing the time between drop instillation and refraction reduces the time paediatric patients and young adults spend in practice, facilitating more eye examinations daily.

Background

The current procedure for paediatric cycloplegic refraction is to wait for at least 30-minutes post-instillation of a cycloplegic before measuring spherical equivalent refraction. This study compared cycloplegia at 20- and 30-minutes following 0.5% proxymetacaine and 1.0% cyclopentolate in 12-13-year-olds.

Methods

Participants were 99 white 12-13-year-olds. One drop of proxymetacaine hydrochloride (Minims, 0.5% w/v, Bausch & Lomb, UK) followed by one drop of cyclopentolate hydrochloride (Minims, 1.0% w/v, Bausch & Lomb, UK) was instilled …

Prescribing Patterns Of Myopia Control Contact Lenses Among Optometrists In Ireland, Michael Moore, Daniel Ian Flitcroft, James Loughman

Articles

Purpose

This retrospective analysis of electronic medical record (EMR) data investigated the prescribing patterns of soft myopia control contact lens (MCCL) treatments since their introduction in Ireland in 2017.

Methods

Anonymised EMR data were sourced from 33 optometry practices in Ireland from 2017 to 2021 to determine the number of practices prescribing MCCLs to myopic children 5–18 years old. In MCCL-prescribing practices, the proportion of contact lens wearing children fitted with MCCLs and the proportion of progressive (≤−0.25 D/year) myopic children fitted with MCCLs were determined. Logistic regression was used to determine which factors influenced the likelihood of being prescribed …

The Future Of Clinical Trials Of Myopia Control, Mark A. Bullimore, Noel A. Brennan, Daniel I. Flintcroft

Articles

In the field of myopia control, effective optical or pharmaceutical therapies are now available to patients in many markets. This creates challenges for the conduct of placebo-controlled, randomised clinical trials, including ethics, recruitment, retention, selective loss of faster progressors and non-protocol treatments: 1. Ethics: It is valid to question whether withholding treatment in control subjects is ethical. 2. Recruitment: Availability of treatments is making recruitment into clinical trials more difficult. 3. Retention: If masking is not possible, parents may immediately withdraw their child if randomised to no treatment. 4. Selective loss: Withdrawal of fast progressors in the control group leading …

Imi—Management And Investigation Of High Myopia In Infants And Young Children, Daniel Ian Flitcroft, John Ainsworth, Audrey Chia, Susan Cotter, Elise Harb, Zi-Bing Jin, Caroline C. W. Klaver, Anthony T. Moore, Ken K. Nischal, Kyoko Ohno-Matsui, Evelyn A. Paysse, Michael X. Repka, Irina Y. Smirnova, Martin Snead, Virginie J. M. Verhoeven, Pavan K. Verkicharla

Articles

The purpose of this study was to evaluate the epidemiology, etiology, clinical assessment, investigation, management, and visual consequences of high myopia (≤−6 diopters [D]) in infants and young children.

Imi—Nonpathological Human Ocular Tissue Changes With Axial Myopia, Jost B. Jonus, Richard F. Spaide, Lisa A. Ostrin, Nicola S. Logan, Daniel Ian Flitcroft, Songhomitra Panda-Jonas

Articles

In axial myopia, the eye changes from a spherical shape to a prolate ellipsoid, photoreceptor, and retinal pigment epithelium cell density and total retinal thickness decrease, most marked in the retroequatorial region, followed by the equator. The choroid and sclera are thin, most markedly at the posterior pole and least markedly at the ora serrata. The sclera undergoes alterations in fibroblast activity, changes in extracellular matrix content, and remodeling. Bruch’s membrane (BM) thickness is unrelated to axial length, although the BM volume increases. In moderate myopia, the BM opening shifts, usually toward the fovea, leading to the BM overhanging into …

Imi 2023 Digest, Padmaja Sankaridurg, David A. Berntsen, Mark A. Bullimore, Pauline Cho, Daniel Ian Flitcroft, Timothy J. Gawne, Kate Gifford, Monica Jong, Lisa A. Ostrin Lisa A. Ostrin, Jacinto Santodomingo-Rubido, Christine Wildsoet, James S. Wolffsohn

Articles

Myopia is a dynamic and rapidly moving field, with ongoing research providing a better understanding of the etiology leading to novel myopia control strategies. In 2019, the International Myopia Institute (IMI) assembled and published a series of white papers across relevant topics and updated the evidence with a digest in 2021. Here, we summarize findings across key topics from the previous 2 years. Studies in animal models have continued to explore how wavelength and intensity of light influence eye growth and have examined new pharmacologic agents and scleral cross-linking as potential strategies for slowing myopia. In children, the term premyopia …

Myopia Outcome Study Of Atropine In Children: Two-Year Result Of Daily 0.01% Atropine In A European Population, James Loughman, Emmanuel Kobia-Acquah, Gareth Lingham, John Butler, Ekaterina Loskutova, David A. Mackey, Samantha S.Y. Lee, Daniel I. Flintcroft

Articles

The Myopia Outcome Study of Atropine in Children (MOSAIC) is an investigator-led, double-masked, randomized controlled trial investigating the efficacy and safety of 0.01% atropine eye drops for managing myopia progression in a predominantly White, European population.

Strabismus And Amblyopia In Africa – A Systematic Review And Meta-Analysis, Prince Kwaku Akowuah, Samuel Adade, Andrews Nartey, Ebenezer Owusu, Richard Donkor, Stephen Ankamah-Lomotey

Articles

The objective of this review was to estimate the prevalence of strabismus and amblyopia in Africa. A systematic online literature search was conducted for articles on strabismus and amblyopia in Africa. Meta-analysis was performed, using the Freeman-Tukey double arcsine transformation, to estimate the prevalence of strabismus and amblyopia in Africa. Subgroup analyses were conducted according to age, gender, study year, and type of amblyopia. Meta-regression was used to evaluate the influence of predetermined factors on the prevalence of amblyopia. 8 (1 population-based & 7 school-based) and 21 (3 population-based & 18 school-based) studies on strabismus and amblyopia with sample sizes …

Agreement Between Lea Symbols And Patti Pics Visual Acuity In Children And Adults, Arjun Sapkotaa, Sanjeeta Sitaula, Gauri Shankar Shresthab, Niraj Dev Joshib, Bipin Koiralaa Bipin Koiralaa, Nabin Paudel

Articles

Patti Pics (PP) and Lea Symbols (LS) are commonly used by eye care practitioners worldwide. Although the relationship between the two tests is fairly well understood, the availability of different chart designs (single optotypes, multiple optotypes, multiple optotypes with crowding box) merits futher understanding. The purpose of this study is to explore the agreement between the acuity measures obtained with Patti Pics and Lea Symbols in children and adults and compare their performance with the Sloan Letter (SL) chart in adults. Methods: Monocular visual acuity was obtained from ninety-three 3 to 5-year-old children using Patti Pics and Lea Symbols. Acuities …

Choroidal Thickness Profiles And Associated Factors In Myopic Children, Emmnuel Kobia Acquah, Daniel Ian Flitcroft, Gareth Lingham, Nabin Paudel, James Loughman

Articles

SIGNIFICANCE: This study addresses the lack of choroidal thickness (ChT) profile information available in European children and provides a baseline for further evaluation of longitudinal changes in ChT profiles in myopic children as a potential biomarker for myopia treatment and identifying children at risk of myopic progression.

PURPOSE: This study aimed to investigate ChT profiles and associated factors in myopic children.

METHODS: Baseline data of 250 myopic children aged 6 to 16 years in the Myopia Outcome Study of Atropine in Children clinical trial were analyzed. Choroidal thickness images were obtained using swept-source optical coherence tomography (DRI-OCT Triton Plus; Topcon …

Distribution Of Axial Length In Australians Of Different Age Groups, Ethnicities, And Refractive Errors, Vinay Kumar Nilagiri, Samantha Sze-Yee Lee, Gareth Lingham, Jason Charng, Seyhan Yazar, Alex W. Hewitt, Lynn R. Griffiths, Paul G. Sanfilippo, Tzu-Hsun Tsai, David A. Mackey

Articles

Treatments are available to slow myopic axial elongation. Understanding normal axial length (AL) distributions will assist clinicians in choosing appropriate treatment for myopia. We report the distribution of AL in Australians of different age groups and refractive errors.

Tfos Lifestyle - Evidence Quality Report: Advancing The Evaluation And Synthesis Of Research Evidence, Laura E. Downie, Alexis Ceecee Britten-Jones, Ruth E. Hogg, Isabelle Jalbert, Tianjing Li, Gareth Lingham, Su-Hsun Liu, Riaz Quereshi, Ian J. Saldanha, Sumeer Singh, Jennifer P. Craig

Articles

Evidence-based practice is a dominant paradigm in healthcare that emphasizes the importance of ensuring the translation of the best available, relevant research evidence into practice. An Evidence Quality Subcommittee was established to provide specialized methodological support and expertise to promote rigorous and evidence-based approaches for the Tear Film and Ocular Surface Society (TFOS) Lifestyle Epidemic reports. The present report describes the purpose, scope, and activity of the Evidence Quality Subcommittee in the undertaking of high-quality narrative-style literature reviews, and leading prospectively registered, reliable systematic reviews of high priority research questions, using standardized methods for each topic area report. Identification of …

Tfos Lifestyle: Impact Of The Digital Environment On The Ocular Surface, James S. Wolffsohn, Gareth Lingham, Laura E. Downie, Bykie Huntjens, Takenori Inomata, Saleel Jivraj, Emmanuel Kobia-Acquah, Alex Muntz, Karim Mohamed-Noriega, Sotiris Plainis, Michael Read, Rony R. Sayegh, Sumeer Singh, Tor P. Utheim, Jennifer P. Craig

Articles

Eye strain when performing tasks reliant on a digital environment can cause discomfort, affecting productivity and quality of life. Digital eye strain (the preferred terminology) was defined as “the development or exacerbation of recurrent ocular symptoms and/or signs related specifically to digital device screen viewing”. Digital eye strain prevalence of up to 97% has been reported, due to no previously agreed definition/diagnostic criteria and limitations of current questionnaires which fail to differentiate such symptoms from those arising from nondigital tasks. Objective signs such as blink rate or critical flicker frequency changes are not ‘diagnostic’ of digital eye strain nor validated …

Systematic Review Of Clinical Practice Guidelines For Uveitis, Nima Ghadiri, Ian R. Reekie, Iris Gordon, Sare Safi, Gareth Lingham, Jennifer R. Evans, Stuart Keel

Articles

To facilitate the integration of eye care into universal health coverage, the WHO is developing a Package of Eye Care Interventions (PECI). Development of the PECI involves the identification of evidence-based interventions from relevant clinical practice guidelines (CPGs) for uveitis.

A systematic review of CPGs published on uveitis between 2010 and March 2020 was conducted. CPGs passing title and abstract and full-text screening were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and data on recommended interventions extracted using a standard data extraction sheet.

Review Of Recent Advances In Photosensitive Polymer Materials And Requirements For Transmission Diffractive Optical Elements For Led Light Sources, Michael Murray, Izabela Naydenova, Suzanne Martin

Articles

Scattered light from outdoor LED sources is a major contributor to blue-spectrum light pollution which negatively impacts ecology and public health. Volume holographic diffractive optical elements (DOEs), made with low-cost photosensitive polymers, are proposed as a technological solution that can minimise this scattering. This review examines requirements needed for efficient operation of transmission-format DOEs with LEDs and implications for material choices. For such DOEs to have a single diffraction order and high efficiency there is a corresponding range of acceptable Δn. A survey of materials also found that many current materials satisfy the Δn requirements for single-element DOEs. It is …

Using Electronic Medical Record Data To Establish And Monitor The Distribution Of Refractive Errors, Sean Longwill, Michael Moore, Daniel Ian Flitcroft, James Loughman

Articles

Objective

To establish the baseline distribution of refractive errors and associated factors amongst a population that attended primary care optometry clinics.

Design

Retrospective cross sectional cohort study of electronic medical records (EMR).

Methods

Electronic medical record data was extracted from forty optometry clinics, representing a mix of urban and rural areas in Ireland. The analysis was confined to demographic and clinical data gathered over a sixty-month period between 2015 and 2019. Distribution rates were calculated using the absolute and relative frequencies of refractive error in the dataset, stratified for age and gender using the following definitions: high myopia ≤ -6.00 …

Visual Factors Associated With Physical Activity In Schoolchildren, Síofra Harrington, John Kearney Prof, Veronica O'Dwyer Dr

Articles

Clinical relevance Physical activity is an essential part of childhood physical and mental development. Recent research identified visual problems associated with a sedentary lifestyle in children in Ireland.

Background This study explored the association between visual function in children and their engagement with physical activities outside school.

Methods Participants were 1,626 schoolchildren (728 aged 6–7 years, 898 old 12–13 years) in randomly selected schools in Ireland. Before data collection, parents/legal guardians of participants completed a standardised questionnaire reporting physical activity as no activity (mostly on screens), light activity (occasional walking/cycling), moderate activity (/week engaged in sports), or regular activity ( …

Big Data Analysis Of Vision Screening Standards Used To Evaluate Fitness To Drive, Michael Moore, John Butler, Daniel Ian Flitcroft, James Loughman

Articles

Purpose: Visual acuity (VA) assessment is the most commonly performed vision screening method for drivers. The standards and repeat assessment intervals used, however, are arbitrary, lack an evidence base and are highly variable across different countries. This study utilizes the power of Big Data to provide evidence-based recommendations for standardized driver vision screening.

Methods: Anonymized electronic medical record data were gathered from 40 Irish optometry practices comprising 81,184 unique patients. A Kaplan-Meier Survival (KMS) analysis was used to determine the effect of increasing age and time since screening on the likelihood of passing the VA standard for driving. A logistic …