Optometry Commons^™

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 …

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 …

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 …

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 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.

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.

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 …

Regional Variations And Temporal Trends Of Childhood Myopia Prevalence In Africa: A Systematic Review And Meta-Analysis, Emmnuel Kobia Acquah, Daniel Ian Flitcroft, Prince Kwaku Akowuah, Gareth Lingham, James Loughman

Articles

Purpose: To provide contemporary and future estimates of childhood myopia prevalence in Africa.

Methods: A systematic online literature search was conducted for articles on childhood (≤18 years) myopia (spherical equivalent [SE] ≤ −0.50D; high myopia: SE ≤ −6.00D) in Africa. Population-or school-based cross-sectional studies published from 1 Jan 2000 to 30 May 2021 were included. Meta-analysis using Freeman–Tukey double arcsine transformation was performed to estimate the prevalence of childhood myopia and high myopia. Myopia prevalence from subgroup analyses for age groups and settings were used as baseline for generating a prediction model using linear regression.

Results: Forty-two studies from 19 …

Will Treating Progressive Myopia Overwhelm The Eye Care Workforce? A Workforce Modelling Study, Gareth Lingham, James Loughman, Stella Kuzmenko, Matilda Biba, Daniel Ian Flitcroft

Articles

Purpose

Treatments for myopia progression are now available, but implementing these into clinical practice will place a burden on the eye care workforce. This study estimated the full-time equivalent (FTE) workforce required to implement myopia control treatments in the UK and Ireland.

Methods

To estimate the number of 6- to 21-year-olds with myopia, two models utilising separate data sources were developed. The examination-based model used: (1) the number of primary care eye examinations conducted annually and (2) the proportion of these that are for myopic young people. The prevalence-based model used epidemiological data on the age-specific prevalence of myopia. The …

The Risks And Benefits Of Myopia Control, Mark A. Bullimore, Eric R. Ritchey, Sunil Shah,, Nicolas Leveziel, Rupert Bourne, Daniel Ian Flitcroft

Articles

The prevalence of myopia is increasing around the world, stimulating interest in 3 methods to slow its progression. The primary justification for slowing myopia progression is to 4 reduce the risk of vision loss through sight-threatening ocular pathology in later life. The paper 5 analyzes whether the potential benefits of slowing myopia progression by one diopter justify the 6 potential risks associated with treatments.

The Relationship Between Serum Zinc Levels And Myopia, Niamh Burke, John Butler, Daniel Ian Flitcroft, James Loughman

Articles

Clinical significance: Myopia is inherently associated with eye growth and thereby possibly amenable to nutritional influence. However, little attention has been given to possible die- tary influences. This study demonstrates that serum zinc does not play a role in myopia development. Background: Myopia is inherently associated with eye growth and thereby possibly amena- ble to nutritional influence. A number of Asian studies have reported lower levels of serum zinc in myopic children. This study was designed to assess the relationship between serum zinc and myopia in the Korean population – using a subsample of participants from nation- ally representative data.

A Comparison Of Dietary Intake Of Children/Adolescents With And Without Myopia, Niamh Burke, John Butler, Daniel Ian Flitcroft, James Loughman

Conference Papers

Myopia is caused by an eye which has grown too long. The prevalence of myopia has increased drastically in recent years and half of the world’s population is expected to be myopic by 2050.(1) Consequently, a significant increase in sight threatening diseases will follow.(1) Myopia most commonly develops in youth, and we now know that environmental factors affect its development. Nutritional status strongly influences growth and development, including that of the eye. It has been hypothesised, therefore, that nutrition may play a role in this excessive eye growth. Current findings are conflicted, with a clear gap in the evidence.(2,3) Therefore, …

The Spatial Frequency Content Of Urban And Indoor Environments As A Potential Risk Factor For Myopia Development, Daniel Ian Flitcroft, Elise Harb, Christine F Wildsoet

Articles

To examine the hypothesis that the spatial frequency spectra of urban and indoor environments differ from the natural environment in ways that may promote the development of myopia. Methods: A total of 814 images were analyzed from three datasets; University of California Berkeley (UCB), University of Texas (UT), and Botswana (UPenn). Images were processed in Matlab (Mathworks Inc) to map the camera color characteristics to human cone sensitivities. From the photopic luminance images generated, two-dimensional spatial frequency (SF) spectra were calculated and converted to one-dimensional spectra by rotational averaging. The spatial filtering profile of a 0.4 Bangerter foil, which has …

Consort Checklist, Myopia Outcome Study Of Atropine In Children (Mosaic): Design And Methodology, Saoirse Mccrann, Daniel Ian Flitcroft, John Butler, James Loughman

Articles

Purpose

The Myopia Outcome Study of Atropine in Children (MOSAIC) aims to explore the efficacy, safety, acceptability and mechanisms of action of 0.01% atropine for myopia control in a European population.

Methods

MOSAIC is an investigator-led, double-masked, placebo-controlled, randomised clinical trial (RCT) investigating the efficacy, safety and mechanisms of action of 0.01% atropine in myopia progression management. During Phase 1 of the trial, 250 children aged 6-16 years with progressive myopia apply eye drops once nightly in both eyes from randomisation to month 24. No treatment is given during Phase 2 from month 24 to 36 (washout period) for those …

Spirit Checklist, Myopia Outcome Study Of Atropine In Children (Mosaic): Design And Methodology, Saoirse Mccrann, Daniel Ian Flitcroft, John S. Butler, James Loughman

Articles

Purpose

The Myopia Outcome Study of Atropine in Children (MOSAIC) aims to explore the efficacy, safety, acceptability and mechanisms of action of 0.01% atropine for myopia control in a European population.

Methods

MOSAIC is an investigator-led, double-masked, placebo-controlled, randomised clinical trial (RCT) investigating the efficacy, safety and mechanisms of action of 0.01% atropine in myopia progression management. During Phase 1 of the trial, 250 children aged 6-16 years with progressive myopia apply eye drops once nightly in both eyes from randomisation to month 24. No treatment is given during Phase 2 from month 24 to 36 (washout period) for those …

Is Optometry Ready For Myopia Control? Education And Other Barriers To The Treatment Of Myopia, Saoirse Mccrann, Daniel Ian Flitcroft, James Loughman

Other Resources

Background

With the increasing prevalence of myopia there is growing interest in active myopia control. However, the majority of progressive myopes are still prescribed single vision spectacles. This prospective study aims to elucidate the knowledge and attitudes of optometrists toward myopia control, and thereby identify perceived barriers to the implementation of a risk focussed model of myopia management.

Methods

A series of four focus group discussions were conducted involving optometrists in different settings and career stages.

Results

The key finding to emerge is a clear disconnect between academic optometrists, optometry students and clinicians in practice. Academic faculty considered themselves competent …

Myopia Outcome Study Of Atropine In Children (Mosaic): Design And Methodology, Saoirse Mccrann, Daniel Ian Flitcroft, John Butler, James Loughman

Articles

Purpose

The Myopia Outcome Study of Atropine in Children (MOSAIC) aims to explore the efficacy, safety, acceptability and mechanisms of action of 0.01% atropine for myopia control in a European population.

Methods

MOSAIC is an investigator-led, double-masked, placebo-controlled, randomised clinical trial investigating the efficacy, safety and mechanisms of action of 0.01% atropine eyedrops in myopic progression management. During phase 1 of the trial, 250 children aged 6-16 years with progressive myopia apply eye drops once nightly in both eyes from randomisation to month 24. No treatment is given during phase 2 from month 24 to 36 (washout period) for those …

Is Optometry Ready For Myopia Control? Education And Other Barriers To The Treatment Of Myopia, Saoirse Mccrann, Daniel Ian Flitcroft, James Loughman

Articles

Background: With the increasing prevalence of myopia there is growing interest in active myopia control. However, the majority of progressive myopes are still prescribed single vision spectacles. This prospective study aims to elucidate the knowledge and attitudes of optometrists toward myopia control, and thereby identify perceived barriers to the implementation of a risk focussed model of myopia management.

Myopia Outcome Study Of Atropine In Children (Mosaic): An Investigator-Led, Double-Masked, Placebo-Controlled, Randomised Clinical Trial Protocol, Saoirse Mccrann, Daniel Ian Flitcroft, Niall C. Strang, Kathryn J. Saunders, Nicola S. Logan, Samantha Szeyee Lee, David A. Mackey, John Butler, James Loughman

Articles

Background: The Myopia Outcome Study of Atropine in Children (MOSAIC) aims to explore the efficacy, safety, acceptability and mechanisms of action of 0.01% unpreserved atropine for myopia control in a European population. Methods: MOSAIC is an

We Can’T Afford To Turn A Blind Eye To Myopia, Christine Marie Bourke, James Loughman, Daniel Ian Flitcroft, Ekaterina Loskutova, Colm O’Brien

Articles

Background

Myopia is becoming increasingly prevalent throughout the world. It is an overlooked but leading cause of blindness, particularly among the working aged population. Myopia is often considered benign because it is easily corrected with glasses, contact lenses, or refractive surgery. Traditionally myopia has been classified into physiological and pathological subtypes based on the degree of myopia present. Higher levels of myopia are associated with increased risk of pathological complications but it is important to note that there is no safe level of myopia. Even low levels of myopia increase the risk of retinal detachment and other ocular comorbidities which …

Risk Factors Associated With Myopia In Schoolchildren In Ireland, Síofra Harrington, Jim Stack, Veronica O'Dwyer

Articles

Aim To examine the demographic and social factors associated with myopia in schoolchildren in Ireland.

Methods Thirty-seven schools participated, representing a mix of urban and rural schools and schools in socioeconomically disadvantaged and non-disadvantaged areas in Ireland. Examination included cyclopleged autorefraction (1% cyclopentolate hydrochloride). Height and weight of participants were measured. Parents filled in a participant’s lifestyle questionnaire, including questions on daily screen time use and daylight exposure. Myopia was defined as spherical equivalent ≤−0.50 D.

Results Data from 1626 participants (881 boys, 745 girls) in two age groups, 6–7 years (728) and 12–13 years (898), were examined. Myopia prevalence …

Parental Attitudes To Myopia: A Key Agent Of Change For Myopia Control?, Saoirse Mccrann, Daniel Ian Flitcroft, Kevin Lalor, John Butler, Aaron Bush, James Loughman

Articles

Purpose

With the increasing prevalence in myopia there is growing interest in active myopia prevention. This study aims to increase our understanding of parental attitudes to myopia development and control, as a means to inform future health planning and policy. It evaluates, for the first time, the attitude of parents to myopia and its associated risks, as well as assessing the exposure of Irish children to environmental factors that may influence their risk profile for myopia development.

Methods

Parents of 8–13 year old children in eight participating schools completed a questionnaire designed to assess their knowledge of and attitudes towards …

Novel Myopia Genes And Pathways Identified From Syndromic Forms Of Myopia, Daniel Ian Flitcroft, James Loughman, Christine F. Wildsoet, Cathy Williams, Jeremy A. Guggenheim

Articles

Clinical phenotypes and syndromes that have refractive errors as a recognized feature were identified using the Online Mendelian Inheritance in Man (OMIM) database. One hundred fifty-four unique causative genes were identified, of which 119 were specifically linked with myopia and 114 represented syndromic myopia (i.e., myopia and at least one other clinical feature). Myopia was the only refractive error listed for 98 genes and hyperopia and the only refractive error noted for 28 genes, with the remaining 28 genes linked to phenotypes with multiple forms of refractive error. Pathway analysis was carried out to find biological processes overrepresented within these …

Novel Myopia Genes And Pathways Identified From Syndromic Forms Of Myopia, Daniel Ian Flitcroft, James Loughman, Christine F. Wildsoet, Cathy Williams, Jeremy A. Guggenheim

Articles

P URPOSE . To test the hypothesis that genes known to cause clinical syndromes featuring myopia also harbor polymorphisms contributing to nonsyndromic refractive errors.

Gene Expression Signatures In Tree Shrew Retina, Rpe, And Choroid During Experimental Myopia And Recovery, Li He

All ETDs from UAB

During the development of induced myopia and recovery, the emmetropization mechanism is stimulated to modulate ocular growth. Emmetropization signals originate in the retina, are transmitted and transformed by retinal pigment epithelium (RPE) and choroid, and reach sclera to induce tissue remodeling. Induced myopia occurs in response to myopiagenic stimuli - minus lens, form deprivation, and darkness - (three GO conditions) which increase ocular elongation; recovery from lens-induced myopia (STOP) occurs when minus-lens wear is discontinued after complete compensation, slowing ocular elongation. This dissertation examined gene expression signatures in the retina, RPE, and choroid under GO and STOP conditions to examine …

Gene Expression Signatures In Tree Shrew Sclera In Different Visual Conditions, Lin Guo

All ETDs from UAB

The sclera is a target tissue that receives signals that are initiated in the retina, cascade through retinal pigment epithelium (RPE) and choroid, and cause scleral extra cellular matrix remodeling. Biomechanical alterations of the sclera are produced by these biochemical changes, and in turn control the axial length of the eye. This dissertation project examined scleral gene expression changes in mRNA level of juvenile tree shrews. Three specific aims were investigated: specific aim one tested the hypothesis that three different GO visual conditions that all produce axial elongation and myopia: minus-lens wear, form deprivation, and continuous darkness, will produce similar …