Taiwan Journal of Ophthalmology最新文献

{"title":"Keeping myopia away: The importance of maintaining hyperopic reserve in premyopia.","authors":"Pei-Chang Wu, Ken-Kuo Lin","doi":"10.4103/tjo.TJO-D-26-00019","DOIUrl":"10.4103/tjo.TJO-D-26-00019","url":null,"abstract":"<p><p>Myopia has emerged as a major global public health challenge, with the prevalence of myopia among children increasing exponentially over the past two decades. Emerging evidence, however, indicates that delaying the onset of myopia through early intervention during the premyopic stage may be more impactful than attempting to control myopic progression after onset. Central to this prevention strategy is the concept of the hyperopic reserve, the physiological hyperopia present in early childhood that functions as a protective buffer against the development of myopia. This narrative review examines the definition and clinical significance of hyperopic reserve in identifying children at risk for myopia (premyopia), as well as evidence-based intervention strategies aimed at preserving this reserve. The recommended safety threshold for hyperopic reserve is +1.00 D before age 12 years. Recommended strategies include behavioral interventions, such as increasing outdoor time and implementing regular breaks during near work. Long-term monitoring and regular follow-up are crucial for identifying high-risk groups associated with factors such as insufficient outdoor time, prolonged near work (including screen time and cram school attendance), parental myopia, younger age with lower baseline hyperopia reserve, rapid myopia shift >0.5 D/year, and rapid axial length elongation >0.2 mm/year. Pharmacological or optical therapies may be considered for high-risk children. By understanding and maintaining hyperopic reserve during the critical premyopic stage, eye care practitioners can shift the clinical paradigm from myopia control to myopia prevention, thereby potentially reducing both the incidence and severity of myopia in future generations.</p>","PeriodicalId":44978,"journal":{"name":"Taiwan Journal of Ophthalmology","volume":"16 2","pages":"194-203"},"PeriodicalIF":1.4,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety, efficacy, and response variability of multifocal and dual-focus soft contact lenses in myopia control: A narrative review.","authors":"Yue Maria Liu","doi":"10.4103/tjo.TJO-D-25-00157","DOIUrl":"10.4103/tjo.TJO-D-25-00157","url":null,"abstract":"<p><p>Myopia is a major global public health concern, projected to affect half the world's population by 2050. High myopia is strongly linked to vision-threatening complications. Multifocal (MF) and dual-focus (DF) soft contact lenses are among the most widely studied interventions for slowing myopia progression. This review summarizes proposed mechanisms, efficacy, variability, and safety considerations of MF soft contact lens (MFSCL) use in children. A narrative synthesis was conducted using findings from randomized controlled trials, paired-eye studies, and recent animal and human investigations. Emphasis was placed on evolving mechanistic theories, cross-population efficacy differences, and clinical implications of study heterogeneity. Initially attributed to reducing peripheral hyperopic defocus, MFSCL efficacy is now thought to involve complex retinal signaling, including competing defocus cues and extended depth-of-focus effects. Pivotal trials such as MiSight 1 day and BLINK reported 43%-59% reductions in axial elongation compared with single-vision controls. However, effects vary by population, with Asian cohorts often showing smaller efficacy, and by individual factors such as lens design, add power, centration, pupil size, genetic predisposition, and baseline progression rate. Methodological differences - study design, compliance, dropout rates, and outcome definitions - further complicate comparisons. Importantly, MFSCLs demonstrate an excellent safety record in children, with adverse event rates comparable to adults and lower than those reported with overnight orthokeratology. MFSCLs are a safe and effective option for pediatric myopia management, though variability highlights the need for personalized treatment and close monitoring. Future work should clarify mechanisms, standardize reporting, and explore combination therapies to optimize outcomes for partial responders.</p>","PeriodicalId":44978,"journal":{"name":"Taiwan Journal of Ophthalmology","volume":"16 2","pages":"240-245"},"PeriodicalIF":1.4,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repeated low-level red-light therapy for myopia control: An update on efficacy and safety.","authors":"Yue Wu, Jijing Li, Yanxian Chen, Mingguang He","doi":"10.4103/tjo.TJO-D-25-00187","DOIUrl":"10.4103/tjo.TJO-D-25-00187","url":null,"abstract":"<p><p>Repeated low-level red-light (RLRL) therapy has emerged as an effective intervention for myopia control, yet concerns regarding its safety remain. This review summarizes the current high-level evidence on the efficacy and safety of RLRL therapy. Randomized controlled trials consistently demonstrate that RLRL therapy significantly reduces axial elongation and slows myopic onset and progression in children, with network meta-analyses indicating superior efficacy compared with established interventions. The short-term safety profile appears favorable, and no irreversible damage has been reported. However, uncertainties persist regarding the clinical significance of observed structural changes, such as transient foveal hyperreflectivity and cystoid abnormality on optical coherence tomography, as well as functional changes on multifocal electroretinogram. Addressing critical knowledge gaps, including long-term monitoring, dose optimization, and device design refinement, will be essential for realizing the full potential of this therapy while ensuring its safety.</p>","PeriodicalId":44978,"journal":{"name":"Taiwan Journal of Ophthalmology","volume":"16 2","pages":"246-255"},"PeriodicalIF":1.4,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolving patterns of childhood myopia in Taiwan: Effects of urbanization, digitalization, and outdoor activity policies.","authors":"Yu-Chieh Yang, Shao-You Fang, Hsin-Yu Yang, Chiao-Yu Wang, Chia-Wei Lee, Pei-Wei Huang, Mong-Ping Shyong, Yen-Lin Chen, Nai-Wei Hsu, Chi-Chen Chiang, Tzu-Tang Lin, Shih-Hwa Chiou, Yiing Mei Liou, Der-Chong Tsai","doi":"10.4103/tjo.TJO-D-25-00213","DOIUrl":"10.4103/tjo.TJO-D-25-00213","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate temporal and spatial trends in childhood myopia in Taiwan and to evaluate the roles of urbanization, digitalization, and outdoor activity policies by comparing three population-based cohorts.</p><p><strong>Materials and methods: </strong>Grade 2 students from three cross-sectional groups were included: Taipei 2013 (<i>n</i> = 11,590), Taipei 2023 (<i>n</i> = 6,350), and Yilan 2023 (<i>n</i> = 804). Cycloplegic autorefraction was used to assess refractive status. Parents completed questionnaires on sociodemographic and behavioral factors.</p><p><strong>Results: </strong>The prevalence of myopia increased from 36.36% in 2013 to 39.39% in 2023 in Taipei, while remaining lower in Yilan (24.00%). Over the past decade, digital device use increased (86.76% vs. 92.83%; <i>P</i> < 0.001) and outdoor activity time also improved (≥1 h/day on weekdays: 15.81% vs. 33.13%, <i>P</i> < 0.001; ≥2 h/day on weekends: 27.14% vs. 31.36%, <i>P</i> = 0.374). Children in more urbanized areas had significantly more myopic spherical equivalence values (0.09 ± 1.22 D in rural area, -0.17 ± 1.43 D in suburban area, and -0.28 ± 1.24 D in urban area, <i>P</i> < 0.001). Multivariate analysis confirmed significant risk factors including greater magnitude of astigmatism (odds ratio [OR] 1.85), living in Taipei (OR 1.82), having myopic parents (1 parent OR 1.30, 2 parents OR 2.35), and reduced weekend outdoor time (OR 1.28).</p><p><strong>Conclusion: </strong>The prevalence of childhood myopia in Taiwan continues to rise, although the rate of increase has slowed compared with historical trends. Educational and environmental factors remain important. Urbanization continues to be a key determinant. Increased outdoor exposure over the past decade remains fundamental to myopia prevention strategies in addressing the childhood myopia burden in Taiwan.</p>","PeriodicalId":44978,"journal":{"name":"Taiwan Journal of Ophthalmology","volume":"16 2","pages":"294-302"},"PeriodicalIF":1.4,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraocular pressure and optic disc cupping in school-aged children: An epidemiological study in Taiwan.","authors":"Hsiao-Lien Chang, Yen-Ching Lin, Yun Hsia, Jehn-Yu Huang, Bo-I Kuo, Tsing-Hong Wang, Chao-Wen Lin, Yao-Lin Liu, Tzu-Hsun Tsai, I-Jong Wang, Chien-Chia Su","doi":"10.4103/tjo.TJO-D-25-00104","DOIUrl":"10.4103/tjo.TJO-D-25-00104","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of the study was to investigate intraocular pressure (IOP), cup-to-disc ratio (CDR), and ocular biometrics in school-aged children in Taiwan and to evaluate the factors associated with IOP and CDR.</p><p><strong>Materials and methods: </strong>This nationwide school-based study prospectively enrolled children aged 6-18 years. Cycloplegic autorefraction, A-scan ultrasonography, IOP measurement with a rebound tonometer, and CDR assessment with indirect ophthalmoscopy were performed. High myopia (HM) was defined as spherical equivalent (SE) <-5.00 diopters or axial length (AL) ≥26 mm. Linear mixed-effects models evaluated the associations between ocular parameters, age, and sex and identified factors associated with IOP and CDR.</p><p><strong>Results: </strong>We enrolled 6264 eyes from 3132 children (1435 girls and 1697 boys; mean age 12.1 ± 3.4 years; mean IOP 17.2 ± 2.6 mmHg). The median CDR was 0.3 (range: 0.1-0.9); 10.8% of eyes had a CDR >0.4, and 1.8% had a CDR >0.6. The overall prevalence of HM was 8.0%, increasing to 25.4% at age 17. AL, anterior and vitreous chamber depth, IOP, and CDR all increased with age (all <i>P</i> < 0.001, except IOP, <i>P</i> = 0.006), whereas lens thickness and SE decreased (<i>P</i> < 0.001). AL was independently associated with IOP (β = 0.118, <i>P</i> = 0.010) and CDR (β = 0.006, <i>P</i> < 0.001). Among adolescents aged 15-18 years, HM eyes had significantly greater IOP than non-HM eyes (18.0 ± 3.2 vs. 17.2 ± 2.7 mmHg, <i>P</i> < 0.001). In HM eyes, greater IOP correlated with larger CDR (β = 0.005, <i>P</i> = 0.020).</p><p><strong>Conclusion: </strong>In school-aged children, IOP and CDR showed a slight increase with age. AL was an important determinant of IOP and CDR. HM may amplify the interaction among IOP, CDR, and AL.</p>","PeriodicalId":44978,"journal":{"name":"Taiwan Journal of Ophthalmology","volume":"16 2","pages":"318-324"},"PeriodicalIF":1.4,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A narrative review on orthokeratology for myopia control: Lens design, combination therapies, and clinical management.","authors":"Jin-Yu Chang, Hsin-Yen Chou, Chih-Chien Hsu","doi":"10.4103/tjo.TJO-D-25-00158","DOIUrl":"10.4103/tjo.TJO-D-25-00158","url":null,"abstract":"<p><p>Orthokeratology (OK) is considered an effective intervention for slowing the progression of myopia. It provides users with unaided corrected daytime vision by wearing contact lenses overnight. This review summarizes contemporary evidence on OK in several aspects, including treatment efficacy, biological mechanisms, lens design, safety, and the use of combination therapies. A structured literature search of PubMed and the Cochrane Library was conducted to identify eligible studies. Studies investigating the efficacy of OK in myopia control demonstrated advantages in reducing axial growth. The mechanisms underlying this effect include the induction of peripheral myopic defocus, changes in higher-order aberrations, and alterations in choroidal thickness. This review synthesizes the zones and fitting considerations of OK lenses. Main and novel lens designs are also discussed. Common adverse events associated with OK use, including corneal staining and lens binding, as well as less frequent but serious adverse events, such as microbial keratitis, are listed in this article. In addition, this review summarizes current evidence for combination therapy, demonstrating additive effects with low-concentration atropine and early findings with repeated low-level red light therapy; however, further investigations regarding rebound and safety are required.</p>","PeriodicalId":44978,"journal":{"name":"Taiwan Journal of Ophthalmology","volume":"16 2","pages":"228-239"},"PeriodicalIF":1.4,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refractory idiopathic peripheral ulcerative keratitis in a pediatric patient.","authors":"Cody Lo, Grant Luke, Victoria Liu, Tala El Tal, Michael D O'Connor","doi":"10.4103/tjo.TJO-D-25-00154","DOIUrl":"10.4103/tjo.TJO-D-25-00154","url":null,"abstract":"","PeriodicalId":44978,"journal":{"name":"Taiwan Journal of Ophthalmology","volume":"16 2","pages":"347-352"},"PeriodicalIF":1.4,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consensus and guidelines on myopia control in children by the Taiwan Myopia Disease Society.","authors":"Jui-Yen Lin, Hung-Chi Chen, Pei-Chang Wu, Ken-Kuo Lin, Chih-Chien Hsu, Der-Chong Tsai, Chih-Ping Wang, Chun-Fu Liu, Han-Chih Cheng, Chau-Yin Chen, Yun-Wen Chen, Wei-Yu Chiang","doi":"10.4103/tjo.TJO-D-26-00038","DOIUrl":"10.4103/tjo.TJO-D-26-00038","url":null,"abstract":"<p><strong>Purpose: </strong>Myopia is a major public health concern in East Asia. Despite available interventions, clinical variations persist in diagnosis and treatment. This study aimed to develop consensus-based clinical recommendations for myopia control in Taiwanese children using a structured Delphi methodology.</p><p><strong>Materials and methods: </strong>A modified Delphi method was used to develop consensus-based clinical recommendations for myopia control in children. Delphi statements were derived from a literature review and were evaluated by an expert panel of 12 ophthalmologists through a two-round anonymous rating process. Agreement was assessed using a five-point Likert scale, and consensus was defined <i>a priori</i> as ≥75% agreement. Descriptive statistics were used to summarize panel responses.</p><p><strong>Results: </strong>Seventeen statements across seven predefined domains were evaluated using a two-round Delphi process. High levels of agreement were achieved for all statements. Key recommendations were as follows: cycloplegic refraction is essential, and premyopia (spherical equivalent > -0.50 D to ≤ +0.75 D) is recognized as a distinct condition requiring active monitoring; family history and environmental factors must be routinely assessed; increased outdoor time is the foundational strategy for all children; low-dose atropine (starting concentration ≤0.05%) and optical interventions are effective primary treatments. Combination therapy is recommended for patients with an inadequate response to single-modality treatment.</p><p><strong>Conclusion: </strong>Using a modified Delphi approach, we established comprehensive consensus-based clinical recommendations for myopia control in children and adolescents in Taiwan. These recommendations reflect broad expert agreement and provide a structured framework to support clinical decision-making and future guideline development for the management of childhood myopia.</p>","PeriodicalId":44978,"journal":{"name":"Taiwan Journal of Ophthalmology","volume":"16 2","pages":"303-309"},"PeriodicalIF":1.4,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of anterior segment biomarkers in the development and progression of myopia.","authors":"Haoran Cheng, Zhen Ling Teo, Mark Yu Zheng Wong, Joey Chung, Jia Ling Lee, Daniel Shu Wei Ting, Marcus Ang","doi":"10.4103/tjo.TJO-D-25-00156","DOIUrl":"10.4103/tjo.TJO-D-25-00156","url":null,"abstract":"<p><p>Myopia is a major global health concern, projected to affect nearly half of the world's population by 2050. While axial elongation is known to be the underlying pathology in myopia, the pathophysiology of factors that drive axial elongation is not fully understood. Factors driving axial elongation include genetic factors and environmental factors such as outdoor activity time and the amount of near work. With advances in ocular imaging technology, there is interest in the role of anterior segment biomarkers in the onset and progression of axial elongation in myopia. Imaging modalities such as corneal tomography, anterior segment optical coherence tomography, optical biometry, and corneal biomechanical analyzers have enabled the precise measurement of corneal shape, anterior chamber depth, lens parameters, and biomechanical properties. These biomarkers have been implicated in myopia development, progression risk prediction, and response to interventions such as orthokeratology. In this review, we explore contemporary anterior segment imaging modalities and seek to better understand the complex relationship between anterior segment biomarkers and axial elongation in myopia. By understanding the role of these biomarkers, we may be better equipped in predicting myopia onset and progression and pave the way for potential treatments in myopia.</p>","PeriodicalId":44978,"journal":{"name":"Taiwan Journal of Ophthalmology","volume":"16 2","pages":"204-211"},"PeriodicalIF":1.4,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrobulbar half-muscle transposition of the superior rectus and lateral rectus for paralysis of the inferior division of the oculomotor nerve.","authors":"Chong-Bin Tsai, Chien-Liang Fang","doi":"10.4103/tjo.TJO-D-25-00173","DOIUrl":"10.4103/tjo.TJO-D-25-00173","url":null,"abstract":"","PeriodicalId":44978,"journal":{"name":"Taiwan Journal of Ophthalmology","volume":"16 2","pages":"353-356"},"PeriodicalIF":1.4,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}