William B Yates, Adrian T Fung, Clare Fraser, Robert Griffits, Anne Lee, Peter J McCluskey
{"title":"Ophthalmology training trends: Insights from an anonymised survey of Australian ophthalmology trainees.","authors":"William B Yates, Adrian T Fung, Clare Fraser, Robert Griffits, Anne Lee, Peter J McCluskey","doi":"10.1016/j.apjo.2024.100120","DOIUrl":"10.1016/j.apjo.2024.100120","url":null,"abstract":"","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":" ","pages":"100120"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bryan Sim, Rachel S Chong, Hla Myint Htoon, Maithily Balakrishnan, Noel A Brennan, Audrey Chia
{"title":"Associations of optic nerve head morphology and peripapillary retinal nerve fibre layer thickness with myopic severity and treatment in children.","authors":"Bryan Sim, Rachel S Chong, Hla Myint Htoon, Maithily Balakrishnan, Noel A Brennan, Audrey Chia","doi":"10.1016/j.apjo.2024.100112","DOIUrl":"10.1016/j.apjo.2024.100112","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the longitudinal associations between myopic optic disc features and optical coherence tomography (OCT) measurements of peripapillary retinal nerve fibre layer (RNFL) thickness in young myopic children in Singapore.</p><p><strong>Methods: </strong>A prospective, single-site cohort study was conducted, involving children aged 7-16 years who participated in the PROM-Kids clinical cohort study from 2019 to 2022. Participants underwent annual assessments, including cycloplegic refraction, axial length measurements, fundus photography, and OCT imaging, with ocular magnification correction. Children were classified into low (LM, 0 to -3D), moderate (MM, -3.01 to -6D), and high (HM, > -6D) myopia, with or without treatment.</p><p><strong>Results: </strong>Data from 1000 children (right eye) were analyzed, including 521 with 2-year follow-up. At baseline, the mean age was 10.2 ± 1.6 years, with 46.4 % male and 90.7 % ethnic Chinese. HM children were older and exhibited greater optic disc tilt (ODT, 92 % vs. 80 %) and more peripapillary atrophy (PPA, 94 % vs. 73 %) compared to LM children. RNFL thickness decreased in the superior, inferior, and nasal quadrants but increased in the temporal quadrant with higher myopia. In the follow-up cohort, myopia progression was associated with thicker temporal quadrant and average RNFL, particularly in younger children. Prior treatment with myopia-control lenses was also associated with increased RNFL thickness in the superior quadrant.</p><p><strong>Conclusion: </strong>Optic disc changes occur early in life, even in low myopia. Increasing myopia is linked to varying RNFL thickness across quadrants and may be influenced by age and myopia treatment.</p>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":" ","pages":"100112"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Enne Hiu Ying Leung, Sun Li, Lizhen Chen, Dennis Shun Chiu Lam
{"title":"Challenges in myopia management and prevention: A call to action.","authors":"Enne Hiu Ying Leung, Sun Li, Lizhen Chen, Dennis Shun Chiu Lam","doi":"10.1016/j.apjo.2024.100111","DOIUrl":"10.1016/j.apjo.2024.100111","url":null,"abstract":"","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":" ","pages":"100111"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Is there an impending epidemic of myopia in Southeast Asia? An appraisal of the evidence.","authors":"Ian George Morgan","doi":"10.1016/j.apjo.2024.100113","DOIUrl":"10.1016/j.apjo.2024.100113","url":null,"abstract":"<p><p>Predictions on the future prevalence of myopia suggest one of the Global Burden of Disease regions will develop an epidemic like in East Asia and Singapore in Southeast Asia. This paper analyses the available evidence on prevalence of myopia in this region, concluding that the bulk of the evidence suggests that the prevalence of myopia at the end of schooling is still modest, although two papers suggest that in young adults in Thailand and Indonesia, the prevalence of myopia may be approaching levels typical of the epidemic of myopia. It also analyses an indicator of expected years of education at school entry, as well as current educational levels of adults, using data from the calculation of the UN Human Development Index. It then analyses the results obtained by the countries of the Southeast Asian region in the PISA international surveys of student achievement. Neither of these educational indicators suggests an impending epidemic of myopia. There is a need for more data to clarify this uncertainty. It is suggested that future collection of data concentrate on determining the prevalence of myopia in young adults finishing their schooling. Even methodology as simple as determining levels of lowered visual acuity in senior school students should be sufficient to resolve the uncertainty. This group provides a sound basis for the prediction of future levels of myopia in the adult population, and avoids the impact of the high levels of myopia and high myopia associated with cataract development that occur in much of Southeast Asia.</p>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":" ","pages":"100113"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yu Zhao, Yuhao Ye, Jingbin Geng, Jiayi Zhang, Zhe Zhang, Yiyong Xian, Yangyi Huang, Fang Liu, Ye Xu, Xingtao Zhou
{"title":"Differences in anterior ocular biometric characteristics among 6-year-old children with different myopic shift rates: A 2-year longitudinal study.","authors":"Yu Zhao, Yuhao Ye, Jingbin Geng, Jiayi Zhang, Zhe Zhang, Yiyong Xian, Yangyi Huang, Fang Liu, Ye Xu, Xingtao Zhou","doi":"10.1016/j.apjo.2024.100116","DOIUrl":"10.1016/j.apjo.2024.100116","url":null,"abstract":"<p><strong>Background: </strong>To investigate longitudinal changes in anterior ocular features during slow and fast myopic shift in 6-year-old children.</p><p><strong>Methods: </strong>In total, 242 eyes of first-year primary school children in Shanghai, China, were included in this study. All children underwent an initial examination and were subsequently followed-up for two years. All participants underwent comprehensive examinations, including ocular biometric assessment and cycloplegic autorefraction. Children were divided into two groups based on the degree of myopic shift in 2 years: group A (slow myopic shift, < 1.0 D, N = 145) and group B (fast myopic shift, > 1.0 D, N = 88). Detailed anterior ocular biometric data were compared between the two groups.</p><p><strong>Results: </strong>In both groups, the axial length and anterior chamber depth (ACD) increased significantly over the follow-up period (P < 0.001). Anterior corneal surface curvature showed a flattening trend in both flat and steep meridians in group A, while these parameters exhibited steepening changes in group B. Lens thickness (LT) decreased significantly from 3.60 ± 0.20 mm to 3.45 ± 0.17 mm in group B (P < 0.001), but not in group A (P = 0.387). The average lens tilt significantly decreased from 5.21 ± 1.26° to 4.95 ± 1.23° in group A (P = 0.043), but it exhibited no significant change in group B (P = 0.181). Furthermore, LT and ACD were significantly correlated with spherical equivalent changes (P < 0.01).</p><p><strong>Conclusions: </strong>Children with slow and fast myopic shift demonstrated comparable ACD deepening changes but showed distinct variations in corneal curvature and lens characteristics.</p>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":" ","pages":"100116"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142816823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Safety of repeated low-level red-light therapy for myopia: A systematic review.","authors":"Yanping Chen, Ruilin Xiong, Shaopeng Yang, Ziyu Zhu, Huangdong Li, Kaidi Xiang, Nathan Congdon, Wei Wang, Mingguang He","doi":"10.1016/j.apjo.2024.100124","DOIUrl":"10.1016/j.apjo.2024.100124","url":null,"abstract":"<p><strong>Purpose: </strong>Establishing the safety profile of repeated low-level red-light (RLRL) therapy is necessary prior to its widespread clinical implementation.</p><p><strong>Methods: </strong>We conducted a systematic review (International Prospective Register of Systematic Reviews, CRD42024516676) of articles across seven databases from inception through February 10, 2024, with keywords related to myopia and RLRL therapy. Pooled safety outcomes and risk-to-benefit ratios were reported, and incidence of side effects was compared with other antimyopia interventions.</p><p><strong>Results: </strong>Among 689 screened articles, 20 studies (2.90 %; median duration 9 months, longest 24 months) were analysed, encompassing 2380 participants aged 3-18 years and 1436 individuals undergoing RLRL therapy. Two case reports described an identical patient with reversible decline in visual acuity and optical coherence tomography (OCT) abnormalities, completely resolved 4 months after treatment cessation. No cases of permanent vision loss were reported. Temporary afterimage was the most common ocular symptom following treatment, resolving within 6 minutes in reported studies. The number needed to harm outweighed the number needed to treat by a ratio of 12.7-21.4 for a person with -3D to -8D myopia treated with RLRL therapy. Incidence of side effects from RLRL was 0.088 per 100 patient-years (95 % confidence interval, 0.02-0.50).</p><p><strong>Conclusions: </strong>No irreversible visual function loss or ocular structural damage was identified with RLRL. Fundus photography and OCT before and during therapy, alongside home monitoring of visual acuity and duration of afterimages, are necessary to identify side effects. Further adequately powered studies of longer duration are needed to evaluate long-term safety of RLRL.</p>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":" ","pages":"100124"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142821855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Effect of school entrance age on myopia among primary schoolchildren using mixed-effect model: The Shantou Myopia Study (SMS).","authors":"Hongxi Wang, Linrong Wu, Yuancun Li, Xin Tan, Jianwei Lin, Kunliang Qiu, Yali Du, Shengjie Yin, Binyao Chen, Jiao Jiang, Hailiu Chen, Mingzhi Zhang","doi":"10.1016/j.apjo.2024.100121","DOIUrl":"10.1016/j.apjo.2024.100121","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the association between children's school entrance age and refractive status and prevalence of myopia in southern China.</p><p><strong>Methods: </strong>Population-based Cross-sectional study was conducted from September 2020 to June 2021 in Shantou, southern China, enrolling primary schoolchildren in the city. The school entrance age was calculated as the months from the birth date to the entrance date, divided by 12. Non-cycloplegic refraction and uncorrected visual acuity test were conducted. Myopia was defined as spherical equivalent refraction (SER) < -0.50D with an uncorrected distant visual acuity < Snellen 20/20. We explored the association between the SER and the school entrance age, with the clustering effect within schools adjusted by the linear mixed-model.</p><p><strong>Results: </strong>We enrolled 410,080 primary schoolchildren, with a mean age of 9.8 ± 1.6 years. The overall prevalence of myopia was 42.04 %. The mean SER of myopic children was - 2.15 ± 1.70 D. The mixed-effects model revealed a significant correlation between the school entrance age and the SER and the prevalence of myopia. One year later for school entrance age would independently result in a less myopic SER of 0.352 D, and significantly decrease the prevalence of myopia. Children born before September 1st had significantly more myopic SER than those born after September 1st.</p><p><strong>Conclusions: </strong>Early school entrance, rather than age or prolonged exposure to schooling, was an independent risk factor for myopia. It is important to put forward some scientific and effective measures, preventing children from early exposure to task-heavy school life and near work.</p>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":" ","pages":"100121"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Edward S F Liu, Mary Kim Elizabeth Tan Cudia, Graham K Y Wong, Chung-Nga Ko, Dennis S C Lam
{"title":"The concept of cone opponency may extend beyond accommodation, to myopiagenesis and emmetropization, for a better peripheral defocus lens.","authors":"Edward S F Liu, Mary Kim Elizabeth Tan Cudia, Graham K Y Wong, Chung-Nga Ko, Dennis S C Lam","doi":"10.1016/j.apjo.2024.100125","DOIUrl":"10.1016/j.apjo.2024.100125","url":null,"abstract":"<p><p>Myopia has ever-rising prevalence in the past few decades globally. Its pathogenesis is still not adequately elucidated especially at the signal transduction level. For the environmental risk factors, there is a large body of fragmented knowledge about the visual inputs for accommodation, myopiagenesis and emmetropization, with the latter two being essentially local processes. The red-green and yellow-blue chromatic pathways, together with the underlying L-M and S-(L+M) cone opponency, seem to be the common denominator amongst them. In this review, experimental and observational evidence are summarized to delineate the interplay of them. This review may establish the pivotal role of longitudinal chromatic aberration (LCA) for a mechanistic approach to future research in myopia control. This review looks into the mechanistic processes underlying myopiagenesis and emmetropization, specifically focusing on chromatic aberration and cone opponency in vision as pivotal components. The roles of longitudinal chromatic aberration (LCA) and cone contrast in myopia onset and development are intriguing. How visual input and chromatic pathways (specifically, red-green and blue-yellow cone opponency) contribute to accommodation that may trigger emmetropization mechanisms, thereby influencing eye growth patterns are explored and discussed. In brief, this manuscript delves into the physiology of visual processing and highlights a foundational aspect of visual science that may account for a \"Go\" or \"Stop\" signaling in axial eye growth. It further proposes a metric to gauge myopia-inhibiting optical devices such as the peripheral defocus lenses, for its best iteration. Future research in the above-mentioned areas is warranted.</p>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":" ","pages":"100125"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Visualization of the scleral structure changes at various stages of eyes with myopic maculopathy using polarization-sensitive OCT.","authors":"Keigo Sugisawa, Hiroyuki Takahashi, Masahiro Yamanari, Michiaki Okamoto, Tae Igarashi-Yokoi, Takeshi Azuma, Takayuki Miki, Hongshuang Lu, Yijin Wu, Jianping Xiong, Kyoko Ohno-Matsui","doi":"10.1016/j.apjo.2024.100117","DOIUrl":"10.1016/j.apjo.2024.100117","url":null,"abstract":"<p><strong>Purpose: </strong>To observe the detailed structures of the inner and outer sclera at various stages of myopic maculopathy using polarization-sensitive optical coherence tomography (PS-OCT).</p><p><strong>Methods: </strong>A PS-OCT system was developed for imaging the posterior eye using a swept laser. Data from highly myopic patients who underwent PS-OCT examination between May and June 2019 were used to generate birefringence images (showing scleral fiber density), optic axis images (visualizing the orientation of scleral fibers), and streamline images (providing 3D reconstructions to visualize scleral fiber stream).</p><p><strong>Results: </strong>A total of 89 eyes of 65 patients with high myopia were examined and analyzed for this study. The mean axial length was 30.4 ± 1.8 mm. In highly myopic eyes with a thin choroid, PS-OCT visualized the detailed structure of the sclera, and the optic axis images differentiated the direction of the inner and outer scleral fibers. In the optic axis and streamline images, the inner layer of the sclera contained radial fibers extending from the optic disc. In contrast, the outer layer of the sclera contained vertical fibers. With the progression of myopia, highly birefringent fibers first disappear in the inner scleral layer, followed by thinning of the inner layer itself. Subsequently, in the outer scleral layer, the number of highly birefringent fibers decreased. As myopic maculopathy worsened, the inner and outer layers of the sclera disintegrated.</p><p><strong>Conclusions: </strong>PS-OCT is useful for observing the structures of the inner and outer sclera in various conditions of myopic maculopathy.</p>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":" ","pages":"100117"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ebenezer Zaabaar, Yuzhou Zhang, Ka Wai Kam, Xiu Juan Zhang, Clement C Tham, Li Jia Chen, Chi Pui Pang, Jason C Yam
{"title":"Low-concentration atropine for controlling myopia onset and progression in East Asia.","authors":"Ebenezer Zaabaar, Yuzhou Zhang, Ka Wai Kam, Xiu Juan Zhang, Clement C Tham, Li Jia Chen, Chi Pui Pang, Jason C Yam","doi":"10.1016/j.apjo.2024.100122","DOIUrl":"10.1016/j.apjo.2024.100122","url":null,"abstract":"<p><strong>Purpose: </strong>Over the past few years, there has been a rapid accumulation of data on the use of low-concentration atropine for myopia control, especially in East Asian children, with its effectiveness varying in different studies. This review aims to evaluate the current evidence surrounding the efficacy and safety of low-concentration atropine in the management of myopia onset and progression in East Asia.</p><p><strong>Methods: </strong>Clinical trials involving atropine for myopia control in East Asia were reviewed.</p><p><strong>Results: </strong>Atropine has been shown to reduce myopia progression in East Asian children, compared with placebo. Its efficacy is concentration-dependent, with 1 % atropine yielding the greatest effect in slowing myopia progression by over 70 %, but it is associated with significant rebound and side effects. Lower concentrations also confer significant myopia-control effects while maintaining a more acceptable safety profile, with relative reductions of 67 % and 43 % reported for 0.05 % and 0.025 % atropine, respectively. While 0.01 % atropine showed the least effect compared to 0.05 % and 0.025 %, it still yielded a significant efficacy in slowing myopic refraction. Over two years, 0.05 % atropine reduced the incidence of myopia by nearly 50 %, demonstrating greater effectiveness than 0.01 % atropine. This effect was particularly notable in children with low hyperopic reserves (< +0.75 D), but not in those with higher reserves.</p><p><strong>Conclusions: </strong>The current evidence shows that low-concentration atropine plays a crucial role in managing myopia in East Asian children and demonstrates satisfactory safety profiles. Timely administration of the most effective and safest concentration can potentially prevent sight-threatening complications and subsequent vision loss.</p>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":" ","pages":"100122"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}