Abstract. Myopia has become a major health problem around the world. The devel-opment of myopia is starting to appear at an earlier age than in previous generations and its consequences have prompted multiple studies, particularly regarding topical atropine treatment aiming at preventing or slowing myopia progression. Our objective is to review randomized and controlled studies on the efficacy and safety of topical atropine to prevent myopia progression in children. This was a narrative review compiled from literature of PubMed and Cochrane Library, including randomized and controlled clinical trials of atropine eye drops for myopia progression published within 2017 - 2023. Fourteen clinical trials were found in the 7 year-period analyzed. All study atropine concentrations were effective in reducing the progression of myopia compared to the placebo. The highest dose of atropine (1%) showed the best efficacy in reducing the spherical equivalent progression and axial elongation over the lower dose (0.01%). Side-effects were mild or moderate. The use of atropine eye drops to prevent myopia progression has shown benefits without involving serious adverse effects. Higher doses of atropine (0.5% and 1%) have been shown to have more efficacy in preventing myopia progression than lower doses (0.01%), so starting intervention with those doses of at-ropine could be considered for preventing myopic children from becoming severe myopia patients later in life.

Knowledge of clinical approaches and barriers in managing childhood myopia is limited. This study explores optometrists' knowledge, attitude, and practice towards childhood myopia. A 26-item survey was circulated online among practising optometrists in India. The questionnaire assessed the demographics, knowledge, self-reported clinical practice behaviour, barriers, source of information guiding their management, and extent of adult caregiver engagement for childhood myopia. Of 393 responses, a significant proportion of respondents (32.6%–92.4%) were unaware of the ocular complications associated with high myopia, with less than half (46.5%) routinely measuring axial length in clinical practice. Despite the improved awareness of emerging myopia management options, the uptake remains generally poor, with single-vision distance full correction spectacles (70.3%) being the most common mode of vision correction. Barriers to adopting emerging evidence are medico-legal concerns and the absence of clinical practice guidelines. Original research articles were the primary source of information supporting clinical practice. Most (>70%) respondents considered involving the adult caregiver in their child's clinical decision-making process. While practitioner knowledge, perspective, and practice are improving, childhood myopia management evidence is constantly evolving and remains inconclusive. Evidence-based practice guidelines and continuing education on myopia control might be helpful for practitioners in improving their clinical decision-making skills.

Background: To investigate the distribution of refractive errors and their characteristics in older adults. Methods: The study design was cross-sectional study. A total of 1107 men and women were interviewed and underwent detailed ophthalmic examinations, 998 subjects underwent refraction. Myopia was defined as spherical equivalent (SER) refraction ≤ −0.5 dioptres (D) and hyperopia was defined as SER ≥ +0.5 dioptres (D). Results: Among those who were refracted the distribution of myopia and hyperopia was 24.1% (95% CI 21.4–26.7) and 37.5% (95% CI 34.5–40.5), respectively. Myopia decreased from 28.7% in subjects aged 35-59 years to 19.3% in those aged 60 years or older and hyperopia increased from 21.8% at 35–59 years of age to 53.3% in subjects aged ≥60 years. Multiple regression analysis showed decreasing age (OR 0.98, 95% CI 0.96–1.00), female gender (OR 1.87, 95% CI 1.18–2.95) and presence of cataract (OR 2.40 , 95% CI 1.24–4.63) were independent risk factors associated with myopia. Conclusions: The distribution of refractive errors found in our study is similar to those reported in other Caucasian populations and differs from Asian populations. Myopia was positively associated with younger age, female gender and presence of cataract.

Importance: Because of the high prevalence of myopia in Taiwan, understanding the risk factors for its development and progression is important to public health. Background: This study investigated the risk factors for myopia and their influence on the progression of myopia in schoolchildren in Taiwan. Design: Patients’ clinical records were obtained retrospectively from ophthalmologists. Questionnaires were given to collect demographic information, family background, hours spent on daily activities, myopia progression, and treatment methods. Participants: A total of 522 schoolchildren with myopia from a regional medical hospital in northern Taiwan participated the study. Written informed consent was obtained from the participants of legal age or the parents or legal guardians. Methods: Multivariable regression analyses were performed. Myopia measured in dioptres was analysed, controlling for patients’ family and demographic information as well as their daily behaviours. Main Outcome Results: Children with high myopic parents were more myopic. Earlier onset age of myopia was associated with a higher level of myopia and greater annual myopic progression. Children reporting more near work activities had higher levels of myopia and greater progression of myopia. Lower levels of myopia were associated with more exercise, longer periods of sleep, and better vision care knowledge in children and parents. Intake of food supplements had no effect on myopia. Conclusions and Relevance: In addition to genetics, education, environment, and near work activity can influence the development of myopia. Health policies for schoolchildren should promote protective activities and vision care knowledge in order to protect the eyesight of schoolchildren.

Background: To evaluate the effectiveness of Defocus Incorporated Multiple Segments (DIMS) in slowing myopia progression in pediatric patients as a function of age. Methods: This was a non-randomized experimenter-masked retrospective controlled observational study of European individuals aged 6 -16 years with progressive myopia but no ocular pathology. We retrospectively reviewed the charts of the participants allocated to receive DIMS spectacles (Hoya® MiyoSmart®) or single vision spectacle lenses (control group). Cycloplegic spherical equivalent (SE) and axial length (AL), were measured at baseline and at 36 month follow up. The results were stratified by age into four groups: patients that wore DIMS spectacles oldest or youngest than 10 years of age (respectively, group A, 20 patients mean age 13.6±2.2 and group C, 20 patients mean age 9.0±1.2) and age-matched control groups (group B, 18 patients mean age 13.2±2.5 and group D, 22 patients mean age 8.5±0.9). Results: At 36 months, SE and AL increase resulted significantly reduced in groups A and C, respectively compared to groups B and D (p<0.05). Linear regression analysis showed a significant correlation (P<0.05) between patient age and myopia progression for SE in groups A and C, but only in group A also for AL. Groups B and D did not show any significant correlation (P>0.05). Conclusion: DIMS spectacles seem to slow myopia increase in pediatric patients, however their effectiveness results greatest in children oldest than 10 years of age. Morover our findings suggest that AL may be the more reliable parameter for evaluating myopia progression.

Background/Objectives: Posterior staphyloma (PS) is a hallmark of pathological myopia corresponding to a circumscribed outpouching of the eyeball with choroidal thinning and inward scleral deformation at its edges. Its pathogenesis is still unclear, thus constituting a research priority as the prevalence of myopia is increasing worldwide. Recently, it has been suggested that the optic nerve sheaths or oblique muscles are potential promoters of PS through the traction or compression effect that they apply to the eye wall. The inferior oblique muscle (IOM) inserts 1-2 mm from the macula. The projection of its insertion is accessible by Optical Coherence Tomography (OCT). Before launching prospective studies, we sought to detect any choroidal thinning (ChT) in the temporal vicinity of the macula and to measure the distance between it and the fovea (FT-distance). Methods: This retrospective cross-sectional pilot study included 120 eyes. Using Spectralis-OCT, the area centered by the Bruch’s membrane opening-fovea axis was analyzed for ChT and FT- distance. Results: Of the 112 defined eyes, 70% (78 eyes) had ChT. Pachymetry was significantly thinner (p = 0.018) in eyes with than without ChT. The mean FT-distance was 3601.9 ± 93.6µm. Conclusion: The location of ChT coincided with the insertion distance of the IOM, suggesting a link between them. The association between the presence of ChT and thinner pachymetry suggests reduced scleral resistance as thinner pachymetry is related to thinner sclera. Our results support a possible involvement of the IOM in the pathogenesis of certain PS, warranting further investigation.

Children with autism spectrum disorder (ASD) may have impaired vision from high refractive errors: near-sighted-myopia or far-sighted-hyperopia and aversion to spectacles or contact lenses. Refractive surgery can restore sharp vision and eliminate the need for spectacles or contact lenses. Restoration of sharp vision may improve ASD behaviors. Data were collated retrospectively for 267 children with refractive errors and neurodevelopmental disorders (NDD) diagnosed as ASD alone or NDD with ASD-like behaviors. Surgery was either laser photo-refractive keratectomy (PRK; 131 children), implantation of a phakic intra ocular lens (pIOL; 129 children) or removal of the crystalline lens and implantation of an IOL (refractive lens exchange, RLE; 21 children) under general anesthesia. Median age was 10.9 yrs. and median follow-up 3.1 yrs. Pre-operative refractive errors ranged from a mean +7.5 ± 0.9 D to -14.3. ± 4.8 D. Surgery corrected 87% to normal focal length (± 1 D). Visual acuity improved an average 0.6 logMAR. Social interactions and ASD behaviors improved in 55% (146/267) of the treated children (p &lt; .01), including school performance; motor skills; depth perception; repetitive or stereotyped movements; anxiety/fear; and attention. Refractive surgery improves both visual function and behaviors in the majority of highly near-sighted or far-sighted children with ASD.

The exact etiology of myopia remains elusive. The author proposes the particle property of photon in living tissue and the photon-electron theory in living tissue, if the frequency of the photon exceeds the threshold, the photon has enough energy to strike the electron away and forms a hole of a diameter in photon diameter scale in living tissue include the eye. Longer time of high-frequency electromagnetic radiation will cause more holes and a larger radius of holes. The visual light which passes through the radiated hole in the eye cannot be refracted on the macula, this is myopia symptom of blurred vision, shortening the distance of the eye and the object will include more visual light into cornea and lens, this is myopia another symptom of nearsightedness. The particle property of photon causes elongation of the eye and the macular holes.Blue light and X-ray are two kinds of high-frequency electromagnetic radiation which can shot holes in eye and cause myopia.

Under the new pattern of “double carbon” development, good ESG performance is the best way to promote the sustainable development of enterprises, and the ESG investment strategies are directly affected by the strategic vision of managers. Based on the upper echelons theory and stakeholder theory, this paper takes Chinese A-share listed companies from 2011 to 2022 as samples to empirically analyze the impact of managerial myopia on corporate ESG performance. The results show that managerial myopia significantly inhibits corporate ESG performance, mainly by inhibiting corporate green investment and green innovation sustainability. Furthermore, for state-owned enterprises (SOE), heavy polluting enterprises (HPE) and non-high-tech enterprises, the inhibitory effect of manager myopia on ESG performance is stronger. When the enterprise is in the growth stage, the above inhibition effect is more severe. For external governance, the greater the analyst attention and public environmental attention are, the more conducive they are to alleviating the restraining effect of managerial myopia on enterprise ESG performance. Therefore, effectively improving the time cognition level of managers and strengthening external supervision have become important measures for comprehensively optimizing the ESG performance.

Type 1 diabetes (T1D) is one of the most prevalent endocrinological diseases among children and young adults, with a growing incidence rate reaching up to 2.9 new cases per year per 100 000 persons below 15 years of age. We report the rare case of a 20-year-old female patient with T1D, hemoglobin D (HbD) heterozygote variant and high myopia of -10,00 spheric diopters and describe the retinal microvascular alterations visible on OCT angiography (angio-OCT). The patient also presented severe stature deficit (less than 3 standard deviations) and delayed puberty, which could not be explained only by suboptimal glycemic control, indicated a possible hypopituitarism. The HbA1c level evaluated with high performance liquid chromatography (HPLC) method was 6.5%, a falsely low value due to the HbD hemoglobinopathy. On ophthalmic evaluation the angio-OCT scan showed the following retinal microvascular alterations for the RE: the FAZ area vas 0.39 mm2, the FAZ perimeter was 2.88 mm and the circularity index was 0.58; for the LE: the FAZ area vas 0.34 mm2, the FAZ perimeter was 3.21 mm and the circularity index was 0.41. Clinicians should consider high performance retinal screening methods such angio-OCT evaluation for young T1D patients, especially for those with associated pathologies like high myopia and hemoglobinopathies. Moreover, multiple evaluation methods of the HbA1c values are mandatory as hemoglobinopathies can interfere with HbA1c assay methods accuracy.

Refractive surgery is an increasingly popular procedure to decrease spectacle or contact lens dependency. The two most commonly used surgical techniques to correct myopia is Photorefractive keratectomy (PRK) and Femtosecond- Lasik (FS-LASIK)There are few publications that gathers such a long term follow up of both surgical techniques (2) Methods It has been performed a retrospective non-randomized study 509 PRK eyes and 310 FS-LASIK surgeries were followed for 10 years for the treatment of myopia and compound myopic astigmatism. Patients were followed up three months, one year, 2 years, 5 and 10 years. The safety index of both procedures was defined as a quotient between the postoperative BCVA (Best Corrected Visual Acuity) and the preoperative BCVA. The predictability is calculated as difference between the expected spherical equivalent and the achieved spherical equivalent. The efficacy index was calculated as a quotient between postoperative UCVA divided by the preoperative BCVA (3) Results. The results were: a safety index higher than 100% (109%) and an efficacy index of 82.4% after 10 years of PRK surgery in both groups. FS-LASIK was the safest surgery after 10 years and the most efficacy technique although in this case there were no statistically significant differences (4) Conclusions. All these data demonstrated better indexes for FS-LASIK

The aim of this study was to evaluate the biomechanical changes of the cornea after wearing soft contact lenses (CLs) in healthy myopic patients measured with the Corvis ST® analyzer. This prospective, cross-sectional, single-center study was performed in twenty-two Caucasian patients aged between 19 and 24 years (20.64 ± 1.21 years) range). Five device-specific biomechanical parameters, central corneal thickness and intraocular pressure were measured prior to fitting and one month after CLs wear. Differences between the means of the DA Ratio and the standard deviation of the DA Ratio pre- and post-CLs wear were found to be significant (p value=0.002 in both cases). Significant differences were found between pre- and post-CLs wear values in CCT (p value=0.013). For all other biomechanical measures, no significant differences were observed before and after treatment. A significant association was found between changes in bIOP and classification according to changes in Int. Radius (p value = 0.047) and SSI (p value = 0.026) standard deviations. The corneal biomechanical indices provided by CST demonstrate that fitting of soft CLs is a safe optical compensation method for the stability of corneal stiffness. No significant differences were found pre- and post-CLs wear in the assessment of bIOP.

Growing incidence of myopia worldwide justifies the search for efficient methods of myopia prevention. Numerous pharmacological, optical, and lifestyle measures have already been utilized, but there remains a need to explore more practical and predictable methods for myopia control. This paper presents a review of the latest literature on preventing the progression of myopia using Defocus Incorporated Multiple Segments Spectacle Lenses (DIMSsl), Repeated Low-level Red-Light Therapy (RLRL), and the combination of low-dose atropine (0.01%) with orthokeratology lenses.

The increased global incidence of myopia requires the establishment of therapeutic approaches. Previous studies have suggested that inflammation plays an important role in the development and progression of myopia. We used human retinal pigment epithelial cell to study the molecular mechanisms on how FJE and PVE lowering the inflammation of the eye. The effect of FJE and PVE in MFD induced hamster model and explore the role of inflammation cytokines in myopia. Expression levels of IL-6, IL-8, and TNF-α were upregulated in retinal pigment epithelium (RPE) cells treated with IL-6 and TNF-α. FJ extract (FJE) + PV extract (PVE) reduced IL-6, IL-8, and TNF-α expression in RPE cells. Furthermore, FJE and PVE inhibited inflammation by attenuating the phosphorylation of protein kinase B (AKT), and nuclear factor kappa-light-chain-enhancer of activated B (NF-κB) pathway. In addition, we report two resveratrol + ursolic acid compounds from FJ and PV and their inhibitory activities against IL-6, IL-8, and TNF-α expression levels in RPE cells treated with IL-6 and TNF-α. FJE, PVE, and FJE + PVE were applied to MFD hamsters and their axial length was measured after 21 days. The axial length showed statistically significant differences between phosphate-buffered saline- and FJE-, PVE-, and FJE + PVE-treated MFD eyes. FJE + PVE suppressed expressions of IL-6, IL-8, and TNF-α. They also inhibited myopia-related transforming growth factor-beta (TGF)-β1, matrix metalloproteinase (MMP)-2, and NF-κB expression while increasing type Ⅰ collagen expression. Overall, these results suggest that FJE + PVE may have a therapeutic effect on myopia and be used as a potential treatment option.

The first step in seeing is light absorption by photopigment molecules expressed in the photore-ceptors of the retina. There are two types of photoreceptors in the human retina that are respon-sible for image formation, rods and cones. Except at very low light levels when rods are active, all vision is based on cones. Cones mediate high acuity vision and color vision. Furthermore, they are critically important in the visual feedback mechanism that regulates refractive development of the eye during childhood. The human retina contains a mosaic of three cone types, short-wavelength (S), long-wavelength (L) and middle-wavelength (M); however, the vast major-ity (~94%) are L and M cones. The OPN1LW and OPN1MW genes, located on the X-chromosome at Xq28, encode the protein component of the light-sensitive photopigments. Here we review mechanism by which splicing defects in these genes cause vision disorders.

The accommodative response of the human eye is predominantly driven by foveal vision but reacts also to off-foveal stimuli. Here, we report on monocular accommodation measurements using parafoveal and perifoveal annular stimuli centered around the fovea and extending up to 8 degree radial eccentricity for young emmetropic and myopic subjects. The stimuli were presented through a sequence of random defocus step changes induced by a pupil-conjugated tunable lens. A Hartmann-Shack wavefront sensor with an infrared beacon was used to measure real-time changes of ocular aberrations up to and including the 4th radial order across a 3 mm pupil at 20 Hz. Our findings show a significant reduction in accommodative response with increased radial eccentricity.

MATERIAL AND METHOD: This is an observational analytical cohort study carried out on a total of 160 patients, divided into 4 groups: healthy, with myopia, with primary open-angle glaucoma (POAG), and with POAG and myopia together. The study variables were Bruch's membrane opening area (BMO), the thickness of the RNFL and the RGC layer using the Glaucoma Premium program of the OCT Spectralis of Heidelberg. RESULTS: Regarding the analysis between age and the thickness of the RNFL, significant results were found in the healthy and glaucoma groups with myopia, for the rest of the groups, although there are no significant results, the correlation is negative, the older the younger is the thickness. Regarding intraocular pressure (IOP), significant results have been found in the nasal sector in the glaucoma group. In the glaucoma with myopia group, statistically significant results have been obtained when analyzing the thickness of the RNFL with refraction. In the analysis between the thickness of the RNFL and the RGC layer, significant results were obtained in the myopia and glaucoma groups; in the group of glaucoma with myopia, it occurs in the superior temporal sector. CONCLUSION: In the case of myopic patients with glaucoma, damage at the functional, both the thickness of the RNFL, the RCG and the BMO-MRW are greater than other groups. All these alterations can be evaluated and monitored with the OCT Spectralis thanks to the programs it includes, making this instrument one of the best for an early diagnosis of glaucoma and the damage produced in myopic patients.

Peripapillary intrachoroidal cavitation (PICC) is a yellow-orange lesion, located at the outer border of the myopic conus. First described as a localized detachment of the retinal pigment epithelium, its intrachoroidal location was later disclosed, justifying its current name. PICC is related to other myopic complications like posterior staphyloma, but its pathogenesis is not clear to date. Although it has been considered a benign condition, most eyes with PICC show visual field defects, leading to diagnostic uncertainty as these deficits resemble those observed in glaucoma. Furthermore, eyes with PICC can develop macular detachment with retinoschisis. Finally, misdiagnosis of PICC as a metastatic choroidal tumor may lead to unnecessary and anxiety-provoking investigation. Advances in optical coherence tomography (OCT) imaging have improved the visualization of ocular structures, contributing to the understanding of PICC. Recently high optic nerve sheaths traction forces during eye movements in highly myopic eyes have been suggested as promoters of PICC, renewing interest around this condition. However, a review of PICC is still lacking. Therefore, we aimed to provide a concise yet comprehensive overview of the current state of the art, focusing on OCT documentation, pathophysiology and potential future perspectives based on biomechanics of the optic nerve.

Environmental studies, metabolic research, and state of the art neurobiology point towards the reduced amount of natural day and sunlight exposure of the developing child’s organism as the consequence of increasingly long hours spent indoors online as the single unifying source of a whole set of health risks identified worldwide, as is made clear in this review of the current literature. Over exposure to digital environments, from abuse to addiction, now concerns even the youngest (ages 0 to 2), and triggers, as argued on the basis of clear examples herein, a chain of interdependent negative and potentially long-term metabolic changes. This leads to a deregulation of the serotonin and dopamine neurotransmitter pathways in the developing brain, currently associated with online activity abuse and/or internet addiction, and akin to that found in severe substance abuse syndromes. A general functional working model is proposed under the light of evidence brought to the forefront in this review.

Increased screen time during the COVID-19 pandemic and the accelerated incorporation of technology into daily practices have directly contributed to the increased prevalence of eye disease. The human eye is not built for continual technological use and must adjust to exposure to digital screens. Overexposure to technology can result in eye strain and an increased risk of eye diseases such as myopia with complications later in life, including retinal tears, cataracts, and macular degeneration. As vision and ocular diseases become more prevalent, the study of eye diseases, including their causes and treatments, is especially relevant. There is a need to prevent ocular diseases before they become a burden to individuals, their families, and their communities by better understanding the pathophysiology of ocular diseases. Several ocular diseases are thought to be caused by imbalances in reactive oxygen species (ROS) and autophagy. ROS refers to a class of highly reactive oxygen-containing molecules that can undergo damaging reactions with other molecules in the cell. Autophagy is a cellular process of self-eating whereby damaged, harmful, or dead material in cells is broken down to maintain cellular homeostasis. This paper discusses the role of ROS and autophagy in the pathogenesis of computer vision syndrome (CVS), digital eye strain (DES), myopia, cataracts, glaucoma, diabetic retinopathy (DR), age-related macular degeneration (AMD), optic nerve crush injury (OCN), optic nerve gliomas, and retinoblastoma. Lifestyle changes such as limiting screen time, ensuring adequate exposure to evening sunlight, and using blue light protection measures or protective eyewear are important in the prevention of eye disease. Nutrition also contributes significantly to eye health. A balanced diet rich in vitamins and antioxidants may help to prevent ROS and autophagy imbalance-induced eye disease. Medical and surgical treatments become necessary when preventative measures fail. This paper also addresses how government measures to decrease the onset of eye disease, including targeted programs to increase access to fresh vegetables and fruits in food deserts, are a critical macro-level avenue to reduce eye disease prevalence in the US, which according to the National Eye Institute, costs $139 billion yearly.