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- Myopia: public health challenges and interventions [editorial]Publication . Iribarren, Rafael; Grzybowski, Andrzej; Lança, CarlaMost school myopia results from an excessive eye axial length that develops in childhood. In the past three decades, there have been significant increases in the prevalence of childhood myopia. By 2050, half of the world's population is expected to have myopia, a 2-fold increase compared to the year 2000. In the last years, the achievements made by scientists have been exceptional, leading to major advancements in the treatment of myopia progression. This Research Topic comprises 14 studies including original research articles and reviews covering several aspects of myopia. Myopia has become one of the fastest-growing eye health challenges of the twenty-first century, with a disproportionate burden on urban Asia regions. Shi et al. conducted a study on temporal and spatial characterization of myopia in China. The authors showed that there was an increase in the prevalence of myopia in children aged 7–18 years old from 1995 to 2014. The study results also showed a shift of myopia to the southeast, identifying the existence of high-risk areas. Those results are important for targeted myopia prevention.
- Myths in myopia epidemiology and treatmentPublication . Lança, Carla; Repka, Michael X.; Grzybowski, AndrzejPracticing evidence-based medicine requires constant effort to acquire, assess, and implement new knowledge that improves our care. Since 2013, more than 1000 publications per year have discussed myopia,1 many challenging existing medical beliefs. As in other areas of medicine, ophthalmologists are expected to translate new knowledge into their clinical practice as well as manage their demanding clinical schedule. However, practicing clinicians, including ophthalmologists, are sometimes slow to discard medical myths contradicted by available evidence. This is especially true in fields with rapidly evolving research, such as myopia. The goal of this viewpoint is to highlight examples of common beliefs about myopia epidemiology and control that are not evidence-based and to consider corrective educational strategies.
- Predicting children’s myopia risk: a Monte Carlo approach to compare the performance of machine learning modelsPublication . Artiemjew, Piotr; Cybulski, Radosław; Emamian, Mohammad Hassan; Grzybowski, Andrzej; Jankowski, Andrzej; Lança, Carla; Mehravaran, Shiva; Młyński, Marcin; Morawski, Cezary; Nordhausen, Klaus; Pärssinen, Olavi; Ropiak, KrzysztofThis study presents the initial results of the Myopia Risk Calculator (MRC) Consortium, introducing an innovative approach to predict myopia risk by using trustworthy machine-learning models. The dataset included approximately 7,945 records (eyes) from 3,989 children. We developed a myopia risk calculator and an accompanying web interface. Central to our research is the challenge of model trustworthiness, specifically evaluating the effectiveness and robustness of AI (Artificial Intelligence)/ML (Machine Learning)/NLP (Nat-ural Language Processing) models. We adopted a robust methodology combining Monte Carlo simulations with cross-validation techniques to assess model performance. Our experiments revealed that an ensemble of classifiers and regression models with Lasso regression techniques provided the best outcomes for predicting myopia risk. Future research aims to enhance model accuracy by integrating image and synthetic data, including advanced Monte Carlo simulations.
- The effectiveness and tolerability of atropine eye drops for myopia control in non-Asian regionsPublication . Simonaviciute, Dovile; Grzybowski, Andrzej; Lança, Carla; Pang, Chi Pui; Gelzinis, Arvydas; Zemaitiene, RedaMyopia is the most common ocular disorder worldwide with an increasing prevalence over the past few decades. It is a refractive error associated with excessive growth of the eyeball. Individuals with myopia, especially high myopia, are prone to develop sight-threatening complications. Currently, atropine is the only drug that is used to slow myopia progression in clinical practice. However, there are still areas of uncertainty such as treatment strategy, optimal concentration when considering the risk-benefit ratio, and active treatment period. Since the prevalence of myopia is much higher in Asian countries, most of the research on myopia control has been conducted in Asia. Data on the efficacy and tolerability of atropine eye drops in the non-Asian population remains limited. In this review, we summarize the results of published clinical trials on the effectiveness and tolerability of atropine eye drops for myopia control in non-Asian regions. The efficacy was evaluated by the mean change in spherical equivalent (SE) or axial length (AL). The tolerability of atropine eye drops was analyzed based on patients' complaints and adverse events. The results of this review suggest that 0.01% atropine eye drops are effective in non-Asian regions achieving fewer side effects compared to 0.5% concentration.
- Association of sleep traits with myopia in children and adolescents: a meta-analysis and Mendelian randomization studyPublication . Dong, Xing-Xuan; Xie, Jia-Yu; Li, Dan-Lin; Dong, Yi; Zhang, Xiao-Feng; Lança, Carla; Grzybowski, Andrzej; Pan, Chen-WeiPurpose: The association between sleep and myopia in children and adolescents has been reported, yet it remains controversial and inconclusive. This study aimed to investigate the influence of different sleep traits on the risk of myopia using meta-analytical and Mendelian randomization (MR) techniques. Methods: The literature search was performed on August 31, 2023, based on PubMed, Embase, Web of Science, and Cochrane Library. A meta-analysis of observational studies reporting the relationship between sleep and myopia was conducted. MR analyses were carried out to assess the causal impact of genetic pre-disposition for sleep traits on myopia. Results: The results of the meta-analysis indicated a significant association between the risk of myopia and both short sleep duration [odds ratio (OR) = 1.23, 95% confidence interval (CI) = 1.08-1.42, P = 0.003] and long sleep duration (OR = 0.75, 95% CI = 0.66-0.86, P < 0.001). MR analyses revealed no significant causal associations of genetically determined sleep traits with myopia, including chronotype, sleep duration, short sleep duration, and long sleep duration (all P > 0.05). Conclusions: No evidence was found to support a causal relationship between sleep traits and myopia. While sleep may not independently predict the risk of myopia, the potential impact of sleep on the occurrence and development of myopia cannot be disregarded.
- Effectiveness of myopia control interventions: a systematic review of 12 randomized control trials published between 2019 and 2021Publication . Lança, Carla; Pang, Chi Pui; Grzybowski, AndrzejPurpose: This study aims to investigate the effectiveness of interventions to control myopia progression. In this systematic review, the primary outcomes were mean differences (MD) between treatment and control groups in myopia progression (D) and axial length (AL) elongation (mm). Results: The following interventions were found to be effective (p < 0.001): highly aspherical lenslets (HAL, 0.80 D, 95% CI, 0.77-0.83; -0.35 mm, 95% CI -0.36 to -0.34), MiSight contact lenses (0.66 D, 95% CI, 0.63-0.69; -0.28 mm, 95% CI -0.29 to -0.27), low dose atropine 0.05% (0.54 D, 95% CI, 0.38-0.70; -0.21 mm, 95% CI-0.28 to -0.14), Biofinity +2.50 D (0.45 D, 95% CI, 0.29, 0.61; -0.24 mm, 95% CI -0.33 to -0.15), defocus incorporated multiple segments [DIMS] (0.44 D, 95% CI, 0.42-0.46; -0.34 mm, 95% CI -0.35 to -0.33) and ortho-k lenses (-0.24 mm, 95% CI -0.33 to -01.5). Conclusion: Low-dose atropine 0.01% was not effective in reducing AL progression in two studies. Treatment efficacy with low-dose atropine of 0.05% showed good efficacy. Spectacles (HAL and DIMS) and contact lenses (MiSight and Biofinity) may confer a comparable treatment benefit compared to atropine, to slow myopia progression.
- Refractive errors: public health challenges and interventions [editorial]Publication . Lança, Carla; Pang, Chi Pui; Grzybowski, AndrzejUncorrected refractive errors are a leading cause of visual impairment and blindness across many countries. Refractive errors that are not corrected during the critical period of visual system development may lead to serious conditions, such as amblyopia. The largest burden of refractive error is myopia which significantly increases the risk of blinding conditions such as myopic macular degeneration, glaucoma, and cataract. Previous studies show that vision impairment in children is associated with symptoms of depression and anxiety, and children with myopia revealed higher scores of depression compared with children having normal vision. Substantial impact in the economic health of individuals as well as decreased educational and employment opportunities have been associated with visual impairment and blindness in adults. Decreased quality of life, increased risk of falls and increased risk of death have also been associated with visual impairment and blindness in older adults. Additionally, visual impairment may coexist with other health conditions, amplifying the impact of comorbidities, thereby increasing the disability risk. In the past few years, epidemiological research has shown that uncorrected refractive errors are a major public health issue in many parts of the world. However, more research is needed to determine the full extent of the threat posed by refractive errors, to establish effective interventions and to consolidate prevention efforts. This Research Topic comprises 28 studies including original research articles and reviews on refractive errors, such as research trends and prevalence, risk factors, retinal biomarkers, treatment, and health promotion.
- Comment on: Development and validation of a novel nomogram for predicting the occurrence of myopia in schoolchildren: a prospective cohort studyPublication . Lança, Carla; Parssinen, Olavi; Mehravaran, Shiva; Nordhausen, Klaus; Emamian, Mohammad Hassan; Grzybowski, AndrzejIn the recent article published by Guo et al., the authors used data from 2nd and 3rd graders to develop a nomogram to predict myopia onset in schoolchildren. Given that myopia can progress to high myopia, which is in turn a risk factor for pathologic myopia, prediction tools are timely and relevant. We would like to provide insights into other limitations and offer suggestions that can inform future works.
- Anti-myopia spectacles: the standard of care in the future?Publication . Lança, Carla; Pan, Chen-Wei; Grzybowski, AndrzejReports of myopia increases across the world show an expanding growing public health problem. Myopia prevalence is exceptionally high in some continents, especially in Asia and particularly east Asian countries, but was also reported to have increased in other continents, such as North America and Europe, although there is considerable variation between geographic areas and racial groups in the myopia burden. The presence of myopia, especially high myopia, increases the risk of development of pathologic myopia and visual impairment. The peak incidence of myopia occurs in childhood, but the associated blinding ocular complications develop later during adulthood. Children with an increased risk of visual impairment due to pathologic myopia often have a longer duration of the disease, longer axial length (AL), and thinner choroid. Thus, myopia control therapies should be implemented early to avoid the development of high myopia, as the early age of myopia onset plays a fundamental role in myopia progression, with about 50% of children with myopia onset at 7 or 8 years of age developing high myopia in adulthood, if left untreated. Increased prevalence of high myopia related to AL elongation is likely to result in higher rates of myopic macular degeneration (MMD). At present, we do not know if treating myopic progression will avoid the development of MMD. However, it seems logical to slow AL elongation to prevent severe disease and complications associated with pathologic myopia. Consequently, controlling myopia progression has become one of the highest priorities for eye care professionals all over the world.
- Accommodative–vergence disorders in a paediatric ophthalmology clinical setting in ArgentinaPublication . Iurescia, Alejandra; Iribarren, Rafael; Lança, Carla; Grzybowski, AndrzejPurpose: To determine the frequency of potential non-strabismic accommodative-vergence anomalies (NSAVA) and investigate associations between NSAVA, refractive errors, and age among children attending a paediatric ophthalmology clinic. Methods: This study included children and adolescents aged 5-19 years attending an ophthalmology clinic with at least two follow-up visits. At their first visit, children had a comprehensive ophthalmic examination, including refractive error measurement by cycloplegic autorefraction, and spectacles were prescribed if necessary. At the second visit, children had an examination of best-corrected visual acuity, convergence, and accommodation to identify potential NSAVA. The relationship between age, sex, heterophoria refractive error, and potential NSAVA was assessed by a multivariable logistic regression model. Results: A total of 384 children and adolescents were evaluated. Their mean age was 10.97 ± 3.07 years and 58.9% were females. Forty-two percent of children failed the NSAVA tests and 34.1% had myopia (≤-0.50 D). Children who failed NSAVA tests self-reported a higher proportion of reading problems (73.7%) compared to those who passed the tests (26.3%; p < 0.001). Children with self-reported reading problems were more likely to have accommodative infacility (57.9%) compared with children without (42.1%; p < 0.001). Refractive error and age were not associated with failure in NSAVA tests (p > 0.05). Conclusions: NSAVA was a frequent cause of vision problems found in a sample of children from an ophthalmology paediatric clinic. Thus, further research is necessary to understand the potential of public health policies to prevent, refer, diagnose, and treat those conditions.