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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.
- Systematic review and meta-analysis on the impact of COVID-19 pandemic-related lifestyle on myopiaPublication . Li, Mijie; Xu, Lingqian; Tan, Chuen-Seng; Lança, Carla; Foo, Li-Lian; Sabanayagam, Charumathi; Saw, Seang-MeiPurpose: To conduct a systematic review and meta-analysis to assess the effects of coronavirus disease 2019 (COVID-19) pandemic–related lifestyle on myopia outcomes in children to young adults. Methods: A systematic search was conducted on PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases (with manual searching of reference lists of reviews). Studies included assessed changes in myopia-related outcomes (cycloplegic refraction) during COVID and pre-COVID. Of 367 articles identified, 7 (6 prospective cohorts; 1 repeated cross-sectional study) comprising 6327 participants aged 6 to 17 were included. Quality appraisals were performed with Joanna Briggs Institute Critical Appraisal Checklists. Pooled differences in annualized myopic shifts or mean spherical equivalent (SE) during COVID and pre-COVID were obtained from random-effects models. Results: In all 7 studies, SE moved toward a myopic direction during COVID (vs pre-COVID), where 5 reported significantly faster myopic shifts [difference in means of changes: −1.20 to −0.35 diopters per year, [D/y]; pooled estimate: −0.73 D/y; 95% confidence interval (CI): −0.96, −0.50; P<0.001], and 2 reported significantly more myopic SE (difference in means: −0.72 to −0.44 D/y; pooled estimate: −0.54 D/y; 95% CI: −0.80, −0.28; P<0.001). Three studies reported higher myopia (SE ≤−0.50 D) incidence (2.0- to 2.6-fold increase) during COVID versus pre-COVID. Of studies assessing lifestyle changes, all 4 reported lower time outdoors (pre-COVID vs during COVID: 1.1–1.8 vs 0.4–1.0 hours per day, [h/d]), and 3 reported higher screen time (pre-COVID vs during COVID: 0.7–2.8 vs 2.4–6.9 h/d). Conclusions: This review suggests more myopic SE shifts during COVID (vs pre-COVID) in participants aged 6 to 17. COVID-19 restrictions may have worsened SE shifts, and lifting restrictions may lessen this effect. Evaluations of the long-term effects of the pandemic lifestyle on myopia onset and progression in large studies are warranted to confirm these findings.
- 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.
- Prevalence of anisometropia and its associated factors in school-age childrenPublication . Hashemi, Hassan; Khabazkhoob, Mehdi; Lança, Carla; Emamian, Mohammad Hassan; Fotouhi, AkbarPurpose: To determine the prevalence of anisometropia and the associated demographic and biometric risk factors in children. Methods: This cross-sectional study was conducted on the elementary school children of Shahroud, east of Iran, in 2015. All rural students were recruited, while multistage cluster sampling was used to select the students in urban areas. All children underwent optometric examinations including the measurement of uncorrected and corrected visual acuity, autorefraction, and subjective refraction with cycloplegia. Biometric components were measured using the Allegro Biograph. Myopia and hyperopia were defined as a spherical equivalent ≤-0.5 and ≥ +2.00 diopter, respectively. Students with a history of ocular trauma or lack of cycloplegic refraction at least in one eye were excluded from the study. Results: Of 6624 selected children, 5620 participated in the study. After applying the exclusion criteria, the data of 5357 students (boys: 52.8%, n = 2834) were analyzed. The mean age of the subjects was 9.2 ± 1.7 years (range: 6-12 years). The prevalence of anisometropia ≥ 1 D was 1.1% (95% CI: 0.8 to 1.4) in all children, 1.0% (95% CI: 0.7-1.3) in boys, 1.3% (95% CI: 0.8-1.7) in girls, 1.1% (95% CI: 0.8-1.4) in urban children, and 1.4% (95% CI: 0.5-2.3) in rural children. The prevalence of anisometropia was 8.8% (95% CI: 5.3-12.2) in myopic and 5.7% (95% CI: 2.8-8.5) in hyperopic children. Axial length asymmetry (OR = 40.9; 95%CI: 10.2-164.1), myopia (OR = 17.9; 95% CI: 9.4-33.9), and hyperopia (OR = 10.1; 95% CI: (5.1-19.7) were associated with anisometropia in multiple logistic regression model. More anisometropia was associated with more severe amblyopia. The odds of amblyopia (OR = 82.3: 38.2-177-3) and strabismus (OR = 17.6: 5.5-56.4) were significantly higher in anisometropic children. The prevalence of amblyopia was 21.7% in children with myopic anisometropia ≥ 3D, 66.7% in children with hyperopic anisometropia ≥ 3D, and 100% in cases with antimetropia ≥ 3D. Conclusion: The prevalence of anisometropia was low in Iranian schoolchildren. However, a high percentage of anisometropic students had amblyopia and strabismus. Axial length was the most important biometric component associated with anisometropia.
- 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.
- Tratamento da progressão da miopia com lentes de contacto em crianças: uma revisão sistemáticaPublication . Cruz, Catarina; Carvalho, Cátia; Almeida, Estefanía; Farinha, Hugo; Poças, Ilda Maria; Lança, CarlaIntrodução – A miopia define-se como um excesso de potência positiva no sistema ótico do olho, que resulta no foco da imagem antes do plano da retina. Sendo considerada um problema de saúde pública torna-se pertinente a investigação de terapêuticas que impeçam a sua progressão. Objetivos – Esta revisão sistemática visa comparar a eficácia de tratamentos da progressão da miopia em crianças, com lentes de contacto hidrófilas (LCH) e lentes ortoqueratológicas (OKL). Métodos – Pesquisaram-se artigos científicos nas plataformas PubMed e ScienceDirect. Todos os artigos foram filtrados de acordo com as guidelines PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) e os critérios de inclusão e exclusão pré-determinados. A eficácia do tratamento foi avaliada através da variação do comprimento axial (AL) e/ou a variação da medição do erro refrativo sob cicloplegia (equivalente esférico, EE) entre o início e o final do estudo, comparando o grupo de tratamento e o de controlo. Resultados – Foram incluídos 13 artigos divididos em dois grupos. No grupo das OKL (n=5) foram estudadas oito lentes em que a sua eficácia na progressão do AL variou entre 0,45mm e 0,09mm. No grupo das LCH (n=8) foram estudadas 11 lentes, sendo que a sua eficácia na progressão do AL variou entre 0,32mm e 0,09mm e na progressão do EE variou entre 0,14 D e 0,73 D. Conclusão – De todas as OKL, a que demonstrou maior eficácia na progressão do AL foi a lente (OKL) Menicon Z Night®: 0,45mm. De todas as LCH, a MiSight 1-Day® mostrou ser a mais eficaz tanto na diminuição da progressão do AL como do EE: 0,32mm e 0,73 D, respetivamente.
- 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.
- Deep learning system to predict the 5-year risk of high myopia using fundus imaging in childrenPublication . Foo, Li Lian; Lim, Gilbert Yong San; Lança, Carla; Wong, Chee Wai; Hoang, Quan V.; Zhang, Xiu Juan; Yam, Jason C.; Schmetterer, Leopold; Chia, Audrey; Wong, Tien Yin; Ting, Daniel S. W.; Saw, Seang-Mei; Ang, MarcusOur study aims to identify children at risk of developing high myopia for timely assessment and intervention, preventing myopia progression and complications in adulthood through the development of a deep learning system (DLS). Using a school-based cohort in Singapore comprising 998 children (aged 6-12 years old), we train and perform primary validation of the DLS using 7456 baseline fundus images of 1878 eyes; with external validation using an independent test dataset of 821 baseline fundus images of 189 eyes together with clinical data (age, gender, race, parental myopia, and baseline spherical equivalent (SE)). We derive three distinct algorithms - image, clinical, and mix (image + clinical) models to predict high myopia development (SE ≤ -6.00 diopter) during teenage years (5 years later, age 11-17). Model performance is evaluated using the area under the receiver operating curve (AUC). Our image models (Primary dataset AUC 0.93-0.95; Test dataset 0.91-0.93), clinical models (Primary dataset AUC 0.90-0.97; Test dataset 0.93-0.94) and mixed (image + clinical) models (Primary dataset AUC 0.97; Test dataset 0.97-0.98) achieve clinically acceptable performance. The addition of 1 year SE progression variable has minimal impact on the DLS performance (clinical model AUC 0.98 versus 0.97 in the primary dataset, 0.97 versus 0.94 in the test dataset; mixed model AUC 0.99 versus 0.97 in the primary dataset, 0.95 versus 0.98 in test dataset). Thus, our DLS allows prediction of the development of high myopia by teenage years amongst school-going children. This has potential utility as a clinical decision support tool to identify "at-risk" children for early intervention.
- 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.