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- The potential of current polygenic risk scores to predict high myopia and myopic macular degeneration in multi-ethnic Singapore adultsPublication . Kassam, Irfahan; Foo, Li-Lian; Lança, Carla; Xu, Ling Qian; Hoang, Quan V.; Cheng, Ching-Yu; Hysi, Pirro; Saw, Seang-MeiPurpose: To evaluate the trans-ancestry portability of current myopia polygenic risk scores (PRS) to predict high myopia (HM) and myopic macular degeneration (MMD) in an Asian population. Design: Population-based study. Subjects: A total of 5,894 (2,141 Chinese, 1,913 Indians, and 1,840 Malays) adults from the Singapore Epidemiology of Eye Diseases (SEED) study were included in the analysis. The mean age was 57.0 (standard deviation, SD = 9.31) years. A total of 361 adults had HM (spherical equivalent, SE <-5.00D) from refraction measurements, 240 individuals were diagnosed with MMD graded by the Meta-PM criteria from fundus photographs, and 3,774 individuals were controls without myopia (SE >-0.5D). Methods: The PRS, derived from 687,289 HapMap3 SNPs from the largest genome-wide association study of myopia in Europeans to date (n = 260,974), was assessed on its ability to predict HM and MMD versus controls. Main outcome measures: The primary outcomes were the area under the receiver operating characteristic curve (AUROC) to predict HM and MMD. Results: The PRS had an AUROC of 0.73 (95% CI: 0.70, 0.75) for HM and 0.66 (95% CI: 0.63, 0.70) for MMD versus no myopia controls. The inclusion of the PRS with other predictors (age, sex, educational attainment (EA), and ancestry; age-by-ancestry; sex-by-ancestry and EA-by-ancestry interactions; and 20 genotypic principal components) increased the AUROC to 0.84 (95% CI: 0.82, 0.86) for HM and 0.79 (95% CI: 0.76, 0.82) for MMD. Individuals with a PRS in the top 5% had 4.66 (95% CI: 3.34, 6.42) times higher risk for HM and 3.43 (95% CI: 2.27, 5.05) times higher risk for MMD compared to the remaining 95% of individuals. Conclusion: The PRS is a good predictor for HM and will facilitate the identification of high-risk children to prevent myopia progression to HM. In addition, the PRS also predicts MMD and will help to identify high-risk myopic adults who require closer monitoring for myopia-related complications.
- 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.
- Non-miotic improvement in binocular near vision with a topical compound formula for presbyopia correctionPublication . Vejarano, Felipe; Alió, Jorge; Iribarren, Rafael; Lança, CarlaIntroduction: The aim of this case series was to examine the association between unaided binocular visual acuity for near vision and pupil change after the instillation of a special topical formulation for presbyopia treatment. Methods: This was a case series consisting of consecutive participants with presbyopia aged 40-70 years who were tested for visual acuity and pupil diameter before and 2 h after the instillation of a formulation of pilocarpine and phenylephrine drops (FOV Tears) for presbyopia. Participants underwent subjective refraction, photopic and scotopic pupil diameter measurement, and unaided monocular and binocular visual acuity testing by logMAR for distance and near vision both pre- and post-instillation of eye drops. Results: The study enrolled 363 subjects (n = 176 women, 48%) with a mean (± standard deviation) age of 50.4 ± 5.8 years. The mean spherical equivalent (SE) changed significantly (- 0.17 Diopters) after the instillation of the FOV Tears formulation (p < 0.001). Post-instillation of eye drops, the scotopic pupil diameter decreased by 0.97 ± 0.98 mm, and the near visual acuity by logMAR improved significantly by nearly two lines (p < 0.01). In the linear regression analyses, age (p < 0.001) and SE pre-drop instillation (p < 0.001) were associated with unaided binocular visual acuity. The changes in photopic pupil diameter and scotopic pupil diameter were not associated with unaided binocular visual acuity. Conclusions: The use of the pilocarpine and phenylephrine formulation (FOV Tears) improved binocular visual acuity for near vision in presbyopic patients, and the effect was independent of pupil change.
- 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.
- Visual function assessment in medical imaging researchPublication . Lança, Carla; Thompson, John D.; Lança, Luís; Hogg, PeterBackground - Medical image perception research relies on visual data to study the diagnostic relationship between observers and medical images. A consistent method to assess visual function for participants in medical imaging research has not been developed and represents a significant gap in existing research. Methods - Three visual assessment factors appropriate to observer studies were identified: visual acuity, contrast sensitivity, and stereopsis. A test was designed for each, and 30 radiography observers (mean age 31.6 years) participated in each test. Results - Mean binocular visual acuity for distance was 20/14 for all observers. The difference between observers who did and did not use corrective lenses was not statistically significant (P = .12). All subjects had a normal value for near visual acuity and stereoacuity. Contrast sensitivity was better than population norms. Conclusion - All observers had normal visual function and could participate in medical imaging visual analysis studies. Protocols of evaluation and populations norms are provided. Further studies are necessary to understand fully the relationship between visual performance on tests and diagnostic accuracy in practice.
- 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.
- Reading performance in children with visual function anomaliesPublication . Lança, Carla; Serra, Helena; Prista, JoãoAims - To compare reading performance in children with and without visual function anomalies and identify the influence of abnormal visual function and other variables in reading ability. Methods - A cross-sectional study was carried in 110 children of school age (6-11 years) with Abnormal Visual Function (AVF) and 562 children with Normal Visual Function (NVF). An orthoptic assessment (visual acuity, ocular alignment, near point of convergence and accommodation, stereopsis and vergences) and autorefraction was carried out. Oral reading was analyzed (list of 34 words). Number of errors, accuracy (percentage of success) and reading speed (words per minute - wpm) were used as reading indicators. Sociodemographic information from parents (n=670) and teachers (n=34) was obtained. Results - Children with AVF had a higher number of errors (AVF=3.00 errors; NVF=1.00 errors; p<0.001), a lower accuracy (AVF=91.18%; NVF=97.06%; p<0.001) and reading speed (AVF=24.71 wpm; NVF=27.39 wpm; p=0.007). Reading speed in the 3rd school grade was not statistically different between the two groups (AVF=31.41 wpm; NVF=32.54 wpm; p=0.113). Children with uncorrected hyperopia (p=0.003) and astigmatism (p=0.019) had worst reading performance. Children in 2nd, 3rd, or 4th grades presented a lower risk of having reading impairment when compared with the 1st grade. Conclusion - Children with AVF had reading impairment in the first school grade. It seems that reading abilities have a wide variation and this disparity lessens in older children. The slow reading characteristics of the children with AVF are similar to dyslexic children, which suggest the need for an eye evaluation before classifying the children as dyslexic.
- Visual acuity in high astigmatic eyes in Salta, ArgentinaPublication . Danza, Rubén D.; Szeps, Abel; Iribarren, Rafael; Lança, CarlaPurpose: To identify factors that affect uncorrected visual acuity (UCVA) in highly astigmatic eyes. Methods: This clinical study was performed at an Ophthalmology Clinic in the Northwest region of Argentina. The study population consisted of all consecutive patients, aged between 10 and 40 years, with bilateral astigmatism higher than 2 dioptres (D) in at least one eye. The protocol included the following tests: UCVA, pinhole VA, best-corrected VA (BCVA), keratometry, scotopic pupil diameter measurement, subjective refraction, and objective refraction with cycloplegia. Results: A total of 405 patients were included in the study. Their mean age was 22.04 ± 10.62 years and 52.3% were female (n=212). The mean SE was -1.53 ± 1.79 D and the mean scotopic pupil was 5.4 ± 0.3 mm. In multiple linear logistic regression analysis, excluding amblyopes, worse pinhole VA (Odds ratio [OR]: 8.19, 95% confidence intervals [CI]: 4.76 to 14.07; p<0,001) and higher scotopic pupil size were significantly associated with worse UCVA. The presence of amblyopia was associated with higher pupillary diameter (OR: 4.37; 95% CI: 1.60 to 11.97; p=0.004). Conclusions: Our study revealed that pupil size affects UCVA in the astigmatic eyes of subjects living in a rural environment. Thus, further studies are necessary to understand if the correction of astigmatism should take in consideration pupil size, pinhole VA, and UCVA.
- 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.