PURPOSE: The purpose of this multi-institute, single-group clinical trial was to evaluate the effectiveness and safety of toric orthokeratology lenses for the treatment of patients with combined myopia and astigmatism. METHODS: A total of 44 patients were included in this clinical trial. The patients ranged in age from 7 to 49 years, with myopia of -0.75 to -6.0 diopters (D) and astigmatism of 1.25 to 4.0 D. After excluding 21 subjects, 23 subjects (39 eyes) were analyzed after toric orthokeratology lens use. The subjects underwent ophthalmologic examination after 1 day and 1, 2, 3, and 4 weeks of wearing overnight toric orthokeratology lenses. RESULTS: A total of 19 subjects (31 eyes) completed the trial after five subjects (eight eyes) dropped out. In the patients who completed the study by wearing lenses for 4 weeks, the myopic refractive error decreased significantly by 2.60 ± 2.21 D (p < 0.001), from -3.65 ± 1.62 to -1.05 ± 1.64 D. The astigmatic refractive error were also significantly decreased by 0.63 ± 0.98 D (p = 0.001), from 2.07 ± 0.83 to 1.44 ± 0.99 D. The mean uncorrected and corrected visual acuities before wearing the lenses were 2.14 ± 0.80 logarithm of the logMAR (logMAR) and 0.05 ± 0.13 logMAR, respectively, which changed to 0.12 ± 0.30 logarithm of the logMAR (p < 0.001) and 0.01 ± 0.04 logMAR (p = 0.156) after 4 weeks. No serious adverse reactions were reported during the clinical trial. CONCLUSIONS: Our results suggest that toric orthokeratology is an effective and safe treatment for correcting visual acuity in patients with combined myopia and astigmatism.
Adolescent ; Adult ; Astigmatism/complications/diagnosis/*therapy ; Child ; Cornea/*diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Myopia/complications/diagnosis/*therapy ; Orthokeratologic Procedures/*methods ; Slit Lamp Microscopy ; Treatment Outcome ; *Visual Acuity ; Young Adult

OBJECTIVE: To evaluate the change in accommodative lag and accommodation convergence/accommodation (AC/A) after patients with myopia wear orthokeratology lenses. 
 METHODS: A total of 48 myopic subjects (a test group), who wore orthokeratology lenses regularly, and 48 myopic subjects (a control group), who wore spectacles regularly, were enrolled for this study from January 2011 to January 2013 in Optometric Center, the Forth Hospital of Changsha. Accommodative lag was measured by fused cross cylinder method, where the patients should gaze at the front optotypes 40 cm away. Gradient of the AC/A ratio was measured by Von Grafe method to check closer distance heterophoria. Accommodative lag and AC/A ratio were analyzed by statistics.
 RESULTS: After 1-year follow-up, accommodative lag and AC/A rate in patients with low or moderate myopia in the test group was decreased in 1, 3, 6 months or 1 year compared with that in the control group (P<0.05). 
 CONCLUSION Compared with spectacles, orthokeratology lenses are able to decrease accommodative lag and high AC/A rate in patients with low or moderate myopia. The relationship between accommodation and convergence is improved by orthokeratology lenses. Orthokeratology is an effective way to control myopia.
Accommodation, Ocular ; Case-Control Studies ; Contact Lenses ; Eyeglasses ; Humans ; Myopia ; therapy ; Orthokeratologic Procedures ; Strabismus

INTRODUCTIONThis study aimed to evaluate the proportion of young patients with type 1 diabetes mellitus (T1DM) who have myopia, as well as the risk factors associated with myopia in this group.

METHODSIn this cross-sectional study, patients aged < 21 years with T1DM for ≥ 1 year underwent a comprehensive eye examination. Presence of parental myopia, and average hours of near-work and outdoor activity were estimated using a questionnaire. Annualised glycosylated haemoglobin (HbA1c), defined as the mean of the last three HbA1c readings taken over the last year, was calculated. Multivariate analysis using genetic, environmental and diabetes-related factors was done to evaluate risk factors associated with myopia.

RESULTSOf the 146 patients (mean age 12.5 ± 3.6 years) recruited, 66.4% were Chinese and 57.5% were female. Myopia (i.e. spherical equivalent [SE] of -0.50 D or worse) was present in 96 (65.8%) patients. The proportion of patients with myopia increased from 25.0% and 53.6% in those aged < 7.0 years and 7.0-9.9 years, respectively, to 59.2% and 78.4% in those aged 10.0-11.9 years and ≥ 12.0 years, respectively. Higher levels of SE were associated with lower parental myopia (p = 0.024) and higher annualised HbA1c (p = 0.011).

CONCLUSIONCompared to the background population, the proportion of myopia in young patients with T1DM was higher in those aged < 10 years but similar in the older age group. Myopia was associated with a history of parental myopia. Environmental risk factors and poor glycaemic control were not related to higher myopia risk.

Adolescent ; Asian Continental Ancestry Group ; Child ; Child, Preschool ; Cross-Sectional Studies ; Diabetes Mellitus, Type 1 ; complications ; ethnology ; Female ; Glycated Hemoglobin A ; analysis ; Humans ; Male ; Multivariate Analysis ; Myopia ; complications ; ethnology ; therapy ; Ophthalmology ; methods ; Refractive Errors ; Risk Factors ; Young Adult

OBJECTIVETo observe the clinical effects of myopia in children treated with abdominal acupuncture.

METHODSNinety children with myopia were randomly divided into an abdominal acupuncture group (45 cases with 90 ill eyes) and an auricular point group(45 cases with 90 ill eyes). In the abdominal acupuncture group, Zhongwan (CV 12), Shangqu(KI 17), Xiawan(CV 10), Tianshu(ST 25), Qihai(CV 6), Guanyuan(CV 4) were treated with tapping method. The needles were not retained and down to the lower in accordance with the order from Zhongwan (CV 12) to Guanyuan(CV 4) for 5 min,and the erubescence skin without blood was proper. In the auricular point group, vaccaria seeds were pasted at gan(CO12), shen(CO10),pi(CO13), wei(CO4), yan(LO5), pingjianqian(TG2i), pingjianhou(ATli) and zhen(AT3); one ear was chosen every time and the other ear the second time with pressing of patient's own for 5 min every day. The treatment was given twice a week and 10 treatments were considered as one course in the two groups. The changes of the visual levels in visual chart before treatment, 20 min after the first treatment, after 5 weeks' and 3 months' treatment were compared between the two groups,and the clinicall efficacy was compared between the two groups as well.

RESULTS(1) The visual levels in visual chart were improved in the abdominal acupuncture group and auricular point group, and the effects 20 min after the first treatment, after 5 weeks' and 3 months' treatment in the abdominal acupuncture group were superior to those in the auricular point group(4. 78±0. 16 vs 4. 69±0. 22, P<0. 01; 4. 85±0. 16 vs 4. 79±0. 21, P<0. 05; 4. 89±0. 13 vs 4. 71±0. 25, P<0. 01). (2)The effective rates 20 min after the first treatment, after 5 weeks' and 3 months' treatment in the abdominal acupuncture group were better than those in the auricular point group[31. 4% (27/86) vs 0% (0/82). 81.4%(70/86) vs 60. 0%(49/82); 88. 4%(76/86) vs 51. 2%(42/82), all P<0. 01].

CONCLUSIONAbdominal acupuncture for improving the visual levels of myopia in children is superior to auricular point sticking.

Abdomen ; physiopathology ; Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Child ; Eye ; physiopathology ; Female ; Humans ; Male ; Myopia ; physiopathology ; therapy ; Treatment Outcome ; Vision, Ocular

BACKGROUNDPathological myopia (PM) is the leading cause for choroidal neovascularization (CNV) in people below 50 years of age, the anti-vascular endothlial growth factor (VEGF) medicine is now available to treat CNV secondary to PM. This study aimed to observe the efficacy of intravitreal ranibizumab for PM associated with subfoveal or juxtafoveal CNV in Chinese patients.

METHODSFifty-four eyes of 52 consecutive patients were included, they treated with intravitreal ranibizumab 0.5 mg for PM associated with CNV. The best corrected visual acuity (BCVA) of Snellen chart, letters of ETDRS chart, retinal thickness, leakage of CNV lesion, and complications with surgery were analyzed pre- and post-treatment. Eligibility criteria included diopter ≥-8.0 D or eye axis ≥ 28 mm with fundus changes of PM (lacquer crack, optic disc atrophy, chorioretinal atrophy, posterior scleral staphyloma); CNV secondary to PM; subfoveal or juxtafoveal CNV.

RESULTSFor 54 affected eyes of 52 consecutive patients, the average BCVA of Snellen chart and letters of ETDRS chart were 0.29 and 30.4, respectively; fundus fluorescein angiography (FFA)/indocyanine green angiography (ICGA) showed CNV leakage, and average retinal thickness on optical coherence tomography (OCT) was 267.2 µm before treatment. Injections of ranibizumab ranged from 1 to 4 (mean 2.2). Follow-up time varied from 12 to 36 months (mean 31.9 months). At the last visit, the BCVA of Snellen chart was increased by three lines (mean 0.65) (P < 0.01); the letters of ETDRS chart were increased to 17.0 letters (mean 47.4, P < 0.01); the visual acuity increased more than 15 letters in 30 eyes (55.5%), decreased in 1 eye (1.9%); the retinal thickness on OCT images was decreased by 17.0 µm (mean 250.2 µm) (P = 0.082); no active leakage from the CNV lesion occurred in 18 eyes (33.3%), reduced leakage in 30 eyes (55.6%), and no change in 6 eyes (11.1%) as shown by FFA/ICGA. Increased retinoschisis was observed in one eye after the second injection.

CONCLUSIONSIntravitreal ranibizumab for neovascular PM was well tolerated in Chinese patients, with functional and anatomic improvements in a short-term study, while a long-term study is still needed.

Adolescent ; Adult ; Aged ; Antibodies, Monoclonal, Humanized ; administration & dosage ; therapeutic use ; Choroidal Neovascularization ; complications ; drug therapy ; Female ; Fluorescein Angiography ; Humans ; Intravitreal Injections ; Male ; Middle Aged ; Myopia, Degenerative ; drug therapy ; etiology ; Ranibizumab ; Visual Acuity ; drug effects ; Young Adult

PURPOSE: To investigate the biometric risk factors for corneal surface complications associated with hydrogel soft contact lens (SCL) fitting in myopic patients in Korea. METHODS: This is a retrospective case-control study. The records of 124 subjects (124 eyes) who wore SCLs on a daily basis were reviewed. Thirty-one patients (31 eyes) who were diagnosed with corneal neovascularization (NV) while wearing SCLs were included in the complication group. Ninety-three age- and sex-matched patients (93 eyes) who wore SCLs, who did not have corneal NV and who visited our clinic for correction of refractive errors were included in the control group. The degree of spherical equivalent, astigmatism and corneal base curve radius (BCR) were compared in both groups. RESULTS: Patients with NV exhibited poorer best corrected visual acuity and more myopia than controls (p = 0.008 and 0.006, respectively). In univariate analysis, highly myopic patients (-9 diopters [D] or higher) were more likely to experience NV (odds ratio [OR], 2.232; 95% confidence interval [CI], 1.602 to 3.105). High astigmatism (> or =2 D) increased the risk of complications (OR, 2.717; 95% CI, 1.141 to 6.451). Steep cornea, in which BCR was <7.5 mm, also raised the risk of complications (OR, 4.000; 95% CI, 1.661 to 9.804). Flat cornea was not a risk factor for the development of NV. CONCLUSIONS: High myopia, high astigmatism, and steep cornea seemed to be risk factors in the development of corneal NV in SCL wearers.
Adult ; Astigmatism/diagnosis ; Biometry ; Case-Control Studies ; Contact Lenses, Hydrophilic/*adverse effects ; Corneal Neovascularization/diagnosis/*etiology ; Female ; Humans ; Hydrogel ; Male ; Myopia/diagnosis/*therapy ; Prosthesis Fitting ; Retrospective Studies ; Risk Factors ; Visual Acuity

BACKGROUNDIntravitreal ranibizumab injection is effecitve on treating myopic CNVs, but it could be a risk factor for developing more severe retinoschisis in eyes with preexisted retinoschisis and epiretinal membrane. This study aimed to explore the incidence and features of retinoschisis after intravitreal ranibizumab injection for myopic choroidal neovascularization.

METHODSEighty-three eyes of 81 patients with choroidal neovascularization secondary to pathologic myopia were treated with intravitreal ranibizumab injection. The best corrected visual acuity and optical coherence tomography (OCT) images were recorded at baseline and every month thereafter. Central retina thickness and maximal retina thickness were measured. The subjects were divided into three groups. Eleven eyes that had retinoschisis and epiretinal membrane were in group 1, six eyes that had simple epiretinal membrane were in group 2, and 66 eyes that had neither retinoschisis nor epiretinal membrane were in group 3. Six contralateral eyes in group 1 which had retinoschisis and epiretinal membrane but were not treated with intravitreal ranibizumab injection were set as the control group.

RESULTSSeven of the 11 eyes in group 1 developed more severe retinoschisis, the mean maximal retinal thickness increased from (380.28 ± 90.13) to (467.00 ± 70.20) µm (P < 0.05). The retinoschisis of all 6 eyes of the control group did not aggravate. Compared with the control group, the aggravation ratio of retinoschisis increased significantly (P < 0.05). No new onset of retinoschisis took place in group 2 and group 3.

CONCLUSIONIntravitreal ranibizumab injection may be a risk factor for aggravation of retinoschisis in eyes with preexisted retinoschisis and epiretinal membrane.

Adult ; Angiogenesis Inhibitors ; administration & dosage ; therapeutic use ; Antibodies, Monoclonal, Humanized ; administration & dosage ; therapeutic use ; Choroidal Neovascularization ; drug therapy ; Female ; Humans ; Intravitreal Injections ; Male ; Middle Aged ; Myopia, Degenerative ; drug therapy ; Ranibizumab ; Retinoschisis ; drug therapy ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo compare the differences in the efficacy on distant version of naked eye in the patients of juvenile myopia between rotating manipulation and lifting-thrusting manipulation of acupuncture.

METHODSOne hundred and twenty cases (240 eyes) were randomized into a rotating manipulation group and a lifting-thrusting manipulation group, 60 cases (120 eyes) in each group. Additionally, a corrective lenses group, 60 cases (120 eyes), was set up as the control. In both manipulation groups, Cuanzhu (BL 2),Yuyao (EX-HN 4), Sizhukong (TE 23), Taiyang (EX-HN 5), Fengchi (GB 20), Zusanli (ST 36), Guangming (GB 37) and Sanyinjiao (SP 6) were punctured, but stimulated with rotating manipulation and lifting-thrusting manipulation respectively three times per week, 10 times as a treatment session and totally one session was required. In the corrective lenses group, the glasses were applied at daytime. The clinical efficacy and the changes in distant vision of naked eye before and after treatment were compared among the three groups.

RESULTSThe total effective rate was 87.5% (105/120) in the rotating manipulation group, which was better than 69.2% (83/120) in the lifting-thrusting manipulation group (P < 0.05). The distant vision of naked eye was improved apparently in the rotating manipulation group and the lifting-thrusting manipulation group after treatment (both P < 0.05). But it was not improved in the corrective lenses group (P > 0.05). The distant vision of naked eye was improved more apparently after treatment in the rotating manipulation group as compared with that in the lifting-thrusting manipulation group (0.75 +/- 0.23 vs 0.68 +/- 0.24, P < 0.05). For 96 cases (192 eyes) with acupuncture treatment, in 3-month follow-up, 87.0% (167/192) of the cases maintained the stable vision as the original level and 13.0% (25/192) of them were reduced in the vision In the acupuncture groups, it was found that the improvement of distant vision of naked eye was more obvious after treatment with younger age, better basic vision and shorter duration of sickness (all P < 0.05).

CONCLUSIONAcupuncture achieves the positive and sustainable clinical effect on juvenile myopia, and the results of rotating manipulation are superior to that of lifting-thrusting manipulation. Age, basic vision and duration of sickness impact the clinical efficacy.

Acupuncture Points ; Acupuncture Therapy ; instrumentation ; methods ; Adolescent ; Child ; Female ; Humans ; Myopia ; therapy ; Young Adult

OBJECTIVEA systematic review of literature was performed to compare various visual function parameters including the final visual acuity outcome and/or adverse events between corneal refractive surgery (CLRS) and phakic intraocular lens implantation (p-IOLi) in the treatment of refractive amblyopic children.

DATA SOURCESTwo reviewers independently searched the PubMed, EMBASE, and Controlled Trials Register databases for publications from 1991 to 2013.

STUDY SELECTIONThere were 25 articles, including 597 patients and 682 eyes, was included in CLRS group. Among them, 21 articles reported the use of CLRS in the treatment of myopic anisometropia for 318 patients (13 photorefractive keratectomy or laser epithelial keratomileusis and eight laser in situ keratomileusis). And 11 articles had the results of CLRS in treating hyperopic anisometropic amblyopia children. Eleven articles reported the effect of p-IOLi for treating high myopia or anisometropic amblyopia, including 61 patients (75 eyes). Age, pre- and postoperation best-corrected vision acuity (BCVA), and spherical equivalent (SE) were compared in CLRS and p-IOLi groups.

RESULTSThe average age of CLRS group and p-IOLi group has no statistically significant difference. The SE in CLRS group for myopic anisometropia amblyopia patients was (-10.13 ± 2.73) diopters (D) and for hyperopic anisometropia amblyopia patients was (5.58 ± 1.28) D. In p-IOLi group the SE was (-14.01 ± 1.93) D. BCVA was improved significantly in both groups, and even better in p-IOLi group. Refractive errors were corrected in both groups, but there was no clinically significant difference in final SE between each group. More than one-half of the children had improved binocular fusion and stereopsis function in both groups.

CONCLUSIONSBoth CLRS group and p-IOLi group showed their advantage in treating refractive amblyopia in children. In comparing p-IOLi with CLRS for treatment of refractive amblyopia, no statistically significant difference in final BCVA was observed.

Amblyopia ; etiology ; surgery ; therapy ; Anisometropia ; complications ; Child ; Child, Preschool ; Humans ; Myopia ; complications

Choroidal Neovascularization ; drug therapy ; etiology ; Humans ; Hyperthermia, Induced ; Myopia, Degenerative ; complications ; epidemiology ; Vascular Endothelial Growth Factor A ; antagonists & inhibitors