CPD: Syndromic myopia

The amount of refractive errors, visual acuity, fundus findings, age of onset and other relevant data were examined in 614 cases of myopia, at the Department of Ophthalmology in Juntendo University.Twenty‐seven per cent (27/100 cases) among high myopia (‐15.0D ± 7.5D) with typical chorio‐retinal atrophy and 20% (55/275 cases) of myopia (‐12.7D ± 6.4D) without typical myopic atrophy had onset at 4 yrs old or younger. However, there was no case whose age of onset was 4 yrs old or younger among 239 cases of myopia with 5D or weaker. All of them had onset in 7 yrs old or older.The average corrected visual acuity became worse as the patient became older, especially in 'high myopia with chorio‐retinal atrophy, it was (0.4‐0.5 already in childhood and about 0.2 in 40 yrs old or older). However, the corrected visual acuity in high myopia without typical myopic atrophy was kept comparatively good (about 0.7 in 40s or younger and 0.4 in 60s or older). Degree of myopia increased significantly by age, but stopped at around the 40s. These facts show that early age of onset of high myopia is very important.

Introduction: The blood groups were rst discovered by Karl Landsteiner. According to the presence of different antigens on the surface of RBCs, he classied four blood groups viz. A, B, AB and O. Many researchers observed the high prevalence of certain diseases in particular blood groups. Myopia or nearsightedness showed familial tendency and strongly suggest genetic causation. The writing, reading, outdoor exposure and family history are the major risk factor for myopia. Previous studies trying to nd relation between myopia and blood groups found contradicting results. Aim: To study the myopia and its relation to blood groups among medical students from Western Maharashtra. Materials and Methods: The present cross sectional study was carried out in department of Physiology at Dr. Balasaheb Vikhe Patil Rural Medical College Loni from Western Maharashtra. Total 159 rst MBBS student were selected for the study. Blood groups were determined by Hem-agglutination Method. Myopia determined by using Snellen's chart. Data analysis was done with SPSS version 21. P value of < 0.05 was considered as signicant. Results: Blood group 'B' had highest cases of myopia 47(29.55%) followed by 'O' 25(15.72%), 'A' 17(10.69%) and blood group 'AB' 03(1.88%). The cases of myopia in decreasing order were B>O>A>AB. No any signicant relationship found between blood groups and myopia (p value=0.2908). Slightly higher cases of myopia 49(30.82%) observed in female as compare to the male 44(27.67%). Conclusion: Prevalence of myopia is higher in medical students. There is no signicant relationship between blood groups and myopia. Encouragement for outdoor activity and reduced use of mobile and laptop may be helpful to reduce the prevalence of myopia in medical students.

To the Editor. —Most complications (loss of graft clarity, graft failure or dehiscence, microbial keratitis) following epikeratoplasty are related to delayed or incomplete reepithelialization. 1 Factors that may contribute to epithelial failure include poor patient selection, inadequate postoperative care or follow-up, and variability in the epikeratoplasty lenticules. 1 We have examined the effectiveness of bandage soft contact lenses (six cases), pressure patching (29 cases), and temporary tarsorrhaphy (13 cases) in the primary therapy of epithelial defects following epikeratoplasty. All 48 cases (20 adult cases of aphakia, 11 pediatric cases of aphakia, ten cases of keratoconus, and seven cases of myopia) met the criteria 2 of having no preexisting ocular surface disorder (eg, dry eye or severe blepharitis) that would be expected to compromise epithelial recovery. All epikeratoplasties were performed according to standard protocols. 3 In each case, the epithelium was debrided with application of 4% cocaine hydrochloride and removal with

Background: Globally the prevalence of myopia has increased alarmingly and is expected to affect an estimated 2.56 billion people in the world by the end of 2020. It is believed to be the leading cause of visual impairment in Kenya, contributing 59.5% of all causes of visual impairment. Still, agreement on the exact prevalence in Kenya and whether socio-demographic factors have an influence on myopia is unknown. This study was aimed at evaluating the prevalence of myopia and its socio-demographic distribution amongst randomly selected school-going adolescent. This study was conducted in Lurambi Sub-County in Kakamega, Kenya. Material and methods: The study adopted a school-based cross-sectional descriptive study design. Using a multi-stage sampling technique, 733 participants from a population of 7,400 secondary school students within Lurambi Sub-County were randomly selected. A standard optometric vision-assessment protocol was applied to those who met the inclusion criteria and cycloplegic refraction was conducted to elicit those who had myopia. Results: The prevalence of myopia was found to be 7.5% of which 29 (52.7%) were male while 26 (47.3%) were female and there was no association between gender and myopia (p = 0.572). Myopia was found to be more prevalent in urban 49 (87.3%) as compared to rural 7 (12.7%) areas and there was no association between place of residences and myopia (p = 0.381). Similarly, 15–18 years was the dominant age group 39 (70.9%) and there was no association between age and having myopia (p = 0.926). The study also found that there was no association (p = 0.207) between school class of the participants and having myopia, although most myopic cases were in the form four class 15 (27.3%). Conclusion: Myopia was found to be mostly prevalent in the urban setting and upper classes as compared to rural and lower classes. This may link myopia to other risk factors such as near work and outdoor activities, but more research needs to be done in these areas.

To study the difference in refraction between right and left eyes (anisometropia) in different age groups, look for evidence of eye laterality (more refractive error in one eye) and compare the size of anisometropia in the myopic and emmetropic ranges. The study was based on children in Hong Kong (examined at the age of 6 years and again at the age of 8.5 years) and their parents (aged 26-60 years). In all age groups the difference between right and left eyes in sphere and cylinder was modest, in most cases < or = 0.25 D. In both children and their parents a tendency towards spherical right eye laterality was found in the myopic individuals (p < 0.05). This was not the case with the cylinder. In the 8.5-year-old children and in their parents, the numerical size of spherical anisometropia increased with myopia (p < 0.05 and p < 0.01, respectively). Cylindrical anisometropia did not exhibit such an increase. In Hong Kong children and their parents we found a tendency towards more spherical myopia in right eyes (laterality) in myopic cases. The numerical size of spherical anisometropia also increased in myopia in these groups. Cylindrical anisometropia appeared to be independent of spherical ametropia. In most cases right/left differences in both sphere and cylinder were small and our findings justify the use of data from one eye only in publications on refraction.

Prescribing Bifocals in Myopic Cases

PurposeTo determine the distribution of keratometry values in a wide age range of 6–90 years.MethodsIn a Cross‐Sectional Study, samples were selected from two villages in Iran using multi‐stage random cluster sampling. After completing ophthalmic examinations for all cases, corneal imaging was done using Pentacam, and keratometry values were determined.ResultsOf the 3851 selected people, 3314 people participated in the study, and after applying the exclusion criteria, analyses were done on data from 2672 people. Mean age of the participants was 36.30 ± 18.51 years (from 6 to 90 years). Mean keratometry in flat and steep meridians was 42.98 (42.9–43.06) diopters (D) and 43.98 (43.91–44.07) D, respectively. Mean Mean‐K was 43.48 (43.41–43.56) D. Mean keratometry increased linearly up to the age of 70 years, and the cornea became slightly flat afterwards. Mean keratometry was significantly higher in females (P &lt; 0.001). Myopic cases had the highest Mean‐K (P &lt; 0.001). The correlation of mean keratometry with age, gender, central corneal thickness, anterior chamber depth, pupil diameter, and spherical equivalent was investigated in a multiple regression model. Only older age and female gender showed a significant association with mean keratometry. Overall, 31.62% (29.14‐34.09) of the sample had at least 1.0D of corneal astigmatism in this study.ConclusionsThis is one of the few studies worldwide that demonstrates changes in keratometry in a wide age range from childhood to old age. Results indicated that age and gender are variables associated with keratometry.

&#x0D; Myopia is a condition in which distant objects cannot be clearly displayed on the retina by the optical system of the eye, because the incoming light is refracted in front of the retina or yellow spot. Along with genetic factors, another important aspect that affect myopia is lifestyle. When a pandemic strikes, it alters people's behavior. Outdoor activities have decreased significantly, while the use of gadgets has increased as a result of youngsters learning online, which needs the use of gadgets. This study aims to determine the increase in the incidence of myopia in children due the online learning process. The type of research conducted is in the form of literature review. Searches for data that meets literature reviews that match the topic are conducted online. Online searches conducted through scientific journal sites have a diverse and quality database, namely PubMed, Schocar, and Libgen published in the last 6 years (2015-2021). Researchers found 8 journals using keywords relevant to the study. The findings highlight that the use of smartphones can cause DED, myopia and blurred vision. Due the pandemic Covid-19 situation that occur today requires children to take part in online learning programs from home via smartphone screens. Indirectly, short distance activities and lack of exposure to natural sunlight increase asthenopia conditions and increase myopia cases for children. If not addressed early on, these risks becoming an explosion of myopia cases, while the end of the COVID-19 pandemic is still unknown. Therefore, myopia preventive measures are required during pandemic outbreaks that are relevant and effective.&#x0D;

Aspect thérapeutique des déchirures géantes de la rétine : expérience sénégalaise

One of the main tasks of the children’s ophthalmological service in any region is to ensure the availability of high-tech medical care, however, personnel and technological shortages can negatively affect this indicator. Using the resources of a federal specialized clinic at the regional level can help resolve this issue. The goal is to reflect the participation of the federal specialized clinic in the work of the regional children’s ophthalmological service. Material and methods. The data used to assess the state of provision of ophthalmological care to children was taken from the electronic database of medical records of patients who received ophthalmological care at the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution in the period from 2017 to 2023. Results. In 2005, a pediatric surgical department was organized at the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution. The work of the department’s ophthalmologists is primarily aimed at providing modern surgical treatment for children with various ophthalmological diseases. The leading scientific and practical direction is retinopathy of prematurity. To ensure optimal accessibility of specialized medical care, implementation of a system for early diagnosis and monitoring of the vision status of children, in the fall of 2020, a Children’s Ophthalmological Diagnostic Center (DOC) was opened within the structure of the Kaluga branch of the MNTK. The priority direction of the DOC is the introduction into clinical practice of innovative medical technologies aimed at early detection and formation of stages in the treatment of eye diseases in children and adolescents, and the determination of recommendations for preventive measures. From 2017 to 2023, the volume of ophthalmological care provided by the Kaluga branch of MNTK was within the range of 1,400–3,000 operations per year. Every year, ophthalmological care is provided directly to more than 1000 children at the Children’s Center. In total, over the entire period of operation of the center, conservative treatment was carried out in 3552 cases of amblyopia, myopia and other forms of ametropia, including severe forms. Using the new treatment method, 809 courses of treatment have been carried out at the Amblyokor complex since September 2020. During the work of the Center, 1908 orthokeratology lens sets were selected and issued. In addition to accepting patients living in the Kaluga region, we are actively accepting children from other regions. Conclusion. Thanks to the work of the branch of the MNTK «Eye Microsurgery» in the Kaluga region, the shortage of highly qualified medical personnel is compensated, the effective use of complex and unique diagnostic and treatment equipment is concentrated and implemented, the widespread introduction of progressive treatment methods into practice is ensured, the optimal route for patients is developed, taking into account the structure of medical organizations, participating in the implementation of the program of state guarantees of providing free assistance to the population. It should be noted that ophthalmological care for the children’s population through the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution is largely provided at the interregional level, affecting the territories of neighboring regions.

To determine the extent to which high myopia in a cohort of 51 U.K. families can be attributed to currently identified genetic loci. The families comprised 245 subjects with phenotypic information and DNA available, of whom 170 were classified as affected. Subjects were genotyped for microsatellite markers spanning approximately 40cM regions on 18p (MYP2), 12q (MYP3) and 17q, together with markers flanking COL2A1, COL11A1, and FBN1. Two-point linkage analyses were performed using the same disease gene segregation model as was used in the original publications, followed by nonparametric and multipoint analyses using Genehunter (http://linkage.rockefeller.edu/soft/gh/ provided in the public domain by Rockefeller University, New York, NY), with additional maximization over the parameter alpha, the proportion of linked families. Evidence of linkage was found for the MYP3 locus on 12q (two-point Zmax = 2.54, P = 0.0003 and multipoint hLOD = 1.08 at alpha = 0.24, P = 0.023 for marker D12S332; nonparametric linkage [NPL] = 1.49, P = 0.07 for marker D12S1607). For the 17q locus there was weak evidence of excess allele sharing and linkage under a recessive model (NPL = 1.34, P = 0.09 for marker D17S956; two-point hLOD = 1.24 at alpha = 0.30 for marker D17S1795; multipoint hLOD = 1.24 at alpha = 0.17, P = 0.014 for marker at 77.68 cM, between markers D17S956 and D17S1853). No significant linkage was found to the MYP2 locus on 18p, or to the COL2A1, COL11A1, and FBN1 genes. These results suggest that the MYP3 locus on 12q could be responsible for high myopia in approximately 25% of the U.K. families showing apparent autosomal dominant transmission, but that the loci on 18p and 17q are less common causes. Thus, additional loci for high myopia are likely to be the cause of the majority of cases of high myopia in the United Kingdom.

Aripiprazole is a new drug for the treatment of adults with schizophrenia. Ocular side effects of aripiprazole are very rare. Review of literature revealed few cases of aripiprazole-induced myopia. We report a rare case of aripiprazole-induced transient myopia. A 22-year-old female patient presented to the department of psychiatry with worsening of symptoms of schizophrenia and was started on aripiprazole. She presented with complaints of blurring of vision in both eyes for 1 week which started on the 3rd day following the use of aripiprazole. Anterior segment examination revealed a shallow anterior chamber and narrow angles. Intraocular pressure was normal. A diagnosis of aripiprazole-induced acute myopia was made and the treating psychiatrist was advised to stop the medication. At 2-week follow-up, the unaided visual acuity improved to 20/20 in both the eyes. Ophthalmologists should be aware of the myopic shift that may occur as an ocular side effect with aripiprazole.

Extreme axial eyeball length is a known risk factor for decreased accuracy of intraocular lens calculations. We report a case of a 35 years-old male with anisometropic amblyopia and an axial length of 35.7 mm in his right eye. To the best of our knowledge, this is a case of one of the longest eyeballs ever scientifically reported. The patient presented with presenile cataracts in the right eye, hand movement visual acuity, and required cataract surgery. Due to his high anisometropia, he was unable to wear spectacle correction prior to surgery in the amblyopic eye. The left (non-amblyopic) eye had moderate myopia and corrected to 20/20 with no signs of cataracts. Various intraocular lens (IOL) calculations were compared, aiming for a slight postoperative residual myopia in the right eye (approx. -1.50 D). The patient required a minus-power intraocular lens, and an IOL with a larger overall diameter (model 92S "Bigfoot IOL" manufactured by Morcher GmbH, Stuttgart, Germany) was selected. On the last available visit at 6 months, his refractive error was -1.50 to -0.75 D × 179° with a corrected visual acuity of 20/63. The large IOL was stable in the capsular bag, and there were no postoperative complications. The patient was able to wear spectacles with correction in both eyes and reported significant improvement in binocular vision and quality of life. Negative power IOLs typically have different optic configurations and require special considerations during IOL calculation. Care should be taken to avoid postoperative hyperopic refractive error. Nowadays, surgeons can choose from a selection of traditional formulas, newer-generation formulas, and axial length adjustment techniques to improve refractive predictability of eyes with extreme axial myopia. With this case report, we would like to demonstrate that even in rare cases of extreme, high myopia and eyeball length > 35 mm, good results can be achieved with correct IOL power implantation if certain considerations are made prior and during the procedure. Special considerations should be taken into account to maximize patient satisfaction.

Vision for the future

One of the serious challenges facing surgeons after congenital cataract extraction with IOL implantation in infancy is unplanned refractive results revealed in the long-term period, including the cases of myopia higher than 3.0 D in approximately 50 %. Purpose. The study aimed to evaluate the clinical and functional condition of the eyes in children with moderate to high myopia. Material and methods. Our study included a total of 33 patients (61 eyes) with pseudophakia, of which 16 (26 eyes) developed moderate (12 eyes) or high (14 eyes) myopia at the age of 5 to 15 years. Parameters of the anterior and posterior eye segments were evaluated using Galilei Dual Scheimpflug Analyzer and Optical Coherence Tomography RS-3000 Advance 2, and the axial length using Optical Biometer Al-Scan. Results. The central corneal thickness (CCT) was found considerably above the norm (up to 580 ± 35 pm) in most cases of pseudophakic myopia (72.2 %). Anterior chamber depth in children (4.07 ± 0.39 mm) was equal to that in adults with pseudophakia. Astigmatism and axial length in children with highmyopia significantly exceeded those in children with moderate myopia (3.5 and 1.88 D; 23.57 ± 1.31 and 25.04 ± 1.90 mm, respectively), while choroidal thickness and best corrected visual acuity (BCVA) were much lower (268 and 181 pm; 0.1 and 0.3, respectively). There were no variations in spherical equivalent between different axial length in high and moderate myopia. Conclusion. Taken together these results suggest that with the increase of astigmatism axial length elongated and high myopia developed in children with pseudophakia. Choroidal thickness declined due this process and may be a cause of poor functional outcome. Sufficient CCT opens possibilities for refractive surgery in those patients to improve visual outcomes.