Risk of Glaucoma and Undergoing Glaucoma Surgery in Myopic and Highly Myopic Eyes: A Nationwide Population-Based Cohort Study.

PurposeTo investigate the impact of myopia on the Brillouin biomechanics and morphology of crystalline lenses in Chinese adults.MethodsPatients with myopia were enrolled and divided into low-medium (spherical equivalent [SE] ≥ −5.75 D, N = 66) and high (SE ≤ –6.0 D, N = 72) myopia groups. All patients underwent routine ophthalmic examinations, including SE, axial length, and anterior chamber metrics (Pentacam) measurements. The Brillouin-related metrics of the crystalline lenses were measured using a Brillouin microscopy. The morphological parameters included the Width of Top Plateau (WTP), Width of Bottom Plateau (WBP), Bottom-Top (B-T), Slope of Anterior Cortex (SAC), and Slope of Posterior Cortex (SPC). The height of Plateau was a biomechanical parameter.ResultsThe study included 138 eyes (138 patients); the mean age was 28.43 ± 8.31 years. WBP, B-T, SAC, and SPC significantly differed between the high and low-medium myopia groups (all P<0.05). WBP, B-T, and SPC significantly correlated with SE in the high myopia group (Pearson’s r = 0.365, 0.287, and 0.294, respectively; all P<0.05) but not in the low-medium group. The SPC significantly decreased for all participants based on the SE values (P<0.05). The biomechanics and thickness of the nucleus displayed no discrepancies with SE in all participants (all P >0.05).ConclusionAn increase in the degree of myopia could be associated with posterior cortex thickening while maintaining stable biomechanics and morphology of the crystalline lens nucleus. Brillouin microscopy can serve as an effective technique for multidisciplinary lens biomechanical and morphological imaging.

Background/aims:To evaluate the relationship between the axial length and refractive error and peripapillary retinal nerve fibre layer (RNFL) thickness profiles measured using Stratus optical coherence tomography (OCT) in subjects with...

Visual and refractive outcomes of small-incision lenticule extraction in mild, moderate, and high myopia: Six-month results

Objective: To evaluate the clinical effect after a femtosecond laser corneal small incision lenticule extraction (SMILE) procedure for the correction of low, moderate, and high myopia. Methods: This was a retrospective case series study. 86 patients (141 eyes) with myopia were chosen to undergo the SMILE procedure between December 2014 and September 2015 at the Department of Ophthalmology, Wuhan General Hospital of the Chinese PLA, all patients completed 1 year of follow-up. The average age of the patients was 23.9±5.2 years (range 18 to 35 years). According to the preoperative spherical equivalent (SE), treated eyes were divided into three groups: a low myopia group (-0.50 D<SE≤-3.00 D) with 35 eyes, a moderate myopia group (-3.00 D<SE≤-6.00 D) with 54 eyes, and a high myopia group (-6.00 D<SE≤-10.00 D) with 52 eyes. Preoperative SE was -2.12±0.63 D, -4.71±0.88 D, and -7.24±0.76 D in the three groups, respectively. Follow-up visits were at 1 day, 1 week and 1, 3, 6, 12 months after surgery. The outcome measures included uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and postoperative SE. The results were analyzed with repeated measures analysis of variance and single factor analysis. Results: UCVA gradually increased with time after surgery in all three groups (P<0.001). At one year postoperatively, 35 eyes (100%), 54 eyes (100%) and 50 eyes (96%) had a UCVA of 5.0 or greater in the three respective groups. The efficacy indexes were 1.00±0.01, 1.00±0.01, 0.99±0.02 for the three groups. BCVA gradually increased after SMILE in the low and moderate myopia groups (F=4.73, P<0.001; F=19.53, P<0.001), but there was no significant difference in the high myopia group (F=1.87, P=0.12). No eyes lost two or more lines. Thirty-four eyes achieved a stable or improved BCVA postoperatively included 34(97%), 51(94%), 47(90%) in the low, moderate and high myopia groups, respectively. The safety indexes were 1.01±0.01, 1.01±0.01, 1.00±0.01 for the three groups. The postoperative SE in the low myopia group remained stable, while in the moderate myopia group, it was overcorrected in the early stages after surgery and gradually reached emmetropia at one year. In the high myopia group, there was a little regression at one year. Conclusions: All patients achieved good vision after SMILE, and SMILE is a safe and effective procedure for the correction of low, moderate, and high myopia, and has excellent predictability and stability, especially for low and moderate myopia. Key words: small incision lenticule extraction; myopia; clinical effect

PurposeTo compare the posterior corneal curvature changes, in terms of corneal power and asphercity, following Refractive Small Incision Lenticule Extraction (ReLEx SMILE) procedure for low, moderate, and high myopia.MethodsThis retrospective, non randomized, comparative, interventional trial; included 52 eyes of 26 patients, divided in three groups: low myopia (myopia ≤3 D [diopters] spherical equivalent [SE]), moderate myopia (myopia >3 D and <6 D SE), and high myopia (myopia ≥6 D SE). All patients were treated for myopia and myopic astigmatism using ReLEx SMILE. The eyes were examined pre-operatively and 3 months post-operatively using SCHWIND SIRIUS, a three-dimensional rotating Scheimpflug camera with a Placido disc topographer to assess corneal changes with regard to keratometric power and asphericity of the cornea.ResultsA statistically significant increase in mean keratometric power in the 3, 5, and 7 mm zones of the posterior corneal surface compared with its pre-ReLEx SMILE value was detected after 3 months in the moderate myopia group (pre-operative [pre-op] −6.14±0.23, post-operative [post-op] −6.29±0.22, P<0.001) and high myopia group (pre-op −6.19±0.16, post-op −6.4±0.18, P<0.001), but there was no significant change in keratometric power of the posterior surface in the low myopia group (pre-op −5.87±0.17, post-op −6.06±0.29, P=0.143). Asphericity (Q-value) of the posterior surface changed significantly (P<0.001) after ReLEx SMILE in the moderate myopia group in the 3, 5, and 7 mm zones, and in the high myopia group in the 3 and 7 mm zones; but there was no significant change in the Q-value in the low myopia group in all three zones (pre-op 0.23±0.43, post-op −0.40±0.71, P=0.170), and in the high myopia group in the 5 mm zone (P=0.228).ConclusionReLEx SMILE causes significant changes in posterior corneal keratometric power and asphericity in moderate and high myopia, but the effect is subtle and insignificant in low myopia.

Patterns of late corneal scarring after photorefractive keratectomy in high and severe myopia

Background: Myopia, a condition of growing concern in Asian populations, has been linked to ocular structural changes that may affect corneal endothelial morphology. Endothelial cell density (ECD), shape, and size changes have been observed in cases of high myopia. However, population-specific data, particularly in Malaysia, remain limited. In this study, we evaluated corneal endothelial morphology across different severities of myopia in young Malaysian adults. Methods: For this cross-sectional study, we categorized individuals with myopia, aged 19–24 years, attending the International Islamic University Malaysia Optometry Clinic, into low, moderate, and high myopia groups, based on spherical equivalent. They underwent non-cycloplegic refraction, axial length, intraocular pressure, and slit-lamp assessments. Using a non-contact specular microscope, we measured corneal endothelial parameters, ECD (cells/mm²), coefficient of variation (CV) of the cell area, percentage of hexagonal cells (HEX, %), and central corneal thickness (CCT, micrometer) centrally, in triplicate, and averaged the values. All assessments were conducted by an experienced optometrist under controlled environmental conditions. Results: We analyzed data from 374 eyes of 187 young adults (mean [standard deviation] age: 20.16 [0.75] years) across varying degrees of myopia. Axial length increased with myopia severity, while best-corrected visual acuity remained comparable among groups. Statistically significant differences in mean ECD, CCT, and HEX (all P &lt; 0.05), but not in CV, were observed across the three myopia groups. Post-hoc analysis revealed that, compared to low myopia, the high myopia group had significantly lower ECD, HEX, and CCT (all P &lt; 0.05), while the moderate myopia group showed significantly reduced ECD and HEX (both P &lt; 0.05). ECD, CCT, and HEX did not differ significantly between the moderate and high myopia groups (all P &gt; 0.05). Conclusions: We demonstrated that higher myopia severity in young Malaysian adults was significantly associated with lower ECD, reduced HEX, and thinner CCT, whereas CV did not differ across myopia levels. These findings indicated that increasing myopia severity is associated with notable morphological changes in the corneal endothelium. Thus, progressive axial elongation in myopia may adversely impact corneal endothelial morphology and biomechanical stability. Given the cross-sectional nature and limited demographic scope of the study, further longitudinal and multi-ethnic studies are warranted to clarify the causal pathways and long-term implications of myopia-related endothelial changes.

Objective To evaluate the optical quality of young patients with myopia by using the Double-pass Optical Quality Analysis System (OQASTM II) to establish a new range of reference values; to further provide evidence for the clinical diagnosis and evaluation of myopia in young patients. Methods This was a cross-sectional study. Three hundred forty-two young patients participated in this study. Patients were divided into three groups based on spherical equivalent (SE) : a low myopia group, a moderate myopia group, and a high myopia group. Optical quality measurements for a 4.0 mm pupil were performed using the OQASTM II. The following parameters were analyzed: the objective scatter index (OSI) , the modulation transfer function cutoff frequency (MTF cutoff) , the Strehl ratio (SR) , visual acuity (VA) at 100%, 20%, and 9% contrasts and the amplitude of accommodation (AMP) . Data were analyzed using ANOVA and pearson correlation. Results ①The normal limits of OSI, MTF cutoff, SR, VA100%, VA20%, VA9%, AMP were 0.48-0.68, 36.54-40.20, 0.22-0.25, 1.22-1.34, 1.25-1.41, 1.32-1.49, 1.18-1.47 in low myopia group, respectively; 0.61-0.76, 34.55-37.07, 0.21-0.22, 1.15-1.24, 1.16-1.26, 1.20-1.30, 1.28-1.48 in moderate myopia, respectively; 1.39-2.20, 28.40-31.99, 0.17-0.19, 0.95-1.07, 0.92-1.05, 0.92-1.05, 1.62-1.88 in high myopia, respectively. As the parameter values increase, visual quality decreases in myopia, while the OSI and AMP values increase. ②The OSI was negatively correlated with the MTF cutoff and SR values and the differences were statistically significant (r=-0.65, -0.50, P 0.05) . Conclusion This study revealed the normal range of reference values of OQASTM II for patients with different refractive statuses. This could provide evidence for establishing reference values, evaluating the visual quality of patients who have different degrees of myopia and discriminating healthy eyes from eyes that have early abnormalities. Key words: Myopia; Visual quality; Optical quality analysis system; Double-pass

Background As assessment of the peripapillary retinal nerve fiber layer (RNFL) has been an important approach for detecting structural damage in patients with glaucoma and myopia is a vital risk factor of primary open glaucoma,it is urgent to establish the correlation between RNFL thickness and myopia,not only for understanding the characteristics of RNFL with the change of the degree of myopia,but also for identifying those myopic patients with the early stage of glaucoma.Objective This study was to assess the influence of myopia for the thickness of RNFL measured by 3D optical coherence tomography (3D-OCT).Methods Two hundred and fifty-eight eyes of 258 myopic subjects from General Hospital of Ningxia Medical University were recruited.The myopic eyes were divided into low myopia group (42 eyes,-0.5 D ≤ SE ≤-3.0 D),middle myopia group (120 eyes,-3.0 D＜SE≤-6.0 D),high myopia group (58 eyes,-6.0 D＜SE≤-8.0 D) and extreme high myopia group (38 eyes,SE ＞-8.0 D).The peripapillary RNFL thickness profile including temporal,superior,nasal and inferior quadrants and each of the 12 clocks was measured by 3D-OCT.The measured values were compared among different degrees of myopia,and the correlations between spherical equivalent (SE) and axial length with RNFL thickness were analyzed using linear regression equation.Results The RNFL thickness was gradually declined with the increase of SE and elongation of axis,showing significant differences among the 4 groups in the superior,nasal and inferior quadrants and mean RNFL thickness (F=10.48,15.60,3.31,8.98,all at P＜0.05),but temporal RNFL thickness was increased with the SE rise,with markedly difference among the 4 groups (F =2.92,P =0.03) ; and RNFL thicknesses in the superior,nasal,inferior quadrants and mean RNFL thickness were evidently declined in the high and extreme high myopia group in comparison with low myopia group (all at P＜0.05).The overall RNFL parameters at 1:00,2:00,3:00,4:00,5:00,6:00,8:00,12:00 o'clock sectors were thinning as the increase of SE (all at P＜0.05) and unchanged at the 7:00,9:00,10:00,11:00 sectors in different SE groups (all at P＞ 0.05).Negative correlations were found between axial length or SE with the RNFL thicknesses at superior,nasal and inferior quadrants,average thickness as well as 1:00,2:00,3:00,4:00,5:00,6:00,11:00,12:00 o 'clock,and positive correlation was seen between the axial length or SE with the RNFL thicknesses at temporal quadrant.Conclusions The thickness of RNFL varys with the different degree of myopia and axial length. Key words: Optical coherence tomography; Myopia; Retinal nerve fiber

To compare the visual and refractive outcomes of low versus high myopic correction using laser in situ keratomileusis (LASIK) surgery. Patients who underwent myopic LASIK between January 2013 and December 2023 were included. Eyes were divided into two groups based on preoperative myopia severity: low (0.50 to 3.00 diopters [D]) and high (≥ 6.00 D). Adjustments were made to account for differences in baseline and intraoperative parameters. In this retrospective study, 12,074 eyes of 6,985 patients were included. Mean spherical equivalent (SEQ) was -6.84 D for high myopia and -2.02 D for low myopia. High myopia was found in 6.7% of patients (n = 813), demonstrating preoperative steeper corneas (maximum keratometry 44.49 vs 44.21 D, P < .001) and worse uncorrected and corrected distance visual acuity (UDVA and CDVA) (2 vs 0.77 logMAR, P < .001; 0.03 vs 0.02 logMAR, P < .001, respectively). Following LASIK, the high myopia group had worse UDVA (0.04 vs 0.01 logMAR, P < .001) and CDVA (0.03 vs 0.01 logMAR, P < .001), higher cylinder (-0.08 vs -0.05 D, P < .001), and SEQ (-0.12 vs -0.07 D, P = .015). Keratometry measurements were flatter in the high myopia group (average: 38.43 vs 41.83 D, P < .001). After accounting for differences in baseline and intraoperative parameters, all of the above-mentioned parameters remained statistically significant. High myopia was not associated with higher re-treatment rates (P = .27). Although LASIK surgery yielded satisfactory short-term outcomes in both low and high myopia, high myopia showed slightly less favorable refractive results. However, overall results were clinically acceptable in both groups. Similar re-treatment rates may reflect patient satisfaction or variability in surgeons' thresholds for offering enhancement procedures.

To evaluate the effect of trabeculectomy (Trab MMC) on visual field (VF) progression in eyes with glaucoma and high myopia. Patients diagnosed with primary open-angle glaucoma or exfoliation glaucoma who underwent Trab MMC as the first glaucoma surgery along with ≥3 VF tests preoperatively and postoperatively were enrolled. High myopia was defined as an axial length ≥26.5 mm. Postoperative reductions in intraocular pressure (IOP) were assessed by survival analysis using IOP measurements obtained preoperatively. The longitudinal trends of the outcome measures were evaluated using linear mixed models. Thirty-five eyes of 32 patients were included in this study, including 22 eyes of 20 patients in non-highly myopic group and 13 eyes of 12 patients in highly myopic group. IOP decreased after Trab MMC, and the survival rate did not differ significantly in relation to axial length. Linear mixed-model analyses suggested that the inhibitory effects of Trab MMC on the rate of mean deviation (MD) changes were significant in the non-highly myopic group (-0.53 ± 0.15 dB/year preoperatively to -0.16 ± 0.13 dB/year postoperatively; P = 0.004), but not in the highly myopic group (-0.66 ± 0.19 dB/year preoperatively to -0.48 ± 0.18 dB/year postoperatively; P = 0.32). Trab MMC reduced IOP in both highly myopic and non-highly myopic eyes, and IOP reduction was very similar in both groups. The VF deterioration rate decreased in both groups, but the change was weaker and nonsignificant in the highly myopic group.

BackgroundCutaneous squamous cell carcinoma (SCC) is associated with underlying immunosuppression, so it may be a prognostic marker in patients with subsequent cancer. We therefore conducted a nationwide population-based Danish cohort study to evaluate whether a history of cutaneuos SCC has prognostic impact in patients with one of the following index cancers: non-Hodgkin's lymphoma (NHL), or cancer of the lung, colon, rectum, breast, or prostate.MethodsWe used Danish medical databases, which cover the entire Danish population of 5.6 million inhabitants and linked them using the unique personal identification number assigned to all Danish residents. From 1982 through 2003, we identified 745 index cancer patients with and 79,143 without previous cutaneous SCC. Using Cox proportional hazards regression, we calculated adjusted mortality rate ratios (MRRs) with 95% confidence intervals (CIs).ResultsOverall, previous SCC was associated with an increased mortality of cancer (MRR 1.13, 95% CI: 1.04-1.23). When examining index cancers separately, increased MRRs were found for cancer of the lung (MRR 1.23, 95% CI: 1.05-1.43), colon (MRR 1.13, 95% CI: 0.92-1.40), rectum (MRR 1.29, 95% CI: 1.00-1.67), breast (MRR 1.09, 95% CI: 0.82-1.43), and NHL (MRR 1.09, 95% CI: 0.81-1.47), but not for prostate cancer (MRR 0.99, 95% CI: 0.83-1.18).ConclusionsOur results suggest that previous cutaneous SCC is associated with poor prognosis of some cancers. This finding stresses the importance of adherence to the existing recommendations of screening, diagnosis, and treatment of cancer in patients with a history of SCC.

目的 对在校中小学生眼健康状况中的动态屈光基本情况进行调查,为青少年眼保健提供基础资料.方法采用横断面调查设计,用自动验光仪(NIKON SPEEDY-K)非散瞳情况下对中小学生5757人次11514眼动态眼屈光状态等指标进行采集,输入编辑的专项应用程序,用SPSS11.0软件行统计分析.结果 1.中小学生(年龄7～18岁)在正常动态情况下,近视眼的检出率为81.4%,在小学1年级(7岁)、初中1年级(13岁)、初中3年级(15岁)、高中3年级(18岁)近视检出率分别为48%、84%、95%、95%.其中51.6%为低度近视,24.5%中度近视,5.3%高度近视;正视眼仅占15.1%,尚有3.5%的远视眼;在初小、高小、初中、高中4个阶段不同屈光状态的变化:高度近视、中度近视逐渐增加,分别由0.8、8.2%上升至7.7、31.8%,正视、远视逐渐下降,分别由40.5、4.8%下降至3.8、2.2%,低度近视在41.7～57.9%间波动.2.中小学平均屈光度(-2.25±2.15)D.4个阶段平均屈光度为:初小(-1.02±1.48)D,高小(-1.67±1.67)D,初中(-2.39±2.10)D,高中(-3.39±2.34)D;小学阶段平均屈光度为(-1.32±1.60)D,中学阶段平均屈光度为(-2.76±2.24)D.性别中,女生平均屈光度(-2.38±2.17)D高于男生(-2.13±2.12)D.眼别中,右眼平均屈光度(-2.33±2.13)D高于左眼(-2.17±2.18)D.各组间有显著性差异(P=0.000).小1和高3的平均屈光度为(-0.82±1.42)D和(-3.57±2.25)D,而高3男生的平均屈光度为(-3.64±2.19)D,女生为(-3.50±2.31)D.其中低度近视平均(-1.64±0.73)D,中度近视平均(-4.31±0.84)D,高度近视平均(-7.43±1.29)D;正视平均(-0.12±0.27)D,远视平均(1.98±1.67)D.3.初小、高小、初中、高中4个阶段平均屈光度依次年增长近视为-0.12D、-0.12D、-0.56D、-0.09D;小学阶段、中学阶段平均屈光度依次年增长近视为-0.16D、-0.67D;7～18岁间平均年增长近视为-0.22D.结论 12个年级中,7岁平均屈光度已呈近视化,高中3年级(18岁)平均屈光度已呈中度近视改变;在初小、高小、初中、高中4个阶段不同屈光状态的构成比的变化:高中度近视逐渐增加,正视、远视逐渐下降;整个中小学阶段呈逐年上升趋势,阶段跳跃式发展,学生的屈光度在高小、特别是初三年级有明显的近视化,在高三年级有继续向近视发展的趋势;女生的近视进展趋势均高于男生,右眼在近视化进展高于左眼.各年级屈光近视化增长在初1和高1、2有2个回退,而在小4、5,初3和高3有3个递增.应针对中小学各年级学生这一人群的眼屈光状态,采取综合手段进行医疗干预。

PurposeThis study aimed to examine the relationship between axial length (AL) and anterior segment biometry in Chinese children and adolescents with high axial myopia.MethodsA cross-sectional study was conducted involving 366,278 Chinese students aged 7 to 18 years from January 2020 to December 2022. The SUOER μ-Meter optical biometric was used for measuring ocular biometric parameters. A multivariate linear regression model was used to examine the correlation with AL.ResultsAmong the participants, 28,877 exhibited high axial myopia (AL ≥ 26 mm). The average keratometry (K) and lens thickness (LT) in the high axial myopia group were significantly lower than those in both the non-myopia and normal myopia groups (all p < 0.001). Central corneal thickness (CCT) and anterior chamber depth (ACD) were significantly greater in the high axial myopia group compared to both non-myopia and normal myopia groups (all p < 0.001). Multivariate linear regression analysis demonstrated that K (β = −0.265), CCT (β = 0.001), ACD (β = 1.609), and LT (β = −0.607) were all correlated with AL (all p < 0.001). After adjusting for gender and age, when AL was <27 mm, AL was negatively correlated with LT; similarly, when AL exceeded 27 mm, there was no linear correlation between AL and LT (p > 0.05).ConclusionIn Chinese children and adolescents, a high AL (i.e., ≥26 mm) was associated with significantly lower K, thicker CCT, and deeper ACD, and thinner LT compared with subjects having AL < 26 mm. When AL was <27 mm, LT thinning may contribute to myopia compensation; however, when AL exceeds 27 mm, this compensatory effect of crystalline lens thickness appears to diminish.

To evaluate the postoperative asphericity in low, moderate, and high myopic eyes after combined transepithelial photorefractive keratectomy and SmartSurfACE treatment (SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany). In this retrospective case series, the outcomes of myopic SmartSurfACE were evaluated at 3 months postoperatively in 106 eyes and divided into low (less than -4.125 diopters [D]), moderate (-4.125 to -6.25 D), and high (more than -6.25 D) myopia groups. In all cases, standard examinations and preoperative and postoperative corneal topography (SCHWIND Sirius) were performed. The analysis comprised evaluating the change in asphericity versus planned correction, comparing expected and achieved postoperative asphericity for all eyes, and comparison of the three groups in terms of the preoperative and postoperatively expected and achieved asphericity. RESULTS At 3 months postoperatively, the low myopia group (n = 33) improved average negative asphericity (Q = -0.04 ± 0.17 preoperative vs -0.19 ± 0.20 postoperative, P < .05). The moderate myopia group (n = 35) maintained or slightly improved average negative asphericity (Q = -0.07 ± 0.14 preoperative vs -0.05 ± 0.24 postoperative, P = .35). For the high myopia group (n = 38), the eyes became more oblate compared to the preoperative status (Q = -0.09 ± 0.15 preoperative vs 0.62 ± 0.70 postoperative, P < .05). In terms of asphericity, the difference between the three groups was not statistically significant preoperatively (P > .10), but showed significant differences postoperatively (P < .007). The cohort's average preoperative corrected distance visual acuity was 0.01 ± 0.04 logMAR (range: 0.0 to 0.18 logMAR) and uncorrected distance visual acuity was 0.03 ± 0.08 logMAR (range: -0.12 to 0.40 logMAR) 3 months postoperatively. SmartSurfACE maintained or slightly improved preoperative corneal asphericity for low to moderate myopic corrections (up to -6.00 D). This may provide advantages in the quality of vision and the onset of presbyopic symptoms after laser refractive surgery in myopic patients. [J Refract Surg. 2017;33(12):820-826.].