ABSTRACT Purpose To investigate the association between reduced hyperopia and the increased risk of myopia onset in preschool children aged 3–6 years. Methods This study utilized data from the Beijing Hyperopia Reserve Research (BHRR) prospective cohort, including 941 children aged 3–6 years who completed baseline and 3‐year follow‐up assessments (2021–2024). Cross‐sectional analyses compared ocular biometry among children with different baseline refractive statuses, followed by longitudinal analyses evaluating the relationship between reduced hyperopia and myopia onset. Children were categorized into pre‐myopia and hyperopia groups based on spherical equivalent refraction (SER). The predictive ability of SER for myopia onset was evaluated using receiver operating characteristic analysis, with optimal cutoffs determined by the Youden index. Age‐stratified (3–6 years) analyses identified age‐specific SER thresholds. Results The baseline cross‐sectional analysis revealed that there were no significant differences in anterior chamber depth (ACD) or corneal radius (CR) in the pre‐myopia group compared to the hyperopia group despite having a significantly lower SER ( p < 0.001) and longer AL ( p < 0.001). Over 3 years, both groups showed decreasing SER, increasing AL, and deepening anterior chambers (all p < 0.05). Furthermore, in the 5‐ and 6‐year‐old groups, the pre‐myopia group demonstrated significantly higher rates of change in SER and AL compared to the hyperopia group (all p < 0.05). The optimal SER cut‐off value for predicting myopia onset in preschool children was +0.90 D. This cut‐off value showed a decreasing trend with age, corresponding to +1.04 D, +0.95 D, +0.87 D, and +0.82 D for children aged 3, 4, 5, and 6 years, respectively. Conclusions Preschool children with lower levels of hyperopia, especially those aged 5 and 6, show a significantly higher rate of myopic drift, and AL growth compared to those with greater hyperopia. Enhanced early monitoring and interventions are essential to prevent excessive loss of hyperopia that may accelerate myopia development. Trial Registration The registration database and the registration number: Chinese Clinical Trial Registry: ChiCTR2000031142.

SIGNIFICANCE:There is a lack of knowledge on myopic progression in patients with moderate to high astigmatism, which has been compounded by their exclusion from myopia control studies. This study found increased myopia that was linearly associated with age, emphasizing the importance of understanding myopia control treatments in this population.PURPOSE:Moderate to high amounts of astigmatism cause visual blur and may affect myopic progression. However, there is little information as to the effect of cylinder on change in myopia, and the vast majority of myopia control studies have excluded children with significant astigmatism. The purpose of this study was to assess myopic and cylinder changes in children with moderate to high astigmatism.METHODS:Retrospective review of children (2 to 15 years) who presented with astigmatism (>2.00D) and myopic spherical equivalent refraction (SER) to a tertiary care pediatric hospital. Best corrected visual acuity and cycloplegic refraction changes over at least 2 years of follow-up were analyzed. Patients with confounding ocular disease, history of myopia control, or Trisomy 21 were excluded.RESULTS:Two hundred twenty-seven patients presented at 6.6 years (IQR 5.2, 9.1) with a median 0.00D (IQR −2.00, 0.50) sphere, −3.00D (IQR −4.25, −2.50) cylinder, and −1.75 (IQR −3.75, −0.99) SER. Twenty-four percent of patients had amblyopia and 46% had strabismus. At final exam (4.9 [IQR 3.0, 6.7] years), patients were more myopic and had greater cylinder (p<0.001). Hispanic patients were disproportionately represented (64%) but had no difference in refractive parameters versus non-Hispanic patients. Initial age was linearly associated with sphere and SER, and the rate of change in sphere and SER over 2 to 3 years of follow-up. Initial J0 was linearly associated with myopic and cylindrical progression.CONCLUSIONS:Children with moderate to high levels of astigmatism showed myopic and cylindrical progression at follow-up. Amblyopia and strabismus were common in our cohort, but neither amblyopia nor strabismus affected the rates of myopic or cylindrical progression. Patients with moderate astigmatism (−2.00 to −3.00D) had more myopic and cylindrical progression compared with those with higher levels of astigmatism.

SIGNIFICANCE:Despite significant evidence supporting the utility of vision screening for identifying children who need further evaluation by an eye care professional, there is considerable variability in screening guidelines along with a lack of consensus for monitoring and reporting outcomes. This article provides updated vision screening recommendations for pre-school-age children (aged 3 to <6 years) in the United States.PURPOSE:The goal of vision screening programs is to identify, refer, and help ensure eye examinations for children who may have vision disorders, such as significant uncorrected refractive errors, amblyopia, strabismus, reduced visual acuity, and other vision and eye health problems. This article provides an update to the 2015 recommendations for vision screening in pre-school-age children in the United States, which were developed by the National Expert Panel to the National Center for Children’s Vision and Eye Health (NCCVEH) at Prevent Blindness.METHODS:Recommendations for vision screening for pre-school-age children were developed by the NCCVEH and published in 2015. The updated recommendations in this article were developed through a targeted literature review (PubMed and Science Direct) and expert opinion from the committee, which approved the final recommendations.RESULTS:The committee recommends that vision screening programs have follow-up systems to ensure that referred children receive comprehensive eye examinations. In addition, screening programs should consist of observation, threshold or critical line (age-specific minimal acuity line to pass) distance visual acuity, binocular critical line near visual acuity, and stereopsis, all of which should be performed annually. Instrument-based screening may be used in place of distance visual acuity and stereopsis, though additional research is needed to guide the recommendation for specific devices.CONCLUSIONS:The NCCVEH recommends that children aged 3 to <6 years have their vision screened annually to identify potential eye health and vision disorders. These updated vision screening recommendations provide lay screeners with a standardized approach for detecting vision problems and ensuring timely intervention and treatment. The NCCVEH will continue to provide vision screening updates at http://nationalcenter.preventblindness.org.

BACKGROUNDDry eye is a common condition with serious implications worldwide. The unique composition of autologous serum (AS) eye drops has been hypothesized as a possible treatment.OBJECTIVESThis study aimed to review the effectiveness and safety of AS.DATA SOURCESWe searched five databases and three registries up to September 30, 2022.STUDY ELIGIBILITYWe included randomized controlled trials (RCTs) comparing AS with artificial tears, saline, or placebo for participants with dry eye.STUDY APPRAISAL AND SYNTHESIS METHODSWe adhered to Cochrane methods for study selection, data extraction, risk-of-bias assessment, and synthesis. We used the Grading of Recommendations Assessment, Development and Evaluation framework to evaluate the certainty of evidence.RESULTSWe included six RCTs with 116 participants. Four trials compared AS with artificial tears. We found low-certainty evidence that AS may improve symptoms (0- to 100-point pain scale) after 2 weeks of treatment compared with saline (mean difference, −12.00; 95% confidence interval, −20.16 to −3.84; 1 RCT, 20 participants). Ocular surface outcomes (corneal staining, conjunctival staining, tear breakup time, Schirmer test) were inconclusive. Two trials compared AS with saline. Very low-certainty evidence suggested that Rose Bengal staining (0- to 9-point scale) may be slightly improved after 4 weeks of treatment compared with saline (mean difference, −0.60; 95% confidence interval, −1.11 to −0.09; 35 eyes). None of the trials reported outcomes of corneal topography, conjunctival biopsy, quality of life, economic outcomes, or adverse events.LIMITATIONSWe were unable to use all data because of unclear reporting.CONCLUSIONSThe effectiveness of AS is uncertain based on current data. Symptoms improved slightly with AS compared with artificial tears for 2 weeks. Staining scores improved slightly with AS compared with saline, with no benefit identified for other measures.IMPLICATIONS OF KEY FINDINGSHigh-quality, large trials enrolling diverse participants with varying severity are needed. A core outcome set would allow for evidence-based treatment decisions consistent with current knowledge and patient values.

On comparing the Humphrey Field Analyzer (HFA) 24-2C Faster, which tests 10 additional points in the central field, with the 24-2 Swedish Interactive Thresholding Algorithm (SITA) Standard for detecting central field defects, we found that the HFA 24-2C Faster may be used for the initial field evaluation in glaucoma with the advantage of a shorter testing time. This study aimed to compare the HFA 24-2C Faster with the 24-2 SITA Standard and 10-2 among patients with glaucoma for the number of defective central points, global indices, and testing time. Sixty eyes of 60 patients with glaucoma and glaucomatous visual field defects on the 24-2 SITA Standard algorithm underwent the 24-2C Faster and 10-2 field tests. The number of central points detected, global indices, and reliability indices were compared between the 24-2C Faster and the 24-2 SITA Standard and 10-2 field tests. The 24-2C Faster, on average, detected 5.5 defective points more on the total deviation plot and 2 defective points more on the pattern deviation plot than the 24-2 SITA Standard in central 10°. The 10-2 algorithm detected 2.5 times more points on the total deviation plot than the 24-2C Faster. There was excellent consistency by an intraclass correlation coefficient of 0.95 for the mean deviation and 0.93 for the pattern standard deviation between the 24-2C Faster and the 24-2 SITA Standard. There was good consistency by an intraclass correlation coefficient of 0.80 for both mean deviation and pattern standard deviation between the 24-2C Faster and the 10-2. The testing time was significantly lower with the 24-2C Faster compared with the 24-2 SITA Standard and 10-2 test. Our study demonstrates that the HFA 24-2C Faster may be used for the initial evaluation of the visual field in glaucoma with the added advantage of a shorter testing time compared with the 24-2 SITA Standard program.