Junwen Zeng

Refractive errors in 3-6 year-old Chinese children: a very low prevalence of myopia?

Purpose To examine the prevalence of refractive errors in children aged 3–6 years in China. Methods Children were recruited for a trial of a home-based amblyopia screening kit in Guangzhou preschools, during which cycloplegic refractions were measured in both eyes of 2480 children. Cycloplegic refraction (from 3 to 4 drops of 1% cyclopentolate to ensure abolition of the light reflex) was measured by both autorefraction and retinoscopy. Refractive errors were defined as followed: myopia (at least −0.50 D in the worse eye), hyperopia (at least +2.00 D in the worse eye) and astigmatism (at least 1.50 D in the worse eye). Different definitions, as specified in the text, were also used to facilitate comparison with other studies. Results The mean spherical equivalent refractive error was at least +1.22 D for all ages and both genders. The prevalence of myopia for any definition at any age was at most 2.5%, and lower in most cases. In contrast, the prevalence of hyperopia was generally over 20%, and declined slightly with age. The prevalence of astigmatism was between 6% and 11%. There was very little change in refractive error with age over this age range. Conclusions Previous reports of less hyperopic mean spherical equivalent refractive error, and more myopia and less hyperopia in children of this age may be due to problems with achieving adequate cycloplegia in children with dark irises. Using up to 4 drops of 1% cyclopentolate may be necessary to accurately measure refractive error in paediatric studies of such children. Our results suggest that children from all ethnic groups may follow a similar pattern of early refractive development, with little myopia and a hyperopic mean spherical equivalent over +1.00 D up to the age of 5–6 yearsin most conditions.

Effects of 7-methylxanthine on the sclera in form deprivation myopia in guinea pigs

Purpose:  The aim of this study was to determine the effect of the adenosine receptor antagonist 7‐methylxanthine (7‐MX) on form deprivation myopia in 3‐week‐old guinea pigs.

Adenosine receptor protein changes in guinea pigs with form deprivation myopia.

Acta Ophthalmol. 2010: 88: 759–765

Validation and Cost-effectiveness of a Home-Based Screening System for Amblyopia

PURPOSE To investigate the cost-effectiveness of a novel home-based screening system for amblyopia and amblyogenic risk factors. DESIGN Evaluation of diagnostic test or technology. PARTICIPANTS Two thousand four hundred forty-two preschoolers 3 to 6 years of age from 10 kindergartens randomly selected from Guangzhou participated in the study in 2009. METHODS Preschoolers were assessed for amblyopia and amblyogenic risk factors by their parents using the home-based screening system and were re-evaluated by professionals who conducted a comprehensive eye examination. MAIN OUTCOME MEASURES Sensitivity, specificity, positive predictive value, negative predictive value, and the cost-benefit of the home-based screening system were calculated by comparing the results from the home-assessed model and those from the professional evaluation. RESULTS Three thousand three hundred children were invited to participate in the study, and 2308 (1216 boys and 1092 girls) completed all of the procedures. Twenty-four amblyopes were found by professional examinations. Fifteen of these amblyopes had not been diagnosed previously, and 12 of them were detected by the home-assessment model. The sensitivity, specificity, positive predictive value, and negative predictive value were 80.0%, 94.1%, 8.2%, and 99.9%, respectively. Professional examinations cost an average of US

BMP-2 Is Involved in Scleral Remodeling in Myopia Development

1131.00 per case of amblyopia detected, whereas the cost was only US

Regulation of scleral fibroblast differentiation by bone morphogenetic protein-2.

266.00 per case for the home-based method. For amblyogenic factors, 50, 87, and 96 children were classified into grade I, II, or III according to the professional examinations. The corresponding numbers in the home-based system were 23, 29, and 15, respectively. Accordingly, the true positive rates were 46.0%, 33.3%, and 15.6% for each grade. CONCLUSIONS The home-based amblyopia screening system was found to be a simple, effective, and cost-beneficial method for amblyopia screening and amblyogenic risk factors. The approach offers a practical option for developing areas with large populations. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Time-Course of Changes in Choroidal Thickness after Complete Mydriasis Induced by Compound Tropicamide in Children.

The development of myopia is associated with scleral remodeling, but it is unclear which factors regulate this process. This study investigated bone morphogenetic protein-2 (BMP-2) expression in the sclera of guinea pigs with lens-induced myopia (LIM) and after recovery from myopia and evaluated the effect of BMP-2 on extracellular matrix (ECM) synthesis in human scleral fibroblasts (HSFs) cultured in vitro. Lens-induced myopia was brought about in two groups of guinea pigs (the lens-induced myopia and myopia recovery groups) by placing -4.00 D lenses on the right eye for three weeks. The left eye served as a contralateral control. In the recovery group, the lenses were removed after one week. The refractive power and axial length of the eyes were measured, and the BMP-2 expression levels in the sclera were measured. After three weeks, the lens-induced eyes acquired relative myopia in both groups of guinea pigs. Immunostaining of the eyeballs revealed significantly decreased BMP-2 expression in the posterior sclera of the myopic eyes compared to the contralateral eyes. One week after lens removal, BMP-2 expression recovered, and no differences were observed between the experimental and contralateral eyes in the recovery group. HSFs were cultured with BMP-2 or transforming growth factor-β1 (TGF-β1). Type I and type III collagen synthesis was significantly up-regulated following BMP-2 treatment in culture after one and two weeks, but the ratio of type III to type I collagen mRNA was not increased. Biosynthesis of glycosaminoglycan (GAG) and aggrecan was increased in HSFs treated with BMP-2. Some chondrogenesis-associated genes expression increased in HSFs treated with BMP-2. From this study, we concluded that BMP-2 is involved in scleral remodeling in the development and recovery of lens-induced myopia.

Retinal and choroidal expression of BMP-2 in lens-induced myopia and recovery from myopia in guinea pigs

Bone morphogenesis proteins (BMPs) are multi-functional growth factors. They are expressed in retina, retinal pigment epithelium (RPE) and sclera and serve as a regulator in the growth and development of the eye. This article reviewed the chondrogenic potency of the sclera, biochemical and pathological changes of myopic scleral tissue and the differentiation of chondrogenesis by BMP-2. We proposed the hypothesis that BMP-2 can regulate differentiate of scleral fibroblasts and affect the development of myopia.

Characteristics of the macula in amblyopic eyes by optical coherence tomography

Purpose The aim of this study was to investigate the time-course of changes in choroidal thickness (ChT) following complete mydriasis induced by compound tropicamide. Methods ChT was measured by OCT with the enhanced-depth imaging technique (Spectralis HRA+OCT, Heidelberg Engineering, Germany) at nine locations of the fundus: subfoveal ChT (SFChT) and ChT at 1 mm and 3 mm from the fovea in four quadrants. Mydriasis was induced with compound tropicamide (0.5% tropicamide plus 0.5% phenylephrine hydrochloride, three doses at 5-minute intervals). Measurements were conducted prior to the instillation and at 0, 30, and 60 min following complete mydriasis. Results at different time-points were compared using repeated-measures ANOVA to investigate the time-course of the changes. Results Thirty-nine subjects (mean age 11.9±2 years; 16 males and 23 females) were enrolled in the study. Compound tropicamide resulted in a statistically significant decrease in SFChT at 0, 30, and 60 min after complete mydriasis, as compared to baseline (−5±4 μm, −12±4 μm, and −13±4 μm, respectively; all P<0.0001). No significant changes were detected in the parafoveal choroid except at 1 mm temporal (T1mm) and nasal (N1mm) to the fovea at 30 and 60 min (T1mm: −6±4 μm and −7±5 μm at 30 and 60 min; N1mm: −6±4 μm and −7±5 μm at 30 and 60 min, respectively; all P<0.0001). Repeated-measures ANOVA showed a significant interaction between the time after complete mydriasis and the effect of the mydriasis agent. Conclusions Complete mydriasis induced by compound tropicamide led to choroidal thinning, and the magnitude varied over time.

Distribution of bone morphogenetic protein receptors in human scleral fibroblasts cultured in vitro and human sclera

The present study investigated the retinal and choroidal expression of bone morphogenetic protein-2 (BMP-2) in myopia and in myopia recovery in a guinea pig model. For this investigation, two groups of guinea pigs, lens‑induced myopia and recovery from myopia, were used, and defocused myopia was induced the guinea pigs wearing ‑4.00 D lenses on the right eyes for 3 weeks, with the left eyes serving as the contralateral. In the following week, the lenses of the guinea pigs in the recovery group were removed, and the refractive power and axial length were measured. The expression of BMP‑2 in the eyeballs was observed using immunohistochemistry and analyzed using Western blot analysis. After 3 weeks, the eyes acquired relative myopia and longer axial lengths in the two groups of guinea pigs. After 1 week without lenses in the recovery group, the myopia and axial lengths regressed. Immunofluorescence staining showed that BMP‑2 was expressed in the posterior retina, RPE, choroid and sclera. The expression of BMP‑2 decreased in the myopic retina of the guinea pigs. Following the regression of myopia in the recovery group, no difference in the expression of BMP‑2 was observed between the recovered treated eyes and the contralateral eyes. The choroidal expression level of BMP‑2 in the treated eyes showed no significant changes in either group. Therefore, BMP‑2 may be involved in the development of myopia, however, it does not have a primary role in the retinal and choroidal signals regulating scleral remodeling.