Nina Jacobsen

Does the level of physical activity in university students influence development and progression of myopia?--a 2-year prospective cohort study.

PURPOSE To study whether physical activity has a protective effect on the development and progression of myopia in medical students. METHODS In a 2-year longitudinal cohort study, 156 Caucasian first-year medical students from the University of Copenhagen were enrolled. The baseline examination included visual acuity, subjective refraction, Maddox Wing test (Clement Clarke International Ltd., Harlow, UK), partial coherence interferometry, slit lamp examination, automated refraction in cycloplegia, an oral questionnaire, and a cycle ergometer test. Measurements were repeated at the follow-up. A total of 151 (97%) participants completed the study. RESULTS The prevalence of myopia (spherical equivalent [SE] <or= -0.5 D) increased from 37% (95% confidence interval [CI]: 29.1-44.9) to 43% (95% CI: 34.6-50.8, P < 0.001). The incidence rate of myopia was 6.1/100 person years of observation. The mean refractive error (SE) decreased from -0.50 (1.81) to -0.74 (1.95) D (P < 0.001), and the mean axial length increased from 23.81 (1.06) to 23.94 (1.09) mm (P < 0.001). In a multiple regression analysis, time spent reading scientific literature (P = 0.024) and younger age (P = 0.022) were associated with a refractive change toward myopia, whereas physical activity was inversely associated with a refractive change toward myopia (P = 0.015). Myopic eyes progressed significantly more than did emmetropic and hyperopic eyes (P = 0.002). CONCLUSIONS An association between physical activity and myopia was observed, suggesting a protective effect of physical activity on the development and progression of myopia in university students. The results confirm that intensive studying is a risk factor of myopia and that myopic progression or development is more likely in medical students in their early 20s than in their late 20s.

Is poor glycaemic control in diabetic patients a risk factor of myopia

Purpose:  As a consequence of an increasing prevalence of short‐sightedness (myopia) in countries that have adopted western dietary patterns, it has been hypothesized that hyperglycaemia and hyperinsulinaemia induce myopia. The purpose of this study was to evaluate the relation between glycosylated haemoglobin (HbA1c), insulin dosage and myopia in diabetic patients.

Physical activity and myopia in Danish children—The CHAMPS Eye Study

To determine associations between physical activity (PA) and myopia in Danish school children and investigate the prevalence of myopia.

Epibulbar Lipodermoids, Preauricular Appendages and Polythelia in Four Generations: A New Hereditary Syndrome?

A new syndrome with abnormalities along the first branchial arch and the milk list is described in a family of four affected generations. The characterisctics of the syndrome are epibulbar lipodermoids, preauricular appendages and polythelia. The expressivity varies but all affected have supernumerary nipples and preauricular manifestations while visible epibulbar lipodermoids do not seem obligatory. The syndrome has a typical dominant pattern of heredity.

A comparison of two methods to measure choroidal thickness by enhanced depth imaging optical coherence tomography

Department of Ophthalmology, Odense University Hospital, Odense, Denmark Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark Department of Ophthalmology, Rigshospitalet-Glostrup University Hospital, Copenhagen, Denmark Danish Institute for Myopia Research, Vedbæk, Denmark National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK

Retinal vascular diameters in relation to physical activity in Danish children - The CHAMPS Eye Study

Our objective was to determine associations between retinal vascular caliber and physical activity (PA) in a school‐based child cohort. In a prospective study, we created a childhood cumulative average PA‐index using objectively measured PA (accelerometry) assessed at four periods between 2009 and 2015. Cumulative exposure to PA intensities was estimated. Cross‐sectional examinations on biomarkers, anthropometry, and ophthalmological data including retinal fundus photographs were performed in 2015. Semi‐automated measurements of retinal vascular diameters were performed and summarized into central retinal arteriolar and venular equivalents (CRAE, CRVE). We included 307 participants. Mean age in 2015 was 15.4 years (0.7). The mean CRAE and CRVE were 156.5 μm (2.8) and 217.6 μm (7.7), respectively. After adjusting for age, gender, and axial length, more time in PA was independently related to thinner retinal venules (β‐coefficient = −1.25 μm/%, 95% confidence interval = −2.20, −0.30, P < .01). Sedentary time was associated with wider venules (P < .01). Furthermore, birthweight (β‐coefficient = 0.56 μm/%, 95% confidence interval = 0.18, 0.95, P < .01) was associated with CRVE. Blood pressure was associated with thinner retinal arterioles (β‐coefficient = −0.19 μm/mmHg, 95% confidence interval = −0.36, −0.01, P = .04). We concluded that children with higher PA in childhood had thinner retinal venular caliber. Our results suggest that PA during childhood positively impacts the retinal microcirculation and that retinal vascular analysis may be a possible assessment to detect microvascular impairments in children with an increased risk of future cardiovascular disease.

Corneal infiltrates; a rare ocular manifestation in a patient with Crohn's disease

Editor, O cular manifestations in chronic inflammatory bowel disease rarely involve cornea. To the best of our knowledge, there are few reported cases and photographs documenting the clinical course of this ocular complication, and the latest reports were published in 1998 (Chowers et al. 1998; Kodjikian et al. 1998). Here, we present a patient with corneal infiltrates related to Crohn’s disease, successfully treated with topical steroids. In 1980, Knox et al. suggested that two distinct types of keratopathy could be significant clinical signs of Crohn’s disease (Knox, Snip, Stark). The two types were described as epithelial or subepithelial small grey dots in the anterior cornea and deeper lamellar nebulous subepithelial infiltrates. The first type might represent an acute inflammatory response, and the second seems to result from postacute phase scarring (Knox et al. 1980). The corneal manifestations are often bilateral and symmetric, usually located in the inferior pole of the cornea, 2–3 mm from the corneoscleral limbus and rarely impact on the central visual axis (Knox et al. 1980, 1984). The infiltrates with epithelial involvement stain with fluorescein, and the subepithelial infiltrates do not (Knox et al. 1980; Schulman & Sugar 1981; Kodjikian et al. 1998). Crohn’s disease-related keratopathy can be treated with systemic and topical steroids. Our report describes a 15-year-old male, recently diagnosed with Crohn’s disease and referred from the Department of Pediatrics for an ophthalmological examination. The patient had a 2month history of bilateral ocular symptoms that included redness, irritation, mucoid discharge and photophobia. He didnot use contact lenses.The symptoms were most prominent in the right eye. Clinical eye examination revealed uncorrectedvisual acuity (VA)of 1.0/1.1on the Snellen VA chart. Intraocular pressure was 12/14 mmHg by Goldmann applanation tonometry. Slit-lamp examination of the right eye showed mixed injection in the inferior conjunctiva, deep lamellar nebulous subepithelial infiltrates and deep vascularization at the corneoscleral limbus (Figure 1A). No blepharitis, meibomitis, corneal precipitates, fluorescein uptake, acne or rosacea was present. Anterior chamber showed no intraocular reaction. The left eye had normal appearance exceptdiscretemixed injection in the inferior conjunctiva. The combination of Crohn’s disease and the subacute presentation of corneal subepithelial infiltrates of deep lamellar nebulous typewere suspected tobeocular manifestations of inflammatory bowel disease. The patient was prescribed one drop of topical corticosteroids (1 ml/ 1 mg dexamethasone) in the right eye, eight times a day. After one week of treatment, the patient had no symptoms and the slit-lamp examination only showed diffuse scarring and ghost vessels (Figure 1B–C). The following clinical control revealed diffuse corneal opacities. Blepharokeratoconjunctivitis, commonly seen in children, can resemble the described clinical presentation, but patients show signs of blepharitis or meibomitis. Ocular rosacea was neither suspected, due to young age and normal skin condition.Thepatient had ahistory of perioral cold sores, but there were no previous episodes of herpes in the corneal epithelium or stroma. The diagnosis of corneal herpetic keratopathy seemed unlikely as bilateral symptoms of the disease are rarely seen and herpes infections tend to worsen when topical steroids are used without the addition of antiviral drugs. Adenoviral keratoconjunctivitis was also unlikely due to profound localization of the infiltrates and atypical clinical presentation. Patients with Crohn’s disease and ocular manifestations would, in most cases, be referred to an ophthalmologist. The two types of kerathopathy described by Knox et al. almost 40 years ago are important to recognize, as they might be the first clinical sign of

Decreasing prevalence of myopia: author’s reply

et al. 1999). The follow-up of an increasing number of patients has decreased the workload in the municipalities and the care process has become more straightforward and streamlined as one unit carries out and is responsible for the different phases of the process. We have also experienced some challenges, mostly related to the technology used, organizational systems and the availability of health care workers. The technological challenges involve the relatively slow speed of remote connections when transferring large files and data security issues. The different information technology systems used in the municipalities and hospital districts have created some difficulties in electronic appointment scheduling. In an attempt to further improve the care process, a service whereby patients can be invited to attend a further appointment directly from the mobile unit is being developed. The shortage of health care professionals creates a further challenge as the delivery of mobile services requires specially trained and highly motivated staff. The Northern Ostrobothnia Hospital District is responsible for the mobile service and EyeMo is considered to represent part of the hospital premises. Because the mobile unit carries out high-volume examinations performed by the same experienced personnel, the quality of the examinations, as well as the implementation, modification and control of care protocols, can be guaranteed. Moreover, in comparison with traditional services, the mobile unit provides relevant services that are acknowledged as being effective and beneficial at a lower cost than any of the available alternatives (Taylor 1996; Tuulonen et al. 1999; Labiris et al. 2003). The mobile services have also been shown to be cost-effective in that the right patients can be examined at an appropriate time in a convenient place (Jin et al. 2004). This supports the allocation of resources at the university eye clinic to more demanding services.