Zhong Lin

Generational Difference of Refractive Error and Risk Factors in the Handan Offspring Myopia Study

PURPOSE To report the refractive error difference (RED) between parents and their children, and its risk factors, in a rural area of China. METHODS Children (6-17 years) and their parents (36.2 ± 4.1 years) from the Handan Offspring Myopia Study (HOMS) were enrolled. Cycloplegic autorefraction (cyclopentolate 1%, Topcon KR8800) of the children and noncycloplegic autorefraction of their parents were assessed. A detailed vision-based questionnaire was also completed. Refractive error difference was defined as the difference between the parental spherical equivalent (SE) and their childrens SE. Generational myopic shift was defined as the estimated RED when a child would be 18 years old according to a prediction model. RESULTS Three hundred fifty-six pairs of parents and 585 children were enrolled. The RED (median, quartiles) increased from -1.33 (-1.99, -0.98) diopters (D) in children aged 6 to 7 years to 0.81 (-0.16, 2.28) D in children aged 16 to 17 years. The childrens SE was predicted to approach the parental SE at 14 years of age. Moreover, the childrens estimated myopic shift would be 1.03 D. Multiple linear regression revealed that older children (β = 0.23 D/y, P < 0.0001) and girls (β = 0.24, P = 0.01) tended to have a higher RED. CONCLUSIONS In this rural Chinese population, the childrens refraction was estimated to be similar to the parental refraction at 14 years of age. Moreover, the generational myopic shift was estimated to be approximately 1 D at 18 years of age. These data suggest that the generational difference reflects the increasing prevalence of myopia in the younger generation, which is likely due to changes in environmental exposure.

Rationale, Design, and Demographic Characteristics of the Handan Offspring Myopia Study

Abstract Purpose: The Handan Offspring Myopia Study (HOMS) aims to investigate the familial associations of myopia between parents and their offspring. Methods: Children aged 6–18 years, residing in 6 villages where all people aged ≥30 years had participated in The Handan Eye Study in 2006–2007, were selected for the current eye study between March and June 2010. A mobile clinic was set up in the 6 villages for comprehensive eye examinations, including visual acuity, ocular biometry, cycloplegic autorefraction and retinal photography. Results: Of 1238 eligible individuals, 878 children (70.2%; 52.6% male) from 541 families were recruited. Mean age of the children was 10.5 ± 2.5 years. The prevalence of myopia (spherical equivalent refraction <−0.5 diopter) was 23.5% (males 16.8%, females 30.8%). The prevalence of low vision (presenting visual acuity ≥20/400 but <20/60) in the better eye was 7.1%. A higher number of females had low vision at the time of presentation (9.2%) compared to males (5.2%, p = 0.02). The prevalence of low vision in the worse eye was 10.6% (males 6.7%, females 14.9%, p < 0.001). The majority of visual impairment in the better-seeing (56/62, 90.3%) as well as the worse-seeing (84/93, 90.3%) eye was correctable. Conclusions: The HOMS examined about 70% of eligible Han Chinese offspring of Handan Eye Study participants in a rural region of northern China. Results from the HOMS will provide key information about the prevalence of refractive errors and eye diseases in rural Chinese children.

Endophthalmitis following 27-Gauge Pars Plana Vitrectomy for Vitreous Floaters

Purpose: To report a case of Staphylococcus epidermidis endophthalmitis following 27-gauge pars plana vitrectomy for symptomatic vitreous floaters. Methods: The clinical course and imaging findings, including fundus optomap, and spectral domain optical coherence tomography of a 24-year-old male patient were documented. Results: The patient, with a preoperative best-corrected visual acuity (BCVA) of 1.0, developed endophthalmitis following 27-gauge pars plana vitrectomy for symptomatic vitreous floaters. After a series of treatments, including emergent vitreous tap and silicone oil injection, antibiotic treatment, and silicone oil removal, the patient regained a BCVA of 0.6. Conclusion: Although rare, the potential risk of endophthalmitis should be explicitly discussed with patients considering surgical intervention for vitreous floaters.

The Association between Maternal Reproductive Age and Progression of Refractive Error in Urban Students in Beijing

Purpose To investigate the association between maternal reproductive age and their children’ refractive error progression in Chinese urban students. Methods The Beijing Myopia Progression Study was a three-year cohort investigation. Cycloplegic refraction of these students at both baseline and follow-up vision examinations, as well as non-cycloplegic refraction of their parents at baseline, were performed. Student’s refractive change was defined as the cycloplegic spherical equivalent (SE) of the right eye at the final follow-up minus the cycloplegic SE of the right eye at baseline. Results At the final follow-up, 241 students (62.4%) were reexamined. 226 students (58.5%) with completed refractive data, as well as completed parental reproductive age data, were enrolled. The average paternal and maternal age increased from 29.4 years and 27.5 years in 1993–1994 to 32.6 years and 29.2 years in 2003–2004, respectively. In the multivariate analysis, students who were younger (β = 0.08 diopter/year/year, P<0.001), with more myopic refraction at baseline (β = 0.02 diopter/year/diopter, P = 0.01), and with older maternal reproductive age (β = -0.18 diopter/year/decade, P = 0.01), had more myopic refractive change. After stratifying the parental reproductive age into quartile groups, children with older maternal reproductive age (trend test: P = 0.04) had more myopic refractive change, after adjusting for the childrens age, baseline refraction, maternal refraction, and near work time. However, no significant association between myopic refractive change and paternal reproductive age was found. Conclusions In this cohort, children with older maternal reproductive age had more myopic refractive change. This new risk factor for myopia progression may partially explain the faster myopic progression found in the Chinese population in recent decades.

Myopigenic Activity Change and Its Risk Factors in Urban Students in Beijing: Three-Year Report of Beijing Myopia Progression Study

ABSTRACT Purpose: To investigate the myopigenic activity change and its risk factors in urban students in Beijing. Methods: A total of 241 primary or secondary students aged 6–17 years from the Beijing Myopia Progression Study (BMPS) were re-examined 3 years after their baseline enrollment. A detailed questionnaire was administered to assess myopigenic activities at both baseline and at the 3-year follow-up. Altogether, 217 students (90.0%) with completed data were included in the analysis. Results: Compared to baseline, primary students (n = 123) had significant increases in outdoor sports time (mean ± standard deviation: 3.5 ± 4.3 vs. 2.4 ± 3.0 hours/week, p = 0.02), near work time (32.1 ± 13.4 vs. 24.8 ± 9.2 hours/week, p < 0.001), diopter hours (128.8 ± 53.3 vs. 97.5 ± 35.9 diopter hours/week, p < 0.001), and indoor time (53.8 ± 22.8 vs. 41.4 ± 16.9 hours/week, p < 0.001) at the 3-year follow-up. At both baseline and follow-up, females spent less time than males on outdoor sports (baseline: 2.4 ± 2.8 vs. 4.0 ± 5.2 hours/week, p = 0.006; follow-up: 2.3 ± 3.1 vs. 5.1 ± 5.0 hours/week, p < 0.001), and total outdoors (baseline: 11.9 ± 7.9 vs. 14.4 ± 9.5 hours/week, p = 0.03; follow-up: 10.5 ± 8.2 vs. 13.9 ± 9.6 hours/week, p = 0.005). In the multivariate regression analysis after adjustment by student’s gender, younger students had more increase in both near work time (slope = −0.99 hours/week for age, p = 0.009) and indoor time (slope = −2.04 hours/week for age, p = 0.001). Conclusions: During the 3-year follow-up, primary students had more myopigenic activities. Female students had more myopigenic activities than males at both baseline and follow-up. Children’s age was a significant risk factor for this myopigenic activity change.

The Safety and Efficacy of Adjustable Postoperative Position after Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

Purpose. To report the safety and efficacy of adjustable postoperative position for rhegmatogenous retinal detachment (RRD). Methods. Retrospective review of 536 consecutive RRD eyes that underwent vitrectomy surgery for retina repair from year 2008 to 2014. The retinal breaks were divided into superior, lateral (nasal, temporal, and macular), and inferior locations, according to the clock of breaks. Patients with superior and lateral break location were allowed to have facedown position or lateral decubitus position postoperatively, while patients with inferior break location were allowed to have facedown position. Results. 403 eyes of 400 patients were included. The mean follow-up interval was 22.7 ± 21.3 months. The overall primary retinal reattachment rate was 93.3%. There were 24 (6.0%), 273 (67.7%), and 106 (26.3%) patients with superior, lateral, and inferior break location, respectively. The primary reattachment rate was 95.8%, 92.3%, and 95.3% accordingly. After further divided the break location into subgroups as a function of duration of symptom, postoperative lens situation, number of retinal breaks, and different vitreous tamponade, the primary reattachment rates were all higher than 82%. Conclusion. Adjustable postoperative positioning is effective and safe for RRD repair with different break locations. Choosing postoperative position appropriately according to retinal break locations could be recommended.

27-Gauge Vitrectomy for Symptomatic Vitreous Floaters with Topical Anesthesia

Purpose: Traditionally acceptable methods of anesthesia for vitrectomy surgery are quite varied. However, each of these methods has its own potential for complications that can range from minor to severe. The surgery procedure of vitrectomy for symptomatic vitreous floaters is much simpler, mainly reflecting in the nonuse of sclera indentation, photocoagulation, and the apparently short surgery duration. The use of 27-gauge cannulae makes the puncture of the sclera minimally invasive. Hence, retrobulbar anesthesia, due to its rare but severe complications, seemed excessive for this kind of surgery. Method: Three cases of 27-gauge, sutureless pars plana vitrectomy for symptomatic vitreous floaters with topical anesthesia are reported. Results: The vitrectomy surgeries were successfully performed with topical anesthesia (proparacaine, 0.5%) without operative or postoperative complications. Furthermore, none of the patients experienced apparent pain during or after the surgery. Conclusion: Topical anesthesia can be considered for 27-guage vitrectomy in patients with symptomatic vitreous floaters.

The difference between cycloplegic and non‐cycloplegic autorefraction and its association with progression of refractive error in Beijing urban children

To investigate the difference between cycloplegic and non‐cycloplegic autorefraction and its association with the progression of refractive error in Beijing urban children.

Surgical Outcomes of 27-Gauge Pars PLana Vitrectomy for Symptomatic Vitreous Floaters

Purpose To report the surgical outcomes of 27-gauge pars plana vitrectomy (PPV) for symptomatic vitreous floaters. Methods 47 eyes of 47 patients (39 males, 83.0%) with symptomatic vitreous floaters who underwent 27-gauge PPV and followed up for more than 6 months were included. The mean age was 34.7 ± 13.5 years. Results No operative complication occurred. At first day postoperatively, the intraocular pressure (IOP) was significantly lower than that at other time points (8.6 ± 2.7 mmHg, p < 0.001). 28 (59.6%) eyes had transient hypotony (IOP < 8 mmHg). All were recovered within 1 week postoperatively. The BCVA of 41 eyes (41/47, 87.2%) remained unchanged or improved. Postoperative complications occurred in two eyes: one (2.1%) had endophthalmitis and one (2.1%) had retinal detachment. No clinical significant cataract was observed in the 42 postoperative phakic eyes. 91.5% of the patients were satisfied with the surgery outcome. Besides, 91.3% of the patients felt that the floaters were removed completely or only had an acceptable residual. Conclusion Visual acuity of most patients remained unchanged or improved following 27-gague pars plana vitrectomy for symptomatic vitreous floaters, resulting in high patient satisfaction. However, this treatment should be performed with great caution since severe postoperative complications may still occur. This trial is registered with NCT03049163.

Acute Primary Angle Closure in the Fellow Eye as a Complication of Facedown Position After Vitrectomy Surgery.

Purpose: To report a case of acute primary angle closure that developed in the fellow eye rapidly after facedown position after vitrectomy surgery. Patients and Methods: A 66-year-old female developed acute primary angle closure in the fellow eye approximately 1.5 hours after facedown position after vitrectomy surgery for macular hole. Results: The intraocular pressure was controlled after treatment that included halting the facedown position, intravenous mannitol injection, and topical pilocarpine instillation. Facedown position was continued after laser peripheral iridotomy was performed. The intraocular pressure was controlled within normal range even after pilocarpine was withdrawn. Conclusions: Although rare, the potential risk of acute-angle closure should be explicitly explained to patients being considered for facedown position after vitrectomy. Prophylactic intervention, such as laser peripheral iridotomy, could be considered for anatomically predisposed eyes.