Myopia is a common eye disease that has become the main cause of vision loss among Chinese children and adolescents. In 2020, the overall myopia rate of Chinese children and adolescents was 52.7%. The problem of low myopia age is still prominent, and the number of high myopia is increasing year by year. Although the country has raised myopia prevention and control to a strategic level, the current situation has not been completely changed. There are still many difficulties and bottlenecks that have not been solved. The etiology of myopia is complex, and there is no universal prevention and control strategy. In view of the current situation of myopia prevention and control, the author starts from the concept of children and adolescents' eye development and myopia cognition, thinks about the way of medical and industrial cross assistance, takes refractive development profile as guidance, establishes a standard system for data collection of refractive development archives, establishes longitudinal data prediction, so as to provide means for early warning and early prevention of children and adolescents' eye health. In order to provide solutions to break through the bottleneck of myopia prevention and control.

眼球在不同子午线上屈光力不同,平行光通过眼球折射所成的像并非在一个焦点,而是在同一空间的不同位置的两条交线和最小弥散圆的一种屈光状态,称为散光.散光可由角膜或晶状体产生,最大屈光力和最小屈光力主子午线相互垂直者为规则散光.最大屈光力主子午线位于90°±30°位置的散光被称为顺规散光.

Background This study aimed to evaluate the distribution characteristics of corneal and lenticular parameters in Chinese children with myopia and explored their association with other ocular components. Methods In this cross-sectional study, all ocular biometric parameters were measured using a Zeiss IOLMaster 700 Biometry. Simulations of the corneal and lenticular curvature radii were implemented using a customised MATLAB program based on cross-sectional swept-source optical coherence tomography images obtained from the same device. The associations of the calculated and simulated refractive powers of the cornea and lens with other ocular parameters were evaluated. Results In total, 119 children with myopia were recruited. Boys had a deeper anterior chamber and longer axial length (AL) than girls, while girls had steeper anterior corneal and lenticular curvatures and greater corneal and lenticular power. Children aged 10 years and older showed a larger anterior lenticular radius of curvature (sR(al)) and less lenticular power (P-L,P-OCT) than younger participants. There was a significant positive correlation between AL and the anterior corneal radius of curvature, regardless of sex or age. The sR(al) exhibited a significant increasing trend, and P-L,P-OCT exhibited a declining trend with a longer AL only in children younger than 10 years. Conclusion AL is the most influential factor in the determination of spherical equivalent refractive error, while decreases in both corneal and crystalline lens power are significantly inversely correlated with axial elongation.

目的 评估NOR型非球面角膜塑形镜矫正近视的临床有效性和安全性.设计前瞻性多中心队列研究.研究对象2019年5月至2020年12月11家医院配戴NOR型非球面角膜塑形镜的近视患者456例(912眼).方法 所有患者均配戴NOR型非球面角膜塑形镜,并完成戴镜前及戴镜后1天、1周、1个月、3个月的检查与随访.主要指标裸眼远视力、球镜度、柱镜度、等效球镜度、眼压、角膜内皮细胞密度、角膜内皮细胞多形性级别、并发症、镜片配适及镜片状态.结果 456例(912眼)中女性300例,平均年龄15.59±8.24岁.戴镜后各随访时间点,双眼裸眼远视力与基线期比较均有显著提升(P均＜0.05).戴镜3个月,裸眼远视力达到0.0 LogMAR的比例为67.76％(右眼)和65.88％(左眼);右眼球镜度由基线(-2.47±0.87)D下降至(-0.30±0.62)D(P＜0.001),左眼球镜度由基线(-2.37±0.87)D下降至(-0.26±0.57)D(P＜0.001);右眼柱镜度由基线(-0.41±0.44)D下降至(-0.12±0.30)D(P＜0.001),左眼柱镜度由基线(-0.50±0.45)D下降至(-0.16±0.38)D(P＜0.001);与基线比较,等效球镜度降低(2.31±1.04)D(右眼)和(2.26±1.01)D(左眼);双眼角膜内皮细胞密度和角膜内皮细胞多形性分级与基线期比较均无显著性差异(P均＞0.05);双眼非接触式眼压与基线期比较均显著降低(P均＜0.05);双眼未出现严重并发症,仅个别病例出现1级或2级球结膜充血、角膜上皮点染及角膜浸润,经停戴或药物控制后均可实现继续戴镜;镜片配适情况及镜片状态总体良好.结论 配戴NOR型非球面角膜塑形镜可有效提升青少年近视患者裸眼远视力,降低等效球镜度,且对角膜内皮细胞参数和眼压影响较小,镜片配适和镜片状态良好.

我国未成年人使用各类电子产品、数字化设备呈普遍化、低龄化发展趋势.长时间使用智能手机、笔记本电脑、平板电脑等进行在线学习、网络社交、网上娱乐,会显著增加学龄期儿童青少年近距离用眼负荷,挤占正常的社会交往、体育活动与户外自然光暴露时间.家长及监护人对儿童青少年使用电子屏幕的管理缺位,儿童青少年易养成不健康的屏幕用眼习惯与行为,对学龄期儿童青少年的生理、心理以及屈光发育可能带来不良影响.为促进学龄期儿童青少年养成屏幕用眼的良好习惯,使他们健康科学地使用各类电子显示屏幕,减缓儿童青少年近视的发病与进展,基于循证医学证据、行业标准规范及临床经验制订《学龄期儿童青少年电子屏幕用眼健康管理专家指导意见》至关重要.

2002年,"医学验光"一词在我国出现后,便在社会和行业中引发强烈反响[1～2],一时间"医学验光"成为了各大医院招揽患者,为其提供验光服务的招牌.但时至今日,绝大多数业内人士对"医学验光"依旧存在误解,认为"只有在医院内进行的验光配镜才是医学验光",其实并非如此.笔者希望通过此文表明观点:现今诸多医院并没有很好地理解和执行医学验光的内容与实质,同时,如果能够遵循医学验光的理念,眼镜行业完全能够凭借自身技术实力与良好的设备,很好地实施"医学验光".

近视是视觉障碍的主要原因之一,患病率高且高度近视并发症后果严重,极大地加重了社会经济负担.应对近视的有效手段是尽早发现和及时控制.随着人工智能技术的飞速发展,机器学习、深度学习等技术在预测近视发生、监测近视进展及预警病理性近视方面表现出了较好的准确度和可靠性.基于屈光数据及眼轴、眼底照相、光学相干层析成像(OCT)图像等眼部生物学信息进行人工智能的近视预测,极大地提升了近视筛查和监测的自动化程度,提高了近视防控工作的工作效率和普及性.

目的 研究手机屏幕亮度对人眼视功能和泪膜稳定性的短期影响.方法 前瞻性随机对照研究.50名被试者在100、130、160 nit手机屏幕亮度下完成20 min阅读任务后,检测受试者阅读前后调节幅度、集合近点、调节反应和泪膜破裂时间.采用单因素方差分析手机亮度对人眼视功能和眼表泪膜稳定性的影响,调节反应和调节滞后做线性相关和回归分析.结果 调节幅度、集合近点和泪膜破裂时间阅读前后差异均有统计学意义(F=3.753,P=0.017;F=4.021,P=0.013;F=6.539,P=0.001),两两比较:100 nit、130 nit、160 nit屏幕亮度组调节幅度、泪膜破裂时间均较对照组显著下降,集合近点均较对照组显著增大,不同亮度组间差异没有统计学意义.屏幕亮度对调节反应和调节滞后量差异无显著影响,130 nit手机阅读亮度在各调节刺激下引起人眼调节反应均最大,滞后量最少.结论 人眼短暂使用手机后调节幅度下降,集合近点远移,泪膜稳定性显著降低,但是手机屏幕亮度在100～160 nit范围内的变化并不影响调节反应.

Aim: To evaluate the effects of 0.5% tropicamide on anterior segment parameters with the CASIA2 imaging device in emmetropic, myopic, and hyperopic eyes.Methods: In this prospective study, a total of 125 subjects (34 emmetropic subjects, 57 myopic subjects, and 34 hyperopic subjects) at the Shanghai Eye and ENT Hospital of Fudan University were recruited from June 2021 to September 2021. The 0.5% tropicamide solution was used once every 5 min a total of 5 times for cycloplegia. The anterior segment parameters were recorded by CASIA2 before and after cycloplegia. Changes in anterior segment parameters were compared among the three refractive groups.Results: Crystalline lens rise (CLR) and crystalline lens thickness (CLT) significantly decreased in all three refractive groups after cycloplegia (all p < 0.01). The anterior radius of lens (ARL) and anterior chamber depth (ACD) significantly increased in all three refractive groups after cycloplegia (all p < 0.01). Posterior radius of lens (PRL) significantly increased in hyperopic eyes after cycloplegia (p < 0.01) while it remained unchanged in emmetropic eyes and myopic eyes. Central corneal thickness (CCT), anterior chamber width (ACW), lens decentration (LD), and lens tilt (LT) remained unchanged after cycloplegia in all three refractive groups (all p > 0.05). Changes in CLR, CLT, ARL, PRL, and ACD in hyperopic eyes were greater than those in emmetropic eyes and myopic eyes (all p < 0.05).Conclusion: Apart from various changes in anterior segment parameters after application by 0.5% tropicamide in all three refractive groups, significant changes in CLR, CLT, ARL, PRL, and ACD in hyperopic eyes should be noted for proper clinical interpretation.

Objective::To explore the refractive status along with relevant factors during the fetal and infancy period in 9-month-old infants, and to provide evidence for early prevention and intervention of refractive errors.Methods::This study analyzed refractive screening data accumulated by the Minhang District Maternal and Child Health Care Institution, Shanghai, from 2012 to 2019. In all, 16 746 infants aged 9 months were included in the description of refractive status. Relevant factors before 9 months of age were collected by child health examination records and questionnaire survey data. Chi-square tests and multivariate regression models were used to analyze the association of factors during the fetal and infancy periods in 9-month-old infants with suspicious refractive errors.Results::The P5- P95 of the refractive sphere for infants aged 9 months was +0.50 D-+3.00 D, and the P5 of the refractive cylinder for infants aged 9 months was -2.50 D. Detection rates of suspected myopia, hyperopia, astigmatism, and anisometropia were 13.46%, 11.13%, 25.58%, 8.29%, respectively. Birth during the winter and frequent contact with electronic devices increased the risk of suspected myopia (adjusted OR were 1.35, 1.55 respectively). Birth during the summer or autumn, prematurity and a physique greater than the P80 quantile at 9 months of age increased the risk of suspected hyperopia (adjusted OR were 1.67, 1.62, 1.80, 1.22 respectively). Birth during the summer, a physique greater than the P80 quantile and artificial feeding at 9 months of age increased the risk of suspected astigmatism (adjusted OR were 1.92, 1.42, 1.19, respectively). Outdoor activities of more than 0.5 h per day decreased the risk of suspected refractive errors (adjusted OR=0.711-0.803). Conclusion::Detection rates of suspected refractive errors in infants aged 9 months are between 8% and 25%, among which astigmatism is most significant. Infants with high-risk factors such as prematurity, parents with refractive errors and large physique should be the focus of refractive screening and follow-up.

在全球范围内,近视的患病率逐年上升且呈现出低龄化趋势.如何防控近视以降低其人群发病率,减缓个体病情进展,降低并发症风险,是我国公共健康领域一项亟待攻克的重大课题.药物干预在近视防治中占据着十分重要的地位,其中低浓度阿托品作为一种能够平衡治疗受益和副作用风险的选择,近年来在学界获得关注.本文就其在近视干预中临床应用及作用机制等方面的研究现况与进展做一综述.

The prevalence of myopia in China is increasing. The early onset and rapid progression of myopia in younger children have attracted more attention. The establishment of standardized children's refractive development records is the basis of myopic prevention and control. It would be helpful to follow the refractive status and pay more attention to the refractive development of potential myopic children, so as to reduce the prevalence of myopia. (Chin J Ophthalmol, 2021, 57: 724-726).

Children respond differently to atropine treatment, and predicting patient factors associated with better myopia control is important. Therefore, we aimed to evaluate factors related to myopia progression in Chinese children treated with atropine 0.01%. This retrospective study included 133 children who were administered atropine 0.01% eyedrops every night for 1 year. Enrolled children were examined at follow-up visits at 3 and 6 months, and 1 year. The primary outcome was clinically significant myopia progression (over a -0.75 diopter (D) increase in spherical equivalent (SE)). Multivariate logistic analysis was used to identify predictive factors for myopia progression. The mean baseline SE was -3.92 ± 2.76D, and the average increase in SE and axial length at 1 year from baseline were -0.55 ± 0.57D and 0.43 ± 0.52 mm, respectively. The risk of myopia progression significantly increased in children whose mothers had moderate myopia of less than -6D compared to that in children whose mothers had no history of myopia (odd ratio [OR] = 2.76, 95% confidence interval [CI]: 1.06 to 7.19, P = 0.0382). Birth by cesarean section was also a risk factor for myopia progression (odd ratio [OR] = 2.35, 95% CI: 1.30 to 4.27, P = 0.0048). The correlation between SE and treatment efficiency was linear, and the risk of myopia progression significantly decreased with increasing SE. Atropine 0.01% controlled myopia more effectively in children with higher myopia, who were delivered naturally, and whose mothers had no genetic background of myopia.

眼科学是一门需要掌握显微操作的学科,因而对于学生的显微技能培训是眼科教学中不可或缺的重要部分.但由于现今大环境的影响,住院医师的动手机会越来越少,因而WetLab实验室的构建显得更加重要.我们通过WetLab实验室对住院医师进行显微操作技能的培训,同时围绕WetLab为中心,采用多方位联合培训的方法,如加强显微手术理论学习,优秀手术录像实况转播和教学,循序渐进的目标训练,建立了操作实时转播和录像系统,国外团队带教手术教学,严格的定期考核,增加实战经验等,将各种新的教学手段融入教学过程中,并借鉴国外著名眼科中心临床教学的一些方法加以改进和完善,在临床中取得了良好的教学效果.

Objective::To evaluate the clinical efficacy and safety of the NOR aspherical orthokeratology lens for the correction of myopia.Methods::This was a prospective randomized controlled study. Subjects over 8 years of age with binocular myopia were randomly assigned to a study group or a control group. The study group wore a NOR aspherical orthokeratology lens, and the control group wore a Euclid orthokeratology lens (model: Night-wear). Follow-up was performed at 1 day, 1 week, 2 weeks, 1 month, 3 months, 6 months, 9 months, and 1 year after wearing the lenses. Uncorrected distance visual acuity, refractive error, keratometry value (K value), slit lamp examination results, lens condition, endothelial cell count, corneal thickness and intraocular pressure were recorded. Data analysis was performed using statistical methods such as an independent samples t test, Wilcoxon rank sum test, and Chi-square test. Results::A total of 291 subjects (143 subjects in the study group and 148 subjects in the control group) completed the initial wear. At each follow-up time after wearing the lenses, there were no statistically significant differences in the left and right eyes between the two groups ( P>0.05) for visual acuity, refractive error or changes from baseline. There were no statistically significant differences in changes in the flat K value of both eyes or the steep K value of the right eyes ( P>0.05). The differences in the changes in the steep K value of the left eye were not statistically significant except for 1 day and 9 months after wearing the lenses. There were no statistically significant differences in corneal thickness, endothelial cell count, intraocular pressure or their changes from baseline in the two groups ( P>0.05) at 6-month and 1-year visits. At each follow-up time point, there were no serious complications in the two groups and there was no statistically significant difference in the incidence of complications between the two groups ( P>0.05). At 1 year after wearing the lenses, the two groups of OK lenses were in good condition and were well fitted, and the comparison between the two groups showed no statistically significant difference ( P>0.05). Conclusions::The NOR aspheric orthokeratology lens and the night-wearing orthokeratology lens are effective and safe for correcting myopia. The two orthokeratology lenses have the same efficacy and both have high security.

Objective?To study the refractive status of primary and secondary school students in Shanghai, and to analyze the epidemiological characteristics of important refractive parameters.?Methods?Totally 9,086 students aged 6-15 years in Shanghai were selected. The distant visual acuity, diopter, ocular axial length and corneal curvatures were measured. The data were analyzed with SPSS 18.0.?Results?The prevalence of myopia was 53.4% in 6-15 years old students, 55.3% in female students; 51.6% in male students; 45.2% in 6-12 years old students and 76.7% in 13-15 years old students. The prevalence of high myopia was 4.8%, that of hyperopia was 4.8%. The risk of suffering from myopia was higher in girls than in boys. The risk of myopia and the negative values of refraction increased with age. OR value was over 3 from the age of 10. The mean spherical equivalent refraction (SER), axial length (AL) and corneal curvature (CC) of the right eye were (-1.96 ± 0.02) D, (23.92 ± 0.01) mm and (43.19 ± 0.02) D. The mean AL was 23.30 mm for emmetropia, 22.37 mm for hyperopia, and 24.66 mm for myopia, and increased gradually with the deepening of myopia degree. The mean CC was 43.08 D for emmetropia, 43.13 D for hyperopia and 43.30 D for myopia, there was statistical difference between myopia and emmetropia (P < 0.05). SER was negatively correlated with AL and CC, and AL was negatively correlated with CC. AL of females was shorter and CC was larger than males. AL increased with age, while CC didn’t change with age.?Conclusions?The students of primary and middle school in Shanghai have a high prevalence rate and a high degree of myopia. Diopter and ocular axial length should be measured for all students as regular screening. From the age of 10, it is necessary to strengthen the intervention, and the females deserve more attention.

资料患儿男性,11岁.因双眼先天性白内障术后近视增长过快2年就诊于我院屈光专科.患儿8年前(3岁)因双眼先天性白内障于我院在全身麻醉下行双眼晶状体切除+前段玻璃体切除+人工晶状体植入术.术前用A超测得双眼眼轴长度分别为20.89 mm和20.43 mm,将角膜曲率半径7.80 mm代入SRK/T公式预测人工晶状体度数,将术后目标屈光度设为+5.00 D,得到双眼人工晶状体度数分别为24.53 D和26.28 D,故术中双眼分别植入24.50 D和26.00 D的博士伦Akreos-Adapt人工晶状体.手术过程顺利,术后予妥布霉素地塞米松滴眼液、普拉洛芬滴眼液双眼3次/d抗炎,术后情况稳定.

Objective To investigate the changes in refraction before and after cycloplegia in different age groups and refractive conditions among children and adolescents aged from 2 to 15 years.Methods Eight hundred and ninety-four children and adolescents (the average age was 7.3 ± 2.9 years,462 boys and 432 girls) were recruited.Diopters of sphere (DS),cylinder (DC) and spherical equivalent (SE) were evaluated before cycloplegia using auto-refractometry and after cycloplegia using retinoscopy with auto-refractometry data results,respectively.The differences in the values of DS,DC,SE of right eyes before and after cycloplegia were assessed using Wilcoxon analysis.Mixed linear model with Bonferroni-adjusted post hoc comparisons were performed to assess the main effects of age and refraction as well as the interaction effect of age × refraction on the changes in the values of DS,DC and SE.Cut-off P value was 0.05.Results Significant hyperopic shifts were detected in the values of DS (Z =-24.082,P ＜ 0.001),DC (Z =-10.795,P ＜ 0.001) and SE (Z =-24.850,P ＜ 0.001) after cycloplegia.The changes in the values of DS and SE were both affected by age (F =10.967,P ＜ 0.001;F =9.786,P ＜ 0.001),refractive status (F =56.864,P ＜ 0.001;F =56.292,P ＜ 0.001) and the interaction effect of age × refractive status (F =2.121,P =0.014;F =2.009,P =0.021).Further analysis detected that the children aged less than 5 years (2 years ≤age ＜5 years) had the maximal hyperopic shift in DS and SE after cycloplegia,meanwhile the hyperopic shift of those hyperopic eyes (＞ +0.50D) was also significantly greater than that of those emmetropic (≥-0.50 D and ≤ +0.50 D) and myopic (＜-0.50 D) eyes (post hoc P values ＜0.01).The DC variation was independent on age (F=2.048,P=0.106),refractive status (F =1.341,P =0.253) as well as the interaction of age × refractive status (F =0.479,P =0.927).Conclusions The values of DS,DC and SE all changed significantly after cycloplegia.The DS and SE values before and after cycloplegia were affected by age and refractive status.Younger children with higher hyperopia tend to have greater hyperopic shift after cycloplegia.The DC variation was independent on age and refractive status.

Myopia is one of the most common eye abnormalities worldwide. Form deprivation or lenses can induce experimental myopia. Melatonin, an important neuroendocrine hormone of the eye and a myopic-related factor, may have an important influence on the development of myopia. This paper elaborates on the relationship between melatonin and form deprivation myopia by focusing on the distribution and synthetic factors of melatonin in the eye, the relationship between melatonin and eye growth rhythm, and the relationship between melatonin and dopamine.