ImportanceMyopia in school-aged children is a public health issue worldwide; consequently, effective interventions to prevent onset and progression are required.ObjectiveTo investigate whether SMS text messages to parents increase light exposure and time outdoors in school-aged children and provide effective myopia control.Design, Setting, and ParticipantsThis randomized clinical trial was conducted in China from May 2017 to May 2018, with participants observed for 3 years. Of 528 965 primary school–aged children from Anyang, 3113 were randomly selected. Of these, 268 grade 2 schoolchildren were selected and randomly assigned to SMS and control groups. Data were analyzed from June to December 2021.InterventionsParents of children in the SMS group were sent text messages twice daily for 1 year to take their children outdoors. All children wore portable light meters to record light exposure on 3 randomly selected days (2 weekdays and 1 weekend day) before and after the intervention.Main Outcomes and MeasuresThe co–primary outcomes were change in axial length (axial elongation) and change in spherical equivalent refraction (myopic shift) from baseline as measured at the end of the intervention and 3 years later. A secondary outcome was myopia prevalence.ResultsOf 268 grade 2 schoolchildren, 121 (45.1%) were girls, and the mean (SD) age was 8.4 (0.3) years. Compared with the control group, the SMS intervention group demonstrated greater light exposure and higher time outdoors during weekends, and the intervention had significant effect on axial elongation (coefficient, 0.09; 95% CI, 0.02-0.17;P = .01). Axial elongation was lower in the SMS group than in the control group during the intervention (0.27 mm [95% CI, 0.24-0.30] vs 0.31 mm [95% CI, 0.29-0.34];P = .03) and at year 2 (0.39 mm [95% CI, 0.35-0.42] vs 0.46 mm [95% CI, 0.42-0.50];P = .009) and year 3 (0.30 mm [95% CI, 0.27-0.33] vs 0.35 mm [95% CI, 0.33-0.37];P = .005) after the intervention. Myopic shift was lower in the SMS group than in the control group at year 2 (−0.69 diopters [D] [95% CI, −0.78 to −0.60] vs −0.82 D [95% CI, −0.91 to −0.73];P = .04) and year 3 (−0.47 D [95% CI, −0.54 to −0.39] vs −0.60 D [95% CI, −0.67 to −0.53];P = .01) after the intervention, as was myopia prevalence (year 2: 38.3% [51 of 133] vs 51.1% [68 of 133]; year 3: 46.6% [62 of 133] vs 65.4% [87 of 133]).Conclusions and RelevanceIn this randomized clinical trial, SMS text messages to parents resulted in lower axial elongation and myopia progression in schoolchildren over 3 years, possibly through increased outdoor time and light exposure, showing promise for reducing myopia prevalence.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR-IOC-17010525

Purpose:To determine the annual incidences and rates of progression of myopia and high myopia in Chinese schoolchildren from grade 1 to grade 6 and explore the possible cause-specific risk factors for myopia. Methods:From 11 randomly selected primary schools in Anyang city, central China, 2835 grade 1 students were examined with annual follow ups for 5 years. Students were invited to undergo a comprehensive examination, including cycloplegic autorefraction, ocular biometry, and standardized questionnaires. Results:The mean spherical equivalent refraction decreased substantially from +0.94 ± 1.03 diopter (D) in grade 1 to -1.37 ± 2.08 D in grade 6, with rapid annual myopic shifts, especially for students in grades 3 through 6 (-0.51 to -0.59 D). The prevalence of myopia increased substantially, with the yearly incidence of myopia increasing from 7.8% in grade 1 and 2 to 25.3% in grades 5 and 6, and the incidence of high myopia increased from 0.1% to 1.0%. The 5-year incidence of myopia was lowest among children who has a baseline spherical equivalent refraction of greater than +2.00 D (4.4%), and increased to nearly 92.0% among children whose baseline spherical equivalent refraction was 0.00 to -0.50 D. The incidence of myopia was higher in children who had less hyperopic baseline refraction, two myopic parents, longer axial length, deeper anterior chamber, higher axial length-corneal radius of curvature ratio, and thinner lenses. Conclusions:Both the annual incidence and progression rates of myopia and high myopia were high in Chinese schoolchildren, especially after grade 3. Hyperopic refraction of children should be monitored before primary school as hyperopia reserve to prevent the onset of myopia and high myopia.

Purpose This study investigated the impact of age and myopia on visual form perception among Chinese school-age children. Methods This cross-sectional study included 1,074 students with a mean age of 12.1 ± 4.7 (range = 7.3–18.9) years. The mean spherical equivalence refraction (SER) of the participants was −1.45 ± 2.07 D. All participants underwent distance visual acuity (VA), refraction measurement and local and global visual form perception test including orientation, parallelism, collinearity, holes and color discrimination tasks. Results The reaction times of emmetropes were slower than those of myopic and high myopic groups on both local (orientation, parallelism, and collinearity) and global discrimination tasks (all p < 0.05). A reduction in reaction times was found with increasing age on both local and global discrimination tasks (all p < 0.05). Age was significantly associated with both local and global visual perception performance after adjusting for gender, visual acuity and SER (orientation, β = −0.54, p < 0.001; parallelism, β = −0.365, p < 0.001; collinearity, β = −0.28, p < 0.001; holes, β = −0.319, p < 0.001; color, β = −0.346, p < 0.001). Conclusions This study revealed that both local and global visual perception improve with age among Chinese children and that myopes seem to have better visual perception than emmetropes.

Objective: To analyze the longitudinal association between hyperopia reserve and the cumulative incidence of myopia in grade 1 primary school students. Methods: Cohort study. This study included 2 628 grade 1 primary school students (2 628 eyes) who without myopic at baseline from the Anyang Childhood Eye Study. There were 1 515 male and 1 113 female, aged(7.16±0.40) years. Every year, cycloplegic autorefraction was performed with 1% cyclopentolate eye drops to obtain data of hyperopia reserve. Students with different ranges of hyperopia reserve at baseline were analyzed. Axial length, anterior chamber depth, corneal curvature, lens thickness, and other parameters were obtained by ocular biometrics and compared by the independent sample t test. Qualitative data were described by frequency and percentage, and comparison between groups was performed by the Chi-square test or exact probability method. Linear regression was used to analyze the association between baseline hyperopia reserve and spherical equivalent at 5 years. Results: The average hyperopia reserve was (+1.09±0.78) diopters (D) in grade 1 non-myopic children. Axial length, anterior chamber depth, corneal radius of curvature, and lens thickness were (22.66±0.72), (2.88±0.24), (7.80±0.25) and (3.62±0.19) mm, respectively. The cumulative incidence of myopia among non-myopic grade 1 primary school students was 8.5%, 21.5%, 35.6%, 47.6% and 64.1% at 1, 2, 3, 4 and 5 years, respectively. The incidence of myopia in girls was significantly higher than that in boys at 3, 4 and 5 years. The 5-year cumulative incidence of myopia was 4.6%, 26.3%, 52.3%, 78.6%, 92.6% and 94.3%, respectively, corresponding to students with baseline hyperopia reserve of >+2.00 D,+1.50 D to +2.00 D,+1.00 D to +1.50 D,+0.50 D to +1.00 D, 0.00 D to +0.50 D and -0.50 D to 0.00 D, and the difference was statistically significant (χ²=490.59, P<0.001). The regression equation between baseline hyperopia reserve and 5-year spherical equivalent was as follows: 5-year spherical equivalent=-3.135+1.692·baseline hyperopia reserve (R2=0.454, P<0.001). Conclusions: The lower the hyperopia reserve, the higher the incidence of myopia. Monitoring children's hyperopia reserve and early protection to reduce its consumption and timely detection of children at high risk of myopia are of great significance to prevent the occurrence and development of myopia.(This article was published ahead of print on the Online-First Publishing Platform for Excellent Scientific Researches of Chinese Medical Association Publishing House on March 15, 2022).

BACKGROUND:This study used spectral-domain optical coherence tomography (SD-OCT) imaging to describe the distribution of macular ganglion cell complex (GCC) thickness and its association with ocular and systemic parameters in 7-year-old children in China. METHODS:The study involved a school-based, cross-sectional analysis of the Anyang Childhood Eye Study (ACES) and included 2,505 first-grade students from urban areas in Anyang, Henan Province, Central China. All participants underwent systemic and ocular examinations. Both GCC and retinal nerve fiber layer (RNFL) thickness were measured using the iVue-100 OCT (Optovue, Fremont, CA, USA). Intraocular pressure (IOP) was recorded with noncontact tonometer (Huvitz, HNT-7000). Axial length (AL) was measured using optical biometry (Lenstar LS 900, Haag-Streit Diagnostics, Koniz, Switzerland). RESULTS:The mean GCC thickness was 95.31±7.67 µm. GCC thickness had negative associations with AL (r=-0.124, P<0.001), cup-to-disc (C-D) area ratio (r=-0.068, P=0.0033), horizontal C-D (H C-D) ratio (r=-0.048, P=0.0384), and vertical C-D (V C-D) ratio (r=-0.074, P=0.0013). Positive correlations were found with spherical equivalent (SE) (r=0.080, P=0.0001), RNFL thickness (r=0.363, P<0.001), height (r=0.059, P=0.0036), fovea parameters, disc area (r=0.078, P=0.0007), rim area (r=0.115, P<0.001), rim volume (r=0.119, P<0.001), and optic nerve head volume (r=0.097, P<0.001). GCC thickness had no significant association with IOP, age, sex, or weight, waist, or head circumference. CONCLUSIONS:This study provides normative GCC data for 7-year-old healthy children in China. The findings support an association between GCC and AL, SE, RNFL, height, and C-D ratio in children.

Background The objective of this study was to examine the association of an integrated model (composed of retinal arteriolar caliber, height, and sex) with blood pressure (BP) among a group of Chinese children, and assess the predictive value of the integrated model for childhood hypertension. Methods This study included 1460 candidates aged 12.634 ± 0.420 years. Height, weight, waist circumference, and BP were obtained and ophthalmological measurements were taken. The computer-imaging program (IVAN, University of Wisconsin, Madison, WI) was used to measure calibers of retinal vessels. Receiver-operating characteristic curve (ROC) analyses were performed to assess the accuracy of the integrated model as a diagnostic test of elevated BP in children. Results The accuracy of the integrated model (assessed by area under the curve) for identifying elevated BP was 0.777 (95% confidence interval: 0.742–0.812). The optimal threshold of the integrated model for defining hypertension was 0.153, and the calculation formula for the specific predictive risk was: Logit ( p /1 − p ) = −5.666 − 0.261 × retinal arteriolar caliber + 0.945 × sex + 0.438 × height. In identifying elevated BP, the sensitivity and specificity were 0.711 and 0.736, respectively. Conclusions The model containing eye message is a comprehensive and relatively effective index to identify elevated BP in 12-year-old children, which can offer assistance to further understand childhood microcirculation disease. Impact We firstly incorporated retinal vascular diameter, sex, and height into one integrated model to identify hypertension in 12-year-old children. The current discrimination of hypertension in children is difficult. There have been some studies to simplify the diagnosis of children’s hypertension, but they were limited to anthropometric measurements. We proposed a composed model containing microcirculation information to predict childhood hypertension. Based on the knowledge that microcirculation is not only a means to study the manifestations but also early pathogenic correlates of hypertension, the combined model containing microcirculation message as a method may provide new insights into the diagnosis of childhood hypertension.

目的:分析玻璃体切割联合内界膜填塞术治疗高度近视黄斑裂孔性视网膜脱离的作用价值.方法:选取我院2018年1月—2019年3月收治的50例(58只眼)高度近视黄斑裂孔性视网膜脱离(MHRD)患者,按不同手术方案分为两组,对照组25例(28只眼),采用玻璃体切割加内界膜剥除;观察组25例(30只眼),采用玻璃体切割联合内界膜填塞术;比较两组患眼黄斑裂孔闭合、视网膜复位等恢复情况.结果:观察组术后黄斑裂孔闭合、视网膜复位发生率均高于对照组,差异有统计学意义(P<0.05).两组术后并发症发生率、视力提高率比较,差异无统计学意义(P>0.05).结论:玻璃体切割联合内界膜填塞术治疗高度近视黄斑裂孔性视网膜脱离患者取得理想效果,黄斑裂孔闭合率高,视网膜复位显著,值得推广.

Objective:To explore the effective myopia prevention and control strategy after "Anyang Childhood Eye Study" .Methods:The research data of 4981 cases (4981 eyes) of grade 1 and grade 7 students of Anyang city from October to December 2011 were collected. There were 1654 males (1654 eyes) and 1203 females (1203 eyes) in grade 1 students with the average age of (7.1±0.4) years-old (ranged from 5.7 to 9.3 years-old). Among them, there were 1065 males (1065 eyes) and 1059 females (1059 eyes) in grade 7 students with the average age of (12.7±0.5) years-old (ranged from 10.0 to 15.6 years-old). 387 students (387 eyes) in grade 1 and grade 7 students in Anyang city from November to December 2018 were randomly selected. Among them, there were 103 males (103 eyes) and 79 females (79 eyes) in grade 1 students with the average age of (6.8±0.3) years-old (ranged from 6.3 to 7.4 years-old). There were 112 males (112 eyes) and 93 females (93 eyes) in grade 7 students with the average age of (12.7±0.4) years-old (ranged from 10.8 to 14.7 years-old). Refraction were measured by noncycloplegic autorefraction for three times, and spherical equivalent (SE) were calculated. SE was described by ±s, and then the prevalence of refractive error were analyzed. During the period of "Anyang Childhood Eye Study" , the government-hospital-school tripartite model was used to prevent and control children′s myopia. The children′ diopters before and after the "Anyang Childhood Eye Study" model were compared by independent sample t test, and the prevalence of myopia before and after was compared by Chi square test.Results:In 2011, the average diopters of 2857 in grade 1 students and 2124 in grade 7 students were (-0.50±1.10) D and (-2.28±1.78) D, respectively. In 2018, the average diopters of 182 in grade 1 students and 205 in grade 7 students were (0.12±0.64) D and (- 2.02±2.01) D. There was statistically significant difference in eye diopter before and after the "Anyang Childhood Eye Study" model (t=-12.024, P<0.05). There was no significant difference in diopter in grade 7 students, but the diopter of children′myopia in 2018 was lower than that in 2011. According to the value of their diopter, they were divided into three groups: myopic group, emmetropic group and hyperopic group. In 2011, there were 1256 cases (43.96%) with myopia in grade 1 students; 1300 cases (45.50%) with emmetropia; 301 patients (10.54%) with hyperopia. There were 1860 cases (87.57%) with myopia in grade 7 students; 225 cases (10.59%) with emmetropia; 39 patients (1.84%) with hyperopia. The prevalence of children′myopia in two grades was 62.56%. In 2018, there were 31 cases (17.00%) with myopia in grade 1 students; 97 cases (53.30%) with emmetropia; 54 patients (29.67%) with hyperopia. There were 167 cases (81.46%) with myopia in grade 7 students; 30 cases (14.64%) with emmetropia; 8 cases (3.90%) with hyperopia. The prevalence of myopia in two grades was 51.16%. The prevalence of children′myopia between grade 1 and grade 7 students decreased by 17.90% over the past 7 years when the population composition ratio was considered. Chi square test showed that there was significant difference in the prevalence of children′myopia in grade 1 students, grade 7 students and the combination (χ2=49.725, 5.649, 19.259; P<0.05).Conclusions:The prevalence of children′ myopia has declined obviously in Anyang city, which suggesting that the "Anyang Childhood Eye Study" model that the myopia prevention and control platform of government-hospital-school, play a key role in the battle fightening against myopia. The myopia control should pay more attention to kindergarten and primary school students.

Purpose: To investigate the relationship between sleep duration and bedtime with myopia progression and axial elongation during a 4-year follow-up in primary school children. Methods: This study included 1887 children (aged 7.09 ± 0.41 years) who had cycloplegic refractions data at baseline and a fourth visit and 2209 children (aged 7.10 ± 0.41 years) for axial length. All children underwent comprehensive ophthalmologic examinations, including cycloplegic refraction and ocular biometry, and standardized questionnaires, including average night-time sleep duration (h/d) and bedtime (time to bed). Myopia was defined as spherical equivalent < –0.5 diopters. Results: At the last follow-up, the mean myopia progression and axial elongation for all children were –1.89 ± 1.28 diopters and 1.22 ± 0.57 mm. After stratifying the sleep duration into tertile groups, myopia progression and axial elongation were slower in children with highest sleep duration tertile (P = 0.04 and P =0.014) in girls but not in boys, compared with the middle sleep duration tertile. However, after adjusting for potential confounders, no significant association was found for sleep duration with myopia progression and axial elongation for the children (P = 0.255 and P = 0.068), and the association with axial elongation was only of borderline significance in girls (P = 0.045). The bedtime was not associated with myopia progression and axial elongation in the regression analyses (P = 0.538; P = 0.801). Conclusions: These results show that there was no significant association between sleep duration and bedtime with myopia progression and axial elongation among children. The findings in girls might be related to the earlier onset of puberty.

Aims To investigate the prevalence and predictors of pseudomyopia in Chinese children and its association with myopia progression. Methods A prospective, school-based, cohort study of 6- and 13-year-old children was conducted in Anyang, China. Pre-cycloplegic and post-cycloplegic autorefraction were performed at baseline and 1 year later. Pseudomyopia was defined as spherical equivalent refractive (SER) error in the better–seeing eye ≤−0.50 D before cycloplegia and >−0.50 D after cycloplegia. Among pseudomyopic children, pseudomyopic power was defined as non-cycloplegic SER subtracted from cycloplegic SER. Market survey was collected in all optometry stores in Anyang city to investigate how cycloplegia is used for refracting children. Results A total of 2612 children aged 6 years and 1984 children aged 13 years were included. Of the two cohorts, median cycloplegic SER (IQR) was 1.00 D (0.50, 1.38) and −1.13 D (−2.63, 0.13) respectively, myopia prevalence was 5.2% and 61.0%, pseudomyopia prevalence was 24.1% and 18.9%, and median pseudomyopic power was 1.13 D (0.63, 1.63) and 0.38 D (0.13, 0.88). In both cohorts, greater baseline hyperopia was the strongest predictor of pseudomyopia (p<0.001), whereas time spent on near work was not associated with pseudomyopic power (p>0.05). After 1 year, 15.6% (98/629) of 6-year-olds and 10.7% (40/374) of 13-year-olds with pseudomyopia developed myopia. Compared with myopes, pseudomyopic children with the same pre-cycloplegic SER had slower myopic progression (p<0.001). Among all 127 optometry stores in Anyang, only 4 (3.15%) used cycloplegia for refracting children. Conclusion Pseudomyopia is more prevalent in younger, more hyperopic children. Pseudomyopia is not an independent risk factor for myopic progression in this setting.

Objective::To study the relationship between intraocular pressure (IOP) and myopic refractive error in children.Methods::This was a cross-sectional study. A total of 2 126 grade 6 primary school students from the Anyang Childhood Eye Study, with an average age of 12.2±0.4 years, were included. The study was conducted in Anyang, Henan Province, from March to July 2017. Cycloplegic refraction was measured using an autorefractor, and spherical equivalent (SE) was calculated. IOP was examined by non-contact tonometry. Ocular biometry, including axial length, central corneal thickness, anterior chamber depth, and lens thickness, was measured using Lenstar LS900. IOP levels were divided into low (IOP<14 mmHg), moderate (14 mmHg≤IOP≤16 mmHg), and high (IOP>16 mmHg) using population tertiles. Emmetropia was def ined as SE between -0.5 and +0.5 D, hyperopia as greater than +0.5 D, and myopia as SE less than -0.5 D. Low myopia was defined as -0.5 D≤SE<-3.0 D, moderate myopia as -6.0 D≤SE<-3.0 D, and high myopia as SE<-6.0 D. Only the data for the right eye was used. The relationship between IOP and refractive errors was analyzed using an independent samples t-test, analysis of variance (ANOVA) with a post hoc Scheffé test and linear regression analysis. Results::The IOP of all subjects was 15.06±3.40 mmHg, and the SE was -1.36±2.08 D. The myopic refractive error in the low, moderate and high IOP level groups gradually increased and the difference was statistically significant ( F=3.863, P=0.021). The SE (-1.22±1.96 D) in the low IOP level group was significantly lower than the SE (-1.52±2.22 D) in the high IOP level group ( P=0.021). The difference in IOP among different categories of refractive errors was statistically significant ( F=2.695, P=0.029). The lowest IOP was 14.77±3.31 mmHg in the hyperopia group, and the highest IOP was 16.32±3.55 mmHg in the high myopia group. The IOP difference between the two groups was 1.55 mmHg ( P=0.047). Using IOP as the dependent variable, the linear regression model after adjusting for other covariates showed that a higher IOP was significantly associated with a higher degree of myopia ( β=-0.168, P=0.013). Conclusions::A higher intraocular pressure is significantly associated with a higher degree of myopia. Intraocular pressure may play a role in the development of myopia in children, but the causality still needs further study.

目的 观察白内障超声乳化术与小切口白内障囊外摘除术治疗对高度近视合并白内障患者角膜内皮细胞(CEC)的影响.方法 回顾性分析2016年1月至2018年1月我院收治的54例高度近视合并白内障患者临床资料,根据手术方式分为白内障超声乳化术组(A组,28例37眼)和小切口白内障囊外摘除术组(B组,26例35眼).记录两组患者不同时间点术眼CEC情况及中央角膜厚度(CCT)检查结果,比较两组患者术眼最佳矫正视力(BCVA)差异以及并发症发生情况.结果 两组患者术眼CEC面积均于T2时上升、T3～T4时逐渐降低,CEC密度、六角形细胞百分比则于T2时降低、T3～T4时逐渐升高,A组变化幅度小于B组(P＜0.05);两组患者术眼CCT均于T2时升高,于T3、T4时逐渐降低(P＜0.05);A组T2时CCT小于B组(P＜0.05),两组患者T1、T3、T4时组间比较差异无统计学意义(P＞0.05).T4时,两组患者BCVA较T1时显著提升,且A组优于B组(P＜0.05);A组患者术后并发症发生率小于B组,差异具有统计学意义(P＜0.05).结论 2种术式治疗高度近视合并白内障患者均会引起CEC损伤,但白内障超声乳化所致损伤相对较轻,更有利于患者术后视力恢复,且安全性良好.

49 Background/Aim: To quantify the impact of baseline presenting visual acuity (VA), 50 refractive error, and spectacles wear on subsequent academic performance among Chinese 51 middle school children. 52 Methods: A prospective, longitudinal, school-based study on grade 7 Chinese children (age, 53 mean ± SD, 12.7 ± 0.5 years, range= 11.1, 15.9) at 4 randomly-selected middle schools in 54 Anyang, China. Comprehensive eye examinations including cycloplegic autorefraction were 55 performed at baseline, and information on demographic characteristics, known risk factors 56 for myopia, and spectacle wear was collected. Academic test scores for all subjects in the 57 curriculum were obtained from the local Bureau of Education. Main outcome measure was 58 total test scores for 5 subjects at the end of grade 9, adjusted for total scored at the 59 beginning of grade 7. 60 Results: Among 2363 eligible children, 73.1%(1728/2363) had 7th grade test scores 61 available. 93.9%(1623/1728) completed eye examinations, and 98.5%(1599/1623) of these 62 had 9th grade test scores. Adjusting only for baseline test score, the following were 63 significantly associated with higher 9th grade scores: younger age, male sex, less time 64 outdoors, better baseline presenting VA and higher parental education, myopia and income, 65 but refractive error and spectacle wear were not. In the full multivariate model, baseline test 66 score (p<0.001), presenting VA (p=0.006), age (p<0.001), quality of life (p=0.036), and 67 parental education (p<0.001) and myopia (either: p=0.03; both: p=0.03) remained 68 significantly associated with better 9th grade scores. 69 Conclusions: In this longitudinal study, better presenting VA, but not cycloplegic refractive 70 error or spectacle wear, was a significant predictor of subsequent academic performance. 71

Background/aimTo quantify the impact of baseline presenting visual acuity (VA), refractive error and spectacles wear on subsequent academic performance among Chinese middle school children.MethodsA prospective, longitudinal, school-based study on grade 7 Chinese children (age, mean±SD, 12.7±0.5 years, range=11.1–15.9) at four randomly selected middle schools in Anyang, China. Comprehensive eye examinations including cycloplegic autorefraction were performed at baseline, and information on demographic characteristics, known risk factors for myopia and spectacle wear was collected. Academic test scores for all subjects in the curriculum were obtained from the local Bureau of Education. Main outcome measure was total test scores for five subjects at the end of grade 9, adjusted for total scored at the beginning of grade 7.ResultsAmong 2363 eligible children, 73.1% (1728/2363) had seventh grade test scores available. 93.9% (1623/1728) completed eye examinations, and 98.5% (1599/1623) of these had ninth grade test scores. Adjusting only for baseline test score, the following were significantly associated with higher ninth grade scores: younger age, male sex, less time outdoors, better baseline presenting VA, higher parental education and income and parental myopia, but refractive error and spectacle wear were not. In the full multivariate model, baseline test score (p<0.001), presenting VA (p<0.01), age (p<0.001), quality of life (p<0.05) and parental education (p<0.001) and myopia (either: p<0.05; both: p<0.05) remained significantly associated with better ninth grade scores.ConclusionsIn this longitudinal study, better presenting VA, but not cycloplegic refractive error or spectacle wear, was significantly associated with subsequent academic performance.

Objective To compare the effects of different combinations of common ocular parameters on the prediction of myopia in children and teenager,with the results of cycloplegia autorefraction as the gold standard for the diagnosis of myopia.Methods A diagnostic trial was adopted.Total of 2 739 first grade students in primary school and 1 797 grade 7 students in junior high school from the "Anyang Childhood Eye Study" were included from 2011 to 2012.Cycloplegic autorefraction using 1％ cyclopentolate was used to diagnose the myopia (spherical equivalent [SE] ≥＞-0.5 D).Uncorrected distant visual acuity (UCDVA),non-cycloplegic autorefraction,axial length (AL)and corneal power were combined randomly,and Logistic regression method was used to establish the prediction models on myopia and evaluate their sensitivity,specificity,positive predictive value and negative predictive value.This study followed the Declaration of Helsinki and this study protocol was approved by the Ethics Committee of Beijing Tongren Hospital.Results When using a single index,the effect of UCDVA was the best,but the sensitivity was only 39.18％ in the first grade of primary school students,and the positive predictive value was 78.35％.Some improvement could be obtained by using two indexes,the effect of UCDVA+AL was the best,the sensitivity was 48.46％,and the positive predictive value was 78.79％,followed by UCDVA + non-cycloplegic autorefraction,the sensitivity was 45.08％ and the positive predictive value was 79.15％.Three indices could further improve the effect of prediction model.The effect of UCDVA+AL+corneal power was the best,the sensitivity was 54.45％ and the positive predictive value was 85.45％,followed by UCDVA+AL+non-cycloplegic autorefraetion,the sensitivity was 52.12％ and the positive predictive value was 81.21％.The best results could be obtained by using all four indices,but the improvement was limited,the sensitivity was 55.26％,and the positive predictive value was 84.57％.In the grade 7 students,sensitivities of the various indices were generally higher (86.63％ to 97.73％),but the specificity was decreased (3.62％ to 90.52％).Conclusions AL can significantly improve the sensitivity of predicting myopia in children,it is non-invasive,simple and easy to perform,and it is an important indicator of eye development and myopia development in children.Therefore,we suggest that AL should be list as a routine indicator of myopia screening,as well as clinical diagnosis and treatment in children.

Aims To document the difference between non-cycloplegic and cycloplegic refraction and explore its associated factors in Chinese young adults. Methods A school-based study including 7971 undergraduates was conducted in Anyang, Henan Province, China. Cycloplegia was achieved with two drops of 1% cyclopentolate and 1 drop of Mydrin P (Tropicamide 0.5%, phenylephrine HCl 0.5%) with a 5 min interval. Non-cycloplegic and cycloplegic refractions were measured by an autorefractor. A paired-sample t-test and Spearman correlation analysis were used for analysis with data from only the right eyes included. Results Of the 7971 students examined, 7793 (97.8%) with complete data were included, aging 20.2±1.5 years. Male students accounted for 36.8%. Overall, there was a significant difference between non-cycloplegic and cycloplegic SE (spherical equivalent) of 0.83±0.81D (p<0.01). The difference was 1.80±1.11D, 1.26±0.93D and 0.69±0.69D for those with cycloplegic hyperopia, emmetropia and myopia, respectively (p<0.01 for all). Those with a hyperopic shift less than 0.25D and 0.5D accounted for 11.1% and 34.1%, respectively. A significant relationship was found between difference in SE and cycloplegic refraction (r=0.33, b=0.11, p<0.01). Without cycloplegia, prevalence of hyperopia and emmetropia would be underestimated by 6.2% (1.0% vs 7.2%) and 5.7% (3.8% vs 9.5%), respectively, with prevalence of myopia and high myopia overestimated by 12.1% (95.3% vs 83.2%) and 6.1% (17.2% vs 11.1%). Conclusion Lack of cycloplegia will lead to significant misclassification of myopia, emmetropia and hyperopia in Chinese young adults. Cycloplegia is therefore essential for this age-group in epidemiological studies.

Total refractive astigmatism is usually the first consideration that guides the selection of contact lens type (e.g., spherical or toric), while the ocular source of the astigmatism is a second, but more important consideration, for the final clinical decision. This study was conducted to provide detailed data on this topic by evaluating astigmatic components in Chinese adolescents.Participants were recruited from healthy high school students undergoing an annual ocular examination at a local hospital. Total astigmatism (TA), corneal astigmatism (CA), and ocular residual astigmatism (ORA) were determined by a Hartmann-Shack wavefront analyzer system (KR-1W, Topcon) with the natural pupil. The axis relationship between CA and ORA was placed into three categories: on-axis, defined as an axis with a difference of 0 ± 10°; opposite-axis, a difference of 90 ± 10°; and the rest defined as oblique-axis.The study consisted of 1,466 students (57.84% girls, age: 16.49 ± 1.05 years). ORA was present in 83.97%, 66.64%, and 45.23% of participants, according to the various criteria for astigmatism (≥ 0.50 D, ≥ 0.75 D, and ≥ 1.00 D, respectively). While with-the-rule was the most common axis orientation for both TA (76.28%) and CA (89.94%), against-the-rule predominated in ORA (93.82%; χ2 = 1688.544, p < 0.001). Opposite-axis was the major type of axis difference (90.96%) of clinical significance (i.e., ≥ 1.00 D) between CA and ORA, which also prevailed in all levels of TA (range: 56.25-82.26%).ORA is common in high school students and usually demonstrates a compensation relationship with CA, which should be taken into consideration when determining the design of contact lenses to correct refractive error.

Purpose To explore the relationship between intraocular pressure (IOP) at baseline and myopia progression in Chinese children from the Anyang Childhood Eye Study. Design Prospective school-based cohort study. Methods A total of 1558 grade 7 students completed the entire 2-year study. Ocular biometry, cycloplegic refractions and pneumotonometry were performed. Three years of follow-up have been completed for the children aged 12 years. The refractive groups and the tertiles of IOP were assessed by analysis of variance, to look for differences in mean values of spherical equivalent and IOP, respectively. Results The children’s mean baseline IOP was 15.87±3.42 mm Hg. Mean IOP was significantly higher in girls by 0.57 mm Hg (p=0.024). In the whole sample, there was a mean change in spherical equivalent of −1.05 D over 2 years. The baseline IOP was 15.69 mm Hg in those progressing 1 D or more vs 16.09 mm Hg for those progressing <1 D (p=0.022). In the myopic group, myopes progressing >1 D had mean IOP of 15.94 vs 16.42 mm Hg for those myopes progressing 1 D or less (p=0.024). Conclusions In this sample of Chinese children, myopia progression over 2 years was inversely related to IOP, suggesting that IOP had essentially no relationship with myopia progression in school children. The lower IOP in progressing myopic eyes may indicate more compliant sclerae.

To establish the independent association between blood pressure (BP) and retinal vascular caliber, especially the retinal venular caliber, in a population of 12-year-old Chinese children.

Purpose To determine prevalence of refractive (RA), corneal (CA) and internal astigmatism (IA), including variation with gender and spherical equivalent refraction (SE), in a population of 12-year-old Chinese children. Methods A total of 1783 students with a mean age of 12.7 years (range 10.0–15.6 years) completed comprehensive eye examinations in the Anyang Childhood Eye Study. Data of cycloplegic refraction and corneal curvature were analysed. Results Prevalences of RA, CA and IA ≥1.0 D were 17.4% (95%CI 15.6% to 19.2%), 52.8% (50.5% to 55.1%)%) and 20.9% (19.0% to 22.8%), respectively. With different limits of astigmatism axes classification, including ±15°, ±20° and ±30°, RA and CA axes were mainly ‘with-the-rule’ (WTR) (ie, correcting axis of negative cylinders at or near 180°), while those for IA axes were mainly ‘against-the-rule’ (ATR) (ie, correcting axis of negative cylinders at or near 90°). RA was not different between the genders, but girls had higher prevalence and greater means of CA and IA. RA and CA increased in students with higher ametropia (more myopia and more hyperopia) and were the highest in a high myopic group (SE≤−6 D), while IA was stable across refraction groups. Children with RA higher than 0.50 D were more likely to have lens corrections (51%, 57%, 61% and 69% for magnitudes of ≥0.50 D, ≥0.75 D, ≥1.0 D and ≥1.5 D, respectively). Conclusions Prevalence of RA in the Chinese 12-year-old children was relatively high compared with other studies. RA and CA had mainly ‘WTR’ astigmatism, while IA was mainly ATR and partially compensated for CA. Girls had greater means and prevalences of CA and IA than did boys. Both RA and CA, but not IA, increased with refractive errors away from emmetropia.