AIM: To develop and validate a clinician-friendly logistic regression prediction model for self-reported visual impairment (VI) in middle-aged and older adults (≥45y) with diabetes. METHODS: Leveraging data from the China Health and Retirement Longitudinal Study (CHARLS), a model for VI among adults aged ≥45y with diabetes were developed. Feature selection involved LASSO regression and subsequent multivariable logistic regression. Eight machine learning algorithms were explored and compared for predictive performance. Logistic regression for its consistent performance, interpretability, and clinical usability was finally selected. A nomogram and interactive web-based tool were constructed to facilitate application. RESULTS: Totally 1918 participants (45.83% males) in CHARLS 2011 with aged ≥45y were analyzed in the training cohort and 1553 in CHARLS 2015 were in validation cohort. Among all participants in the training cohort, 39.6% reported VI. Seven variables were found to be independently associated with VI. The optimal model, logistic regression model, achieved area under the curve (AUC) of 0.702 and 0.706 in the training and validation cohorts, respectively. The model's potential for clinical application was supported by calibration and decision-curve analyses; the resulting nomogram and web calculator provided individualized risk prediction. CONCLUSION: We developed a clinically interpretable logistic regression model to predict the risk of VI in adults aged ≥45y with diabetes. The accompanying nomogram and web tool may assist with early identification and targeted vision care.

BACKGROUND/AIMS:Cost-effective screening models for ocular diseases in large populations remain a critical challenge for blindness prevention. Our preliminary study demonstrated the feasibility of opportunistic glaucoma screening integrated into general health examinations. This study aimed to evaluate the efficacy of this model for fundus disease screening in a multicentre, large-sample Chinese population. METHODS:This study was conducted in five health examination centres from four provinces of China. Chinese participants aged ≥18 years undergoing routine health examinations were invited to complete bilateral presenting visual acuity and non-mydriatic fundus photography. Fundus photography was assessed by two experienced graders. Proportion of fundus diseases/changes were calculated. Costs for the screening were also assessed. RESULTS:A total of 63 935 eligible participants (age 45.4±14.0 years, 51.3% men) were enrolled. The top five diseases/changes were non-macular drusen (8.80%), macular degeneration (6.30%), glaucoma suspect (5.54%), epiretinal membrane (3.92%) and diabetic retinopathy (3.89%). The proportion of low vision and blindness in the total population was 5.85% and 0.15%, respectively. The top five diseases/changes with vision impairment were retinitis pigmentosa (18.18%), myopic retinopathy (16.52%), macular hole (11.76%), non-glaucomatous optic neuropathy (7.25%) and glaucomatous optic neuropathy (6.37%). The unit cost of screening a single case and an ocular disease suspect was US$22.2 (US$15.7 to US$26.7) and US$83.2 (US$58.7 to US$99.9), respectively. CONCLUSIONS:This health examination centre-based screening model is feasible, effective and affordable for detecting multiple fundus diseases in large populations. As the model is promoted and its coverage expands, screening costs may be further reduced.

There has been a growing prevalence of cardiovascular metabolic diseases (CMD) in adults aged ≥ 45 years, and vision impairment (VI) is highly prevalent in this population. The objective of this study was to explore the critical determinants of VI in individuals affected by CMD and to develop risk prediction models. We analyzed data collected in 2011 (n = 1,926) and 2015 (n = 3,033) within the China Health and Retirement Longitudinal Study (CHARLS). Risk factors were selected using the least absolute shrinkage and selection operator (LASSO) regression followed by multivariable logistic regression analysis. Eight machine learning (ML) algorithms were applied: LR, GBM, XGBoost, LightGBM, CatBoost, AdaBoost, NN, and SVM. The evaluation of model performance incorporated ROC curves, calibration assessments, and decision curve analysis. Eleven predictors demonstrated significant links to VI in CMD patients: hearing impairment, depressive symptoms, pain, lower uric acid levels, poorer self-rated health, functional limitations, multimorbidity, reduced cognitive function, poorer sleep quality, and histories of glaucoma and cataract surgery. Among the eight ML algorithms, LR achieved the most stable performance, with AUCs of 0.705 (2015 training set), 0.693 (2015 internal validation set), and 0.695 (2011 temporal validation set). Shapley Additive exPlanations (SHAP) analysis ranked the relative contribution of predictors, and a nomogram was developed for individualized risk estimation. We established an LR-based prediction model for VI in patients with CMD aged ≥ 45 years, exhibiting stable accuracy and favorable interpretability in clinical settings. This tool may support timely recognition and intervention of eye health risks in CMD patients aged ≥ 45 years, particularly in settings with limited ophthalmic resources.

Purpose: This study aimed to evaluate the effectiveness of single-field fundus photography for diabetic retinopathy (DR) screening and monitoring versus six-field imaging in community settings. Methods: Adults aged ≥30 years with Type 2 diabetes from 15 communities in Northeast China were recruited for this prospective cohort study (n = 2,006 at baseline and n = 1,456 at follow-up). Participants underwent both single-field and six-field digital fundus photography at baseline and follow-up visits (mean duration of 21.2 ± 3.2 months). Photographs were graded using international standards. Agreement in DR severity grading, referral recommendations, and detection of DR progression were compared between single-field and six-field fundus photography. Results: Single-field grading showed substantial agreement with multifield grading in classifying DR severity (81.9% identical at baseline, 80.6% at follow-up, Gwet AC1 0.79 and 0.77). For referring eyes with moderate nonproliferative DR or worse, single-field grading had ∼70% sensitivity and 100% specificity compared with six-field grading. Single-field grading identified 74.9% or 79.7% of eyes progressing or regressing by six-field grading, respectively. Conclusion: Single-field fundus photography demonstrated reasonable effectiveness for DR screening and monitoring in a community setting, supporting its use for improving access to DR detection. However, reduced sensitivity compared with multifield imaging should be acknowledged.

ObjectiveTo examine the association between visual acuity (VA), sleep quality, and sleep duration among Chinese adults.Subjects/MethodsData were derived from the Fushun Diabetic Retinopathy Cohort Study (FS-DIRECT), a cross-sectional, community-based study conducted in Fushun, China, from July 2012 to May 2013. The study included 1284 participants (58.7% female, mean age 61.3 years) with type 2 diabetes. VA was assessed using the LogMAR chart and stratified into six groups based on LogMAR scores: <0 (optimal), 0-0.1, 0.1-0.2, 0.2-0.3, 0.3-0.5, and ≥0.5 for multivariable-adjusted analyses. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI).ResultsRestricted cubic splines revealed a significant J-shaped association between VA and sleep quality (P for non-linearity = 0.004). This relationship was characterized by a positive correlation for VA values below 0.5 LogMAR, with the association plateauing at higher VA levels. Compared to the optimal VA group, the odds ratios (ORs) for poor sleep quality were: 1.18 (95% CI: 1.05-1.33) for 0-0.1, 1.73 (1.52-1.97) for 0.1-0.2, 1.99 (1.74-2.28) for 0.2-0.3, 1.55 (1.33-1.80) for 0.3-0.5, and 1.80 (1.54-2.10) for ≥0.5. No significant association was found between VA and sleep duration, whether short or long, in fully adjusted models.ConclusionsOur findings reveal a J-shaped association between visual acuity and sleep quality, while no significant association was observed with sleep duration. Even mild vision changes, not typically classified as impairment, may significantly affect sleep. This underscores the importance of early sleep health consideration in eye care.

Purpose: We aimed to study the effects of aspirin intake for diabetic retinopathy (DR) and diabetic macular edema (DME) in a cohort from northeastern China. Methods: Participants in the Fushun Diabetic Retinopathy Cohort Study were enrolled between July 2012 and May 2013. Fundus photographs of six fields were graded according to the modified Airlie House Classification system. The prevalence, incidence, progression, and regression of DR, as well as the prevalence/incidence of DME, were evaluated at baseline and during follow-up examinations after at least 1 year. Results: In total, 1370 patients were enrolled in the study, and 270 (19.7%) were taking aspirin. The prevalence of any DR in participants with and without aspirin intake was 47.4% and 44.9%, respectively (P = 0.46). The incidence of any DR in patients with and without aspirin intake was 9.2% and 8.3%, respectively (P = 0.74). In univariate regression, there was no association between aspirin intake and the prevalence of any DR and DME (odds ratios (OR), 95% confidence intervals (CI): 0.93, 0.68–1.27 and 1.22, 0.79–1.88, respectively). Aspirin intake was not significantly associated with the prevalence and incidence of DME (OR, 95% CI: 1.22, 0.79–1.88 and 1.79, 0.62–5.17, respectively). Furthermore, aspirin intake was not significantly associated with DR progression or regression (OR, 95% CI: 1.04, 0.66–1.66 and 0.75, 0.52–1.09, respectively). Conclusion: Aspirin intake was not associated with the prevalence and incidence of any DR or DME in a northeastern Chinese population. Neither progression nor regression of DR revealed a significant association with aspirin intake.

SIGNIFICANCE This study reported the relationship between intraocular pressure (IOP) and myopia progression, which helps to understand more comprehensively whether IOP can be an important reference factor to intervene in the progression of myopia. PURPOSE This study aimed to investigate the association between IOP and myopia progression as well as axial length elongation in rural Chinese children. METHODS A total of 598 (598 of 878 [68.1%]) children (6 to 17 years) from the baseline Handan Offspring Myopia Study who completed a 3.5-year follow-up vision examination were included. Ocular examinations at both visits included cycloplegic autorefraction, IOP, and axial length measurements. RESULTS Children with myopia had the highest baseline IOP of the three refractive groups (14.13 ± 1.31, 13.78 ± 1.71, and 13.59 ± 1.64 mmHg in myopes, emmetropes, and hyperopes, respectively, P = .002). However, IOPs showed no significant difference between eyes with or without newly developed myopia (13.63 ± 1.68 vs. 13.89 ± 1.68, P = .16), with or without faster myopia progression (13.75 ± 1.61 vs. 13.86 ± 1.63, P = .46), or with axial length elongation (13.80 ± 1.61 vs. 13.76 ± 1.64, P = .80). The multivariate regression analysis demonstrated that neither baseline refractive error (β = −0.082, P = .13) nor baseline axial length (β = −0.156, P = .08) was associated with baseline IOP. CONCLUSIONS Myopic eyes have slightly higher IOP compared with emmetropic and hyperopic eyes, although it was not clinically significant. However, IOP was not found to be associated with either myopia progression or axial length elongation in this cohort sample of rural Chinese children.

To investigate the current surgery strategies for bilateral proliferative diabetic retinopathy (PDR), as well as the surgical outcomes of patients with bilateral PDR who underwent pars plana vitrectomy (PPV). Patients undergoing bilateral vitrectomy for PDR from January 2019 to December 2020 at The Eye Hospital of Wenzhou Medical University were enrolled. Clinical data were collected from the electronic medical records. Factors associated with the time interval between the surgeries on two eyes and postoperative visual outcomes were analyzed. In total, 152 patients with bilateral PDR who underwent bilateral PPV were included in this analysis. Mean age was 53.7 ± 11.4 years. Compared with second-surgery eyes, 60.5

BACKGROUND:Pathological myopia (PM) is closely associated with blinding ocular morbidities. Identifying biomarkers can provide clues on pathogeneses. This study aimed to identify metabolic biomarkers and underlying mechanisms in the vitreous humour (VH) of PM patients with complications. METHODS:VH samples were collected from 39 PM patients with rhegmatogenous retinal detachment (RRD) (n = 23) or macular hole (MH)/myopic retinoschisis (MRS) (n = 16) and 23 controls (MH with axial length < 26 mm) who underwent surgical treatment. VH metabolomic profiles were investigated using ultra-performance liquid chromatography‒mass spectrometry. The area under the receiver operating characteristic curve (AUC) was computed to identify potential biomarkers for PM diagnosis. RESULTS:Bioinformatics analysis identified nineteen and four metabolites altered in positive and negative modes, respectively, and these metabolites were involved in tryptophan metabolism. Receiver operating characteristic analysis showed that seventeen metabolites (AUC > 0.6) in the positive mode and uric acid in the negative mode represent potential biomarkers for PM with complications (AUC = 0.894). Pairwise and pathway analyses among the RRD-PM, MH/MRS-PM and control groups showed that tryptophan metabolism and uric acid were closely correlated with PM. Altered metabolites and pathways in our study were characterized by increased oxidative stress and altered energy metabolism. These results contribute to a better understanding of myopia progression with or without related complications. CONCLUSIONS:Our study provides metabolomic signatures and related immunopathological features in the VH of PM patients, revealing new insight into the prevention and treatment of PM and related complications.

AIM To estimate and compare the incidence and characteristics of rhegmatogenous retinal detachments (RRDs) in the Wenzhou area in 2015 to 2019. METHODS All newly developed RRD cases among residents of the Wenzhou area, from January 2015 to December 2019, were retrospectively retrieved from hospital records. Annual population data were extracted from the Wenzhou Statistical Yearbook. RESULTS There were 3629 eligible cases. The average incidence of RRD was 7.79 cases per 100 000 population (95% confidence interval, 7.24-8.34), and the incidences were 7.99 and 7.56 for males and females, respectively. The annual incidence increased gradually from 7.26 cases per 100 000 in 2015 to 10.00 cases per 100 000 in 2019, with an overall increase of 37.74%. The highest rate of increase occurred in the age group from 60 to 69 years. Of 2750 eyes with axial length (AL) data, 1675 (60.91%) had an AL greater than 24 mm. CONCLUSION A trend to increasing RRD incidence is observed in the Wenzhou area over the past 5-year period.

Purpose To describe the prevalence and risk factors for refractive errors in a northeastern Chinese population with type 2 diabetes. Methods Subjects (age >= 30 years) from a community-based study, the Fushun Diabetic Retinopathy Cohort Study, were enrolled. All subjects underwent comprehensive ocular examinations, including autorefraction. Myopia, high myopia, and hyperopia were defined as a spherical equivalent (SE) of the right eye <-0.5 diopter (D), <-5.0D, and >0.5D, respectively. Astigmatism was defined as cylinder 1.0D between two eyes. Results A total of 1929 participants (790 males, 41.0%) were enrolled. The age and gender standardized prevalence of myopia, high myopia, hyperopia, astigmatism, and anisometropia were 43.1% (95% confidence interval [CI]: 40.9%-45.3%), 8.5% (95% CI: 7.3%-9.8%), 21.5% (95% CI: 19.7%-23.4%), 61.0% (95% CI: 58.9%-63.2%), and 17.2% (95% CI: 15.5%-18.9%), respectively. Advancing age was associated with a higher frequency of hyperopia, astigmatism, and anisometropia, as opposed to a lower frequency of myopia. Female (adjusted odds ratio [aOR], 1.27; 95% CI, 1.02-1.57) participants, higher intraocular pressure (aOR, 1.03; 95% CI, 1.00-1.07), and lenticular opacity (aOR, 1.53; 95% CI, 1.20-1.94) were also found to be associated with myopia. Long duration of diabetes (>15 years) was found to be a significant factor for astigmatism (aOR, 1.62; 95% CI, 1.15-2.27) and anisometropia (aOR, 1.87; 95% CI, 1.29-2.71). Conclusion Nearly two-thirds of participants with type 2 diabetes had a refractive error. Age is a common factor with different types of refractive errors.

PURPOSE:To assess the prevalence of and risk factors for fundus pathology in patients with type 2 diabetes mellitus (T2DM) in a cohort from northeastern China. METHODS:Patients were included from the Fushun Diabetic Retinopathy Cohort Study. Patients aged ≥ 30 years with T2DM were recruited between July 2012 and May 2013. Fundus pathology included retinal vascular occlusion (RVO), age-related macular degeneration (AMD), macular pathology, pathologic myopia (PM) and glaucomatous optic atrophy (GOA). RESULTS:A Total of 1998 patients with gradable fundus photographs were included in this study, of whom 388 (19.42%) had fundus pathology regardless of whether they had diabetic retinopathy (DR). There were 187 (9.36%) patients with AMD, 97 (4.85%) with GOA, 67 (3.35%) with macular pathology, 35 (1.75%) with PM and 23 (1.15%) with RVO. Advanced age was significantly associated with AMD (odds ratio (OR), 95% confidence interval (CI): 1.03, 1.01-1.05), macular pathology (OR, 95% CI: 1.06, 1.03-1.09) and GOA (OR, 95% CI: 1.06, 1.04-1.09). A wider central retinal arteriolar equivalent was protective against PM (OR, 95% CI: 0.78, 0.66-0.92). Wider central retinal venular equivalent was a protective factor for PM (OR, 95% CI: 0.75, 0.68-0.82) and GOA (OR, 95% CI: 0.93, 0.87-0.99). CONCLUSIONS:One-fifth of these patients in northeast China with T2DM had fundus pathology regardless of whether they had DR, indicating the importance of early screening and long-term follow-up.

AimTo determine the incidence, progression and regression of diabetic retinopathy (DR), with corresponding risk factors, in a northeastern Chinese population of patients with type 2 diabetes.MethodsAmong 2006 patients who completed baseline examinations in 2012–2013 and underwent re-examination after a mean interval of 21.2 months, 1392 patients with gradable fundus photographs for both baseline and follow-up examinations were included. Incidence was defined as new development of any DR among patients without DR at baseline. An increase of ≥2 scales (concatenating Early Treatment Diabetic Retinopathy Study levels of both eyes) in eyes with DR at baseline was defined as progression, while a reduction of ≥2 scales was defined as regression.ResultsThe age- and sex-standardised incidence, progression and regression were 5.8% (95% CI 4.7% to 6.9%), 26.8% (95% CI 24.8% to 28.8%) and 10.0% (95% CI 8.6% to 11.3%), respectively. In addition to poor blood glucose control, wider central retinal venular equivalent was associated with both incidence (relative risk (RR) 2.17, 95% CI 1.09 to 4.32, for ≥250 µm vs <210 µm) and progression (RR 2.00, 95% CI 1.02 to 3.96, for ≥250 µm vs <210 µm). Patients without insulin therapy (RR 0.64, 95% CI 0.43 to 0.97) and patients with wider central retinal arteriolar equivalent (RR 1.14, 95% CI 1.02 to 1.26, per 10 µm increase) were likely to exhibit DR regression.ConclusionWe determined the incidence, progression and regression of DR among northeastern Chinese patients with type 2 diabetes. Retinal vessel diameters, in addition to blood glucose level, influence the natural evolution of DR.

Supplemental Digital Content is Available in the Text. Ocular perfusion pressure was found to be an independent risk factor for the incidence of diabetic retinopathy in a Chinese cohort of patients with Type 2 diabetes. Purpose: To investigate the association between mean ocular perfusion pressure (MOPP), estimated cerebrospinal fluid pressure (CSFP), and changes in diabetic retinopathy (DR) in a Northeastern Chinese population with Type 2 diabetes. Methods: A total of 1,322 subjects from the Fushun Diabetic Retinopathy Cohort Study were enrolled. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and intraocular pressure (IOP) were recorded. MOPP was calculated by the following formula: MOPP = 2/3 [DBP + 1/3 (SBP − DBP)] – IOP, and CSFP was estimated according to the following formula: CSFP = 0.44 × body mass index + 0.16 × DBP − 0.18 × age − 1.91. New development, progression, and regression of DR were graded based on fundus photographs at baseline and during follow-up examinations with a mean interval of 21.2 months using the modified Early Treatment Diabetic Retinopathy Study criteria. Results: Increasing MOPP was associated with the incidence of DR in the multivariate model (per 1-mmHg increase: relative risk, 1.06; 95% confidence interval, 1.02–1.10; P = 0.007) and showed a borderline negative association with DR regression (per 1-mmHg increase: relative risk, 0.98; 95% confidence interval, 0.97–1.00; P = 0.053). However, MOPP was not associated with progression of DR. Cerebrospinal fluid pressure was not associated with new development, progression, or regression of DR. Conclusion: The MOPP, but not the CSFP, was found to influence the development, but not the progression of DR in this Northeastern Chinese cohort.

Introduction: The aim of this study was to compare the patterns of visual field (VF) defects in primary angle-closure glaucoma (PACG) to control groups of eyes with high-tension glaucoma (HTG) and normal-tension glaucoma (NTG). Methods: Forty-eight eyes with PACG were enrolled, and control eyes with HTG and NTG matched for age, sex, and mean deviation of VF defect were selected. VF tests were performed using the 24-2 program of the Humphrey field analyzer. VF defects were classified into six patterns with the Ocular Hypertension Treatment Study classification system and were categorized into three stages (early, moderate, and advanced). Each hemifield was divided into five regions according to the Glaucoma Hemifield Test (GHT). The mean total deviation (TD) of each GHT region was calculated. Results: Compared with HTG and NTG groups, the partial arcuate VF defects were more common in the PACG group. In the PACG group, the nasal GHT region in the inferior hemifield had the worst mean TD (−8.48 ± 8.62 dB), followed by the arcuate 1 (−7.81 ± 7.91 dB), arcuate 2 (−7.46 ± 7.43 dB), paracentral (−7.19 ± 7.98 dB), and central (−5.14 ± 6.24 dB) regions; the mean TD of the central region was significantly better than those for all other regions (all p < 0.05). A similar trend was observed in the superior hemifield in the PACG group but not the VF hemifields of the HTG and NTG groups. Conclusion: Patterns of VF defect in PACG patients differ from those with HTG and NTG. This discrepancy might be due to the differences in the pathogenic mechanisms of glaucomatous optic neuropathy.

AIM: To investigate the effects of school-based comprehensive intervention on myopia development in elementary school children. METHODS: As a part of the Wenzhou Epidemiology of Refraction Error Study, there were 1524 participating elementary students (730 girls, 47.9%) in grades 1 to 3 from three campuses of one school, aged 7.3±0.9y, who were examined twice every year for a 2.5y follow up period. Comprehensive intervention and other reminders were given at school every semester for the intervention group. The control group did not receive comprehensive intervention and did not have reminders of it. RESULTS: There were 651 students in the intervention group [mean age 7.3±0.9y; 294 (45.2%) girls] and 737 students in the control group [mean age 7.2±0.9y; 346 (46.9%) girls]. Overall mean myopia progression during the 2.5y follow-up was -0.49±1.04 diopters (D) in the intervention group and -0.65±1.08 D in the control group (P=0.004). The majority that not get myopia at baseline spherical equivalent (SE≤-1.0 D). Their mean myopia progression during the 2.5y follow-up was -0.37±0.89 D in the intervention group and -0.51±0.93 D in the control group (27.5% reduction, P=0.009); Overall, mean axial length elongation was less in the intervention group (0.56±0.32 mm) than in the control group (0.61±0.38 mm, 10.5% reduction, P=0.009). The percentage of close reading distance (<30 cm) in the intervention group was less than in the control group (73.4% vs 76.2%, P<0.001), the percentage of everyday perform eye exercises in the intervention group was more than in the control group (27.8% vs 20.7%, P<0.001) 30mo later. CONCLUSION: The comprehensive intervention program at elementary school has a significant alleviating effect on myopia progression for children during the 2.5y follow-up, especially for those non-myopia at baseline.

AIM: To estimate the prevalence of diabetic macular edema（DME） and clinically significant macular edema（CSME）, and to assess their risk factors in a population with type 2 diabetic mellitus（T2DM） located in northeast China.METHODS: Patients were included from the Fushun Diabetic Retinopathy Cohort Study（FS-DIRECT）, a community-based study conducted in northeast China.The presence of DME and CSME was determined by the Early Treatment Diabetic Retinopathy Study（ETDRS） retinopathy scale of fundus photographs.The age-standardized prevalence of DME and CSME was estimated.The association between DME/CSME and risk factors was analyzed in a multivariate Logistical analysis.RESULTS: A total of 292（15.4%） and 166（8.8%） patients were diagnosed as DME and CSME, yielding the age and sex standardized prevalence of 13.5%（95%CI: 11.9%-15.0%）, and 7.1%（95%CI: 5.9%-8.3%）, respectively.Female patients had a higher prevalence of DME compared to their male counterparts（15.7% vs 10.4%, P=0.03）.Multivariable Logistic regression analysis showed that younger age, insulin use, proteinuria, longer duration of diabetes, and higher glycosylated hemoglobin A1c, were associated with the prevalence of DME and CSME.Patients with higher fasting plasma glucose, systolic blood pressure, and blood urea nitrogen were also found to be associated with DME.CONCLUSION: Early fundus screening in diabetic patients is invaluable and given the relatively high prevalence of DME and CSME in this study cohort, those with a high risk of sight threatening maculopathy would invariably benefit from earlier detection.

AIM:To investigate fluctuation of intraocular pressure (IOP) and seasonal variation of 24-hour IOP during one year in healthy participants.METHODS:Totally 13 young healthy volunteers participated in this study. IOP was measured with Canon TX-20 at about 8:00-9:00 a.m. from Monday to Friday every week for a whole year. They also underwent 24-hour IOP examination every three months. Blood pressure, heart rate, temperature, humidity, atmosphere pressure, sunshine duration and other environment parameters were recorded.RESULTS:The yearly fluctuation curve showed IOP in the summer months were lower than other seasons. In the multivariable generalized estimating equation analysis, IOP had a negative correlation with both temperature and sunshine duration (P<0.05). There also was a seasonal effect on 24-hour IOP. However, all intraclass correlation coefficients values of minimum, maximum and average of the 24-hour IOP and each individual IOP were less than 0.30.CONCLUSION:IOP is trend to be higher in cold days than warm days. IOP have negative association with both environmental temperature and duration of sunshine. On a season-to-season basis, 24-hour IOP is not highly reproducible in healthy volunteers.

Purpose To assess the refractive change and incidence of myopia, as well as their risk factors, among Chinese rural children aged 6–17 years. Methods Children who completed the baseline vision examination of the Handan Offspring Myopia Study were re-examined, including both cycloplegic and non-cyloplegic autorefraction, with a mean follow-up time of 42.4±1.47 months. Results A total of 601 children (68.5%) who completed both baseline and the follow-up examinations were enrolled. The cumulative refractive change and axial length change were −0.53±1.03 diopter and 0.39±0.46 mm (−0.15 diopter/year and 0.11 mm/year), respectively. A hundred and five out of the 469 non-myopic children at baseline become myopic at the follow-up, yielding a cumulative myopia incidence of 22.4% (95% CI: 18.6% to 26.2%), or annual myopia incidence of 6.3%. After adjustment, younger age (β=0.08, p<0.001), more myopic baseline refraction (β=0.31, p<0.001), larger difference between cycloplegic and non-cycloplegic refraction (β=−0.20, p=0.007) and more myopic paternal refraction (β=0.09, p=0.007) were found to be associated with more rapid myopic refractive change. More myopic baseline refraction (relative risk (RR), 95% CI: 0.19, 0.13–0.28, p<0.001) and more myopic paternal refraction (RR, 95% CI: 0.92, 0.84–1.00, p=0.039) were also associated with myopia incidence. Conclusion Relatively low myopic refractive change and myopia incidence were found in this study cohort. Children’s refraction and paternal refraction were associated with both myopic refractive change and myopia incidence. Such information will be helpful for further comparisons in other rural versus urban areas of China, and other countries.

Purpose. Approximately 30% of patients with an open-globe injury (OGI) develop a secondary epiretinal membrane (ERM). This study was performed to assess whether internal limiting membrane (ILM) peeling in the treatment of posterior segment OGI prevents ERM formation. Methods. The medical records of 33 patients who underwent vitrectomy for posterior segment OGI from 2016 to 2019 were retrospectively analyzed. Of these patients, 17 underwent ILM peeling during the vitrectomy and 16 did not. The patients’ demographic and surgical data were collected. The associations of ILM peeling with the preoperative findings of posterior segment OGI and development of a postoperative ERM were analyzed. Student’s t-test was used to evaluate differences in continuous variables, and the chi-squared test or Fisher’s exact test was used for categorical variables. Time-to-event curves were calculated from postestimation Cox proportional hazards models. Results. An ERM developed in three eyes (17.6%) in the ILM peeling group and in eight eyes (50.0%) in the nonpeeling group (p<0.05). There was no statistically significant difference between the groups in visual acuity at baseline (1.68 vs. 1.58 logMAR, p=0.68) or at final follow-up (0.72 vs. 0.78 logMAR, p=0.66). Median visual acuity significantly improved in both groups (p<0.001). In the multivariable models, ILM peeling (odds ratio, 0.19; 95% confidence interval, 0.04–0.91; p=0.04) and worse preoperative vision (odds ratio, 0.29; 95% confidence interval, 0.10–0.80; p=0.02) were associated with lower likelihood of ERM formation. Conclusion. Preventative treatment with ILM peeling contributed to decreased development of an ERM in patients with OGI involving areas near the fovea.