Search Results (353)

Background/Objectives: Although both the MEL90 (Carl Zeiss Meditec AG, Jena, Germany) and WaveLight EX500 (Alcon Laboratories, Inc., Fort Worth, TX, USA) are two widely used excimer lasers, comparisons between the two remain limited. This study evaluates visual and refractive outcomes from the U.S. Food and Drug Administration (FDA) premarket approval trials of these platforms in the treatment of myopia with and without astigmatism, hyperopia with and without astigmatism, and mixed astigmatism. Methods: Clinical outcomes from FDA premarket approval trials were compared between the recently approved MEL90 and the WaveLight (now termed EX500) excimer lasers. Results: A total of 714 eyes (358 patients) from MEL90 and 1353 eyes (706 patients) from EX500 were analyzed up to 6 months postoperatively. In the hyperopia/hyperopic astigmatism cohort, the EX500 demonstrated greater efficacy relative to MEL90, with more eyes achieving a postoperative uncorrected distance visual acuity (UDVA) of 20/20 or better (48.6% vs. 68.7%, respectively; p < 0.001). In both the MEL90 and EX500, at least 85% of eyes with myopia/myopic astigmatism and 68% with mixed astigmatism achieved a postoperative UDVA of 20/20 or better. For all refractive cohorts, more than 95% of eyes achieved a UDVA of 20/40 or better at 6 months (all p > 0.05). The EX500 was more likely to demonstrate an improvement of more than two lines of UDVA compared to baseline CDVA (all p < 0.05). In contrast, the MEL90 showed greater predictability of spherical equivalent within ±0.50 D and ±1.00 D for the hyperopia/hyperopic astigmatism cohort (both p = 0.007), as well as within ±0.50 D for the myopia/myopic astigmatism cohort (p < 0.001). Postoperatively, both platforms were associated with decreased glare and halos, although findings were variable in the EX500 mixed astigmatism cohort. Conclusions: Both excimer lasers demonstrated safe and effective outcomes that exceed the threshold set by the FDA. Full article

Background/Objectives: To assess the optical performance of two refractive premium IOLs across pupil sizes and values of corneal spherical aberration (SA). Methods: Two refractive IOLs were evaluated in this study: Tecnis Eyhance and Mini Well. The surface profiles were obtained to calculate the through-object MTF (TO MTF) curves and simulate optotype images. Entrance pupil sizes ranging from 2 to 5.5 and three corneal models were analyzed in the simulation: an average population aberrated cornea, an aberration-free cornea and a post-Lasik myopic cornea. Results: For Model 1 and pupil sizes between 3.0 and 3.5 mm, Mini Well provided acceptable visual quality from far to near distances, whereas Eyhance struggled to maintain visual quality at distances closer than intermediate. For patients with lower-than-normal corneal SA (i.e., more prolate corneas, such as post-hyperopic LASIK) both IOLs exhibited a hyperopic shift in far focus. Conversely, for patients with higher-than-normal corneal SA (i.e., more oblate corneas, such as post-myopic LASIK), the shift occurred in the myopic direction. Despite the implementation of an optimized IOL power to circumvent any shift, the TO MTF nevertheless reflected the interaction between corneal and IOL SA. Furthermore, the Mini Well demonstrated increased tolerance to less negative SA values, while Eyhance exhibited behavior consistent with a monofocal lens for more positive SA values. Conclusions: Surgeons should consider each patient’s corneal asphericity and typical pupil diameter when selecting and calculating the power of the premium IOLs studied, particularly in patients with a history of refractive surgery. Full article

Objectives: To determine how optometrists in Canada manage their pediatric myopia patients and to assess whether this has changed over time. Methods: In a retrospective chart review, records for children aged 6–10 years who had an eye exam between 2017 to 2021 were reviewed. Children were grouped by presenting refraction (myopes ≤ −0.50 D or pre-myopes ≤ +0.75 D). Up to five unique patients were selected for each age (6, 7, 8, 9, and 10) and initial visit year (2017 to 2021) for each group (myopes and pre-myopes), for a maximum of 250 files per practice. Demographic information, refraction, and recommended interventions were recorded. Logistic regression was used to model the likelihood of being prescribed a myopia control intervention based on patient and optometrist characteristics. Results: A total of 2905 patients (n = 1467 (50%) female) from 15 practices across Ontario, Canada, were included, accounting for 8546 visits. Optometrists predominantly prescribed single-vision spectacle correction as a first-line intervention for myopic children, although this declined from 98.2% in 2017 to 56.7% in 2023. The use of myopia control modalities increased from 1.8% to 43.3% over this same period. Optometrists began recommending myopia control at lower myopic refractive errors over time (−2.63 DS in 2017 vs and −1.49 DS in 2020). Myopia control spectacles were the most commonly prescribed intervention, despite the observation that optometrists are not hesitant to fit contact lenses in younger children. Optometrists who had been in practice longer were more likely to prescribe older forms of myopia control (e.g., bifocals/progressives) than more recent graduates. Conclusions: While single-vision spectacle correction remains a primary approach for initial myopia management in Ontario, Canada, optometrists increasingly recommend myopia control and are initiating interventions earlier. Full article

Background/Objectives: Myopia is associated with peripapillary changes, namely, gamma peripapillary atrophy (γPPA) and optic disc ovalization, estimated by the ovality index (OI). These changes have been suggested to be promoted by adduction. Recent studies highlight that near reading significantly contributes to the development and progression of myopia and that the interpupillary distance (IPD) influences vergence amplitudes. While both adduction and convergence are involved during near reading, a potential link between IPD and myopic peripapillary changes has not yet been explored. We, therefore, sought to determine whether IPD is related to the OI or γPPA width. Methods: In this monocentric cross-sectional study, 100 eyes from 100 adults (mean age of 62.6 ± 13.7 years) were analyzed. Axial length (AL), refractive error, and IPD were recorded. The OI and γPPA width were assessed using spectral-domain Optical Coherence Tomography. Pearson correlations and multivariable linear regressions were performed, adjusting for age, gender, and myopia status. Results: IPD showed no significant correlation with the OI (r = 0.001; p = 0.989) or γPPA (r = −0.028; p = 0.789). A weak, non-significant correlation was found between IPD and AL (p = 0.059). In contrast, AL was strongly correlated with both a lower OI and wider γPPA (p < 0.001). Conclusions: These findings suggest that IPD-related biomechanical forces do not influence optic nerve head (ONH) shape or γPPA. Axial elongation remains the key driver of myopic ONH remodeling. Full article

The research aims to compare the dynamic visual acuity (DVA) in myopic adults wearing spectacles prescribed to 0.05D and 0.25D steps. This double-blind, randomized, self-control study included 40 myopic participants aged 18–40. The participants were randomly assigned to receive spectacles with one 0.05D step lens and the contralateral lens of 0.25D step. The monocular horizontal and vertical motion DVA at 20 and 40 degrees per second (dps) was measured. The DVA was compared between eyes with 0.25D and 0.05D step lenses and further analyzed by eye dominance and test sequence. The result demonstrated no significant difference in DVA between two eyes with 0.25D or 0.05D step lenses at 20 and 40 dps horizontal and vertical motion test (p > 0.05, respectively). When the eye with a 0.25D step lens was the dominant eye (p = 0.004) or measured secondly (p = 0.002), it outperformed the contralateral eye with a 0.05D step lens in the 40 dps horizontal motion test. In conclusion, the horizontal and vertical motion DVA of the eye with 0.05D step lens spectacles was comparable to that of contralateral eyes corrected with 0.25D step lens. Full article

Background: Keratorefractive Lenticule Extraction (KLEx) is an emerging flap-free surgical technique for the correction of myopic astigmatism. However, postoperative astigmatic accuracy remains variable. This study aimed to identify clinical and surgical factors that influence the outcomes of astigmatic correction following KLEx. Methods: A total of 98 patients with myopic astigmatism underwent KLEx. Manifest refraction was evaluated at three months postoperatively. Astigmatic outcomes were assessed using Alpins vector analysis. Multivariate linear and logistic regression models were used to determine associations between preoperative and intraoperative variables—such as age, eye laterality, tear film quality, sphere-to-cylinder ratio, and preoperative cylinder—and astigmatic correction parameters, including residual cylinder, correction index, magnitude of error, and angle of error. Results: Older age was associated with larger residual cylinder and angle of error. Eye laterality and tear film quality significantly influenced correction accuracy. A higher sphere-to-cylinder ratio and preoperative cylinder were also predictive of astigmatic correction performance. Conclusions: The accuracy of astigmatic correction in KLEx is significantly influenced by multiple clinical and surgical factors. Awareness of these predictors may guide surgical planning and improve refractive outcomes. Full article

Several soluble mediators are activated during myogenesis and progression, and severe neurodegeneration, with related biomarkers, characterizes high myopia-related retinal atrophy. Targets of oxidative stress, epigenetics and neurogenic inflammation have been reported in the prospecting of some bioindicators to mirror retinal insults occurring in high myopia. The aim of the present study was to assess the expression of a few selected biomarkers belonging to the neurotrophin (NGF and BDNF), oxidative (NO, KEAP1/NRF2), and epigenetic (DNMT3 and HD1) pathways. Sixty-five (65; 76.25 ± 9.40 years) specimens—aqueous, anterior capsule (AC), and lens epithelial cells (LEC)—were collected at the time of cataract surgery and used for ELISA (aqueous) and transcripts analysis (AC/LEC). Biosamples were grouped as emmetrope (23; 81.00 ± 6.70 years); myopia (24; 75.96 ± 7.30); and high (pathological) myopia (18; 70.56 ± 11.68 years), depending on axial length (AL) and refractive error (RE). Comparisons and correlations were carried out between myopic and high-myopic subgroups. NGF and BDNF were lowered in myopic samples; NGF and BDNF transcripts were differentially expressed in LEC, and their expression correlated positively with NGF and negatively with BDNF, with the expression of the αSMA phenotype. NGF and BDNF correlated negatively with NO and nitrites. Oxidative stress (iNOS/NOX1/NOX4 and KEAP1/NRF2) and epigenetic (DNMTα3/HD1) transcripts were upregulated in myopic LEC, compared with emmetropic ones. Herein, we prospect the contribution of NGF and BDNF in both neuroinflammation and neuroprotection occurring in this chronic disease. Full article

Discipline is a significant predictor of parent–child attachment and relationship quality across the lifespan. Yet, much of the research on Black families’ disciplinary strategies uses a deficit and myopic lens that focuses on punitive punishment styles (e.g., spanking or taking away privileges). In the current exploratory qualitative study, we used an intergenerational narrative lens and thematic analysis to explore semi-structured interview data from 31 Black mothers (25–60 years, M_age = 46) in the United States around their mothers’ disciplinary practices during their childhood. We explored the connections that Black adult daughters made between their childhood disciplinary practices and their current disciplinary practices with their children, as well as their current relationships with their mothers. Adult daughters varied widely in their retrospective accounts of their mothers’ disciplinary strategies, which we categorized into three themes: (a) punitive, (b) logical, and (c) natural. We also identified three themes around how their mothers’ practices informed their current disciplinary practices with their own children: namely, (d) continuity, (e) mix, and (f) shift. Finally, we identified three themes around the current nature of their mother–daughter relationships: (g) strained, (h) progressing, and (i) healthy. The results highlighted the personal and cultural factors that informed Black women’s disciplinary strategies across two generations of mothers and revealed that when adult daughters shifted away from what they experienced during childhood—it was often towards less punitive strategies. Our exploratory findings also pointed to patterns regarding the extent to which Black adult daughters felt connected, validated, and supported by their mothers. The findings lend insight into Black mother–daughter relationship dynamics, particularly around the importance of communication patterns and emotional connection in the culture of discipline within families. Full article

Background: The World Health Organization defines myopia as a global epidemic. Its growing prevalence and the increasingly early age onset all raise a major concern for public health due to the elevated risk of loss and deterioration of visual function as a result of myopia-related ocular pathological complications. However, it remains unclear whether the vision-related quality of life of patients with myopia is the same as in healthy individuals. The aim of the present study is to assess the quality of life in children and adolescents with myopia between the ages of 8 and 16 years, who underwent observation at USBOBAL-Varna. Methods: This study prospectively included 190 patients with myopia between −1.00 and −5.50 D, corrected with different optical aids. After a thorough physical ocular examination and inquiry into the best visual acuity with and without distance correction, specially designed questionnaires were completed by the patients and their parents/guardians for the purpose of the study. The data from the questionnaires was statistically processed. The mean age of the patients in the study was 11.65 years, 101 were female and 89 were male. Of these, 83 wore monofocal glasses, 50 were monofocal and 47 were multifocal contact lenses, and 10 wore ortho-K lenses. Results: No significant difference in best corrected visual acuity (BCVA) was found among the three types of optical correction (p-value > 0.05). Cronbach’s alpha of the questionnaire for all 10 factors was higher than 0.6, indicating acceptable internal consistency. Significantly higher scores were reported for overall, near, and distance vision, symptoms, appearance, attitude, activities and hobbies, handling, and perception for soft contact lens wearers than for spectacle wearers (p-value < 0.05). Ortho-K wearers performed better than spectacle wearers in all aspects except for pronounced symptoms (p = 0.74). No significant difference was found between ortho-K wearers and soft contact lens wearers for any factor (p > 0.05). Conclusions: Patients wearing spectacles and with myopia above −5.00 D had the highest anxiety scores and lower quality of life among all myopic participants. The research on the quality of life in children with myopia with different refractive errors and optical correction devices is crucial for improving corrective devices and meeting the needs of patients. Full article

Background/Objectives: Post-keratoplasty astigmatism can limit visual recovery even after successful corneal transplantation. Femtosecond laser-assisted arcuate keratotomy (FSAK) has emerged as a method to reduce high residual astigmatism and enhance visual outcomes. This study aimed to evaluate the outcome of FSAK in treating astigmatism following keratoplasty. Methods: This retrospective study included 32 eyes from 31 patients who underwent FSAK after keratoplasty. Inclusion required complete suture removal, regular corneal topography, and the absence of additional ocular pathology or prior intraocular surgery. Data collected included uncorrected (UCVA) and best-spectacle-corrected visual acuity (BSCVA), manifest refraction, and tomographic parameters. The primary outcomes were changes in visual, refractive, and tomographic measures across the entire cohort, with further subgroup analysis between penetrating keratoplasty (PKP) and lamellar keratoplasty (LKP) eyes. Secondary outcomes were documentation of complications. Results: UCVA improved significantly from 0.92 ± 0.33 to 0.58 ± 0.39 LogMAR (p < 0.001). BSCVA showed a non-significant trend toward improvement from 0.32 ± 0.21 to 0.26 ± 0.22 LogMAR (p = 0.158). The manifest cylinder reduced significantly from −6.15 ± 2.75 D to −4.49 ± 2.92 D (p = 0.037). Corneal topography revealed significant postoperative steepening in keratometric values. While overall outcomes were comparable between the subgroups, LKP eyes demonstrated a greater myopic shift and a higher rate of overcorrection, whereas PKP eyes tended toward undercorrection. Conclusions: FSAK appears to be an effective approach for reducing post-keratoplasty astigmatism and improving uncorrected visual acuity. Given the biomechanical differences between graft types, individualized treatment planning based on graft characteristics may enhance surgical predictability and optimize outcomes. Full article

With the improvement of living standards, consumer demand for fresh produce has witnessed a remarkable upsurge. Fresh products present significant preservation challenges, as their freshness directly correlates with sales performance and ultimately impacts the sustainable development of the fresh supply chain. Enhancing freshness preservation standards, boosting market demand, strengthening brand reputation, and promoting the development of a fresh supply chain are urgent problems that need to be solved. This paper delves into the dynamic optimal decision-making processes within a fresh food supply chain, which is composed of a supplier and a retailer, under different government subsidy scenarios: centralized decision-making, decentralized decision-making under supplier myopia, and decentralized decision-making under supplier’s foresight. Herein, a differential game model is constructed, and through the utilization of dynamic optimization and backward induction techniques, feedback strategies for various decision-making paradigms are derived. A comparative evaluation of decision-making models is conducted, grounded in theoretical frameworks and substantiated through numerical simulations, to assess critical parameter impacts. The results indicate the following: (1) the effect coefficients of consumer preference and preservation efforts show significant positive correlations with suppliers’ preservation strategies and retailers’ promotional tactics, respectively; (2) supply chain profitability reaches its Pareto-optimal state under centralized decision-making structures, while myopic supplier behavior leads to systematically lower profits than foresighted supplier strategies; (3) retailers demonstrate stronger collaboration preferences toward foresighted suppliers, as such partnerships ensure enhanced quality consistency and supply continuity; and (4) government agencies should implement dynamically adjusted subsidy schemes during preservation initiatives to facilitate sustainable operational frameworks in fresh produce supply chains. Full article

The impact of prematurity has been reported to affect ocular development during infancy and childhood. Research into long-term ocular outcomes in adults born preterm is highly relevant due to a possible impact on the development of age-related ocular diseases such as macular degeneration. The aim was to review the currently available literature regarding outcomes of prematurity on ocular morphology in adults to provide a summary of the long-term effects of prematurity and associated factors such as low birth weight (BW) and retinopathy of prematurity (ROP) and its treatment. Adults formerly born preterm have a higher prevalence of refractive error, lower visual acuity, a higher prevalence of strabismus, shorter axial length, a steeper corneal radius, increased macular thickness, and a thinner peripapillary retinal nerve fiber layer thickness (RNFL), as well as changes in vessel anatomy and the foveal avascular zone. Adults who suffered from ROP have a high risk of myopic refractive error, amblyopia, shallower anterior chambers and thicker crystalline lenses, higher corneal aberrations, thinner RNFL thickness, and foveal hypoplasia. Individuals with advanced ROP requiring treatment also have higher rates of astigmatism, an increased temporal RNFL thickness, altered macular curvature, and reduced visual acuity. Prematurity leads to lifelong ocular morphological and functional changes, suggesting that fetal origins may contribute to age-related ocular diseases. This could have implications for ophthalmologic monitoring and the frequency of check-ups in adulthood. Full article

Objectives: The aim of this study was to evaluate the effectiveness of using low-dose atropine (ATR) at different instillation frequencies on myopia control in a low-myopia population. Methods: A retrospective cohort study was conducted, and patients using 0.01% ATR and exhibiting a myopia degree ranging from +0.00 to −1.00 diopter (D) were included. A total of 32 and 26 eyes from 32 and 26 individuals were included in the daily group and two-day group, respectively. The main outcomes of this study are the progression of the spherical equivalent refraction (SER) and the elongation of the axial length (AXL). The Mann–Whitney U test and generalized linear model were used to perform the statistical analysis. Results: After a follow-up period of one year, the change in SER was similar between the daily group and two-day group (−0.24 ± 0.09 versus −0.26 ± 0.08, p = 0.393). In addition, there was an insignificant difference in AXL elongation between the daily group and two-day group (0.09 ± 0.07 versus 0.10 ± 0.09, p = 0.655). The trends observed in SER progression (p = 0.604) and AXL elongation (p = 0.779) were statistically identical between the daily group and the two-day group. Conclusions: The results of the two-day use of low-dose ATR regarding SER and AXL control are similar to those with the daily use of low-dose ATR in children with low myopia. Full article

The shipping industry employs various strategies for outsourcing between freight forwarders and ocean shipping (OS) companies, including consignment and turnkey strategies. Freight forwarders often have a competitive edge in cargo canvassing, but many OS companies still engage in this practice. With China’s new policy liberalizing coastal shipping rights, OS companies are presented with two coastal shipping tactics: coastal transition and coastal piggyback (CPB). The interaction between OS companies and freight forwarders in the context of this policy change raises important strategic questions. This study examines the coastal piggyback business model within a three-tier shipping supply chain, involving a freight forwarder and two competing OS companies (OS1, which does not qualify for the coastal piggyback policy, and OS2, which does) using game theory. Through game analysis, we find that CPB may represent a myopic equilibrium. Specifically, when the freight forwarder’s cargo-canvassing capability is higher than a certain threshold, CPB is not advantageous for OS2’s market entry. Conversely, if the freight forwarder’s capability is relatively low, both OS companies can benefit from CPB. Additionally, OS companies enter the market when entry costs are low and avoid it when costs are high. With moderate costs, their strategy depends on the other OS company’s actions. Interestingly, the forwarder can deter market entry by enhancing cargo canvassing and adjusting outsourcing tactics. Notably, OS companies’ market entry may boost the forwarder’s payoffs in a horizontally competitive supply chain. Furthermore, this research examines the economic sustainability of coastal piggyback policy by analyzing its impacts on the profitability of all supply chain members. Full article

Background: Myopia progression in children is a growing public health concern, with increasing evidence suggesting that lifestyle factors may influence its development. This study aimed to evaluate the potential benefits of regular badminton activity in slowing myopia progression in children. Methods: We analyzed data from 40 children aged 7–14 years with myopia ranging from −1.50 D to −6.25 D who participated in supervised badminton training (three 45 min sessions per week) for 10 months. A control group of 62 myopic children who did not engage in regular physical activity was included. Ophthalmological assessments were performed at baseline and after 10 months. Results: The axial length increased by 0.37 mm in the badminton group compared to 0.56 mm in the control group. The mean change in the spherical equivalent was −0.52 D in the badminton group and −0.84 D in controls. Myopia progression was slower in the group participating in regular physical activity. Conclusions: Regular badminton activity may help reduce the rate of axial elongation and myopia progression in children. These findings support the inclusion of physical activity as a complementary strategy in managing pediatric myopia. However, further research is needed to determine whether this effect is specific to badminton or reflects the general benefit of physical activity. Full article