Search Results (24)

As climate governance policies are steadily rolled out and scrutiny over corporate social responsibility intensifies, corporate ESG decoupling undermines the efficacy of climate governance and resource allocation. Using data on Chinese listed firms from 2012 to 2022, this study exploits the China Pilot Climate Adaptation City (CPCAC) program in 2017 as a quasi-natural experiment and employs a difference-in-differences (DID) approach to identify the impact of the CPCAC on corporate ESG decoupling. The results show that the CPCAC significantly reduces firms’ ESG decoupling, with the mitigating effect being particularly pronounced in the environmental responsibility dimension. Moreover, CPCAC alleviates corporate ESG decoupling by reducing corporate agency costs. Heterogeneity results show exerting a stronger influence on firms in regions with strong Confucian culture, firms with higher managerial myopia, non-politically connected firms and highly digitalized firms. The findings enrich the literature on corporate ESG behavior and its interaction with the institutional environment, and offer valuable insights for advancing climate adaptation governance and improving ESG regulatory frameworks. Full article

Background/Objective: Myopia has become a prominent public health issue in China, significantly impacting the visual health of children and adolescents. The condition is characterized by a high incidence rate, increasing prevalence, and a trend toward earlier onset, highlighting the critical need for early and accurate diagnosis. Current clinical diagnostic methods primarily depend on subjective evaluations by optometrists and the use of isolated parameters, leading to inefficiencies and inconsistent outcomes. Moreover, there remains a lack of diagnostic tools that can effectively integrate multi-parameter analysis while ensuring robust data privacy protection. This study aims to develop an artificial intelligence (AI) diagnostic model that achieves objective, accurate, and safe diagnosis of myopia in children without cycloplegia through multi-parameter fusion and to enable local deployment. The proposed model is intended to be a reliable tool for clinical applications and large-scale screening projects, while ensuring strong protection of patient privacy. Methods: We built a transparent, rule-driven AI framework using clinical guidelines. Key ocular parameters—visual acuity, spherical equivalent, axial length, corneal curvature, and axial ratio—were encoded as logical rules in Python and incorporated via instruction fine-tuning. The model was trained and validated on retrospective clinical data (70% training, 15% validation, 15% test) using five algorithms: gradient boosting, logistic regression, random forest, SVM, and XGBoost. Performance was evaluated using accuracy, precision, recall, F1 score, and mean AUC across classes. Results: The model classifies refractive status into five categories: hyperopia, pre-myopia, mild, moderate, and high myopia. All five different algorithms demonstrated excellent diagnostic and classification performance. Gradient boosting achieved the best overall performance, with an accuracy of 98.67%, an F1 score of 98.67%, and a mean AUC of 0.957—outperforming all other models. Conclusions: This study successfully developed an artificial intelligence-based myopia diagnosis system for children under non-dilated pupil conditions. The system is interpretable and privacy-preserving, and has excellent diagnostic and classification performance, making it suitable for clinical decision support and large-scale screening applications. It has great potential to promote the development of early intervention, precision prevention, and control strategies for childhood myopia. Full article

Employing textual analysis of the “short-term vision” vocabulary in annual reports, we investigate the impact of managerial myopia on firm innovation and performance. Our results indicate that managerial myopia hampers innovation, and this result remains robust across a battery of robustness checks. Managerial myopia also weakens the positive impact of innovation on firm growth, and value in the long run. We find that state ownership and good corporate governance mitigate the negative impact of managerial myopia. The evidence supports the upper echelon theory and time orientation theoretical framework. This paper enriches the research on the influencing factors of corporate innovation, by providing evidence that people’s perception of time affects decision making and provides support for government ownership and strong corporate governance practices in alleviating the negative consequences of managerial myopia. Full article

Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD) is an extremely rare autosomal recessive disorder, with only a few hundred affected individuals worldwide. Since its initial recognition in the 1980s, only a limited number of studies have described its ocular manifestations. The aim of this review was to summarize and organize the available published evidence regarding ocular findings in LCHADD and their classification. A PubMed search was conducted for studies describing ocular findings associated with LCHADD, using combinations of the following keywords: LCHADD, chorioretinopathy, ocular findings, vision, therapy, and long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency. The review included studies published within the past 20 years that reported at least six cases. The search identified 11 eligible studies. Findings were grouped into three categories: LCHADD-associated chorioretinopathy, macular neovascularization (MNV), and the effects of dietary therapy on visual function. Chorioretinopathy emerged as the major pathognomonic ocular feature of LCHADD. MNV was reported in approximately 20% of eyes, often bilaterally but not simultaneously. Progressive myopia was observed in most patients. Newborn screening and early initiation of dietary therapy appear critical and may slow the progression of chorioretinopathy. A strong correlation between patient age and chorioretinopathy severity was consistently demonstrated, and visual deterioration occurred even in individuals with good metabolic control. LCHADD is a life- and vision-threatening disorder characterized by a distinctive chorioretinopathy present in nearly all patients. Early detection through newborn screening and regular ophthalmic follow-up is essential for the optimal management of affected individuals. Full article

Background/Objectives: Nutritional supplementation has been proposed as a potential adjunct strategy in myopia prevention and control through antioxidative, anti-inflammatory, and extracellular matrix-regulating mechanisms. This systematic review aimed to evaluate randomized controlled trial (RCT) evidence on the effects of carotenoids, anthocyanins, polyunsaturated fatty acids, and combined nutraceutical formulations on refractive outcomes, axial length, macular pigment optical density (MPOD), visual function, and symptoms of visual fatigue. Methods: The review was registered in PROSPERO (CRD420251149727) and conducted in accordance with PRISMA 2020 and AMSTAR-2 guidelines. PubMed, Web of Science, and Scopus were searched up to 5 August 2025. Eligible studies were RCTs involving individuals with myopia or at risk of myopia, comparing nutritional supplementation with placebo or active controls. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane RoB 2 tool. Results: Nine RCTs were included. Carotenoids such as crocetin, lutein, zeaxanthin, and astaxanthin produced modest benefits, including improved MPOD, reduced visual fatigue, and—in one pediatric trial—slightly less axial elongation. Anthocyanin-rich extracts improved mesopic contrast sensitivity and subjective asthenopia. A combined carotenoid–polyphenol formulation enhanced accommodative facility. However, no consistent clinically meaningful reduction in myopia progression was observed. Trials were generally small, heterogeneous, and short in duration. Conclusions: Nutritional supplementation may improve visual function and retinal antioxidant status but lacks strong evidence for slowing myopia progression. Larger, long-term RCTs are needed before recommending supplementation for routine myopia management. Full article

Myopia is a common refractive error with a rising prevalence worldwide, and its early diagnosis is crucial to prevent long-term visual impairment. This study presents an accessible, automated approach for detecting myopia from fundus photographs by analyzing the optic disc, using a deep learning model based on the YOLO (You Only Look Once) architecture, version 8 and 11. The pipeline was designed to be usable by eye care practitioners (ECPs) with no expertise in computer science. Fundus images were processed to extract the optic disc region using a custom-trained YOLOv8 model, and a subsequent classification algorithm determined the presence or absence of myopia based on features from the extracted region. The system was trained on a single-clinic dataset of 730 augmented images, with 98 images reserved for internal validation, and tested on 50 independent optic disc images. It achieved a high diagnostic accuracy, with strong sensitivity and F1 scores. Lightweight models such as YOLOv11-nano performed comparably to larger variants in the testing dataset (AUC 97.5% vs. 97.3%), effectively supporting myopia detection. This work highlights the feasibility of integrating AI-based screening tools into clinical practice without requiring advanced technical skills, offering a scalable and cost-effective solution to support early diagnosis of myopia in diverse healthcare settings. Full article

Background/Objectives: Keratoconus (KC) is a corneal ectatic disease, characterized by the progressive thinning of the cornea, myopia, and astigmatism, which lead to a decrease in visual acuity. Corneal collagen crosslinking (CXL) is an efficient method of stopping the progression of the disease. The objective of this study is to investigate the endothelial and biomechanical properties of the cornea in keratoconus patients, before and after undergoing corneal collagen crosslinking. Methods: A total of 66 eyes were diagnosed with progressive keratoconus and were recommended epi-off corneal crosslinking. Before the procedure, they were investigated with corneal topography (for minimum, maximum, average keratometry, and corneal astigmatism), specular microscopy (for the following endothelial cell parameters: number, density, surface, variability, and hexagonality), and an ocular response analyzer (for the following biomechanical parameters: corneal hysteresis and resistance factor). All measurements were repeated 1 month and 6 months after the intervention. Results: Several parameters differ according to the Amsler–Krumeich stage of keratoconus: in more advanced stages, patients present higher endothelial cell variability, a lower number of endothelial cells in the paracentral region of the cornea, lower CCT and CRF, and higher keratometry and astigmatism. Endothelial cell variability and number correlate with average keratometry, and there are also strong correlations between topography and CH and CRF. After CXL, the paracentral number of endothelial cells decreased; cell variability and average cell surface increased. Conclusions: More advanced keratoconus cases present with altered corneal biomechanics and topographical parameters, the endothelial layer also being affected proportional to the stage of the disease and also slightly affected after corneal collagen crosslinking. Full article

Objectives: Visual field (VF) testing is key to assessing functional loss in glaucoma. Despite its clinical value, traditional VF testing has a number of limitations, including its dependency on medical equipment and posturing requirements. The present study examines the acceptance, tolerability, and comfort of home-based VF testing using a virtual reality (VR) headset. Method: Healthy subjects were prospectively enrolled to undergo VF examination in a non-clinical setting using a commercially available stereoscopic VR headset and SORS (sequentially optimized reconstruction strategy) on the VisionOne platform. Subjects were supervised and wore their own spectacles within the headset. After the VR VF test, they were asked about their comfort, side effects, and readiness to repeat the examination at home. Results: Of the 12 subjects enrolled, 7 were female (58.3%) and 5 were male (41.7%). Mean age was 45 years (range: 30–68). While none of the subjects suffered from glaucoma, their medical histories included severe arthritis, refractive surgery, high myopia, amblyopia, and esotropia. The mean self-reported comfort score was 8.75 out of 10 (range: 8–10), with some subjects taking the test in the dorsal decubitus position. Eleven subjects (91.7%) considered the device to be easy to use, and 100% responded that they would be willing to repeat the test at home, of which 41.7% stated they would prefer to be supervised by a clinician. Overall, three subjects reported mild side effects, namely light asthenopia, epiphora, and periocular flushing. All side effects were mild and self-limited. The mean perceived duration of the test (187 s) correlated strongly with the mean actual duration (166 s; Pearson correlation coefficient r = 0.76, p-value = 0.007). In all, 58.3% of perceived durations were shorter than the actual test durations. Mean false negative and false positive responses were 3.75% and 4.7%, respectively. Central fixation recorded by real-time eye tracking was maintained on average 73.23% of the time and showed a strong correlation with false negative responses (r = 0.75; p = 0.026). Conclusions: While the present study did not examine the test algorithm itself, it suggests that home-based VF testing using a VR headset is well tolerated and accepted, with high levels of self-reported comfort and only mild side effects. While all subjects welcomed the opportunity to perform clinical tests from home, over a third expressed a preference for supervision. Real-time eye tracking correlated well with traditional reliability markers, suggesting potential clinical value. Full article

Background/Objectives: The prevalence of myopia is increasing globally, including in Spain. The early detection of ocular biometric parameters associated with myopia development is crucial for implementing control strategies. This study aims to describe the normative biometric values in a Spanish school-aged population and compare them with previously established reference data. Methods: A cross-sectional, observational, and analytical study was conducted on 558 students aged 6 to 12 years from the Educare Valdefuentes School in Madrid. Ocular biometric parameters, including axial length (AL), corneal curvature (CR), anterior chamber depth (ACD), crystalline lens thickness (LT), corneal thickness (CCT), and posterior vitreous depth (PVD), were measured using IOLMaster 700. The axial length/corneal radius (AL/CR) ratio was calculated. Percentile growth curves were generated, and the results were statistically analyzed using IBM SPSS 29. Results: AL significantly increased with age (p < 0.001), and boys had longer AL than girls. The AL/CR ratio showed a moderate correlation with myopia risk (ρ = 0.647, p < 0.001). Compared to previous European studies, no significant differences were found, except for minor variations in AL and CR. Conclusions: These percentile-based biometric values provide a useful reference for monitoring ocular growth and assessing myopia risk in Spanish children. The AL/CR ratio remains a strong predictor of myopia development, supporting its role in early detection strategies. Full article

Background and Objectives: This study explores the relationship between retinal structure, vascular densities (VD), and the progression of myopia, aiming to identify novel biomarkers for assessing myopia severity. Materials and Methods: A total of 260 eyes were divided into four groups: Emmetropia (EM) (n = 74), Low Myopia (LM) (n = 68), Moderate Myopia (MM) (n = 64), and High Myopia (HM) (n = 54). VD and retinal thickness (RT) in the macular and peripheral quadrants were measured using optical coherence tomography-angiography (OCTA). SVD and DVD were analyzed across the paranasal, peritemporal, perisuperior, and peri-inferior quadrants. Results: Significant differences in superficial vessel density (SVD) were found in the paranasal (EM vs. MM, p = 0.017; EM vs. HM, p = 0.001), peritemporal (EM vs. MM, p = 0.006; EM vs. HM, p = 0.001; LM vs. HM, p = 0.004; MM vs. HM, p = 0.032), perisuperior (EM vs. MM, p = 0.005; EM vs. HM, p = 0.001; LM vs. HM, p = 0.027), and perifoveal quadrants (EM vs. MM, p = 0.003; EM vs. HM, p = 0.008; LM vs. HM, p = 0.004; MM vs. HM, p = 0.012). Deep vessel density (DVD) showed significant differences in the paranasal (p = 0.012–0.022), peritemporal (p = 0.002–0.026), perisuperior (p = 0.003–0.034), perifoveal (p = 0.002–0.017), and peri-inferior (p = 0.002–0.022) quadrants. Retinal thickness was significantly reduced in HM eyes, with the most pronounced reduction in the peritemporal quadrant (mean difference: 16.7 ± 3.2 µm; p < 0.001). Conclusions: Structural and vascular changes in the retina become more pronounced as myopia progresses from moderate to high. The strong correlation between DVD, RT, and myopia severity highlights their potential as reliable biomarkers for monitoring myopia progression through OCTA imaging. These findings provide new insights into the vascular and structural changes underlying myopia and their diagnostic significance. Full article

Background: Single-step transepithelial photorefractive keratectomy (TPRK) is a modern refractive surgery technique that offers a no-touch approach for correcting myopia and astigmatism. This study aims to evaluate the short-term visual and refractive outcomes of TPRK in patients with myopia and astigmatism over a 6-month follow-up period. Methods: This retrospective cohort study included patients who underwent single-step TPRK using the Amaris 750S laser platform with SmartSurf^ACE and SmartPulse^® technologies, targeting a plano refraction. Procedures were performed with aspheric, non-wavefront-guided profiles, and outcomes were assessed postoperatively. Results: 96% of eyes achieved 20/20 or better uncorrected distance visual acuity (UDVA), with 98% reaching 20/25 or better, and 100% achieving 20/32 or better. UDVA was the same or better than preoperative corrected distance visual acuity (CDVA) in 96% of eyes, and no eyes lost two or more Snellen lines. Refractive outcomes showed strong precision, with 93% of eyes within ±1.00 D of the target. Astigmatism correction was accurate, with 100% of eyes having ≤1.00 D of astigmatism, and 80% achieving a precise astigmatism angle of error between −5° and 5°. Conclusion: Single-step TPRK with SmartSurf^ACE and SmartPulse^® technologies provides highly effective and predictable visual and refractive outcomes for myopia and astigmatism. The procedure consistently delivers precise corrections with minimal complications, making it a reliable option for refractive surgery. Full article

Background: Diabetic macular edema (DME) causes vision impairment and significant vision loss. Portable optical coherence tomography (OCT) has the potential to enhance the accessibility and frequency of DME screening, facilitating early diagnosis and continuous monitoring. This study aimed to evaluate the reliability of a portable OCT device (ACT100) in assessing DME compared with a traditional stationary OCT device (Cirrus 5000 HD-OCT plus). Methods: This prospective clinical investigation included 40 eyes of 33 patients with DME. Participants with significant refractive errors (myopia > −6.0 diopters or hyperopia > +3.0 diopters), vitreous hemorrhage, tractional retinal detachment, or other ocular diseases affecting imaging were excluded. Spectral-domain OCT was performed by a single examiner using both devices to capture macular volume scans under mydriasis. Central macular thickness (CMT) was evaluated using the analysis software for each device: Cirrus used version 6.0.4, and ACT100 used version V20. We analyzed inter-evaluator and inter-instrument agreements for qualitative assessments of the intraretinal fluid (IRF), subretinal fluid (SRF), and epiretinal membrane (ERM) using Cohen’s kappa coefficient, whereas quantitative CMT assessments were correlated using Spearman’s correlation coefficient. Results: Substantial inter-evaluator agreement for IRF/SRF (κ = 0.801) and ERM (κ = 0.688) with ACT100 and inter-instrument agreement (κ = 0.756 for IRF/SRF, κ = 0.684 for ERM) were observed. CMT values measured using ACT100 were on average 29.6 μm lower than that of Cirrus (285.8 ± 56.6 vs. 315.4 ± 84.7 μm, p < 0.0001) but showed a strong correlation (R = 0.76, p < 0.0001). Conclusions: ACT100 portable OCT demonstrated high reliability for DME evaluations, comparable to that of stationary systems. Full article

We report a surgically challenging case, in the context of a diagnosis of juvenile glaucoma refractory to drug therapy, multi-operated, known patient with congenital ichthyosis, part of Dorfman–Chanarin Syndrome (DCS), with a single functional eye. She is a young patient (54) and housewife in an urban environment known to have DCS and BE (both eyes), strong myopia, and congenital nystagmus. She initially underwent cataract surgery in 2015 and again in 2017. As of 2015, she was known to have juvenile glaucoma under maximal therapy. The important increases in pressure started in 2020 when the dermatological condition worsened (exacerbation of skin changes in the context of ichthyosis), the patient is in menopause, and presbyopia has set in. The glaucoma could no longer be controlled with medication and required serial surgery in both eyes (initially in the right eye in 2020 and in the left eye in 2023). The right eye showed a favorable evolution until 2024, when a second trabeculectomy became necessary, with a favorable evolution. Conclusions: To our knowledge, such a case has not been documented in the medical literature. Frequent monitoring of intraocular pressures and prompt treatment are required. It is a rare association, a very complicated case of managing a patient with refractory glaucoma and multiple associated ophthalmic and systemic pathologies. We are also dealing with a single functional eye, difficult to manage due to a thin sclera that has caused intraoperative difficulties, and the association of congenital nystagmus and strabismus. Full article

Myopia control with new designs of spectacle lenses is a flourishing area of research. The present work reviews the effectiveness of new designs (DIMSs, defocus-incorporated multiple segments; CARE, cylindrical annular refractive element; HALs/SALs, highly/slightly aspherical lenslets; DOT, diffusion optics technology) aiming at slowing myopia progression. A search through the PubMed database was conducted for articles published between 1 January 2003 and 28 February 2023. Publications were included if they documented baseline central refraction (SER) and/or axial length (AL) data, and the change in these parameters, in myopic children wearing new designs of spectacle lenses (treatment group) compared to myopic children using single-vision lenses, SVLs (control group). The selection process revealed nine suitable articles. Comparing the mean and standard error values of the treatment and control groups, the highest differences in the change in the SER and AL were −0.80 (1.23) D [95% CI: −1.053 to −0.547; p < 0.001] and 0.35 (0.05) mm [95% CI: 0.252 to 0.448; p < 0.001], respectively; the effect of treatment provided by a HAL design, compared to SVLs, led to a deceleration of 54.8% in the SER and 50.7% in the AL. However, the heterogeneity of the results prevents reaching strong conclusions about the effectiveness of these new designs. Full article

Despite high discontinuation rates for myopia optical interventions, limited attention has been given to the potential rebound effects post-discontinuation. This systematic review aims to assess the extent of the rebound effects following the cessation of common clinical optical myopia-control interventions in children. A comprehensive search of PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov was conducted from inception to October 2023. The rebound effects, defined as changes in the axial length or spherical equivalent during and after treatment cessation, were categorized into four levels. These studies encompassed 703 participants and spanned from 2019 to 2023, with durations of treatment and cessation ranging from 6 months to 3.5 years and from 2 weeks to 5 years, respectively. This review, encompassing 14 studies, revealed a predominant strong rebound effect in orthokeratology (8 studies), a weak rebound effect in multifocal soft contact lenses (4 studies), and a variable rebound effect in peripheral-plus spectacle lenses (2 studies). Notably, with the increasing cessation duration, the rebound effects diminished, potentially linked to the reversal of choroidal thickening and the disappearance of peripheral myopic defocus. In conclusion, a temporal trend of rebound effects exists in all three myopia optical interventions, possibly contributing to their myopia control mechanisms. Full article