Purpose: Use of appropriate cycloplegic agent is an essential area of management in children with strabismus and refractive error. This study was designed to audit our own department’s understanding and practice with...Purpose: Use of appropriate cycloplegic agent is an essential area of management in children with strabismus and refractive error. This study was designed to audit our own department’s understanding and practice with respect to cycloplegia. Methods: Children in age group of 0 - 12 years with refractive errors and strabismus were evaluated with respect to four parameters: adherence to cycloplegic refraction (group-I), choice of cycloplegic agent (group-II), dosage of cycloplegia (group-III) and duration of cycloplegia (group-IV). Following the initial audit, the hospital audit committee evaluated the results;thereafter concerned staff was educated and aidememoires of the dilatation protocol were introduced;a second audit cycle was carried out after 3 months. Results: First and second audit cycle included 334 children (mean age 6.2 ± 2.2 years) and 436 children (mean age 7.25 ± 2.9 years) respectively. A statistically significant improvement was found in all four parameters in the second audit cycle: adherence to dilation protocol (82.3% in first cycle to 94.3% in second cycle;p = 0.001), choice of cycloplegic agent (77% in the first cycle to 94.8% in the second cycle;p = 0.001), dosage of cycloplegic agent (84% in the first cycle to 96.3% in the second cycle;p = 0.001) and duration of cycloplegic agents (65% in the first cycle to 97.5% in the second cycle;p = 0.001 for CTC and 71.8% in the first cycle to 98% in the second cycle;p = 0.001 for Tropicamide). Conclusions: A complete audit cycle demonstrated a statistically significant improvement in all four parameters related to cycloplegic refraction in children. Regular auditing coupled with targeted interventions aimed to maintain the “best practice guidelines” for determination of refractive errors in children could prove effective in improving standards of clinical practice.展开更多
Introduction:Cycloplegic refraction is the gold standard for assessing refractive error in children.However,logistical constraints hinder its implementation in large-scale surveys.Methods:Data obtained from a nationwi...Introduction:Cycloplegic refraction is the gold standard for assessing refractive error in children.However,logistical constraints hinder its implementation in large-scale surveys.Methods:Data obtained from a nationwide ocular health survey conducted in ten provincial-level administrative divisions in China were analyzed(2020–2024).Participants aged 5–18 years underwent standardized non-cycloplegic and cycloplegic autorefraction,axial length(AL),corneal radius(CR),and AL/CR measurements.Random forest and XGBoost models were trained to predict the cycloplegic spherical equivalent(SE)using noncycloplegic SE,uncorrected visual acuity(UCVA),and biometric parameters.Performance was evaluated using R^(2),root mean square error(RMSE),and Bland–Altman analysis.Results:Both models exhibited strong predictive performance.In the test set,random forest achieved R^(2)=0.88 and RMSE=0.55 diopter(D),whereas XGBoost achieved R^(2)=0.89 and RMSE=0.54 D.Noncycloplegic SE,AL/CR ratio,AL,and UCVA were consistently the top predictors.The predicted SE exhibited strong agreement with the cycloplegic SE,with minimal residual bias.Conclusion:Machine learning models incorporating noncycloplegic SE and ocular biometrics accurately estimate cycloplegic SE in children and adolescents,providing a practical alternative for largescale refractive-error surveillance when cycloplegia is impractical.展开更多
Introduction:Non-cycloplegic refraction is widely utilized in vision screening.However,interpreting non-cycloplegic refraction results remains a significant challenge in both clinical practice and public health settin...Introduction:Non-cycloplegic refraction is widely utilized in vision screening.However,interpreting non-cycloplegic refraction results remains a significant challenge in both clinical practice and public health settings.This study aimed to establish grade-and sexspecific reference values for non-cycloplegic spherical equivalent(SE)to enhance myopia screening and risk prediction among Chinese students.Methods:A comprehensive study was conducted between 2020 and 2024,involving 67,260 students from kindergarten through high school across 10 provincial-level administrative divisions(PLADs)in China.The Lambda-Mu-Sigma method was employed to model non-cycloplegic SE.Reference values were established by calculating SE centiles corresponding to myopia and high myopia prevalence across grades 0 through 12.Results:Among boys,the estimated prevalence of myopia and high myopia increased from 1.2%and<0.1%in grade 0(senior kindergarten)to 82.4%and 11.6%in grade 12(third year of high school),respectively.For twelfth-grade boys,the 82.4th and 11.6th percentiles of SE(–0.99 D and–6.16 D)were established as reference values for screening myopia and high myopia,respectively.The corresponding percentiles in lower grades served as predictive reference values for grade 12 outcomes.For instance,a grade-0 boy with non-cycloplegic SE>0.70 D(82.4th percentile)was predicted to remain free of myopia before grade 12.Similarly,SE>–0.73 D(11.6th percentile)indicated a low likelihood of developing high myopia before grade 12.Conclusions:This study established comprehensive non-cycloplegic SE reference values for screening and predicting myopia among Chinese students.The methodology developed here may be applicable to other regions where student myopia prevalence patterns demonstrate relative stability.展开更多
To determine the sensitivity and specificity of using a computer photoscreener and non cycloplegic retinoscopy in the detection of amblyopiogenic factors in nine to fifty months old infants and children Methods Th...To determine the sensitivity and specificity of using a computer photoscreener and non cycloplegic retinoscopy in the detection of amblyopiogenic factors in nine to fifty months old infants and children Methods Three hundred children, nine to fifty months old, were screened with the computer photoscreener and non cycloplegic retinoscopy With a blinded standardized clinical assessment as the standard, an overall comparison of the sensitivity of and specificity results obtained with the two techniques was made Photoscreen images on the computer monitor screen were reviewed and analyzed immediately by two independent observers for indicators of amblyopiogenic risk factors Simultaneously, the results were compared to the findings of a full ophthalmologic examination Results The computer photoscreener revealed a sensitivity of 94 6% and specificity of 90 1%, and the non cycloplegic retinocopy revealed a sensitivity of 85 7% and specificity of 81 0% for the detection of amblyopiogenic risk factors, including hyperopia (+2 75 D or more), myopia (-1 50 D or more), astigmatism (1 75 D or more), anisometropia (2 00 D or more), ocular misalignment (5 degrees or more), and media opacity (1 5?mm or more) Conclusions The computer photoscreener offers an opportunity to identify problems that limit vision, and could provide a feasible and sufficiently reliable screening technique in infants and preschool children to be screened successfully for amblyopiogenic risk factors展开更多
AIM： To study the evolution of the refractive status and examine the affected factors in infants during the first year of life in a large sample size in China. METHODS： A total of 1258 babies （2516 eyes） aged 32w...AIM： To study the evolution of the refractive status and examine the affected factors in infants during the first year of life in a large sample size in China. METHODS： A total of 1258 babies （2516 eyes） aged 32wk gestational age to ty participated in the study, including 766 premature and 492 full-term infants. First, each baby received an orthoptic examination, slit-lamp checking and fundus imaging. Patients with diseases which might affect refractive status were excluded from the cohort. The cycloplegia retinoscopy was performed. Their neonatal histories were reviewed. Each measurement contained the refractive status and calculation of the spherical equivalent （SE）. RESULTS： Refractive state showed an average hyperopia of ＋0.94_＋1.63 D at early ages, followed by a trend toward more hyperopia. The refractive state reached the top （＋2.431.46 D） at the age of one to two months. Then gliding till one year old when the refractive state reached ＋0.59：1.41 D. The prevalence of astigmatism was 42.17% in the study, being 2.82% myopic astigmatism and 39.35% hyperopic astigmatism. The 94.1% of hyperopic astigmatism was with-the-rule astigmatism and 71.83% of myopic astigmatism was with-the-rule astigmatism. Refractive state between boys and girls was different. The mean SE of boys was ＋1.97＋1.57 D, while that of girls was ＋1.79＋1.46 D, and the difference was significant. CONCLUSION： Before one year old, the change of refractive status is associated with checking age and sex. At the age of one to two months, the degree of hyperopia reaches the top. Boys have more hyperopic degree than girls, and with- the-rule astigmatism is predominant. Excluding premature infants with advanced retinopathy of prematurity, premature and full-term children have same refraction status.展开更多
Introduction:To investigate the distribution characteristics of hyperopic reserve across 10 PLADs in China and determine the levels and patterns of change in spherical equivalent after cycloplegic refraction among chi...Introduction:To investigate the distribution characteristics of hyperopic reserve across 10 PLADs in China and determine the levels and patterns of change in spherical equivalent after cycloplegic refraction among children and adolescents aged 5–18 years by sex.Methods:The National Disease Control and Prevention Administration of China conducted a comprehensive study between 2020 and 2024,involving 61,076 students from kindergarten through high school across 10 provincial-level administrative divisions(PLADs)in China.Median[first quartile(Q1),third quartile(Q3)]values were used to describe SE distribution,and the Mann–Whitney U test was employed to compare SE between males and females within the same age group.Results:The median SE decreased progressively with age in both sexes,with females demonstrating a more rapid decline than males.The median SE reached≤−0.5 D at age 12 for males and age 11 for females.Among non-myopic participants,both sexes exhibited a consistent decline in median SE from ages 5–12,followed by relatively stable fluctuations from ages 13–18.However,the magnitude of both decline and fluctuations was greater in females than in males.Conclusion:Hyperopic reserve among Chinese children and adolescents aged 5–18 years is substantially insufficient,with myopia onset occurring at increasingly younger ages,particularly among females approaching puberty and younger children.Early initiation of myopia prevention and control measures is essential,with timely monitoring of hyperopic reserve to prevent premature depletion.展开更多
Cornea is the most important optical surface in the eye dioptric system. Three kinds of methods in measuring corneal astigmatism were used. Three hundred and sixty eyes suffered ametropia were selected on a random bas...Cornea is the most important optical surface in the eye dioptric system. Three kinds of methods in measuring corneal astigmatism were used. Three hundred and sixty eyes suffered ametropia were selected on a random basis. Computer_assisted corneal topographic system was compared with keratometer and cycloplegic retinoscopy in measuring corneal curvature. There was no statistical difference in axes of astigmatism among the three groups. It is thought that ΔSim \%K\% could show the corneal regular astigmatism. As for diopters of astitigmatism, no difference was found between the groups of corneal topography and keratometer, but there was a significant difference between the group of cycloplegic retinoscopy and the other two groups. It was demonstrated that keratometer could function similarly as the corneal topography. However, it measured only four points from a small region of the cornea and was limited in measuring slight changes in corneal curvature. Some discussion was also made about the graphic patterns and ΔSim \%K\% in corneal topography.展开更多
文摘Purpose: Use of appropriate cycloplegic agent is an essential area of management in children with strabismus and refractive error. This study was designed to audit our own department’s understanding and practice with respect to cycloplegia. Methods: Children in age group of 0 - 12 years with refractive errors and strabismus were evaluated with respect to four parameters: adherence to cycloplegic refraction (group-I), choice of cycloplegic agent (group-II), dosage of cycloplegia (group-III) and duration of cycloplegia (group-IV). Following the initial audit, the hospital audit committee evaluated the results;thereafter concerned staff was educated and aidememoires of the dilatation protocol were introduced;a second audit cycle was carried out after 3 months. Results: First and second audit cycle included 334 children (mean age 6.2 ± 2.2 years) and 436 children (mean age 7.25 ± 2.9 years) respectively. A statistically significant improvement was found in all four parameters in the second audit cycle: adherence to dilation protocol (82.3% in first cycle to 94.3% in second cycle;p = 0.001), choice of cycloplegic agent (77% in the first cycle to 94.8% in the second cycle;p = 0.001), dosage of cycloplegic agent (84% in the first cycle to 96.3% in the second cycle;p = 0.001) and duration of cycloplegic agents (65% in the first cycle to 97.5% in the second cycle;p = 0.001 for CTC and 71.8% in the first cycle to 98% in the second cycle;p = 0.001 for Tropicamide). Conclusions: A complete audit cycle demonstrated a statistically significant improvement in all four parameters related to cycloplegic refraction in children. Regular auditing coupled with targeted interventions aimed to maintain the “best practice guidelines” for determination of refractive errors in children could prove effective in improving standards of clinical practice.
文摘Introduction:Cycloplegic refraction is the gold standard for assessing refractive error in children.However,logistical constraints hinder its implementation in large-scale surveys.Methods:Data obtained from a nationwide ocular health survey conducted in ten provincial-level administrative divisions in China were analyzed(2020–2024).Participants aged 5–18 years underwent standardized non-cycloplegic and cycloplegic autorefraction,axial length(AL),corneal radius(CR),and AL/CR measurements.Random forest and XGBoost models were trained to predict the cycloplegic spherical equivalent(SE)using noncycloplegic SE,uncorrected visual acuity(UCVA),and biometric parameters.Performance was evaluated using R^(2),root mean square error(RMSE),and Bland–Altman analysis.Results:Both models exhibited strong predictive performance.In the test set,random forest achieved R^(2)=0.88 and RMSE=0.55 diopter(D),whereas XGBoost achieved R^(2)=0.89 and RMSE=0.54 D.Noncycloplegic SE,AL/CR ratio,AL,and UCVA were consistently the top predictors.The predicted SE exhibited strong agreement with the cycloplegic SE,with minimal residual bias.Conclusion:Machine learning models incorporating noncycloplegic SE and ocular biometrics accurately estimate cycloplegic SE in children and adolescents,providing a practical alternative for largescale refractive-error surveillance when cycloplegia is impractical.
基金Supported by the Ministry of Science and Technology of the People’s Republic of China,National Key Research and Development Program of China(2021YFC2702102)the Beijing Municipal Health Commission High-level Public Health Technical Talent Construction Project(Leading Talent-01-09).
文摘Introduction:Non-cycloplegic refraction is widely utilized in vision screening.However,interpreting non-cycloplegic refraction results remains a significant challenge in both clinical practice and public health settings.This study aimed to establish grade-and sexspecific reference values for non-cycloplegic spherical equivalent(SE)to enhance myopia screening and risk prediction among Chinese students.Methods:A comprehensive study was conducted between 2020 and 2024,involving 67,260 students from kindergarten through high school across 10 provincial-level administrative divisions(PLADs)in China.The Lambda-Mu-Sigma method was employed to model non-cycloplegic SE.Reference values were established by calculating SE centiles corresponding to myopia and high myopia prevalence across grades 0 through 12.Results:Among boys,the estimated prevalence of myopia and high myopia increased from 1.2%and<0.1%in grade 0(senior kindergarten)to 82.4%and 11.6%in grade 12(third year of high school),respectively.For twelfth-grade boys,the 82.4th and 11.6th percentiles of SE(–0.99 D and–6.16 D)were established as reference values for screening myopia and high myopia,respectively.The corresponding percentiles in lower grades served as predictive reference values for grade 12 outcomes.For instance,a grade-0 boy with non-cycloplegic SE>0.70 D(82.4th percentile)was predicted to remain free of myopia before grade 12.Similarly,SE>–0.73 D(11.6th percentile)indicated a low likelihood of developing high myopia before grade 12.Conclusions:This study established comprehensive non-cycloplegic SE reference values for screening and predicting myopia among Chinese students.The methodology developed here may be applicable to other regions where student myopia prevalence patterns demonstrate relative stability.
基金This work was supported in part by the 863 Hi tech Plan of China(No Z19-01-04 02).
文摘To determine the sensitivity and specificity of using a computer photoscreener and non cycloplegic retinoscopy in the detection of amblyopiogenic factors in nine to fifty months old infants and children Methods Three hundred children, nine to fifty months old, were screened with the computer photoscreener and non cycloplegic retinoscopy With a blinded standardized clinical assessment as the standard, an overall comparison of the sensitivity of and specificity results obtained with the two techniques was made Photoscreen images on the computer monitor screen were reviewed and analyzed immediately by two independent observers for indicators of amblyopiogenic risk factors Simultaneously, the results were compared to the findings of a full ophthalmologic examination Results The computer photoscreener revealed a sensitivity of 94 6% and specificity of 90 1%, and the non cycloplegic retinocopy revealed a sensitivity of 85 7% and specificity of 81 0% for the detection of amblyopiogenic risk factors, including hyperopia (+2 75 D or more), myopia (-1 50 D or more), astigmatism (1 75 D or more), anisometropia (2 00 D or more), ocular misalignment (5 degrees or more), and media opacity (1 5?mm or more) Conclusions The computer photoscreener offers an opportunity to identify problems that limit vision, and could provide a feasible and sufficiently reliable screening technique in infants and preschool children to be screened successfully for amblyopiogenic risk factors
基金Supported by Shandong Nature Scienc Foundation(No.ZR2015HM026)
文摘AIM： To study the evolution of the refractive status and examine the affected factors in infants during the first year of life in a large sample size in China. METHODS： A total of 1258 babies （2516 eyes） aged 32wk gestational age to ty participated in the study, including 766 premature and 492 full-term infants. First, each baby received an orthoptic examination, slit-lamp checking and fundus imaging. Patients with diseases which might affect refractive status were excluded from the cohort. The cycloplegia retinoscopy was performed. Their neonatal histories were reviewed. Each measurement contained the refractive status and calculation of the spherical equivalent （SE）. RESULTS： Refractive state showed an average hyperopia of ＋0.94_＋1.63 D at early ages, followed by a trend toward more hyperopia. The refractive state reached the top （＋2.431.46 D） at the age of one to two months. Then gliding till one year old when the refractive state reached ＋0.59：1.41 D. The prevalence of astigmatism was 42.17% in the study, being 2.82% myopic astigmatism and 39.35% hyperopic astigmatism. The 94.1% of hyperopic astigmatism was with-the-rule astigmatism and 71.83% of myopic astigmatism was with-the-rule astigmatism. Refractive state between boys and girls was different. The mean SE of boys was ＋1.97＋1.57 D, while that of girls was ＋1.79＋1.46 D, and the difference was significant. CONCLUSION： Before one year old, the change of refractive status is associated with checking age and sex. At the age of one to two months, the degree of hyperopia reaches the top. Boys have more hyperopic degree than girls, and with- the-rule astigmatism is predominant. Excluding premature infants with advanced retinopathy of prematurity, premature and full-term children have same refraction status.
基金the Ministry of Science and Technology of the People’s Republic of China through the National Key Research and Development Program of China(2021YFC2702102)the Beijing Municipal Health Commission High-level Public Health Technical Talent Construction Project(Leading Talent-01-09).
文摘Introduction:To investigate the distribution characteristics of hyperopic reserve across 10 PLADs in China and determine the levels and patterns of change in spherical equivalent after cycloplegic refraction among children and adolescents aged 5–18 years by sex.Methods:The National Disease Control and Prevention Administration of China conducted a comprehensive study between 2020 and 2024,involving 61,076 students from kindergarten through high school across 10 provincial-level administrative divisions(PLADs)in China.Median[first quartile(Q1),third quartile(Q3)]values were used to describe SE distribution,and the Mann–Whitney U test was employed to compare SE between males and females within the same age group.Results:The median SE decreased progressively with age in both sexes,with females demonstrating a more rapid decline than males.The median SE reached≤−0.5 D at age 12 for males and age 11 for females.Among non-myopic participants,both sexes exhibited a consistent decline in median SE from ages 5–12,followed by relatively stable fluctuations from ages 13–18.However,the magnitude of both decline and fluctuations was greater in females than in males.Conclusion:Hyperopic reserve among Chinese children and adolescents aged 5–18 years is substantially insufficient,with myopia onset occurring at increasingly younger ages,particularly among females approaching puberty and younger children.Early initiation of myopia prevention and control measures is essential,with timely monitoring of hyperopic reserve to prevent premature depletion.
文摘Cornea is the most important optical surface in the eye dioptric system. Three kinds of methods in measuring corneal astigmatism were used. Three hundred and sixty eyes suffered ametropia were selected on a random basis. Computer_assisted corneal topographic system was compared with keratometer and cycloplegic retinoscopy in measuring corneal curvature. There was no statistical difference in axes of astigmatism among the three groups. It is thought that ΔSim \%K\% could show the corneal regular astigmatism. As for diopters of astitigmatism, no difference was found between the groups of corneal topography and keratometer, but there was a significant difference between the group of cycloplegic retinoscopy and the other two groups. It was demonstrated that keratometer could function similarly as the corneal topography. However, it measured only four points from a small region of the cornea and was limited in measuring slight changes in corneal curvature. Some discussion was also made about the graphic patterns and ΔSim \%K\% in corneal topography.
