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Jost B Jonas - One of the best experts on this subject based on the ideXlab platform.

  • high Myopia in greater beijing school children in 2016
    2017
    Co-Authors: Yin Guo, Jia Li Duan, Li Juan Liu, Ying Sun, Ping Tang, Jost B Jonas
    Abstract:

    Purpose To assess prevalence and associated factors of Myopia and high Myopia in schoolchildren in Greater Beijing. Methods The school-based, cross-sectional Greater Beijing School Children Myopia study was carried out in the year 2016 in 54 schools randomly selected from 15 districts in Beijing. Non-cycloplegic auto-refractometry of the right eyes was performed. Results The study included 35,745 (99.4%) out of 35,968 eligible pupils with a mean age of 12.6±3.4 years (range 6–18 years). Prevalence of Myopia defined as myopic refractive error of ≥-0.50 diopters (D),≥-1D,≥-6D,≥-8D and ≥-10D was 70.9%(95% confidence intervals (CI):70.5,71.4), 60.9% (95%CI:60.4,61.4), 8.6%(95%CI:8.4,8.9), 2.2%(95%CI:2.0,2.4), and 0.3% (95%CI:0.3,0.4), respectively. The frequency of high Myopia (≥-6D, ≥-8D, ≥-10D) increased from 1.5% (95%CI:1.0,2.0), 0.4% (95%CI:0.1,0.6) and 0.1% (95%CI:0.00,0.02), respectively in 10-year-olds to 19.4% (95%CI:17.3,21.6), 5.2% (95%CI:4.0,6.4) and 0.9% (95%CI:0.4,1.5), respectively, in 18-year-olds. Mean refractive error in the 18-year-olds was -3.74±2.56D (median:-3.63D;range:-19.6D to + 6.25D). Higher prevalence of high Myopia (≥-6D and ≥-8D) was correlated (all P<0.001) with older age (OR:1.18, and 1.15, respectively), female gender (OR: 1.44 and 1.40, respectively), higher body mass index (OR: 1.02 and 1.03, respectively), taller body height (OR: 1.03 and 1.02, respectively), urban region of habitation (OR: 1.26 and 1.33, respectively) and higher school type (OR:1.57 and 2.22, respectively). Prevalence of severe high Myopia (≥-10D) was associated only with older age (P<0.001; OR: 1.44; 95%CI: 1.31, 1.59) but not with any education-related parameter such as higher school type (P = 0.48), urban region of habitation (P = 0.07) or female gender (P = 0.37). Conclusion In this most recent survey, prevalence of high Myopia (≥-6D:19.4%;≥-8D:5.2%;≥-10D:0.9%) in 18-year-old school children was higher than in previous surveys from mainland China. In contrast to minor high Myopia and moderate high Myopia (defined as myopic refractive error of <-10D), severe high Myopia (myopic refractive error ≥-10D) was not strongly correlated with educational parameters.

  • peripapillary diffuse chorioretinal atrophy in children as a sign of eventual pathologic Myopia in adults
    2016
    Co-Authors: Tae Yokoi, Jost B Jonas, Muka Moriyama, Natsuko Nagaoka, Takeshi Yoshida, Noriaki Shimada, Kyoko Ohnomatsui
    Abstract:

    Purpose To search for a morphologic biomarker to differentiate between pathologic Myopia and simple childhood Myopia. Design Retrospective case series. Participants The study included children (age ≤15 years) with high Myopia (as defined by the Japanese Ministry of Health and Welfare) who attended the High Myopia Clinic between April 1982 and March 1994, had undergone fundus photography, and had a follow-up of 20 years or more. Methods Fundus photographs obtained in childhood and adulthood were examined for presence of pathologic Myopia, defined by high Myopia (myopic refractive error >8 diopters or axial length ≥26.5 mm) and the presence of stage 2 or higher myopic maculopathy. Main Outcome Measures Myopic maculopathy in childhood. Results The study included 56 eyes of 29 patients with a mean age of 10.2±3.6 years at the initial visit and an age of 36.0±7.6 years at the last visit. Mean axial length was 27.0±1.4 mm at baseline and 29.7±2.0 mm at the last visit. At the last visit, 19 eyes (34%) had tessellated fundus alone, 31 eyes (55%) had diffuse chorioretinal atrophy, 3 eyes (5%) showed patchy chorioretinal atrophy, and 1 eye (2%) had macular atrophy. Thus, 35 eyes (63%) had pathologic Myopia in adulthood. Among the 35 eyes, 29 (83%) already had diffuse chorioretinal atrophy at the initial visit in childhood and the remaining 6 eyes (17%) showed tessellated fundus in childhood. The diffuse chorioretinal atrophy seen in childhood was restricted to the area temporal to the peripapillary region. Conclusions The presence of peripapillary diffuse chorioretinal atrophy in children with high axial Myopia may be an indicator for the eventual development of advanced myopic chorioretinal atrophy in later life. These features in children may be helpful for differentiating simple childhood Myopia from eventual pathologic Myopia.

  • scleral and choroidal thickness in secondary high axial Myopia
    2016
    Co-Authors: Ling Shen, Zhibao Zhang, Qi Sheng You, Fei Gao, Jost B Jonas
    Abstract:

    Purpose To assess differences in scleral and choroidal thickness between eyes with secondary high axial Myopia caused by congenital glaucoma, eyes with primary high axial Myopia, and nonhighly myopic eyes. Methods The study consisted of 301 Chinese individuals with a mean age of 23.9 ± 22.6 years and mean axial length of 24.8 ± 4.2 mm. It included the "secondary highly myopic group" (SHMG) because of congenital glaucoma (n = 20 eyes; axial length >26.0 mm), the "primary highly myopic group" (PHMG) (n = 73; axial length >26.0 mm), and the remaining nonhighly myopic group (NHMG). Results The secondary highly myopic group versus the primary highly myopic group had significantly thinner sclera in the pars plana region (343 ± 71 μm versus 398 ± 83 μm; P = 0.006), whereas scleral thickness in other regions did not differ significantly between both highly myopic groups and was significantly thinner in both highly myopic groups than in the NHMG. Mean total scleral volume did not differ significantly (P > 0.20) between any group (SHMG: 659 ± 106 μm; PHMG: 667 ± 128 μm; NHMG: 626 ± 135 μm). Choroidal thickness was significantly thinner in both highly myopic groups than in the NHMG, with no significant differences between both highly myopic groups. Choroidal volume did not differ significantly (P > 0.40) between any of the groups (SHMG: 43 ± 12 μm; PHMG: 43 ± 13 μm; NHMG: 46 ± 17 μm). Conclusion In secondary high axial Myopia, the sclera gets thinner anterior and posterior to the equator; whereas in primary high axial Myopia, scleral thinning is predominantly found posterior to the equator. Because volume of sclera and choroid did not differ between any group, scleral and choroidal thinning in Myopia may be due to a rearrangement of tissue and not due to the new formation of tissue.

  • education related parameters in high Myopia adults versus school children
    2016
    Co-Authors: Ya Xing Wang, Jost B Jonas, Wen Jun Jiang, Vinay Nangia, Ajit Sinha, Dan Zhu, Yong Tao, Yin Guo, Qi Sheng You
    Abstract:

    Purpose Since high Myopia in the younger generation may differ etiologically from high Myopia in older generations, we examined whether education-related parameters differ between high Myopia in today´s school children and high pathological Myopia in today´s elderly generation. Methods The investigation included the adult populations of the population-based Beijing Eye Study (BES) (3468 adults;mean age:64.6±9.8years;range:50–93years) and Central India Eye and Medical Study (CIEMS) (4711 adults;age:49.±13.2years;range:30–100years), and the children and teenager populations of the Shandong Children Eye Study (SCES) (6026 children;age:9.7±3.3years;range:4–18years;cycloplegic refractometry), Gobi Desert Children Eye Study (1565;age:11.9±3.5years;range:6–21 years;cycloplegic refractometry), Beijing Pediatric Eye Study (681 children;age:7.7±1.6years;range:5–13 years;non-cycloplegic refractometry,calculation of axial length to corneal curvature radius ratio), Beijing Children Eye Study (15066 children;age:13.2±3.4years;range:7–18years;non-cycloplegic refractometry), Beijing High School Teenager Eye Study (4677 children;age:16.9±0.7years;range:16–18years;non-cycloplegic refractometry). Results In the BES and CIEMS, educational level did not differ significantly between, or was significantly lower in the highly myopic group (myopic refractive error ≥6 diopters) than in the non-highly myopic group. In all non-adult study populations, higher prevalence of high Myopia was significantly associated with higher degree of education related parameters such as attendance of high-level schools, and more time spent for indoors near work versus time spent outdoors. Conclusions Comparing associations of old or genetic high Myopia in adults with new or acquired high Myopia in school children revealed that education-related parameters did not show a clear association with old or genetic high Myopia, while in contrast, new high Myopia showed strong associations with education. It confirms previous studies that the two forms of high Myopia not only differed in age of onset, but also in associations with education as well. The data support the notion of two types of high Myopia. Future studies may assess whether the risk of pathologic myopic maculopathy and high Myopia associated open-angle glaucoma differs between both types of high Myopia.

  • scleral and choroidal thickness in secondary high axial Myopia
    2016
    Co-Authors: Ling Shen, Xiaolin Xu, Zhibao Zhang, Bin Li, Jost B Jonas
    Abstract:

    Abstract To assess differences in scleral and choroidal thickness between eyes with secondary high axial Myopia caused by congenital glaucoma, eyes with primary high axial Myopia, and nonhighly myopic eyes. The study consisted of 301 Chinese individuals with a mean age of 23.9 ± 22.6 years and mean axial length of 24.8 ± 4.2 mm. It included the "secondary highly myopic group" (SHMG) because of congenital glaucoma (n = 20 eyes; axial length >26.0 mm), the "primary highly myopic group" (PHMG) (n = 73; axial length >26.0 mm), and the remaining nonhighly myopic group (NHMG). The secondary highly myopic group versus the primary highly myopic group had significantly thinner sclera in the pars plana region (343 ± 71 μm versus 398 ± 83 μm; P = 0.006), whereas scleral thickness in other regions did not differ significantly between both highly myopic groups and was significantly thinner in both highly myopic groups than in the NHMG. Mean total scleral volume did not differ significantly (P > 0.20) between any group (SHMG: 659 ± 106 μm; PHMG: 667 ± 128 μm; NHMG: 626 ± 135 μm). Choroidal thickness was significantly thinner in both highly myopic groups than in the NHMG, with no significant differences between both highly myopic groups. Choroidal volume did not differ significantly (P > 0.40) between any of the groups (SHMG: 43 ± 12 μm; PHMG: 43 ± 13 μm; NHMG: 46 ± 17 μm). In secondary high axial Myopia, the sclera gets thinner anterior and posterior to the equator; whereas in primary high axial Myopia, scleral thinning is predominantly found posterior to the equator. Because volume of sclera and choroid did not differ between any group, scleral and choroidal thinning in Myopia may be due to a rearrangement of tissue and not due to the new formation of tissue.

Tien Yin Wong - One of the best experts on this subject based on the ideXlab platform.

  • is artificial intelligence a solution to the Myopia pandemic
    2021
    Co-Authors: Li Lian Foo, Kyoko Ohnomatsui, Tien Yin Wong, Seangmei Saw, Marcus Ang, Chee Wai Wong, Daniel S Ting
    Abstract:

    Artificial intelligence (AI) has been billed as a key component of the Fourth Industrial Revolution. Currently, we are witnessing the growing shift of AI from theoretical ideations to practical applications in healthcare.1 2 Ophthalmology has emerged as one of the focal points of AI research.3–5 Current AI platforms are highly successful in screening for diabetic retinopathy, age-related macular degeneration and glaucoma.6–11 Other fields including cataract screening are similarly producing promising results.12 13 The WHO has identified that least 1 billion suffer from vision impairment that is preventable or treatable—of which Myopia is a significant factor. With its growing prevalence in East Asia and many parts of the world, the ‘Myopia pandemic’ is estimated to affect 50% (4.7 billion) of the world’s population by 2050, with 10% (1 billion) having high Myopia (≤−5.00 D).14–16 This could lead to a staggering number of myopic individuals at risk of developing blinding conditions including myopic macular degeneration (MMD) and macular neovascularisation (MNV).17 However, AI research efforts in the field of refractive errors,18 particularly Myopia19 are still relatively under-developed (table 1). View this table: Table 1 Summary of current Artificial Intelligence research in Myopia The global attention towards Myopia has led to a renewed focus on prediction, prevention, prognostication, early control as well as diagnostic accuracy.20 Early identification of high-risk individuals and unhindered access to appropriate healthcare will be critical in stemming the myopic tide. This has led to greater emphasis to develop dedicated AI models to address these unmet needs, especially for different phenotypes of Myopia—childhood and adult Myopia (high and pathological Myopia). Relevant considerations include age, population size of each segment and measurable dataset, resource allocation, potential social burden, complication …

  • age of onset of Myopia predicts risk of high Myopia in later childhood in myopic singapore children
    2016
    Co-Authors: Sharon Chua, Tien Yin Wong, Audrey Chia, Chingyu Cheng, Charumathi Sabanayagam, Yin Bun Cheung, Robert K Valenzuela, Donald T H Tan, Seangmei Saw
    Abstract:

    Purpose To investigate the effect of age of Myopia onset on the severity of Myopia later in life among myopic children. Methods In this prospective study, school children aged 7–9 years from the Singapore Cohort Of the Risk factors for Myopia (SCORM) were followed up till 11 years (n = 928). Age of Myopia onset was defined either through questionnaire at baseline (age 7–9 years) or subsequent annual follow-up visits. Age of onset of Myopia was a surrogate indicator of duration of Myopia progression till age 11 years. Cycloplegic refraction and axial length were measured at every annual eye examination. High Myopia was defined as spherical equivalent of ≤−5.0 D. A questionnaire determined the other risk factors. Results In multivariable regression models, younger age of Myopia onset (per year decrease) or longer duration of Myopia progression was associated with high Myopia (odds ratio (OR) = 2.86; 95% CI: 2.39 to 3.43), more myopic spherical equivalent (regression coefficient (β) = −0.86 D; 95% CI: −0.93 to −0.80) and longer axial length (β = 0.28 mm; 95% CI: 0.24 to 0.32) at aged 11 years, after adjusting for gender, race, school, books per week and parental Myopia. In Receiver Operating Curve (ROC) analyses, age of Myopia onset alone predicted high Myopia by 85% (area under the curve = 0.85), while the addition of other factors including gender, race, school, books per week and parental Myopia only marginally improved this prediction (area under the curve = 0.87). Conclusions Age of Myopia onset or duration of Myopia progression was the most important predictor of high Myopia in later childhood in myopic children. Future trials to retard the progression of Myopia to high Myopia could focus on children with younger age of Myopia onset or with longer duration of Myopia progression.

  • epidemiology and disease burden of pathologic Myopia and myopic choroidal neovascularization an evidence based systematic review
    2014
    Co-Authors: Tien Yin Wong, Alberto Ferreira, R Hughes, Gemma Carter, Paul Mitchell
    Abstract:

    Purpose To summarize the epidemiology of pathologic Myopia and myopic choroidal neovascularization (CNV) and their impact on vision. Design Systematic literature review of all English-language studies evaluating the epidemiology and visual burden of pathologic Myopia or myopic CNV. Methods PubMed and EMBASE were searched with no time limits using predefined search strings for English-language studies evaluating the epidemiology and visual burden of pathologic Myopia and myopic CNV. Results In total, 39 relevant publications were identified. Population-based studies reported pathologic Myopia to be the first to third most frequent cause of blindness. The prevalence of pathologic Myopia was reported to be 0.9%-3.1%, and the prevalence of visual impairment attributable to pathologic Myopia ranged from 0.1%-0.5% (European studies) and from 0.2%-1.4% (Asian studies). The prevalence of CNV in individuals with pathologic Myopia was reported to be 5.2%-11.3%, and was bilateral in approximately 15% of patients. All studies of visual outcome in patients with myopic CNV (duration ranging from less than 3 months to 21.5 years) reported deterioration in best-corrected visual acuity over time. Older age, subfoveal CNV location, and larger baseline lesion size were predictors of worse visual outcomes. Conclusions Pathologic Myopia is an important cause of vision loss worldwide, affecting up to 3% of the population. Of these, a substantial proportion of patients develop myopic CNV, which mostly causes a significant progressive decrease in visual acuity. This condition should therefore be a target for new treatment strategies.

  • Myopia related fundus changes in singapore adults with high Myopia
    2013
    Co-Authors: Lan Chang, Kyoko Ohnomatsui, Gus Gazzard, Terri L Young, Paul Mitchell, Gemmy Cheung, Haslina Hamzah, Tin Aung, Tien Yin Wong
    Abstract:

    Purpose To examine the pattern of Myopia-related macular and optic disc changes in Singapore adults with high Myopia (spherical equivalent ≤−6.00 diopters). Design Asian adults with high Myopia from 3 population-based surveys. Methods Adults 40 years and older (n = 359) with high Myopia were pooled from 3 population-based surveys in Singapore Asians: (1) the Singapore Prospective Study Program (SP2, n = 184); (2) the Singapore Malay Eye Study (SiMES, n = 98); and (3) the Singapore Indian Eye Study (SINDI, n = 77). All study participants underwent standardized refraction and fundus photography, and SiMES and SINDI subjects also completed ocular biometry measurements. Myopia-related macular (posterior staphyloma, lacquer cracks, Fuchs spot, myopic chorioretinal atrophy, and myopic choroidal neovascularization) and optic disc (optic nerve head tilt, optic disc dimensions, and peripapillary atrophy) changes were evaluated. Results The most common Myopia-related macular finding in adults with high Myopia was staphyloma (23%), followed by chorioretinal atrophy (19.3%). There were few cases of lacquer crack (n = 6, 1.8%), T-sign (n = 6, 1.8%), retinal hemorrhage (n = 3, 0.9%), active myopic choroidal neovascularization (n = 3, 0.9%), and no case of Fuchs spot. The most common disc finding associated with high Myopia was peripapillary atrophy (81.2%), followed by disc tilt (57.4%). Staphyloma and chorioretinal atrophy increased in prevalence with increasing age, increasing myopic refractive error, and increasing axial length (all P P  = .04) among Malays, the highest proportion of peripapillary atrophy ( P  = .01) and disc tilt ( P P Conclusions Staphyloma and chorioretinal atrophy lesions were the most common fundus findings among Asian adults with high Myopia. In this population, tilted discs and peripapillary atrophy were also common, while choroidal neovascularization and Fuchs spot were rare. In contrast with Singapore teenagers, in whom tilted disc and peripapillary atrophy were common while staphyloma and chorioretinal atrophy were rare, pathologic Myopia appears to be dependent on the duration of disease and, thus, age of the individual.

  • choroidal neovascularization in pathological Myopia
    2012
    Co-Authors: Kumari Neelam, Chiu Ming Gemmy Cheung, Kyoko Ohnomatsui, Tien Yin Wong
    Abstract:

    Abstract Myopic choroidal neovascularization (CNV) is one of the leading causes of visual impairment worldwide. The clinical and socioeconomic impact of myopic CNV in Asian countries is particularly significant due to rising trend in the prevalence and severity of pathological Myopia. The exact pathogenesis of myopic CNV remains unclear and there is paucity of information with respect to incidence and risk factors for myopic CNV from prospective studies. Furthermore, there are no recognized measures that may prevent or delay the development of CNV in eyes with pathological Myopia. Advances have been made in the diagnosis and characterization of myopic CNV over the years. Until recently, treatment modalities for myopic CNV were limited to thermal laser photocoagulation and photodynamic therapy with verteporfin, both these modalities primarily aim at prevention of further visual loss. In the last 5 years, inhibitors of vascular endothelial growth factor (VEGF) have been used successfully and may improve vision to some extent. Nevertheless, the long-term safety and efficacy of anti-VEGF agents remains unknown. Furthermore, the risk of developing chorioretinal atrophy remains the key factor in determining the final visual outcome. This review article summarizes the current literature on myopic CNV, highlighting new evolving diagnostic and treatment modalities, prognostic factors influencing visual outcome, and areas of future research.

Kyoko Ohnomatsui - One of the best experts on this subject based on the ideXlab platform.

  • is artificial intelligence a solution to the Myopia pandemic
    2021
    Co-Authors: Li Lian Foo, Kyoko Ohnomatsui, Tien Yin Wong, Seangmei Saw, Marcus Ang, Chee Wai Wong, Daniel S Ting
    Abstract:

    Artificial intelligence (AI) has been billed as a key component of the Fourth Industrial Revolution. Currently, we are witnessing the growing shift of AI from theoretical ideations to practical applications in healthcare.1 2 Ophthalmology has emerged as one of the focal points of AI research.3–5 Current AI platforms are highly successful in screening for diabetic retinopathy, age-related macular degeneration and glaucoma.6–11 Other fields including cataract screening are similarly producing promising results.12 13 The WHO has identified that least 1 billion suffer from vision impairment that is preventable or treatable—of which Myopia is a significant factor. With its growing prevalence in East Asia and many parts of the world, the ‘Myopia pandemic’ is estimated to affect 50% (4.7 billion) of the world’s population by 2050, with 10% (1 billion) having high Myopia (≤−5.00 D).14–16 This could lead to a staggering number of myopic individuals at risk of developing blinding conditions including myopic macular degeneration (MMD) and macular neovascularisation (MNV).17 However, AI research efforts in the field of refractive errors,18 particularly Myopia19 are still relatively under-developed (table 1). View this table: Table 1 Summary of current Artificial Intelligence research in Myopia The global attention towards Myopia has led to a renewed focus on prediction, prevention, prognostication, early control as well as diagnostic accuracy.20 Early identification of high-risk individuals and unhindered access to appropriate healthcare will be critical in stemming the myopic tide. This has led to greater emphasis to develop dedicated AI models to address these unmet needs, especially for different phenotypes of Myopia—childhood and adult Myopia (high and pathological Myopia). Relevant considerations include age, population size of each segment and measurable dataset, resource allocation, potential social burden, complication …

  • peripapillary diffuse chorioretinal atrophy in children as a sign of eventual pathologic Myopia in adults
    2016
    Co-Authors: Tae Yokoi, Jost B Jonas, Muka Moriyama, Natsuko Nagaoka, Takeshi Yoshida, Noriaki Shimada, Kyoko Ohnomatsui
    Abstract:

    Purpose To search for a morphologic biomarker to differentiate between pathologic Myopia and simple childhood Myopia. Design Retrospective case series. Participants The study included children (age ≤15 years) with high Myopia (as defined by the Japanese Ministry of Health and Welfare) who attended the High Myopia Clinic between April 1982 and March 1994, had undergone fundus photography, and had a follow-up of 20 years or more. Methods Fundus photographs obtained in childhood and adulthood were examined for presence of pathologic Myopia, defined by high Myopia (myopic refractive error >8 diopters or axial length ≥26.5 mm) and the presence of stage 2 or higher myopic maculopathy. Main Outcome Measures Myopic maculopathy in childhood. Results The study included 56 eyes of 29 patients with a mean age of 10.2±3.6 years at the initial visit and an age of 36.0±7.6 years at the last visit. Mean axial length was 27.0±1.4 mm at baseline and 29.7±2.0 mm at the last visit. At the last visit, 19 eyes (34%) had tessellated fundus alone, 31 eyes (55%) had diffuse chorioretinal atrophy, 3 eyes (5%) showed patchy chorioretinal atrophy, and 1 eye (2%) had macular atrophy. Thus, 35 eyes (63%) had pathologic Myopia in adulthood. Among the 35 eyes, 29 (83%) already had diffuse chorioretinal atrophy at the initial visit in childhood and the remaining 6 eyes (17%) showed tessellated fundus in childhood. The diffuse chorioretinal atrophy seen in childhood was restricted to the area temporal to the peripapillary region. Conclusions The presence of peripapillary diffuse chorioretinal atrophy in children with high axial Myopia may be an indicator for the eventual development of advanced myopic chorioretinal atrophy in later life. These features in children may be helpful for differentiating simple childhood Myopia from eventual pathologic Myopia.

  • current and predicted demographics of high Myopia and an update of its associated pathological changes
    2015
    Co-Authors: Pavan K Verkicharla, Kyoko Ohnomatsui, Seangmei Saw
    Abstract:

    Purpose Excessive axial elongation of the eye in high Myopia can cause biomechanical stretching leading to various ocular complications. The purpose of this review is to provide an update on various pathologic changes, especially in the chorio-retina and sclera that have been reported recently using advanced ophthalmic bio-imaging modalities such as optical coherence tomography, magnetic resonance imaging and fundus photography. Recent findings The prevalence rates of pathologic Myopia (myopic retinopathy and maculopathy) mirror the prevalence rates of high Myopia as the risks of pathologic Myopia increase with high Myopia. Peripapillary and sub-foveal choroidal thinning, scleral thinning, and deformed/irregular eye shapes were found to be strongly associated with various pathologic myopic lesions, especially with posterior staphyloma and chorio-retinal atrophy. Considering the increasing prevalence rate of Myopia and pathologic Myopia, these degenerative changes are likely to increase dramatically over the next few decades due to the rapid growth in the number of individuals with high Myopia and the ageing population. Summary The current prevalence rates of pathologic Myopia in older adults might have significantly underestimated the future prevalence rates and warrants age of onset of Myopia being considered a major risk factor for pathologic Myopia. Using advanced technology, identification of novel quantifiable chorio-retinal and scleral parameters in pathologic Myopia would help to identify people at risk of developing pathologic Myopia and potentially may revolutionise the management of Myopia especially in risk prognostication and monitoring of disease progression.

  • areas of nonperfusion in peripheral retina of eyes with pathologic Myopia detected by ultra widefield fluorescein angiography
    2014
    Co-Authors: Yuichiro Kaneko, Muka Moriyama, Shuichiro Hirahara, Yuichiro Ogura, Kyoko Ohnomatsui
    Abstract:

    PURPOSE We investigated the vascular system in the far peripheral retina in eyes with pathologic Myopia by ultra-widefield fluorescein angiography (FA). METHODS We analyzed retrospectively 230 with pathologic Myopia (myopic refractive error >8 diopters [D] or axial length >26.5 mm) and 42 emmetropic (refractive error < ± 2 D) controls who were examined with ultra-widefield FA by the Optos P200 system. Far peripheral retina was defined as the area anterior to the ampullae of the vortex veins. RESULTS Retinal capillary telangiectasia was observed in the far periphery of 34 of 42 (81.0%) emmetropic eyes and in 90 of 115 (78.3%) highly myopic eyes. Retinal capillary microaneurysms were observed in 13 of 42 (31.0%) emmetropic eyes and in 60 of 115 (52.2%) eyes with pathologic Myopia. The differences in the incidences of these two lesions were not significant. Areas of nonperfusion in the far periphery were found in two of 42 (4.8%) emmetropic eyes and in 95 of 115 (82.6%) eyes with pathologic Myopia. In these myopic eyes, the arterioles and venules had an abrupt ending, and in advanced cases, the perfused area was limited to just beyond the staphyloma border. None of the eyes developed retinal neovascularization. Statistical analyses showed that the highly myopic patients with avascular areas in the far periphery were significantly older, and had significantly longer axial length. CONCLUSIONS Areas of nonperfusion in the far periphery are common in eyes with pathologic Myopia. Retinal vasculature in the far periphery is significantly altered in eyes with pathologic Myopia, and this may be due to a mechanical stretching.

  • Myopia related fundus changes in singapore adults with high Myopia
    2013
    Co-Authors: Lan Chang, Kyoko Ohnomatsui, Gus Gazzard, Terri L Young, Paul Mitchell, Gemmy Cheung, Haslina Hamzah, Tin Aung, Tien Yin Wong
    Abstract:

    Purpose To examine the pattern of Myopia-related macular and optic disc changes in Singapore adults with high Myopia (spherical equivalent ≤−6.00 diopters). Design Asian adults with high Myopia from 3 population-based surveys. Methods Adults 40 years and older (n = 359) with high Myopia were pooled from 3 population-based surveys in Singapore Asians: (1) the Singapore Prospective Study Program (SP2, n = 184); (2) the Singapore Malay Eye Study (SiMES, n = 98); and (3) the Singapore Indian Eye Study (SINDI, n = 77). All study participants underwent standardized refraction and fundus photography, and SiMES and SINDI subjects also completed ocular biometry measurements. Myopia-related macular (posterior staphyloma, lacquer cracks, Fuchs spot, myopic chorioretinal atrophy, and myopic choroidal neovascularization) and optic disc (optic nerve head tilt, optic disc dimensions, and peripapillary atrophy) changes were evaluated. Results The most common Myopia-related macular finding in adults with high Myopia was staphyloma (23%), followed by chorioretinal atrophy (19.3%). There were few cases of lacquer crack (n = 6, 1.8%), T-sign (n = 6, 1.8%), retinal hemorrhage (n = 3, 0.9%), active myopic choroidal neovascularization (n = 3, 0.9%), and no case of Fuchs spot. The most common disc finding associated with high Myopia was peripapillary atrophy (81.2%), followed by disc tilt (57.4%). Staphyloma and chorioretinal atrophy increased in prevalence with increasing age, increasing myopic refractive error, and increasing axial length (all P P  = .04) among Malays, the highest proportion of peripapillary atrophy ( P  = .01) and disc tilt ( P P Conclusions Staphyloma and chorioretinal atrophy lesions were the most common fundus findings among Asian adults with high Myopia. In this population, tilted discs and peripapillary atrophy were also common, while choroidal neovascularization and Fuchs spot were rare. In contrast with Singapore teenagers, in whom tilted disc and peripapillary atrophy were common while staphyloma and chorioretinal atrophy were rare, pathologic Myopia appears to be dependent on the duration of disease and, thus, age of the individual.

Paul Mitchell - One of the best experts on this subject based on the ideXlab platform.

  • Myopic Choroidal Neovascularization: Review, Guidance, and Consensus Statement on Management.
    2017
    Co-Authors: Chui Ming Gemmy Cheung, Kyoko Ohno-matsui, Paul Mitchell, Timothy Y. Y. Lai, Jennifer J. Arnold, Frank G. Holz, Kyu Hyung Park, Michael Larsen, Shih-jen Chen, Sebastian Wolf
    Abstract:

    Topic The aim of this article is to review and compile available information on the classification, pathophysiology, and clinical features of myopic choroidal neovascularization (CNV); to describe the latest data on the management of this disease; and to present guidance. Clinical Relevance In the United States, Myopia affects approximately 34 million people (2010), and similar figures have been reported in Europe. Pathologic Myopia (PM), a possible consequence of Myopia, is estimated to affect up to 3% of the global population. One of the most serious complications of PM is myopic CNV, which often leads to a sudden onset but progressive decline in central vision and is associated with a poor prognosis unless treated. Furthermore, 35% of patients with myopic CNV develop bilateral disease in the fellow eye within 8 years. Although intravitreal anti–vascular endothelial growth factor (VEGF) therapies have had a major impact on the management of patients with myopic CNV, there remain significant gaps in our understanding of this condition and how to best administer treatment. Additionally, the long-term safety and efficacy of these treatments are largely unknown. Methods We carried out a literature review (September 2015) of all English-language articles in PubMed resulting from searches of the following terms: "choroidal neovascularization" AND "Myopia" OR "myopic macular degeneration" OR "degenerative Myopia" OR "myopic maculopathy" OR "myopic retinopathy" OR "pathological Myopia" OR "pathologic Myopia." Results We screened a total of 566 abstracts, and 250 articles were deemed relevant for full publication review. We excluded a further 71, but an additional 44 articles were identified. This resulted in 223 articles being used to develop this review. Conclusions Highly myopic patients experiencing a sudden loss of central vision should be referred for further examination. Once a diagnosis of myopic CNV has been confirmed, after fluorescein angiography, treatment initiation should be prompt and anti-VEGF agents considered as first-line therapy, unless contraindicated. Continued monitoring of patients is required to assess any progression or recurrence of the condition.

  • epidemiology and disease burden of pathologic Myopia and myopic choroidal neovascularization an evidence based systematic review
    2014
    Co-Authors: Tien Yin Wong, Alberto Ferreira, R Hughes, Gemma Carter, Paul Mitchell
    Abstract:

    Purpose To summarize the epidemiology of pathologic Myopia and myopic choroidal neovascularization (CNV) and their impact on vision. Design Systematic literature review of all English-language studies evaluating the epidemiology and visual burden of pathologic Myopia or myopic CNV. Methods PubMed and EMBASE were searched with no time limits using predefined search strings for English-language studies evaluating the epidemiology and visual burden of pathologic Myopia and myopic CNV. Results In total, 39 relevant publications were identified. Population-based studies reported pathologic Myopia to be the first to third most frequent cause of blindness. The prevalence of pathologic Myopia was reported to be 0.9%-3.1%, and the prevalence of visual impairment attributable to pathologic Myopia ranged from 0.1%-0.5% (European studies) and from 0.2%-1.4% (Asian studies). The prevalence of CNV in individuals with pathologic Myopia was reported to be 5.2%-11.3%, and was bilateral in approximately 15% of patients. All studies of visual outcome in patients with myopic CNV (duration ranging from less than 3 months to 21.5 years) reported deterioration in best-corrected visual acuity over time. Older age, subfoveal CNV location, and larger baseline lesion size were predictors of worse visual outcomes. Conclusions Pathologic Myopia is an important cause of vision loss worldwide, affecting up to 3% of the population. Of these, a substantial proportion of patients develop myopic CNV, which mostly causes a significant progressive decrease in visual acuity. This condition should therefore be a target for new treatment strategies.

  • risk factors for incident Myopia in australian schoolchildren the sydney adolescent vascular and eye study
    2013
    Co-Authors: Amanda N French, Paul Mitchell, Ian G Morgan, Kathryn A Rose
    Abstract:

    Purpose To examine the risk factors for incident Myopia in Australian schoolchildren. Design Population-based, longitudinal cohort study. Participants The Sydney Adolescent Vascular and Eye Study (SAVES) was a 5- to 6-year follow-up of the Sydney Myopia Study (SMS). At follow-up, 2103 children were reexamined: 892 (50.5%) from the younger cohort and 1211 (51.5%) from the older cohort. Of these, 863 in the younger cohort and 1196 in the older cohort had complete refraction data. Methods Cycloplegic autorefraction (cyclopentolate 1%; Canon RK-F1; Canon, Tokyo, Japan) was measured at baseline and follow-up. Myopia was defined as a spherical equivalent refraction of ≤−0.50 diopters (D). Children were classified as having incident Myopia if they were nonmyopic at baseline and myopic in either eye at follow-up. A comprehensive questionnaire determined the amount of time children spent outdoors and doing near work per week at baseline, as well as ethnicity, parental Myopia, and socioeconomic status. Main Outcome Measures Incident Myopia. Results Children who became myopic spent less time outdoors compared with children who remained nonmyopic (younger cohort, 16.3 vs. 21.0 hours, respectively, P P =0.001). Children who became myopic performed significantly more near work (19.4 vs. 17.6 hours; P =0.02) in the younger cohort, but not in the older cohort ( P =0.06). Children with 1 or 2 parents who were myopic had greater odds of incident Myopia (1 parent: odds ratio [OR], 3.2, 95% confidence interval [CI], 1.9–5.2; both parents: OR, 3.3, 95% CI, 1.6–6.8) in the younger but not the older cohort. Children of East Asian ethnicity had a higher incidence of Myopia compared with children of European Caucasian ethnicity (both P P P Conclusions Time spent outdoors was negatively associated with incident Myopia in both age cohorts. Near work and parental Myopia were additional significant risk factors for Myopia only in the younger cohort. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

  • Myopia related fundus changes in singapore adults with high Myopia
    2013
    Co-Authors: Lan Chang, Kyoko Ohnomatsui, Gus Gazzard, Terri L Young, Paul Mitchell, Gemmy Cheung, Haslina Hamzah, Tin Aung, Tien Yin Wong
    Abstract:

    Purpose To examine the pattern of Myopia-related macular and optic disc changes in Singapore adults with high Myopia (spherical equivalent ≤−6.00 diopters). Design Asian adults with high Myopia from 3 population-based surveys. Methods Adults 40 years and older (n = 359) with high Myopia were pooled from 3 population-based surveys in Singapore Asians: (1) the Singapore Prospective Study Program (SP2, n = 184); (2) the Singapore Malay Eye Study (SiMES, n = 98); and (3) the Singapore Indian Eye Study (SINDI, n = 77). All study participants underwent standardized refraction and fundus photography, and SiMES and SINDI subjects also completed ocular biometry measurements. Myopia-related macular (posterior staphyloma, lacquer cracks, Fuchs spot, myopic chorioretinal atrophy, and myopic choroidal neovascularization) and optic disc (optic nerve head tilt, optic disc dimensions, and peripapillary atrophy) changes were evaluated. Results The most common Myopia-related macular finding in adults with high Myopia was staphyloma (23%), followed by chorioretinal atrophy (19.3%). There were few cases of lacquer crack (n = 6, 1.8%), T-sign (n = 6, 1.8%), retinal hemorrhage (n = 3, 0.9%), active myopic choroidal neovascularization (n = 3, 0.9%), and no case of Fuchs spot. The most common disc finding associated with high Myopia was peripapillary atrophy (81.2%), followed by disc tilt (57.4%). Staphyloma and chorioretinal atrophy increased in prevalence with increasing age, increasing myopic refractive error, and increasing axial length (all P P  = .04) among Malays, the highest proportion of peripapillary atrophy ( P  = .01) and disc tilt ( P P Conclusions Staphyloma and chorioretinal atrophy lesions were the most common fundus findings among Asian adults with high Myopia. In this population, tilted discs and peripapillary atrophy were also common, while choroidal neovascularization and Fuchs spot were rare. In contrast with Singapore teenagers, in whom tilted disc and peripapillary atrophy were common while staphyloma and chorioretinal atrophy were rare, pathologic Myopia appears to be dependent on the duration of disease and, thus, age of the individual.

  • outdoor activity and Myopia in singapore teenage children
    2009
    Co-Authors: Mohamed Dirani, Louis Tong, Gus Gazzard, Xiaoe Zhang, Audrey Chia, Terri L Young, Kathryn A Rose, Paul Mitchell
    Abstract:

    Aim: To investigate the relationship of outdoor activities and Myopia in Singapore teenage children. Methods: Teenage children (1249 participants), examined in the Singapore Cohort study Of Risk factors for Myopia (SCORM), during 2006 were included in analyses. Participants completed questionnaires that quantified total outdoor activity, and underwent an eye examination. Results: The mean total time spent on outdoor activity was 3.24 hours per day. Total outdoor activity (hours per day) was significantly associated with Myopia, odds ratio 0.90 [95% confidence interval (CI) 0.84, 0.96] (p=0.004), after adjusting for age, gender, ethnicity, school type, books read per week, height, parental Myopia, parental education and intelligence quotient. In addition, total time spent outdoors was associated with significantly less myopic refraction (regression coefficient = 0.17; CI 0.10, 0.25, p Conclusions: Participants who spent more time outdoors were less likely to be myopic. Thus, outdoor activity may protect against development of Myopia in children, supporting recent Australian data. As near work did not predict outdoor activity, this can be viewed as an independent factor and not merely the reciprocal of near work.

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  • scleral and choroidal thickness in secondary high axial Myopia
    2016
    Co-Authors: Ling Shen, Zhibao Zhang, Qi Sheng You, Fei Gao, Jost B Jonas
    Abstract:

    Purpose To assess differences in scleral and choroidal thickness between eyes with secondary high axial Myopia caused by congenital glaucoma, eyes with primary high axial Myopia, and nonhighly myopic eyes. Methods The study consisted of 301 Chinese individuals with a mean age of 23.9 ± 22.6 years and mean axial length of 24.8 ± 4.2 mm. It included the "secondary highly myopic group" (SHMG) because of congenital glaucoma (n = 20 eyes; axial length >26.0 mm), the "primary highly myopic group" (PHMG) (n = 73; axial length >26.0 mm), and the remaining nonhighly myopic group (NHMG). Results The secondary highly myopic group versus the primary highly myopic group had significantly thinner sclera in the pars plana region (343 ± 71 μm versus 398 ± 83 μm; P = 0.006), whereas scleral thickness in other regions did not differ significantly between both highly myopic groups and was significantly thinner in both highly myopic groups than in the NHMG. Mean total scleral volume did not differ significantly (P > 0.20) between any group (SHMG: 659 ± 106 μm; PHMG: 667 ± 128 μm; NHMG: 626 ± 135 μm). Choroidal thickness was significantly thinner in both highly myopic groups than in the NHMG, with no significant differences between both highly myopic groups. Choroidal volume did not differ significantly (P > 0.40) between any of the groups (SHMG: 43 ± 12 μm; PHMG: 43 ± 13 μm; NHMG: 46 ± 17 μm). Conclusion In secondary high axial Myopia, the sclera gets thinner anterior and posterior to the equator; whereas in primary high axial Myopia, scleral thinning is predominantly found posterior to the equator. Because volume of sclera and choroid did not differ between any group, scleral and choroidal thinning in Myopia may be due to a rearrangement of tissue and not due to the new formation of tissue.

  • education related parameters in high Myopia adults versus school children
    2016
    Co-Authors: Ya Xing Wang, Jost B Jonas, Wen Jun Jiang, Vinay Nangia, Ajit Sinha, Dan Zhu, Yong Tao, Yin Guo, Qi Sheng You
    Abstract:

    Purpose Since high Myopia in the younger generation may differ etiologically from high Myopia in older generations, we examined whether education-related parameters differ between high Myopia in today´s school children and high pathological Myopia in today´s elderly generation. Methods The investigation included the adult populations of the population-based Beijing Eye Study (BES) (3468 adults;mean age:64.6±9.8years;range:50–93years) and Central India Eye and Medical Study (CIEMS) (4711 adults;age:49.±13.2years;range:30–100years), and the children and teenager populations of the Shandong Children Eye Study (SCES) (6026 children;age:9.7±3.3years;range:4–18years;cycloplegic refractometry), Gobi Desert Children Eye Study (1565;age:11.9±3.5years;range:6–21 years;cycloplegic refractometry), Beijing Pediatric Eye Study (681 children;age:7.7±1.6years;range:5–13 years;non-cycloplegic refractometry,calculation of axial length to corneal curvature radius ratio), Beijing Children Eye Study (15066 children;age:13.2±3.4years;range:7–18years;non-cycloplegic refractometry), Beijing High School Teenager Eye Study (4677 children;age:16.9±0.7years;range:16–18years;non-cycloplegic refractometry). Results In the BES and CIEMS, educational level did not differ significantly between, or was significantly lower in the highly myopic group (myopic refractive error ≥6 diopters) than in the non-highly myopic group. In all non-adult study populations, higher prevalence of high Myopia was significantly associated with higher degree of education related parameters such as attendance of high-level schools, and more time spent for indoors near work versus time spent outdoors. Conclusions Comparing associations of old or genetic high Myopia in adults with new or acquired high Myopia in school children revealed that education-related parameters did not show a clear association with old or genetic high Myopia, while in contrast, new high Myopia showed strong associations with education. It confirms previous studies that the two forms of high Myopia not only differed in age of onset, but also in associations with education as well. The data support the notion of two types of high Myopia. Future studies may assess whether the risk of pathologic myopic maculopathy and high Myopia associated open-angle glaucoma differs between both types of high Myopia.

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