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      Axial length elongation in primary school-age children: a 3-year cohort study in Shanghai

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      BMJ Open
      BMJ Publishing Group
      axial length, axial length elongation, refractive error, primary school-age children

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          Abstract

          Objective

          To investigate the axial length (AL) elongation in primary school-age children during 3-year follow-up period and evaluate the associations of AL elongation with spherical equivalent (SE), AL at baseline, body height and weight.

          Design

          A 3-year observational cohort study from 2014 to 2017.

          Setting

          Jinshan Hospital of Fudan University in Shanghai.

          Methods

          A total of 452 children successfully completed their measurements in the 3-year follow-up period. The mean age of those children was 6.9±0.7 years, ranging from 6 to 8 years, and 217 (42.7%) were boys. AL was measured with an ocular biometry system. Refractive error was measured using an auto-refractor without cycloplegia.

          Results

          The mean changes of ALs were 0.27±0.28 mm, 0.52±0.40 mm and 0.89±0.51 mm over 1, 2 and 3 years, respectively. The mean changes of SEs were −0.27±0.80 D, −0.56±1.00 D and −0.95±1.41 D over 1, 2 and 3 years, respectively. Multivariate linear regression analysis revealed that mean change of AL was associated with mean change of SE at all points (all p <0.001). In addition, linear regression analysis revealed that AL elongation in the 3year follow-up period was associated with AL at baseline (R 2=0.009, p=0.045).

          Conclusions

          AL elongation is relatively high in the primary school-age children in Jinshan District, Shanghai. Effect strategies are needed to control AL elongation.

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          Most cited references25

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          The epidemics of myopia: Aetiology and prevention.

          There is an epidemic of myopia in East and Southeast Asia, with the prevalence of myopia in young adults around 80-90%, and an accompanying high prevalence of high myopia in young adults (10-20%). This may foreshadow an increase in low vision and blindness due to pathological myopia. These two epidemics are linked, since the increasingly early onset of myopia, combined with high progression rates, naturally generates an epidemic of high myopia, with high prevalences of "acquired" high myopia appearing around the age of 11-13. The major risk factors identified are intensive education, and limited time outdoors. The localization of the epidemic appears to be due to the high educational pressures and limited time outdoors in the region, rather than to genetically elevated sensitivity to these factors. Causality has been demonstrated in the case of time outdoors through randomized clinical trials in which increased time outdoors in schools has prevented the onset of myopia. In the case of educational pressures, evidence of causality comes from the high prevalence of myopia and high myopia in Jewish boys attending Orthodox schools in Israel compared to their sisters attending religious schools, and boys and girls attending secular schools. Combining increased time outdoors in schools, to slow the onset of myopia, with clinical methods for slowing myopic progression, should lead to the control of this epidemic, which would otherwise pose a major health challenge. Reforms to the organization of school systems to reduce intense early competition for accelerated learning pathways may also be important.
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            Updates of pathologic myopia.

            Complications from pathologic myopia are a major cause of visual impairment and blindness, especially in east Asia. The eyes with pathologic myopia may develop loss of the best-corrected vision due to various pathologies in the macula, peripheral retina and the optic nerve. Despite its importance, the definition of pathologic myopia has been inconsistent. The refractive error or axial length alone often does not adequately reflect the 'pathologic myopia'. Posterior staphyloma, which is a hallmark lesion of pathologic myopia, can occur also in non-highly myopic eyes. Recently a revised classification system for myopic maculopathy has been proposed to standardize the definition among epidemiological studies. In this META-PM (meta analyses of pathologic myopia) study classification, pathologic myopia was defined as the eyes having chorioretinal atrophy equal to or more severe than diffuse atrophy. In addition, the advent of new imaging technologies such as optical coherence tomography (OCT) and three dimensional magnetic resonance imaging (3D MRI) has enabled the detailed observation of various pathologies specific to pathologic myopia. New therapeutic approaches including intravitreal injections of anti-vascular endothelial growth factor agents and the advance of vitreoretinal surgeries have greatly improved the prognosis of patients with pathologic myopia. The purpose of this review article is to provide an update on topics related to the field of pathologic myopia, and to outline the remaining issues which need to be solved in the future.
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              Age of onset of myopia predicts risk of high myopia in later childhood in myopic Singapore children

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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2019
                31 October 2019
                : 9
                : 10
                : e029896
                Affiliations
                [1] departmentOphthalmology , Jinshan Hospital of Fudan University , Shanghai, China
                Author notes
                [Correspondence to ] Xiaodong Zhou; xdzhou_2013@ 123456163.com
                Article
                bmjopen-2019-029896
                10.1136/bmjopen-2019-029896
                6830838
                31676647
                f9233211-3ae7-4af2-b05d-d0c91f9d37bb
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 17 February 2019
                : 28 July 2019
                : 30 August 2019
                Funding
                Funded by: Project of Shanghai Health and Family Planning Committee;
                Award ID: 20174Y0177; 201640046
                Funded by: Project of Shanghai Science and Technology;
                Award ID: 17411950200; 17411950203; 17ZR1404200
                Categories
                Ophthalmology
                Original Research
                1506
                1718
                Custom metadata
                unlocked

                Medicine
                axial length,axial length elongation,refractive error,primary school-age children
                Medicine
                axial length, axial length elongation, refractive error, primary school-age children

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