Focus on the prevention and rehabilitation of low vision is a manifestation of the progress of the society, not only for reducing the functional impact from visual impairment on the low vision patient, but also for promoting the ophthalmology in China from the diseases management to visual rehabilitation. This paper reviewed the concept of low vision, the goal and the ophthalmologist role of the prevention and rehabilitation for the low vision, in order to evoke the attention to the management of the low vision.

Objective To describe the principle and technique for designing a 10X continuous zoom optical system with a fixed finite conjugate distance as an E-vision aid device. Methods After the initial structure was designed by using Gaussian optics, optical design software was used to perform aberration correction and optical property evaluation which included modulation transfer function (MTF), spot diagram and diffuse spot diameter. The performance stability of the system was predicted by using a tolerance sensitivity analysis and the Monte Carlo method. Results The mechanically compensated zoom lens designed for an E -vision aid device combines four group components: a fixed front group, a moving variator, a fixed middle group and a compensator that includes a total of 10 lenses, an optical tube length of 84 mm and a front intercept distance of 316 mm. The zoom lens could achieve 10-60 mm continuous zoom and a magnification range from -0.03 to -0.3 without any image vignetting or obvious fluctuation in image quality. Conclusion A continuous zoom optical system with a fixed finite conjugate distance and large zoom ratio can be designed for an E-vision aid device with the help of Gaussian optics and aberration theory.

Objective To evaluate the rehabilitation of children with different levels of visual impairment involving both distance vision and near vision and to discuss the range of rehabilitation achieved with vision aids. Methods Two hundred and six children aged 4 -14 years from the Guangzhou school for the blind and low vision clinic were grouped according to levels of visual impairment. Distance vision and reading rate performance were compared using a domestic 4X or 6X telescope for distance vision rehabilitation glasses and simple electronic devices. Results were analyzed with rank sum test or chi -square test. Results The improvement in visual acuity was statistically significant for children with visual impairment before and after the use of ordinary optical vision aids in the FC/10 cm to <0.05 group (P=0.0034) and the 0.05 to <0.3 group (P<0.01). The differences in the reading performance rate in the light perception to <0.05 group and low vision group between near-vision aids and simple electronic vision aids were both statistically significant (P<0.01). The success rate with simple electronic vision aids was much higher than that with optical vision aids. Conclusion The range of rehabilitation for children with visual impairment can extend to 0.01 or even less. Vision aids for children with visual disability are very effective and necessary. Early visual rehabilitation, especially with the use of simple electronic devices, can improve the children's learning ability. It is critical for their growth and their return to society.

Objective To investigate the discontinuance of using visual aids among the low vision patients after visual aids distribution. To analyze the related factors and discuss the way to improve the visual aids use. Methods A customized questionnaire was designed, including visual impairments diagnosis and treatment, visual aids, and the reasons for continue or discontinue. Eighty -six visual impaired subjects who fitted with kinds visual aids were investigated. Results Eighty -six subjects obtained visual aids successfully accordingly at the initial delivery through charity & welfare program, with 1 to 4 pieces for each and 162/86 in average. During follow-up investigation, 21.0% subjects rely on the devices very much while 43.2% subjects reported using the device regularly. However, the percentage of using merely or even discontinuance of the device was 24.1% and 11.7% , respectively. Among the discontinuance, the positive reasons, such as physiological recovery, made the discontinuance was 17.2% while the negative reasons, such as uncomfortable, no improvement, or psychological factors, were responsible for this discontinuance was up to 82.8%. Conclusion Welfare social assistance service brings low vision subjects to access "low vision rehabilitation" very successfully. However, there are factors for detention the effectiveness use of the visual aids, because low vision rehabilitation is a complexity process. Cares is needed to reduce the negative factors while uplift the quality of low vision rehabilitation service.

Objective To investigate and analyze the types of visual impairment and their prevalence by collecting data from stroke patients. Methods After being diagnosed with stroke by neurologists, ocular pathology and visual function such as visual acuity, eye position and movement, visual perception and visual field, etc., were examined. Results One hundred forty-seven stroke patients were recruited with a mean age of (71.7±13.3)years. Of these, 46.9% had eye alignment/ movement impairment, 34.0% had visual field impairment, 19.7% had low vision or were blind and 19.0% had visual perceptual difficulties. Conclusion Some kind of visual impairment was found in 72.1% of the stroke patients. This not only affects the patient's ability to live independently but also affects the results of clinical rehabilitation. Doctors should give a lot of attention to visual therapy and rehabilitation for stroke patients.

Objective To explore the effect and mechanism of exogenous TNF-α on corneal neovascularization (CNV) in BALB/c mice injured by alkali burn. Methods ①Fifteen BALB/c mice were burned on central comea of left eye by 1 mol/L NaOH for 40 s combine with epithelial denudation, then divided into 3 groups (5 mice each group): 0.2% sodium hyaluronate control group, 100 μg/ml TNF-α treated group, 500 μg/ml TNF-α treated group. The eye drops were applied twice daily for one week. CNV was observed by ophthalmic microscope. Corneal microvessel densities of each group were detected at day 14 after alkali injury by CD31 immunohistochemical analysis. The effect of recombinant murine TNF-α on alkali injury induced CNV was observed. ②After alkali injury, 20 BALB/c mice were divided into 2 groups (10 mice each group): 0.2% sodium hyaluronate control group, 100 μg/ml TNF-α treated group. The eye drops were applied twice daily. At day 2 and day 4 after injury, 5 randomly selected mice of each group were euthanized, vascular endothelial growth factor (VEGF) expressions in the comeal tissue were detected by RT-PCR. ③ Effect of exogenous TNF-α on macrophage depleted mice. Macrophages were depleted by Cl2MDP-lip. 10 BALB/c mice were divided into 2 groups (5 mice each group): Cl2MDP-lip treated group and PBS-lip control group. After alkali injury, all mice were given 100 μg/ml TNF-α eye drops twice daily for one week. Macroscopic CNV was observed by ophthalmic microscope, and the length and area of CNV on day 14 after injury were evaluated and compared between Cl2MDP-lip experimental and control group. Results ①Corneal microvessel density in 100 μg/ml TNF-α treated group were significantly greater than those in control group (P<0.05), and no significant difference was found between 500 μg/ml TNF-α treated group and control group (P>0.05). ②The intra-comeal VEGF mRNA expression in the early phase (day 2, day 4) after alkali injury in 100 μg/ml TNF-α treated group were significantly higher compared to those in control group (P<0.05). ③Lengt

Objective To evaluate the role of all-trans retinoic acid (ATRA) on proliferation and function in the secretion of TGF-β2 and in the related signal cascades in cultured guinea pig retinal pigment epithelium cells (RPE). Methods RPE cells were taken from 3-week-old guinea pig eyes. The 2-3 passage cells in the logarithmic growth phase were used for the experiment. Cells were verified by keratin immunohistochemistry. When cells almost attained confluence, the medium was changed to a DMEM/F12 medium without FBS (fetal bovine serum) for 24 hours before being used. The cells were then divided into 3 groups. ①The medium was changed to a DMEM-F12 medium without FBS but contained different concentrations 6f the drug ATRA (5×10-6, 10×10-6, 40×10-6 mol/L). After 24 hours, cell proliferation was analyzed using an MTT assay. ②The medium was changed to DMEM/F12 containing 10×10-6 mol/L ATRA. The TGF-β2 secreted by RPE cells was tested using an ELISA kit at 2, 4, 6, 8, and 16 hours. ③ Intracellular 1, 4, 5 -trisphosphate (IP3) and cyclic adenosine monophosphate (cAMP) were extracted at 0 min, 5 min, 30 min, 2 h and 6 h, and their concentrations were measured with the ELISA method and radioimmunoassay. The same dose of DMSO was added to all of the control groups. Results Twenty-four hours after ATRA concentrations of 5×10-6 mol/L, 10×10-6 mol/L, and 40×10-6 mol/L were added to RPE cells, the respective OD values were 0.099±0.008, 0.117±0.008, and 0.087±0.011. Compared to the controls, 0.103 0.017, cell proliferation was inhibited by 40×10-6 mol/L ATRA (P<0.05). After 10×10-6 mol/L ATRA was added, the secretion of TGF-β2 increased in the first 6 hours (P<0.05), and then decreased. And the decrease was time related. Intracellular IP3 was inhibited at each time point. However, the amount of cAMP production increased at 30 min and 2 h. Conclusion A concentration of 40×10-6 mol/L ATRA can inhibit the proliferation of guinea pig RPE cells. But the RPE cells can grow well in lower concentrations. The secretion of TGF-β2 increased in

Objective To study the relationship between fibronectin and primary open-angle glaucoma (POAG) pathogenesis by investigating the effect of fibronectin on the proliferation, adhesion and migration of human trabecular meshwork cells (HTC) in POAG patients. Methods Using HTC that were successfully established from the albuginea oculi in the trabeculectomy of patients, HTC were cultivated for primary culture and subculture. The third passage cells were incubated with different doses of fibronectin (5, 10, 20, 40, 100 μg/ml) cultivated with DMEM/F12. No fibronectin was used in the control group. In order to see the effect of different doses of fibronectin on cell proliferation, adhesion and migration, a Cell Counting Kit-8 and Transwell Kit were used after 24 hours of cultivation. The number of living cells was calculated to detect the optical density value and the data was used to calculate the results, with SPSS 17.0 statistics software. The normal distribution of data between the 2 groups was analyzed with a One-Way ANOVA. SNK test was used to compare the difference between groups. Results POAG trabecular meshwork cells were identified and confirmed with immunocytochemistry and electron microscopy. After 24 hours, a serum -free culture was incubated with different doses of fibronectin (5, 10, 20, 40, 100 μg/ml) cultivated with DMEM/F12. Different doses of fibronectin (5, 10, 20, 40, 100 μg/ml) significantly promote the proliferation of POAG trabecular meshwork cells. However, the proliferation of POAG trabecular meshwork cells with lower doses of fibronectin (5, 10 μg/ml) promote a relatively slow proliferation. There was an upward trend with an increase after the dosage of 10 μg/ml, and proliferation of trabecular meshwork cells reached a peak with higher doses of fibronectin (40 μg/ml). High doses of fibronectin (100 μg/ml) still promote the proliferation of cells, but the proliferation is relatively slow. The difference was significant compared to the control group (P<0.01). Fibronectin (5, 10, 20, 40, 100 μg/m

Objective To investigate expression of adenosine receptors in uveal melanocytes and uveal melanoma cell, and the effect of adenosine on cell proliferation on these two types of cells. Methods Adenosine receptors (A1, A2A, A2B, A3) mRNA expression were detected in cultured uveal melanocytes cell U95 and uveal melanoma cell S65 by Real-time PCR. After U95 and S65 cells were treated with 0, 0.1, 1, 10 or 100 μLmol/L adenosine for 24 h or 48 h, cell viability of each group was measured by MTT. Results Four subtypes of adenosine receptors (A1, A2A, A2B and A3) mRNA were expressed in U95 and S65 cells. The expression of adenosine receptors A1 and A2B is similar to each other but higher than that of A2A and A3 in U95 cells (A1: 1.32±0.47; A2A: 0.28± 0.05; A2B: 1.03±0.10; A3: 0.20±0.07; F=15.90, P<0.01). The mRNA expression of adenosine receptor A2B was much higher than the three other subtypes of adenosine receptors in S65 cells (A1: 1.03±0.27; A2A: 2.23±0.35; A2B: 127.34±18.69; A3: 0.17±0.07; F:163.20, P<0.01). Adenosine receptor A2B and A2A mRNA expression was higher in S65 cells than in U95 cells (A2A: t=9.35, P< 0.01; A2B: t=11.43, P<0.01). After treated with 0, 0.1, 1, 10 and 100 μmol/L adenosine for 24 h and 48 h, S65 cells growth inhibition ratio were 3.47%, 14.93%, 19.79%, 26.04% at 24 h and 11.43%, 23.10%, 34.76%, 46.67% at 48 h. However different concentrations of adenosine had no effect on the proliferation of U95 cells. Conclusion The adenosine receptor subtypes express differently in uveal melanocytes and uveal melanoma cells. Adenosine is able to inhibit uveal melanoma cells proliferation, but has no effect on uveal melanocytes cells, which may be because of different adenosine receptor subtypes expression in these two types of cells.

Objective To establish a systematic specified measurement for peripheral refraction in myopic eyes under spectacle correction. Methods A peripheral refractive measurement system was established based on the Grand Seiko WAM-5500 autorefractor. An accessory with a modified visual angle device was used to replace the headrest. A ray-tracing method was used for determining the offset of the visual field angle. Using this system and technique, peripheral refraction was measured at 7 different points at 10° intervals over the central±30° of the horizontal visual field on 35 myopic subjects under spectacle correction conditions. The same measurement for peripheral refraction was also taken on another 35 myopic subjects (control group) under uncorrected conditions by using the unmodified system. The reliability of the system and technique were analyzed by using an independent samples t -test. Results This system and technique were effective for measuring peripheral refraction in myopes under spectacle correction. The reliability of this method was in compliance with traditional methods for measuring peripheral refraction under spectacle correction (P> 0.05). Peripheral refractions were more hyperopic than that of the fovea in myopic subjects under spectacle correction. Conclusion This system and technique are effective and reliable for measuring peripheral refraction in myopic eyes under spectacle correction.

Objective To evaluate the efficacy of bimanual microincisional cataract surgery (B-MICS) versus conventional coaxial small-incision cataract surgery (C-SICS) for visual quality. Methods A systematic review of B-MICS and C-SICS was conducted by a computer search on Medline, EMCC, OVID, and CNKI and a supplementary manual search was also done. The effect was measured as an odds ratio (OR) and weighted mean difference (WMD). Review manager 4.2 software was used to perform the meta-analysis. A sensitivity analysis was then performed and a publication bias was evaluated by a funnel plot and Egger's regression test. Results Only relevant articles from the resource material were included and/or excluded using a strict criterion. A total of 9 articles were included in the meta-analysis. The ORs of naked visual acuity 0.5 or better at 1 day, 1 week, and 1 month after surgery were 1.82 (95%CI was 1.38-2.39), 2.36 (95%CI was 1.27-4.37) and 1.61 (95% CI was 1.08-2.41), respectively. The differences were statistically significant (P<0.05). The OR of the best corrected visual acuity 0.5 or better at 1 month after surgery was 1.69 (95% CI was 0.93-3.07), but there was no statistically significant difference (P>0.05). A summary WMD of the meta-analysis showed a significant reduction in surgically induced astigmatism in the B-MICS group (WMD =-0.35 D, 95%CI:-0.48- -0.21 D, P<0.01). Sensitivity analysis and publication bias showed that the outcomes of this research were stable and reliable. Conclusion The evidence currently available showed that B-MICS is a safer and more reliable surgery for restoration of visual acuity and reducing surgically induced astigmatism in patients with cataract.

Objective To prepare and test a hydrophilic antifogging nano -coating with favourable stability and antireflective characteristics. Methods Hydrophilic antifogging coating consisted of cationic polyacrylamide (CPAM), sodium silicate and polyacrylic acid (PAA). To obtain a stable multilayer film, the coatings were filmed by layer-by-layer coating method followed with a thermal torrefraction process. The material particle size was measured by a laser particle sizer, lens transmittance prior to and after coating was evaluated by ultraviolet spectrophotometer, coating hydrophilicity was tested by contact angle meter, and coating hardness was determined by pencil test. Results The coating particle size was about (145.0±15.6)nm. In the light spectrum between 400 nm and 800 nm, the transmittance of the coated optical lens was higher than that of the uncoated one, the transmittance peaked at 550 nm wavelength which reached 92.2% . Water drop dispersed completely 470 ms after it contacted with the coating surface. The coating hardness was higher than 3 H. Conclusion The antifogging coating prepared by layer -by -layer method forms stable film structure after thermal torrefaction and improves lens hydrophilicity and transmittence.

Objective To compare rigid gas permeable contact lenses (RGPCL), progressive multifocal lenses, and single-vision glasses in the role of delaying the development of myopia. Methods Eight-five cases (170 eyes) 9 to 14 years old young people with -1.00- -4.00 D of myopia were divided into 3 groups. The RGPCL group (30 cases) with astigmatism less than 1/2 of spherical; the multifocal lenses group (30 cases) with near esophoria and accommodative lag ≥+0.25 D; and the single-vision glasses group (25 cases). Basic information of the 3 groups showed no significant differences. Patients were required to wear their corrective lenses 6 hours a day. Biological parameters were measured and compared after one year. One-Way ANOVA was used to analyzed the data. Results Myopia progression was found in all 3 groups. The equivalent refractive increase in myopia in the RGPCL group was (-0.48±0.42)D, in the multifocal lenses group was (-0.54±0.36)D, and in the single-vision glasses group was (-0.93±0.53)D. Comparisons for the 3 groups differed significantly (F=29.36, P=0.01). Axial length and anterior chamber depth increased and there was a tendency for the comeal curvature to flatten and the lens to become thinner in all 3 groups. However, the differences in the changes for the groups were not statistically significant. Conclusion Compared to single-vision glasses, progressive multifocal lenses for near esophoria and RGPCL lenses may slow the progression of myopia. But both methods can not prevent myopia progression.

Objective To observe the characteristics of three-dimensional optical coherence tomography (3D-OCT) in congenital zonal choroidal dystrophy (CZCD) patients. Methods 3D-OCT data from 11 patients (13 eyes) who were diagnosed with CZCD was retrospectively analyzed and combined with fundus photography. Results The characteristics of 3D-OCT in CZCD patients were as follows: ①The reflex curve changes of the retinal pigment epithelium (RPE) and choroid band as well as the notch were observed in 9 eyes of 8 patients. And the notches were all located on the temporal side of the fovea. The separated layer of the retina revealed by 3D-OCT showed that there was an obvious concavity of the RPE corresponding to the notch. ②RPE was discontinuous in 1 eye. The separated layer of the retina revealed by 3D -OCT showed that there was an obvious corresponding concavity in the RPE and choroid band. ③The RPE and choroid band were absent in the macular area in 2 eyes. There was a hollow in the RPE and choroid band under the fovea. ④A higher reflex was observed in the choroid where the RPE and choroid band had dystrophy. This is the result of the fibration of the choroid structure. Conclusion There are different degrees of change in the RPE and choroid membrane of the macular area. These changes include a change in the reflex curve, a discontinuity of the RPE and the absence of the RPE. All of this is the result of an anormaly of the embryonic fissure. It is difficult to discover where there is no complication. Therefore, we suggest that 3D-OCT should be performed routinely when a patient's visual acuity is not normal even if there is no evidence of eye disease. It may be diagnosed as CZCD by 3D-OCT.

Objective To assess if optical coherence tomography (OCT) can provide objective measurements of the thickness of the retinal nerve fiber layer (RNFL) in patients with pituitary adenomas, offering a dependable prediction of visual function. Methods Thirty-two eyes of 16 consecutive patients who visited our hospital between January 2007 and December 2008 and were diagnosed with pituitary adenomas compressing the chiasma as determined by magnetic resonance imaging (MRI) were included in the study. All patients underwent transsphenoidal resection of pathologically proven pituitary adenomas by the same surgeon. The patient group consisted of 7 males and 9 females, and the mean age of the patients was (44.4±14.7)years (range 23-67 years). Visual acuity, automated visual fields (VF) and OCT (fast-RNFL program) were assessed before treatment, and 1 week and 3 months after treatment. RNFL thickness was measured with the Stratus OCT Ⅲ and mean deviation (MD) visual field (VF) with the automated Humphrey Field Analyzer (both from Carl Zeiss Meditec, Dublin, CA). Eyes were divided into 3 groups based on the initial VF defect and its evolution. The presence of an initial VF defect in group A either without improvement or had worsened 3 months after treatment, the presence of an initial VF defect in group B with improvement 3 months after treatment, and group C without VF defect either initially or after treatment. Covariance analysis was applied to analyze the data for the mean RNFL measurements and the initial VF defect in the groups. A logistic regression model was used to evaluate the prognostic value of the initial VF defect and the RNFL thickness on the final visual outcome. A paired samples t-test was used to compare preoperative visual acuity and mean RNFL thickness with postoperative visual acuity and thickness. Results For all patients (32 eyes), there are 10 eyes in group A, 11 eyes in group B and 11 eyes in group C. In the eyes with a VF defect before treatment, a greater mean RNFL thickness increased the probabil

Objective To investigate the outcome of the surgical treatment for congenital blepharophimosis syndrome. Methods This was a retrospective case study to analyze a treatment approach for congenital blepharophimosis syndrome and its clinical efficacy. A bilateral correction of the epicanthus and blepharoptosis was performed simultaneously. Suitable methods were adopted to correct the epicanthus: Y-V, Stallars "Z" , Speath and classic Mastands. Twenty-three patients (46 eyes) were involved in the study, ranging in age from 2 to 11 years. All patients suffered from eye or systemic disease. There were cases of strabismus, refractive error, amblyopia, inherited and systemic disease. The study analyzed effectiveness by comparing the preoperative and postoperative status of palpebral fissure length, palpebral fissure width, inner canthic diameter and eyebrow-eyelid diameter using a paired t-test. Patients were followed up for 1 to 24 months after the operation. Results There was an obvious improvement in palpebral fissure length and palpebral fissure width in all patients, and an obvious decrease in the inner canthic diameter and eyebrow-eyelid diameter. Comparisons one month after the operation showed that palpebral fissure length changed from (18.5±1.1)mm to (23.4±1.2)mm, palpebral fissure width changed from (2.1±1.2)mm to (6.7±0.9)mm, inner canthic diameter changed from (35.2±1.4)mm to (31.1±1.1)mm, and eyebrow-eyelid diameter changed from (13.6±1.3)mm to (9.8±1.2)mm. The differences were statistically significant (P<0.05). There was only one case with complication of exposure keratitis after the operation. Conclusion For congenital blepharophimosis syndrome with refractive errors and amblyopia, it is better to perform a bilateral correction of the epicanthus and blepharoptosis simultaneously, which is a more ideal approach than other treatments.

Objective To study the effect of large-dose glucocorticoid therapy in patients with traumatic optic neuropathy and to identify the major correlates in medical therapy that result in better visual function after trauma. Methods Twelve cases of patients with injured optical nerve diagnosed by computer-assisted tomography of the brain and eye received a combination therapy consisting of methylprednisolone (1000 mg intravenously, days 1-5) and mannitol (MINT) (250 mg intravenously, days 1-5). After 5 days, methylprednisolone was reduced to 800 mg/d, the therapy dose was reduced 200 mg every three days, when methylprednisolone was reduced to 200 mg/d, the therapy dose was reduced 50 mg every three days, when methylprednisolone was reduced to 50 mg/d, the therapy dose was reduced 5 mg everyday until to zero. Additional therapy included nerve growth factor. Results Thirty to 46 days after treatment, visual acuity was ≥0.15 in 9 cases, 0.06 in 1 case and 2 cases gained light perception. The 0.06 case lost light perception in the temporal visual field. No severe optic atrophy was found during long-term follow-up. Conclusion Patients who received a large dose of methylprednisolone and MNT shortly after traumatic optic neuropathy gained better visual acuity and optic atrophy was prevented.

Fungal keratitis, a common cause of cornea] infectious diseases, is an important contributor to vision loss. Toxins and exoenzymes released from infiltrating fungi led to damage of the comea. Matrix metalloproteinases played an important role in fungal keratitis. Recognition of fungi by pattern-recognition receptors such as Toll-like receptors mediated the host to produce initiate and adaptive immune responses. Immunoprotection and inflammatory reaction which include numerous cells, cytokines and chemokines were involved in the responses of comea versus invading fungi. The cells and cytokines could protect cornea from fungi invasion but also cause some damage. The final outcome was depended upon the balance between impaired factors and repaired factors. A better understanding of molecular mechanism of the immunity and inflammation will provide new ideas for the treatment of fungal keratitis. The molecular mechanism of fungal keratitis was reviewed in this article.