Glaucoma is a type of nerve blinding eye disease that is irreversible. The features of the disease and our cognitive limitations make it impossible to fully prevent development and progression. Even though many great innovations in basic science and clinical practice have been made, the clinical management and blindness rate of glaucoma have not been improved. Therefore, it is necessary that new clinical strategies be adapted that focus precisely on the management of individual glaucoma cases.

Objectives: To study the prevalence of glaucoma in first-generation relatives (FGRs) of patients with primary open angle glaucoma (POAG), and to identify the likelihood of family history as a risk factor for the presence of POAG. Methods: In this case control study, 290 FGRs of 99 patients who were diagnosed
with POAG in West China Hospital from February 2012 to October 2013 were enrolled (POAG-related group). FGRs (n=355) of 105 cataract patients were also enrolled (control group). Both groups were matched for sex and age (40 years or older). All participants were asked to complete a questionnaireand undergo a comprehensive eye examination. A chi-square test, t-test, and multiple logistic regression analysis were used to analyze the data. Results: The FGRs of patients with POAG had a greater prevalence of glaucoma than the controls (10.7% vs. 1.4%, χ 2=26.090, P<0.001). There was a greater prevalence of glaucoma in females (11.7% vs. 1.6%, χ 2=15.203, P<0.001) and in males (9.8% vs. 1.2%, χ 2=11.098, P<0.001) in the FGRs of patients with POAG compared with the controls. For three different age groups, <50,50-59, and ≥ 70 years of age, the FGRs of patients with POAG had a greater prevalence of glaucoma than did the controls (χ 2=14.328, 4.919, 6.959, P<0.05). The calculated odds ratio (OR) for the characteristics associated with glaucoma were strong when adjusted for age and gender [OR=8.45 (95% confidence interval: 3.24-22.06)], and offspring [OR=11.53 (95% confidence interval: 2.45-54.26)] had an obvious association with POAG. Most of the FGRs of patients with POAG, 92.1%, had no awareness of the need for glaucoma screening. Conclusions: Our study shows that the FGRs of patients with POAG are at high risk for having POAG, and a family history of glaucoma is associated with the presence of glaucoma. The FGRsof patients with POAG should be made more aware of the need for glaucoma screening.

Objective: To assess the modulating function of osteopontin (OPN) on human Tenon's fibroblasts (HTFs). Methods: With the intervention of OPN in different concentrations (0, 0.05 μmol/L, 0.5 μmol/L,and 5 μmol/L), the proliferation rate of HTFs was measured by 3-(4,5-dimethylthiazol-2-Yl)-2,5-
diphenyltetrazolium bromide (MTT), and the motility was surveyed by the cell scratch method. Real-time polymerase chain reaction (PCR) was applied to measure the mRNA of vascular endothelial growth factor(VEGF) and transforming growth factor β (TGF-β) in HTFs in the presence of different concentration of OPN. Western blot was used to measure the collagen-I levels. Data were analyzed using ANOVA. Results:OPN induced the proliferation of HTFs as indicated by MTT and enhanced the motility of HTFs as shownby the cell scratch method. The effects were concentration dependent (F =174.5, 297.1, P <0.01). In the presence of anti-OPN 1A12 (5 μmol/L OPN+20 μg/ml 1A12), the effects of OPN on HTFs were inhibited. None of the concentrations of OPN affected mRNA levels of VEGF and TGF-β mRNA. OPN augmented HTF expression of collagen-I protein in a concentration-dependent manner (F =30.2, P <0.01). Conclusions:The enhancement of HTF proliferation, motility, and collagen-I expression OPN was concentration dependent. Incubation with the monoclonal OPN antibody 1A12 inhibited the effects of OPN on the HTFs.

Objective: To explore the applied value of ganglion cell inner plexiform layer (GCIPL) thickness asmeasured by high definition resolution optical coherence tomography (HD OCT), in the macular region of chronic angle closure glaucoma (CACG). Methods: In this descriptive study, 76 eyes of CACG patients at the Changsha Aier Hospital from December 2014 to March 2016 and 30 eyes of normal subjects were enrolled. The patients were divided into an early CACG group (37 eyes), a medium CACG group (10 eyes), and a late CACG group (29 eyes). The thickness of the macular GCIPL was made by HD OCT, and visual fields were examined in each quadrant. We compared the HD OCT and the visual field measurementsamong the different groups using one-way ANOVA, and analyzed the correlation between the average GCIPL thickness and visual field defects with Pearson correlation analysis. Results: The mean GCIPL
thicknesses in the normal group, early, medium, and late CACG groups were 85±14 μm, 84±9 μm, 72± 21 μm, 62±15 μm respectively. The difference between the 4 groups were statistically significant (F =15.89, P <0.001). The difference between the normal group and the early CACG group was not statistically significant (P =0.120), but the medium and late CACG groups were each significantly thinner than the normal group (P <0.001). The mean GCIPL was positively correlated with visual field mean differences in the glaucoma patients (r=0.636, P <0.001). Conclusions: GCIPL thickness parameters have clinical value in the diagnosis of medium and late CACG. When combined with perimetry, they can be used as an important reference index for the diagnosis, staging, and follow-up of CACG.

Objective: To analyze and compare the differences of anterior segment structure parameters between pseudoexfoliation open angle glaucoma (PXOAG) and primary open angle glaucoma (POAG). Methods: This clinical case control study was conducted from December 2012 to December 2016, and the patients
were selected consecutively. The PXOAG group included 54 eyes of 54 cases with an average intraocular pressure of 28.8±7.9 mmHg. The POAG group included 53 eyes of 53 cases that were matched for age,gender, and intraocular pressure, 26.3±7.4 mmHg. Anterior segment structure parameters such as corneal thickness, corneal endothelial cell density, hexagonality, anterior chamber depth, and lens thickness were measured and analyzed using independent samples t -tests. Results: For the PXOAG group, the central corneal thickness (523±41 μm), hexagonality (52%±14%), anterior chamber depth (2.79±0.60 mm), and lensthickness (4.98±0.42 mm) were not significantly different from the POAG group (t =1.57, 0.18, 1.11, 0.26, respectively, P >0.05 each). However, the corneal endothelial cell density of the PXOAG group (2 323± 451/mm2) was significantly lower than that of the POAG group (2 538±356/mm2; t=2.78, P=0.01). Conclusions: The corneal endothelial cell density of POXG patients is lower than that of POAG patients. This is a reminder to pay more attention to the protection of corneal endothelial cells during clinical treatment.

Objective: To evaluate the accuracy of intraocular pressure (IOP) and central corneal thickness (CCT) measured by corneal visualization scheimpflug technology (CST), and to investigate the influence of corneal biomechanical properties on IOP. Methods: For this descriptive study, 28 glaucoma patients (56 eyes) were recruited. An experienced clinician obtained IOP measurements with both the CST and the Goldmann
applanation tonometer (GAT). CCT measurements were obtained with the CST and the IOLMaster. The results of the different devices were compared by paired t-tests. The correlation between IOP measurements by the CST and the GAT and between the CCT measurements by the CST and the IOLMaster were assessed by a nonparametric Spearman test. Device agreement was calculated by Bland-Altman analysis. Results: The mean IOP measured by the CST, 19.5±12.0 mmHg, was not significantly different for that measured by the GAT, 20.9±8.8 mmHg. The mean CCT was 544±40 μm for CST and 538±40 μm for the IOLMaster. Both pairs of devices showed a high correlation for the respective measurements (ρ=0.837, 0.958, both P <0.001). Bland- Altman analysis revealed an IOP bias between the CST and the GAT of 1.3±5.4 mmHg with 95% limits of agreement of -9.3 to 12.0 mmHg. There was also a CCT bias between the CST and the IOLMaster of 6±10 μm,with 95% limits of agreement of -26 to 15 μm. Conclusions: The CST precision is excellent for IOP and
CCT measurements. CST can result in a lower IOP measurement than GAT, so these devices may not be interchangeable in the diagnosis and treatment of glaucoma.

Objective: To localize the distribution of the adenosine A2A receptor (A2AR) in the mouse retina using a Cre/loxP system. Methods: In this experimental study, male A2A-cre mice [B6.FVB (Cg)-Tg (Adora2a-cre) KG139Gsat/Mmucd] were mated with female Ai9 mice [B6.129S6-Gt (ROSA) 26Sortm9 (CAG-tdTomato)
Hze/J]. The genotypes of the newborn mice were identified and five A2A-cre+, Ai9 mice were chosen at 4 weeks of age. The Cre enzyme of the mice can knock out the STOP sequence of Ai9 mice, which will cause the expression of the tomato fluorescent protein. The localization of A2AR in the retina can be determinedthrough the double immunostaining of the tomato red fluorescent protein and markers of different retinal cells. Results: Immunofluorescence microscopy showed that Tomato+ cells were mainly distributed in the ganglion cell layer and inner nuclear layer, and not in the outer nuclear layer. In the ganglion cell layer, the minority of Tomato+ cells were ganglion cells while the majority were ectopic amacrine cells. In the innernuclear layer, Tomato+ cells were mainly Müller and amacrine cells. With further analysis of the amacrine cell subtypes, we discovered that most of the Tomato+ cells were AⅡ amacrine cells, not cholinergic or dopaminergic amacrine cells. Conclusions: This study suggests that A2AR is expressed in ganglion cells, amacrine cells, and Müller cells in 4-week-old mouse retinas.

Objective: To evaluate the effects of video terminal protective lenses in relieving asthenopia of videooperators. Methods: This prospective clinical research included 60 video operators (age range: 26-45years) with asthenopia symptoms while working in the ultrasound department of our hospital. The subjectswere randomly assigned to two groups. The test group (n=30) wore video terminal protective lenses.The control group (n=30) wore ordinary aspherical lenses. After one hour of video operation, binocular vision-related testing and tear break up time (BUT) were measured in all subjects wearing the ordinary aspherical lenses, and an asthenopia questionnaire assessment was administered. After that, subjects in each group underwent contrast sensitivity (CS), and then they worked as usual, wearing their assigned lenses. Three months later, the subjects in each group underwent binocular vision-related testing, and BUT measurements. The asthenopia questionnaire assessment was again administered as well as the adverse reaction questionnaire. Data were analyzed by t-tests and chi-square tests. Results: After wearing videoterminal protective lenses, the CS with glare at low and medium-frequency grating (1.0 cpd, 1.7 cpd, 2.6 cpd) in the test group were significantly higher than in the control group under bright conditions (t=2.181,2.012, 2.088, all P<0.05). Under dark conditions, the CS of various frequencies in the test group also higher than in the control group (t=2.220, 2.558, both P<0.05) at low-frequency grating (1.0 cpd、1.7 cpd). The CS at low-frequency grating in the absence of glare in the test group was higher than in the control group
(bright: t=2.123, 2.530, both P<0.05; dark: t=2.433, 2.140, both P<0.05). In the test group, after wearing the video terminal protective lenses for three months, the amplitude of accommodation, accommodative sensitivity, and BUT were significantly elevated (t=-2.735, -3.281, -2.249, all P<0.05), while the near
point of convergence, near lateral exophoria, and the asthenopia gratings were significantly decreased (t=3.049, 1.369, 3.754, all P<0.05). However, in the control group, the amplitude of accommodation, near point of convergence, accommodative sensitivity, phorias, and BUT after 3 months were not significantly
altered compared with those before the experiment. Further, the asthenopia grating was not significantly decreased. Accommodative converse/Accommodation ratio in neither group was significantly altered compared with before the experiment. At 3 months, the constituent ratio of adverse reactions was not significantly different between the two groups. Conclusions: A 3-month follow-up revealed that compared with ordinary glasses, video terminal protective lenses increased the low- and medium-frequency CS under bright and dark conditions and improved binocular visual function and BUT. The improvements effectively relieved asthenopia and had no severe adverse reactions, suggesting the potential for clinical application.

Objective: To investigate the effect of pranoprofen on the expression of CXC chemokine receptor 3(CXCR3) and CC chemokine receptor 5 (CCR5) of Th1 cells in dry eye patients, and to explore thecorrelation of changes in receptor expression with clinical changes of dry eye signs. Methods: This study
included 170 patients with dry eye in a randomized, controlled clinical trial. The right eyes of the patients (n=85) administered 0.1% pranoprofen and 0.1% sodium hyaluronate drops (4 times/day). The right eyes of the control dry eye patients (n=85) received 0.1% sodium hyaluronate drops alone (4 times/day). The two groups were followed up before administration and 30 days later. The primary clinical indexes thatwere evaluated included Schirmer I test (SIt), tear film break-up time (BUT), and corneal fluorescein staining (CFS). Differences in the expression of CXCR3 and CCR5 were compared between the two groups. Changes in the expression levels of CXCR3 and CCR5 were correlated with changes in SIt, BUT, and FIS. The data were analyzed by t test and pearson correlation. Results: The tear BUT was significantly longer in both groups after treatment compared to the pretreatment values (t=-13.27, -13.53, both P <0.05). Additionally, the tear BUT was significantly longer in the pranoprofen-treated test group compared to the control group (t=10.11, P <0.05). The CFS scores in both groups were lower than before treatment (t=7.34, 5.27, both P <0.05), and it was significantly lower in the test group compared with the control group (t=5.15,P<0.05). Expression levels of both CXCR3 and CCR5 were significantly reduced in the test group than pretreatment (t=6.74, 9.27, both P <0.05), and it was significantly lower in the test group, compared with the pretreatment values (t=3.29, 2.83, both P <0.05). The expression levels of both CXCR3 and CCR5 were negatively correlated with BUT (r=-0.22, -0.22, both P <0.05) and positively correlated with CFS (r=0.28,0.23, both P <0.05).Conclusion: Pranoprofen inhibits the inflammatory immune response in dry eye bydown-regulating the expression of the chemokine receptors CXCR3 and CCR5 on Th1 cells.

Objective: To evaluate the distribution of astigmatism in children and adolescents in the Wenzhou area and determine the correlation of astigmatism with related risk factors, such as parents’ astigmatism, age, gender, and body mass index (BMI). Methods: This was a cross-sectional study conducted in cooperation with the Eye Hospital and the Second Affiliated Hospital of Wenzhou Medical University. Subjects came from the Children’s Health Examination Center of the Second Affiliated Hospital of Wenzhou Medical University, from September 2011 to March 2016. Ophthalmology exams included entrance tests (visual acuity, pupil reaction, extraocular muscles, etc.) and cycloplegic refraction. Each child’s height, weight, bust, waist, and hips were also measured. For this study, astigmatism was considered when the cylinder was higher than or equal to 0.5 diopter (D) in the right eye. The non-cycloplegic refractive status of the parents were measured for further analysis. Rank sum test, chi-square test and logistic regression analysis were used toanalyze the distribution of astigmatism in children and adolescents and its risk factors. Results: A total of 525 subjects were examined, and 83.4% (438/525) completed the study. The prevalence of astigmatism was 59.4% (260). The percent of subjects with astigmatism between 0.50 D and 1.00 D was 80.8%, and the
percent between 1.25 D and 2.00 D was 11.2%. The percent with astigmatism higher than 2.00 D was 8.1%. Obese children tended to have a higher prevalence of astigmatism ( χ2=6.347, P=0.042) compared with nonobese children. With the rule (WTR) astigmatism was predominant (73.8%), and there was no significant difference in the astigmatism axis distribution between males and females (χ2=3.104, P=0.212) or among the different age groups (χ2=10.578, P=0.102). In the analysis of risk factors, the prevalence of astigmatism was higher in children with at least one astigmatic parent (χ2=7.484, P=0.024) compared with the children without an astigmatic parent. Logistic regression analysis indicated that the main factor that influenced the development of children and adolescents's astigmatism was the cylinder of mother (odds ratio=2.2, 95% confidence interval: 1.1-4.4, P=0.023). Conclusions: The prevalence of astigmatism in children and adolescents was 59.4% in Wenzhou area, and WTR was predominant. The astigmatism of the mother may
increase the risk of astigmatism in children and adolescents.

Objective: To compare the prediction accuracy of intraocular lens (IOL) formulas using partial coherenceinterferometry (IOLMaster) and applanation ultrasound (AL-3000) assisted corneal topography (TMS-4).Methods: Eyes (n=133) undergoing phacoemulsification cataract surgery with posterior chamber IOLimplantation in our hospital between January 15, 2016 and May 1, 2016 were studied proactively. Axial length(AL), K-value, and anterior chamber depth (ACD) were preoperatively measured using the IOLMaster, AL 3000, and TMS-4. Haigis, Hoffer Q, Holladay I, and SRK/T biometric formulas with optimized constants were used to calculate IOL power. Refractive outcomes were determined by streak retinoscopy and subjective manifest refraction 3 months after the surgeries. Formulas and biometers were evaluated by mean error, standard deviation (SD), range of error, mean absolute error, median absolute error, 95% confidence interval of mean absolute error,and percentage of eyes within ±0.5 diopter (D), ±1.0 D, and ±2.0 D of prediction. F-tests were used to comparethe results between formulas and biometers. Results: The SDs of the Haigis, Hoffer Q, Holladay I, and SRK/T formulas using IOLMaster were 0.468, 0.591, 0.613, and 0.624. The SDs of Hoffer Q, Holladay I, and SRK/T were significantly larger than that of Haigis (F=9.632, 11.984, 9.215, all P<0.05). SDs of the AL-3000 assisted with TMS-4 were 0.580, 0.624, 0.642, and 0.700, respectively. The SD of SRK/T was significantly larger than that of Haigis (F=5.365, P=0.021). In short eyes, the SD of SRK/T was significantly larger than that of Haigis (F=7.071, P=0.012) using IOLMaster. In long axis eyes, the SD of SRK/T was significantly larger than that of Haigis (F=6.681, P=0.012) using IOLMaster, with hyperopic shifts of 0.44 D and 0.43 D in Hoffer Q and Holladay I. Conclusions: The Haigis formula with measurements using the IOLMaster was promising in eyes with all ranges of AL.