To assess the validity, differences and agreements among measurements of refractive status in school-aged children and adolescents using Goaleye RM-9000, Nidek AR-1 and Topcon RM-800. Methods: In this prospective study, 449 individuals (449 right eyes) aged from 9 to 18 from Eye Hospital, Wenzhou Medical University were measured in turns by the three autorefractors for their refractive status in random sequence from May to June, 2019. Then a professional optometrist conducted a subjective refraction for them by phoropter. All measurements by the three autorefractors were compared using a Friedman test, and measurements by the three autorefractors were compared with the subjective refraction   respectively using Wilcoxon signed ranks test. Results: The median of spherical equivalent (SE) from Goaleye RM-9000, Nidek AR-1, Topcon RM-800 and the subjective refraction were -2.38(2.63)D,

To evaluate the clinical efficacy of corneal wavefront aberration-guided TransPRK surgery in the correction of moderate to high astigmatism with the help of smart pulse technology (SPT). Methods: In this retrospective study, TransPRK- corrected myopia in 29 patients (54 eyes) with high astigmatism in Yuncheng City Eye Hospital during July 2016 to December 2017 were examined. The eyes were examined before treatment and 1 month, 3 months and 6 months after treatment for uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and manifest refraction, slit lamp microscopy, intraocular pressure  measurements, and Pentacam corneal topography measurements. The preoperative spherical scope ranged from -6.00 to -1.25 D (mean -3.57±1.19 D), and the cylinder range was 1.50 to 4.00 D (mean 2.06± 0.55 D). The clinical outcomes and evaluation of the postoperative astigmatism vector in the correction of myopia with moderate and high astigmatism were evaluated. Preop and postop indexes were analyzed by repeated measurement analysis of variance, and Pearson correlation coefficients were used to assess the correlation between different variables. Results: Six months after surgery, 98% of the eyes had a UCVA of 1.0 or better, and an 87% equivalent spherical value of between ±0.50. The intended refractive correction (IRC) was 2.03±0.51 D, the mean of the surgically induced refractive correction (SIRC) was 2.02±0.69 D, the mean of the error vector (EV) was 0.49±0.35 D, the mean of the error angle (EA) was -1.37±7.62°, the mean of error magnitude (EM) was 0.23±0.40 D, the mean of error ratio (ER) was 0.25±0.19, and the mean of correction ratio (CR) was 0.99±0.21. There were significant correlations between IRC and SIRC (r=0.95, P<0.001), between EM and IRC (r=0.55, P<0.001) and between EV and ER (r=0.92, P<0.001). The EA results suggested that astigmatism changes counterclockwise, with the percentage of eyes in the range of 5° and 15° being 65% (35 eyes) and 96% (52 eyes). The CR results suggested a slight under correction of postoperative astigmatism. Conclusions: Corneal wavefront-guided TransPRK and the smart pulse technology assisted TransPRK show safe, predictable results in the correction of myopia with moderate and high astigmatism. It is necessary to improve the accuracy of astigmatism power and its axial direction before and during the surgery

To assess the reliability and relevance of a new test of inter-ocular suppression for childrenwith amblyopia, as well as its sensitivity and specificity for clinical use. Methods: In this prospectivestudy, inter-ocular suppression was measured quantitatively with polarized and neutral density filter lenseswith visual targets both for near and distance, and then compared to the standard tests for suppression(Worth 4 dot, stereoacuity) in 29 amblyopic children (8.7±2.4 years) with strabismus, anisometropia, or a   combination of both and 20 age-matched normal controls (8.0±1.9 years), from May 2014 to September2017 in the Eye Hospital, Wenzhou Medical University. To evaluate the correlation between measurement results and clinical characteristics of children in the amblyopia group, a Wilcoxon signed-rank sum test was used for analysis. A receiver operating characteristic curve was adopted to assess its reliability, sensitivity and specificity. Results: There was no statistically significant difference between the performance of normal and amblyopic patients (Z=1.830, P=0.067; Z=0.653, P=0.514). Inter-ocular suppression with the Worth 4-dot test was used as the diagnostic criteria. The results showed that stronger inter-ocular suppression was found in amblyopes than in controls at both near (Z=2.974, P=0.003) and far distances (Z=3.580, P<0.001). Using TNO and Optec 3500 as the diagnostic criteria, the results showed that stronger inter-ocular suppression was found in amblyopes than in controls at both near (Z=2.142, P=0.032) and far distances (Z=2.031, P=0.042). Inter-ocular suppression using the new test for diagnosis to distinguish between inhibition and non-inhibition showed the results were statistically significant for the diagnosis of differential inhibition and no inhibition. The results for the diagnostic criteria for the Worth 4-dot detection were: Near: AUC=0.824, 95%CI: 0.672-0.975, P=0.003; Far: AUC=0.911, 95%CI: 0.798-1.000, P<0.001; Diagnosis criteria for the TNO and Optec 3500 were: Near: AUC=0.878, 95%CI: 0.724-1.000, P=0.035;Far: AUC=0.926, 95%CI: 0.819-1.000, P=0.048). Conclusions: Good reliability and agreement is suggested for the new quantitative measurement of suppression in children with amblyopia. The measured inter-ocular suppression is in agreement with other clinical measures.

To investigate the association between different ocular dominance and fixation preferences in adolescents with intermittent exotropia (IXT). Methods: In this case serial study, a total of 43 patients with IXT from Aier Institute of Optometry and Vision Science from July to December 2018 participated. With full refractive error correction, the hole-in-the-card test was used to identify sighting dominance, the near point of convergence test was used to determine motor dominance, and a continuous flash technique based on a Gabor patch was used to determine ocular sensory dominance. The preferred eye for fifixation was determined by Mayo's office control scale when observing a target at long distance. The degree of agreement between the dominant eye and the preferred eye for fifixation was quantifified with Kappa statistics. And the association between the above-mentioned concordance and ocular dominance index (ODI) was analyzed by logistic regression. Results: For a total of 43 patients with IXT, sighting dominance, motor dominance, and sensory dominance showed moderate agreement with fixation preference (the Kappa values were 0.46, 0.43, and 0.68, respectively, P<0.001). When there was a clear sensory dominance, the agreement between the sensory dominant eye and the preferred fifixation eye was fairly high (Kappa values was 0.86, P<0.001), while the agreements of the other two kinds of ocular dominance and fixation preference were still moderate (the Kappa values were 0.57 and 0.44, respectively, P<0.01). Logistic regression showed that the probability for the preferred fifixation eye to agree with the sensory dominant eye increased with the value of ODI (B=0.53, OR=1.70, P<0.001), the greater the ODI value, the higher the probability for agreement between the sensory dominant eye and the preferred fifixation eye. Conclusion: For IXT adolescents, there is a consistent relationship between ocular dominance and fixation preference. The results of sensory ocular dominance are more closely related to the preferred eye for fifixation, especially when there is a clear sensory dominance, which is more reliable than a sighting dominance test or motor dominance test.

Objective: To evaluate the effect of the posterior fixation of the mass of the inferior oblique muscle  in treating inferior oblique overaction (IOOA) with small-angle hypertropia and V pattern strabismus.  Methods: A retrospective study of 16 cases of patients who had undergone inferior oblique mass posterior  fixation was performed. Among the 16 patients (22 eyes), 10 patients had small-angle hypertropia in  their primary gaze (≤5 prism diopters), 8 patients had unilateral superior oblique palsies, 2 patients had  horizontal strabismus with a mild monocular IOOA; and the other 6 patients had V pattern strabismus.  Patients were followed from 3 to 6 months. The vertical deviation in the primary position, degree of the V  pattern and objective cyclodeviations were compared pre- and postoperatively with fundus photography. A paired samples t test was used for statistical analysis. Results: The pre- and postoperative average vertical  deviations in the primary position of 10 hypertropia patients were: 4.9△±1.0△ and 0.1△±0.3△, respectively.  The difference was statistically significant (t=19.24, P<0.001). The preoperative average amount of the V  pattern was 18.3△±3.2△, which collapsed to 1.7△±2.3△ postoperatively. The pre- and postoperative foveadisc angles (FDAs) in the group of unilateral superior oblique palsy patients were: 10.6°±4.2° and 4.4°±2.4°,  respectively. The difference was statistically significant (t=5.80, P<0.001). The pre- and postoperative  FDAs in the group of V pattern patients were: 13.1°±4.3° and 5.4°±3.4°, respectively. The pre- and postoperative average overactions of the inferior oblique were 1.5(+) ± 0.5(+) and 0.1(+) ± 0.4(+), respectively.

Objective: To observe the efficacy and safety of wavefront-guided transepithelial photorefractive  keratectomy (WG-TransPRK) with simultaneous accelerated corneal collagen cross-linking (A-CXL)  in early-stage keratoconus. Methods: In this retrospective study, twelve eyes of 7 patients with early  keratoconus underwent simultaneous WG-TransPRK with A-CXL. Visual acuity, refractive status,  topography, confocal microscopy and aberrations were examined before treatment and 1 week, 1 month, 3 months, 6 months, and 12 months after surgery. Data were analyzed by paired t test. Results: Twelve  months after the surgery, the average UCVA improved from 0.77±0.25 LogMAR to 0.34±0.26 LogMAR  (P=0.001), the average BCVA improved from 0.18±0.21 LogMAR to 0.05±0.09 LogMAR (P=0.034).  The K1, K2 spherical equivalent of the cornea were reduced from 43.85±1.72 D and 46.64±2.36 D to  40.63±2.13 D (t=9.48, P=0.001) and 42.27±1.89 D (t=8.29, P=0.001), respectively. And Kmax decreasing  from 48.88±3.62 D to 45.43±1.54 D (t=3.02, P=0.014). Sub-basal nerve density decreased (P=0.001). The  anterior and mid-stromal keratocyte density was reduced also (P<0.05). No significant change was detected  in the deep stromal and endothelial cell density. The aberration parameters decreased in the 4 mm diameter  analysis area (P<0.05). Conclusion: WG-TransPRK combined with simultaneous A-CXL is safe and  effective for the treatment of early-stage keratoconus, with an improvement in visual acuity.

Objective: To compare the clinical effects of 2 types of topography-guided customized excimer laser  ablations (Contoura Vision-LASEK and Contoura Vision-FS-LASIK) and small incision lenticule extraction (SMILE) for myopic patients with asymmetric corneal astigmatism. Methods: In this  prospective cohort study, a total of 105 patients (105 eyes) underwent one of the 3 types of procedures:  Contoura Vision-LASEK (CV-LASEK), Contoura Vision-FS-LASIK (CV-FS-LASIK) or SMILE. All  patients with | C7 | >0.2 μm or | C8 | >0.2 μm at a 6-mm pupil diameter were examined preoperatively and  postoperatively (1 day, 1 week and 1, 3 and 6 months). Exams included uncorrected visual acuity (UCVA,  logMAR), refractive status, Pentacam HR, intraocular pressure (IOP) and slit lamp microscopy. One eye  of each participant was randomly selected (right or left) then randomly grouped. Subjective refraction was  measured at 6 months after the procedures. MANOVA was used to evaluate the changes and differences in  UCVA, IOP and corneal higher order aberrations (HOAs) in the 3 groups before and after the procedures.  An MA mixed linear model was used to analyze the possible influencing factors of corneal HOAs at the  postoperative time points for the 3 groups. Results: In the CV-LASEK group, one eye lost 1 line and one  eye lost 2 lines at 6 months postoperatively. No eyes in the other 2 groups lost UCVA (P=0.174). There  were significant differences among the groups at every follow-up for IOP, coma and spherical aberration on  the corneal surface (all P<0.05). In addition, fluctuation in IOP was significantly correlated with changes  in HOAs for the 3 groups postoperatively (both P=0.001), but baseline central corneal thickness (CCT)  had a significant effect on spherical aberration (C12) (P=0.003). Conclusion: The three types of refractive  procedures are safe and effective for myopic patients with asymmetric corneal astigmatism. However, there  should be more emphasis on postoperative IOP control for better visual quality.

Objective: To evaluate the short-term therapeutic effect of intense pulsed light combined with meibomian  gland expression (IPL/MGX) for the treatment of meibomian gland dysfunction (MGD). Methods: This  was a prospective single-arm clinical study that included 55 MGD patients, in which 48 patients (96  eyes) finished the follow-up. IPL/MGX treatment was administered in both eyes, once every 3 weeks  for 3 sessions. Testing was performed before treatment and 1 week after treatment and included the  ocular surface disease index (OSDI), a questionnaire survey, tear film break-up time, corneal staining,  meibomian gland function and imaging, conjunctival bulbar redness, confocal microscope examination of the meibomian gland and mites, etc. A paired t test, Wilcoxon rank sum test and Spearman rank correlation  were used for statistical analysis. Results: Ocular surface disease index (t=2.300, P=0.024) meibomian  gland expression score and meibum quality score (Z=-3.617, P<0.001; t=2.472, P=0.017), corneal staining  score and bulbar redness score (Z=-2.757, P=0.006; t=2.040, P=0.044), inflammatory cell density (t=4.765,  P<0.001), and total number of demodex mites in the follicle (t=2.121, P=0.037) were all improved after  treatment. The patients with a meibomian gland dropout area of less than 50% had significant improvement  of subjective symptoms, ocular surface inflammation and meibomian gland function after treatment. Patients  with a meibomian gland dropout area of more than 70% showed no significant improvement before and  after treatment. Conclusion: IPL/MGX can significantly improve the subjective symptoms and meibomian  gland function of MGD patients with mild atrophy of the meibomian gland, alleviate the inflammation of the  ocular surface, reduce the number of demodex mites, and relieve damage onthe ocular surface.

Objective: To investigate the safety, efficacy, predictability, stability and posterior corneal elevation of  small incision lenticule extraction (SMILE) for high myopia. Methods: This study was a descriptive  longitudinal study. A retrospective analysis was performed on 37 patients (67 eyes) with high myopia  (spherical equivalent, -10.75--6.25 D) who underwent SMILE in the Ophthalmology Department of  Xiangya Hospital, Central South University in 2016. Uncorrected visual acuity (UCVA), best corrected  visual acuity (BCVA), refractive error, intraocular pressure (IOP), axial length, and corneal topography  were measured preoperatively and postoperatively at 1 day, 1 month, 3 months and 6 months. The data  before and after surgery and the influencing factors were analyzed by a generalized estimation equation.Results: The UCVA (LogMAR) of the high myopes was -0.1 (-0.2, 0), the effective index was 0.83±0.20,  the BCVA (LogMAR) was -0.2 (-0.2, -0.2), and the safety index was 1.03±0.16 at 6 months after SMILE.  The degree of myopia increased gradually from 1 month to 6 months postoperatively. The refractive error  was -0.25 (-0.50, 0) D and regression was -0.25 (-0.50, 0) D at 6 months after SMILE. UCVA was  positively correlated with age, refractive error and regression and was negatively correlated with age after  surgery. The difference value of the posterior corneal surface was 0.030±0.006 mm before and 0.046± 0.012 mm 6 months after surgery, which was lower than that in the first month, and was not statistically  different at 3 months. Difference and Δdifference at 6 months were positively correlated with mPTA  (modified percent tissue altered). Conclusions: This study demonstrates SMILE to be a safe, effective,  predictable and stable procedure for the treatment of high myopia, with a slight myopic regression at 6  months after surgery, especially in elders. The posterior corneal surface shifts forward postoperatively and  partially recovers after 3 months; the amounts are associated with mPTA.

Objective: To examine the test-retest reliability and validity of the College of Optometrists in Vision  Development Quality of Life questionnaire (COVD-QOL) that had been translated and culturally adapted  to the Mandarin Chinese language. Methods: In this cross-section study, the final Chinese version of  COVD-QOL was established after translation, back-translation and cognitive interviews based on the  Brislin translation model. A sample of 20-23 year-old subjects (118 participants) from Xiamen Medical  College completed the Chinese version of COVD-QOL, only 80 subjects were retested after three weeks.  All data were analyzed using item analysisi, Cronbach's α coeffcient, retest reliability and so on. Results: The correlation coefficient between each item score and total score ranged from 0.333 to 0.684 (P<0.01).  The coefficient of internal consistency (Cronbach's α) was 0.791, the Chinese version of COVD-QOL had  good retest reliability with a Pearson correlation coefficient of 0.750 (P=0.002). The content validity index  was 0.985. The construct validity was not good, because six factors were extracted by exploratory factor analysis, which could explain 62.3% of the total variance, but the results cannot be analyzed by professional  interpretation. Conclusions: The Chinese version of COVD-QOL demonstrates good test-retest reliability  and content validity. This questionnaire is an appropriate tool to assess the changes in visual symptoms for  these native Chinese language speakers.

Objective: To observe and analyze the clinical features and misdiagnosis of iridocorneal endothelial  (ICE) syndrome. Methods: In this retrospective case analysis, 86 eyes of 86 patients who were diagnosed  with ICE syndrome between 1993 and 2015 in Qingdao Eye Hospital. Sex, age, maincomplaints, course  of disease, types, complication and misdiagnosis were recorded and analyzed. Results: Eighty-six cases  were unilateral. The ratio of male to female was 1:1.2, and the age ranged from 20 to 73 years, average  50.1±11.8 years. 91% of patients with progressive visual loss and red eye were the main complaints. The course of disease ranged from 0.17 to 10 years, average 2.4±2.3 years. 1% of patients complained about  pupil deformation, the course of disease was 1 year. 6% of patients complained black eye foggy, the  course of disease ranged from 0.5 to 2 years, average 1.4±0.6 years. 2% of patients with high intraocular  pressure founding by physical examination were treated in time. 95% of patients with obvious iris atrophy  were classified as primary progressive iris atrophy, Chandler and Cogan-Reese syndrome were 4% and  1%. The typical morphology of corneal endothelial cell showed irregular, cavitation, central black area  and brighter edge. The atypical sign was no significant iris atrophy. 68% of patients had developed  glaucoma and corneal endothelial dysfunction. Ultrasawnd biomicroscepy and angle mirror examination  showed peripheral iris extensive anterior and local filamentous adhesion, angle pigment classification  level was 1 to 3. 27% of patients were misdiagnosed for the first visit and 20% of these patients were  misdiagnosed in other hospitals. 8% of patients were misdiagnosed as primary glaucoma, 12% of  patients were misdiagnosed as Posner-Schlossman syndrome, Fuchs syndrome and uveitis. Absence of  corneal endothelial cell morphology examination and atypical clinical manifestation were main causes of  misdiagnosis. Conclusions: Progressive visual loss is the main reason for patients with ICE syndrome,  long course of disease and delay treatment. More than 50% of patients have complications at visiting time.  95% of patients are primary progressive iris atrophy. Most easily misdiagnosed as primary glaucoma and  uveitis. Absence of corneal endothelial cell morphology examination and atypical clinical manifestation are  main causes of misdiagnosis.

Glaucoma is a type of optic neuropathy. It is the main cause of irreversible blindness in the world. Its  pathogenesis is unclear at this time. In recent years, with the development of a genome-wide association  study (GWAS), family studies and functional studies, great progress has been made in the understanding of  the molecular basis and complexity of glaucoma. Primary open angle glaucoma (POAG) accounts for about  70% of glaucomatous cases worldwide and the prevalence rate has been increasing. POAG has obvious  genetic characteristics, but since it is a complex genetic pattern, only about 10% of the cases represent a  typical Mendelian single gene inheritance, and the others may be the interaction of multiple genetic factors,  or the result of the common effects of genetic and environmental factors. At present, more than 30 genes  directly related to glaucoma have been identified. The encoding proteins are involved in a wide range of  cell processes and biological systems, including the extracellular matrix, cytokine signal transduction, lipid  metabolism membrane biology, cell differentiation, autophagy and eye development. This report intends to further the understanding of the internal relationship between glaucoma and genes and clarify its possible  pathogenesis from several important biological processes such as endoplasmic reticulum stress response,  tumor necrosis factor-alpha signal pathway, autophagy regulation, TGF-beta signal pathway and others.