Chinese Journal of Optometry Ophthalmology and Visual science

中华眼视光学与视觉科学杂志

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Chinese Journal of Optometry Ophthalmology and Visual science

	2021 Vol.23 Issue.1 Published 2021-01-25

	Orignal Article Consensus Case Reports Review

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		2021 Vol. 23 (1): 0- [Abstract] ( 204 ) [HTML 1KB] [ PDF 599KB] ( 1624 )

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		2021 Vol. 23 (1): 0- [Abstract] ( 219 ) [HTML 1KB] [ PDF 591KB] ( 1637 )

Consensus

	1	Expert Consensus on Orthokeratology Fitting Process (2021)


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		2021 Vol. 23 (1): 1-5 [Abstract] ( 314 ) [HTML 1KB] [ PDF 1013KB] ( 5583 )

Orignal Article

	6	Evaluation of Accommodative Ability in Patients with Intermittent Exotropia Concomitant with Myopia
		Wei Dai, Jing Fu, Jie Hong, Bowen Zhao, Zhaojun Meng
		Objective: To compare the clinical characteristics relevant to the ability to accommodate in patients with intermittent exotropia (IXT) concomitant with myopia or non-myopia. Methods: This was a retrospective clinical study. Forty IXT patients between 6 and 15 years old were recruited from Beijing Tongren Hospital between December 2019 and January 2020. Of these, 20 patients were diagnosed with both IXT and myopia, while the other 20 patients were diagnosed with IXT and non-myopia. The evaluation parameters were refractive errors, dominant eyes, strabismus angle, AC/A, accommodative response (normal, accommodative lag, and accommodative lead), accommodative amplitude, and negative/positive relative accommodation. The revised Newcastle Control Score (RNCS) method was used to evaluate the ability to control exotropia. A paired t-test for dependent samples was used for comparison between the two eyes in each group and a two-sample t-test and nonparametric test were used to compare data between the two groups. Categorical data were compared using Fisher's exact test or a χ2 test. Results: The AC/A (2.78±1.09) of the myopia group was significantly lower than that of the non-myopia group (3.93±1.99) (t=-2.263, P=0.029). The accommodative amplitudes for the dominant eye (6.77±2.42) and non-dominant eye (6.52±2.16) in the myopia group were both lower than those for the dominant eye (9.14±2.89) and non-dominant eye (8.07±2.60) in the non-myopia group (t=-2.80, P=0.008; t=-2.05, P=0.047). The accommodative amplitude of the dominant eyes was significantly higher than the non-dominant eyes in the non-myopia group (t=2.572, P=0.019). The differences in accommodative amplitudes between the two eyes in the myopia group were not statistically significant. No significant differences were found in the positive relative accommodation, negative relative accommodation or accommodative response. The RNCS in the IXT combined with myopia group (7.20±1.96) was significantly higher than that in the non-myopia group (5.50±2.83)(t=2.203, P=0.034). Conclusions: Changes in accommodative characteristics are important indicators for the onset and progression of myopia, including a decline in AC/A and a decrease in accommodative amplitudes in the dominant and non-dominant eyes and a trend to balance between the two eyes.
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		2021 Vol. 23 (1): 6-12 [Abstract] ( 287 ) [HTML 1KB] [ PDF 812KB] ( 2368 )

	13	Analysis of a Gene Mutation in a Family and Sporadic Patients with Concomitant Exotropia
		Huimin Gong1,Zhanyu Zhou1,Guixiang Liu2
		Objective: To report a novel mutation of the PAX3 gene in a family with concomitant exotropia. Methods: A concomitant exotropia pedigree with 6 persons over 3 generations included 2 persons from the family in this experimental study, 180 sporadic patients and 150 normal controls. The genomic DNA was extracted. Using the Illumina Hiseq 4000 high-throughput sequencing system, exome sequencing was performed, followed by a bioinformatics analysis of the sequencing results to screen out possible pathogenic candidate genes. Then the primers were designed for the selected candidate genes and Sanger sequencing was carried out to verify the mutation. Results: The mutation of the PAX3 gene c.G434T (p.R145L) was detected by exome sequencing. Both patients in the family were confirmed to carry the PAX3 c.434G>T heterozygous missense mutation by using Sanger generation sequencing. The c.434G>T heterozygous mutation of the PAX3 gene was co-segregated from concomitant exotropia in the family. The mutation was detected in 27 of 180 sporadic patients and no c.434G>T mutation in the PAX3 gene was found in 150 normal individuals who were not related to the family. Conclusions: The PAX3 gene c.434G>T (p.R145L) heterozygous missense mutation may be the pathogenic gene of concomitant exotropia.
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		2021 Vol. 23 (1): 13-18 [Abstract] ( 277 ) [HTML 1KB] [ PDF 979KB] ( 2439 )

	19	Agreement between the i.Profiler and iTrace Aberrometers for Measuring the Wavefront Aberrations in Healthy Eyes of Young People
		Meijie Wang, Xuan Liao, Qingqing Tan, Changjun Lan
		Objective: To evaluate the agreement between the i.Profiler and iTrace aberrometers for measuring wavefront aberrations in healthy young eyes and the correlation between corneal aberration and pupil diameter. Methods: Ninety-six healthy young eyes of 96 healthy young persons were examined by the i.Profiler and iTrace in this diagnostic test study. Corneal (2-6 mm pupil diameter) and ocular (3 mm and 5 mm pupil diameters) higher-order aberrations, including total higher-order aberrations (tHOA), fourth order (Z40 ) spherical aberration (SA), vertical coma (Z3 -1), horizontal coma (Z31 ), vertical trefoil (Z3 -3),and horizontal trefoil (Z33 ), were measured. Agreement between the two aberrometers was evaluated by a t-test, Pearson correlation, Bland-Altman and 95% limits of agreement (95%LoA). Results: The 95%LoA of the higher-order aberrations measured by i.Profiler and iTrace were relatively narrow, showing good agreement. At a 4 mm pupil diameter, corneal Z40 measured by i.Profiler and iTrace were 0.049±0.016 μm and 0.048±0.016 μm, respectively. At a 6 mm pupil diameter, corneal Z40 were 0.270±0.040 μm and 0.266±0.037 μm, respectively. At a 2-6 mm pupil diameter, corneal tHOA, SA (Z40 ), (Z3 -1), (Z31 ), (Z3-3) and (Z33 ) increased with an increase in pupil diameter. The corresponding correlation coefficients between corneal higher-order aberrations and pupil diameter were 0.960, 0.916, 0.978, 0.970, 0.982 and 0.984 when using i.Profiler (all P<0.05), and the counterparts were 0.960, 0.916, 0.983, 0.970, 0.984 and 0.969 when using iTrace (all P<0.05). At 3 mm and 5 mm pupil diameters, the measured ocular Z40 were 0.010±0.008 μm and 0.073±0.052 μm, respectively, which were smaller than corneal Z40 (0.016±0.007 μm and 0.116±0.031 μm) when using i.Profiler. Conclusions: The i.Profiler and iTrace show good agreement in measuring wavefront aberrations in healthy young eyes.
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		2021 Vol. 23 (1): 19-26 [Abstract] ( 321 ) [HTML 1KB] [ PDF 1250KB] ( 2401 )

	27	Changes in Corneal Thickness and Relevant Factors after Small Incision Lenticule Extraction
		Xuemei Zhang1,Xinhua Xu1, 2, Qin Liu1,Xinzhi Song1,Jun Yang1
		Objective: To study the changes in corneal thickness and relevant factors after small incision lenticule extraction (SMILE). Methods: This was a retrospective case series study. A total of 120 patients (240 eyes) with low to high myopia who had undergone SMILE surgery and completed a 1-year follow-up were enrolled from the Optometry Center of Gansu Provincial People's Hospital. Corneal thickness of the apex and concentric circles of the diameter at 2 mm and 6 mm locations were examined by Pentacam at 1 day, 1 week, 1 month, 3 months, 6 months and 1 year after surgery. The changes in corneal thickness (△CT) in the same area at the adjacent time points and the different areas at the same time were compared. Paired samples t-test was used for intra-group comparison, repeated measurement of variance was used for intergroup comparison, and LSD-t test was used for pairwise comparison between groups. Results: In the three groups, the △CT of the different areas all increased from 1 day to 1 week after surgery, and the results were statistically significant (P<0.05). From 1 week to 1 month, corneal thickness became thinner; from 1 month to 3 months after the operation, all the corneal areas had thickened by different degrees (P<0.05). From 3 months to 1 year, the △CT of the different areas were positive and the growth of corneal thickness decreased slowly, and the difference was not statistically significant. The thickness from the center to the periphery decreased from 1 month to 1 year after surgery, and the thickening in the center was more obvious than that in the periphery. There were statistically significant differences at the apex and concentric circles of the diameter at 2 mm among the three groups (P<0.05), while there were no statistically significant differences at 6 mm circles. The changes in corneal thickness had a positive correlation with spherical equivalence (SE) and ablation depth (AD) (r=0.73, P<0.001; r=0.38, P<0.001), but a negative correlation with residual bed thickness (RBT)(r=-0.27, P=0.01). There was a positive correlation between IOP (r=0.69, P<0.001) and thickening of the cornea in the high myopia group. Conclusions: Corneal thickness gradually increases after SMILE and is basically stable after 3 months. Central thickening is more obvious than peripheral thickening. The higher the degree of myopia, the more obvious the thickening is.
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		2021 Vol. 23 (1): 27-33 [Abstract] ( 301 ) [HTML 1KB] [ PDF 840KB] ( 2539 )

	34	Changes and Correlation of Corneal Subbasal Nerve Plexus and Langerhans Cells in Diabetic Retinopathy Patients after Panretinal Photocoagulation
		Gang Liu, Xiaowu Wang, Jizhong Yang, Xiaofen Zheng, Yuping Han, Juwei Zhao, Guangping Hou, Hua Yu
		Objective: To observe changes of corneal subbasal nerve plexus and langerhans cells in diabetic retinopathy patients after panretinal photocoagulation (PRP) based on the wide-field mosaic, analyze the their correlation. Methods: In this prospective clinical study, type 2 diabetic patients with binocular diabetic retinopathy stage Ⅳ and waited for PRP treatment in Shanxi Eye Hospital from April to November in 2019 were included. Their severe eyes were chosen as the treatment eye and the contralateral eyes were chosen as the control eye. Corneal confocal microscopy (CCM) was performed before PRP treatment, 1 week after every photocoagulation for 4 times, and 1 month after the completion of PRP to examine the changes of SNP and Langerhans cell (LC) over an area of 2-3 mm around the whorl-like complex, and measure the of NFL value and LC density. The NFL value and LC density among each observation time point were compared by repeated measurement ANOVA, and the correlation between repeated measurement of NFL value and LC density before and after PRP treatment was analyze by MIXED model of SAS software. Results: A total of 49 patients were included. After PRP treatment, SNP nerve fibers showed decrease in diameter, accompanied by different degrees of nerve architecture loss in the whorl-like region in the treatment eye of some patients; the overall comparison of NFL values among observation time points was statistically significant (F=8.039, P=0.004), among which the NFL value differences between pre-PRP treatment [(15.5±3.7)mm/mm2 ] and 1 week after the second photocoagulation [(15.0±3.5)mm/mm2 ], 1 week after the third photocoagulation [(13.4±4.3)mm/mm2 ], and 1 week after the fourth photocoagulation [(13.5±4.1)mm/mm2 ] were statistically significant (all P<0.05). Meanwhile, LC was increased, clustering around the whorl-like area; the mature LC infiltration area also were accompanied nerve architecture loss. The overall difference in LC density among observation time points was statistically significant (F=12.350, P<0.001), among which the LC density differences between pre-PRP treatment [(40±54)cells/mm2 ] and 1 week after the third photocoagulation [(79±91)cells/mm2 ], 1 week after the forth photocoagulation [(98±126)cells/mm2 ] and 1 month after PRP [(87±102)cells/mm2 ] was statistically significant (all P<0.05); Correlation analysis showed that the LC density 1 week after the fourth photocoagulation were significantly positively correlated with their corresponding baseline levels in the treatment eye (r=0.674, P<0.001), and there was a negative correlation between repeated measurement of NFL value and LC density (P-=-0.041). Conclusions: Multiple photocoagulation of PRP treatment can lead to the increase of LC density; mature LC can lead to the damage of SNP nerve architecture.
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		2021 Vol. 23 (1): 34-40 [Abstract] ( 281 ) [HTML 1KB] [ PDF 3131KB] ( 2748 )

	41	A Preliminary Study on the Correlation between the Biomechanical Properties of Pupillary Light Reflex and Age in Normal Humans
		Zheyi Chen, Zuopao Zhuo, Bin Zhang, Binbin Su, Xiangqin Chen, Jun Jiang
		Objective: To conduct a preliminary investigation of a biomechanical model of the pupillary light reflex in normal human pupils; to understand the relationship between the parameters of the model and age. Methods: This was a descriptive study. A total of 143 patients with normal eyes were enrolled in a caseseries study at the Optometric Clinic Center of the Eye Hospital, Wenzhou Medical University, from February 2015 to July 2018. The pupillary light reflex (PLR) data were obtained using the pupillometer program of Oculus Keratograph 4. The biometric model fitting was applied to the PLR data compiled by Matlab software, which was solved using a step-by-step approximation method to obtain the elasticity coefficient and viscous coefficient of the pupil dilator muscle and constrictor muscle. The amount of resting time and impulsive sympathetic and parasympathetic nerves and the delayed response of the nerve impulse were also calculated. Results: A total of 143 subjects, 65 males and 78 females, aged 45.3±22.6 years, with an average pupil diameter (PD) of 5.58±1.06 mm participated in the study. The following parameters were calculated: elastic constant of the constrictor (kc) 0.29±0.29 mN/g·mm2 , radius of the constrictor at rest (L0c) 0.89±0.05 mm, elastic constant of the dilator (kd) 1.27±1.08 mN/g·mm2 , dilator muscle resting length (L0d) 3.40±0.28 mm, viscous constant of the pupil muscle (D) 3.57±0.15 mN·s/g·mm, muscle forces originating from the parasympathetic system induced by a light stimulus (fp) 134.77±33.23 mN/g and from the sympathetic system induced by a light stimulus (fs) 1.26±1.84 mN/g, muscle forces originating from the parasympathetic system at rest (fp0) 0.19±0.26 mN/g and from the sympathetic system at rest (fs0) 0.09±0.12 mN/g, the delayed response of the parasympathetic nerve impulse (tp) 1.15±0.10 s and the sympathetic nerve impulse (ts) 2.14±0.36 s. The Kc parameters of the PLR data increased with age and the parameters of the pupil-to-light reflection that decreased with age were PD, kd, L0d, fp, tp. The multilinear regression equation of predicting pupil diameter (PD) using the PLR model is PD=2.9585- 0.0099×age+0.0059×fp+1.3259×fs0-1.4853×kc+0.3006×kd+1.0159×L0d (F=79.906, P<0.001). Conclusions: By establishing the biomechanical model of PLR, the study obtained the elastic and viscous constants, coefficients, and parasympathetic and sympathetic nerves in PLR, which is beneficial to the application of PLR in autonomic neuro-related diseases.
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		2021 Vol. 23 (1): 41-48 [Abstract] ( 282 ) [HTML 1KB] [ PDF 1054KB] ( 2604 )

	49	Fenestration with Membranectomy to Open the Fibrous Membrane Closure of Continuious Curvilinear Capsulorrhexis after Cataract Surgery
		Guangen Yan, Honghui Duan, Lingjie Zhang, Haijian Wu
		Objective: To study the primary clinical effects that occur with fenestration membranectomy to produce an opening through the fibrous membrane closure of the continuous curvilinear capsulorrhexis (CCC) after cataract surgery. Methods: This was a restrospective study. Fifteen patients (15 eyes) had surgical CCC openings that were completely closed by a fibrous membrane after cataract surgery. They underwent fenestration with membranectomy in the Taizhou Eye Hospital between September 2011 and September 2018. The causes of fibrous membrane closure, surgical methodology and its effectiveness are also discussed. Results: Visual acuity improved significantly postoperative. Among them the uncorrected visual acuity (UCVA) was 0.2-0.3 in 4 eyes, 0.4-0.5 in 8 eyes and 0.6-0.7 in 3 eyes the next day after operation. The interior of the fenestration opening of the anterior capsule was transparent, the size of the fenestration opening was about 4.5 mm×5.0 mm, the intraocular lens (IOL) position was normal without displacement, and the optical part of IOL was flattened in all eyes postoperatively. None of the patients had major complaints about glare. Conclusions: The causes of fibrous membrane closure of the CCC opening may be related to the proliferation and migration of lens epithelial cells and fibroblasts after cataract surgery. The fibrous membrane closure of the CCC opening can be effectively solved by fenestration of the membrane and can significantly improve visual acuity
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		2021 Vol. 23 (1): 49-53 [Abstract] ( 260 ) [HTML 1KB] [ PDF 4217KB] ( 2189 )

	54	Comparison of the Results between the Spot Photoscreener and Auto Refractometer in the Screen of Myopia
		Ying Li, Ya Liao, Yiru Liu, Wenxuan Zhang, Xiaojuan Wang
		Objective: To assess the difference, agreement and relevance for the results of the Spot photoscreener (Welch Allyn, VS100) and auto refractometer (Topcon, KR8800) in detecting myopia in students from a school in Xuzhou, China. Methods: In this cross-sectional study, 500 randomly selected students (500 right eyes) aged from 6 to 19 from a school in Xuzhou were measured in turns by the two autorefractors to obtain their refractive status. 1% tropicamide was used as the cycloplegic refraction drug in 498 students. The spherical equivalences (SE) measured by the two autorefractors were compared by a paired t test. Agreement of spherical equivalents from the two devices was assessed by Bland-Altman plots. Spearman correlation analysis was also used to compare the measurements from the two devices. Results: At last, 498 students included. The difference in SE between the two methods was statistically significant (P<0.001). The SE of the Spot appeared more positive compared to the results of the auto refractometer in myopic students (P<0.001). The SE before and after ciliary muscle paralysis was all highly correlated between the two devices (r>0.8, P<0.001). Bland-Altman plots showed a good agreement between the results of the two devices. Conclusions: The Spot photoscreener can give reliable results with or without cycloplegia.
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		2021 Vol. 23 (1): 54-58 [Abstract] ( 296 ) [HTML 1KB] [ PDF 1041KB] ( 3497 )

	59	Current Use Condition of Goggles among the Staff of 169 Hospitals during the COVID-19 Outbreak
		Xiaoqiong Huang1,Wenzhe Zhou1,Jia Qu1,Hanxi Yang2,Yanyan Chen1,Qiangli Xie3
		Objective: To investigate the current use of goggles among hospital staff during the COVID-19 outbreak, so as to provide guidelines for protecting staff scientifically and effectively. Methods: This cross-sectional study used a questionnaire and a convenience sampling strategy. Data was collected from 1 050 employees, including 69 doctors (6.6%), 945 nurses (90%), 24 administrative staff (2.3%), and 6 support staff (0.6%) at 169 hospitals by using a self-designed questionnaire, which consisted of questions about basic information and the use of goggles. Results: In this study, it was found that during the COVID-19 outbreak, 380 hospital employees (36.2%) did not wear goggles while in the hospital, of which 171(45.1%) were clinical front-line medical staff. Among 670 employees who wore goggles, 488 people reported discomfort (72.8% of wearers), the major reason for discomfort reported by 375 wearers (76.8% of wearers) was the issue of fogging. This issue was reported by 615 wearers (91.8% of wearers). Its impact on performing their work can be considerably huge. 401 employees (65.2% of those who reported fogging) had experienced moderate or serious impact from fogging, which caused blurred vision and reduced work efficiency. In severe cases, work could not be performed. Moreover, 243 employees (39.5% of those who reported fogging) urgently required the problem of fogging goggles be solved, while 361 people (58.7% of those who reported fogging) were expecting the problem to be solved. In addition, high-risk individuals were more inclined to use hand sanitizers, iodine and soap detergents to prevent the goggles from fogging; nonhigh-risk individuals were more inclined to use paper towels on the bridge of the nose, iodophor, and antibacterial hand sanitizer to prevent fogging. Conclusions: A relatively low rate of investigated hospital staff wear goggles. Fogging is the main issue that hospital staff did not wear goggles during the outbreak. If goggles fog up, it can lead to a reduction in efficiency and an increase in exposure risks and difficulties of providing medical services. Therefore, it is suggested that medical staff be guided to adopt scientific measures to avoid fogging of goggles during clinical work.
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		2021 Vol. 23 (1): 59-63 [Abstract] ( 287 ) [HTML 1KB] [ PDF 767KB] ( 2247 )

Case Reports

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		2021 Vol. 23 (1): 64-66 [Abstract] ( 246 ) [HTML 1KB] [ PDF 8101KB] ( 2131 )

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		2021 Vol. 23 (1): 67-68 [Abstract] ( 239 ) [HTML 1KB] [ PDF 9127KB] ( 2064 )

Review

	69	Genetic Study of Congenital Idiopathic Nystagmus
		Lijuan Huang1,Ningdong Li2
		Congenital idiopathic nystagmus (CIN) is characterized as involuntary, rhythmic ocular oscillations without any obvious disorders in the eyes and in the visual pathway. It usually presents in the early period after birth. It is estimated that the prevalence of CIN is approaching 0.015% to 0.14%. Patients with CIN may have reduced visual acuity and compensatory head position. The etiology and the underlying pathogenesis of CIN are still unknown, but there is a tendency for family inheritance, which can be inherited as autosomal dominant, autosomal recessive, or X-linked inheritance trait. Seven pathogenic gene loci have been reported, including four loci on different autosomal chromosomes and three on the X chromosome. However, only the FERM domain containing the protein 7 (FRMD7) gene on the X chromosome has been identified to be associated with the onset of CIN. In this paper, we describe the inheritance patterns of CIN, its related clinical features, as well as relevant pathogenic gene loci and genes. We will further elaborate on the underlying molecular pathogenesis of nystagmus caused by the FRMD7 gene mutations.
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		2021 Vol. 23 (1): 69-72 [Abstract] ( 250 ) [HTML 1KB] [ PDF 731KB] ( 2440 )

	73	Research Progress in Measuring Corneal Biomechanical Properties with the Brillouin Microscope
		Mengdi Yan, Rongrong Gao, Junjie Wang, Qinmei Wang, Jinhai Huang
		The cornea has complex biomechanical properties such as anisotropy, nonlinearity and viscoelasticity. Corneal biomechanics plays an increasingly important role in the diagnosis and treatment of corneal diseases thanks to development in relevant basic and clinical research. There is a significant difference in mechanical properties between in vitro and in vivo corneas. Exploring methods to measure in vivo corneal biomechanics is of direct significance for the diagnosis and treatment of corneal diseases. At present, both of the two main in vivo measurement instruments, ocular response analyzer (ORA) and Corvis ST, only provide the biomechanical parameters of the whole cornea, failing to reveal local characteristics of corneal material properties. The Brillouin microscope focuses on corneal tissue with a low-power, near-infrared laser beam and determines the longitudinal modulus of the tissue by analyzing the return signal spectrum from the cornea, enabling in vivo and non-contact measurements of the biomechanical properties of various corneal regions. This paper summarizes the measurement principle and safety of the Brillouin microscope, and its comparison with other equipment and clinical applications.
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		2021 Vol. 23 (1): 73-77 [Abstract] ( 251 ) [HTML 1KB] [ PDF 742KB] ( 2987 )

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