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.8 Published 2021-08-25

	Orignal Article Case Report Review

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		2021 Vol. 23 (8): 0- [Abstract] ( 238 ) [HTML 1KB] [ PDF 611KB] ( 1828 )

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		2021 Vol. 23 (8): 0- [Abstract] ( 199 ) [HTML 1KB] [ PDF 40299KB] ( 1334 )

Orignal Article

	561	Local Accommodative and Central Visual Perceptual Changes in the Early Stages after SMILE and FS-LASIK for High Myopia
		Aiqun Xiang, Kaixuan Du, Xiaoying Wu, Yewei Yin, Yanyan Fu, Ying Lu, Qiuman Fu, Tu Hu, Yuanjun Li, Dan Wen
		Objective: To compare the changes and differences of accommodative and visual perceptual functions after small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomiluesis (FS-LASIK) for the correction of high myopia. Methods: This prospective, comparative clinical study included 60 patients (SMILE: n=35, FS-LASIK: n=25) who underwent SMILE or FS-LASIK surgery at the Eye Center of Xiangya Hospital, Central South University between November 2019 and July 2020. Accommodation (including negative/positive relative accommodation, amplitude of accommodation, accommodative response and facility of accommodation) and visual perceptual functions (including perceptual eye positon, fixation stability and fine stereopsis) were measured preoperatively and at week 1, month 1 and month 3 postoperatively. Using a t test, Wilcoxon test or λ2 test for comparison between the two groups, comparisons between the pre- and all three postoperative time-points were performed using repeated measures analysis of variance, LSD-t test, Kruskal-Wallis H or λ2 test. Results: In the SMILE group, the positive relative accommodations at month 1 and month 3 were higher than before surgery (all P<0.05). The monocular and binocular amplitudes of accommodation and facility of accommodation improved at month 1 and month 3 compared to week 1 (all P<0.05). The monocular amplitude of accommodation at month 3 was larger than the preoperative amplitude (P=0.028). The vertical eye position and 5 meters fine stereopsis at month 1 and month 3 were improved compared to preoperative levels (all P<0.05). In the FS-LASIK group, the positive relative accommodation at month 1 was larger than accommodation at week 1 (P=0.02), and improved at month 3 compared to preoperative and week 1 levels (P<0.05). The monocular and binocular amplitudes of accommodation at month 3 were improved compared to the earlier measurements (all P<0.05). The monocular and binocular facility of accommodation at week 1 was less than preoperative levels, but increased at month 1 and month 3 (all P<0.05), and at month 3 after surgery returned to the preoperative level. The 5 meters fine stereopsis was increased at month 3 compared to week 1 (P<0.05). When comparing the two groups, the preoperative binocular amplitude of accommodation (t=-2.067, P=0.043), the negative relative accommodation at month 1 (t=-3.181, P=0.03) and the monocular amplitude of accommodation at month 3 (t=-2.126, P=0.036) in the FS-LASIK group were higher than in the SMILE group. However, the positive relative accommodation (t=-2.249, P=0.028) and monocular facility of accommodation (t=3.013, P=0.003) at week 1 and binocular amplitude of accommodation at month 1 (t=3.031, P=0.004) in the FS-LASIK group were lower than in the SMILE group. The grades of 2.5 meters fine stereopsis in week 1 and month 1, and the 5 meters fine stereopsis in the three follow-ups after surgery in the FS-LASIK group were generally less than in the SMILE group (all P<0.05). Conclusions: Both SMILE and FS-LASIK have good results for correcting high myopia. The two operations cannot only improve the local accommodation functions of the eyes, but also improve the high-level visual perceptual function of the brain. The early postoperative visual perception function in the SMILE group recovers faster than that in the FS-LASIK group.
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		2021 Vol. 23 (8): 561-569 [Abstract] ( 468 ) [HTML 1KB] [ PDF 1758KB] ( 15134 )

	570	Comparative Study on the Influence of Different Types of Visual Display Terminals on Visual Function
		Yao Yao, Jing Fu
		Objective: To investigate the differences in visual fatigue caused by different types of visual display terminals (VDT) and their impact on visual health. Methods: This was a self-controlled study that enrolled 30 subjects, 7 males, 23 females, age 23(23, 25) years old, with an equivalent spherical lens of -3.86±2.71 D. The subjects used the digital table method to watch either a paper screen or TV screen video, one after the other, in random order. All subjects watched the video in the same environment for 30 minutes. Before and after watching the video, they filled in the Asthenopia Scale, and adjustment, aggregation, fusion and other visual function indicators were measured and the number of blinks was recorded. The comparison of the observation indicators and the data between the viewing modes was statistically analyzed by Friedman test and Wilconxon rank sum test. Results: After viewing the two screens, the blink frequency of all subjects increased, and the relative adjustment ability of the single eye and both eyes improved for those who looked closer at the screen. The score on the visual fatigue scale after watching the paper screen was significantly lower than that before watching (P=0.02) and was significantly lower than that after watching TV (χ2 =5.57, P=0.01), but there was no significant change in the scale score before and after watching the TV screen. When watching either the paper screen or TV, the median blink frequencies of subjects in front of the screen were 15.7(11.8, 17.3) and 16.9(13.1, 19.4) times/min. Median frequencies were 18.9(12.7, 20.1) and 20.4(15.3, 21.9) times/min after watching the two screens. Both screens elicited a significant increase in blinking frequency compared to before viewing (Z=2.82, P=0.01; Z=-2.27, P=0.02), but there was no significant difference between the two screens. After viewing paper-like screens, the horizontal heterophoria degree increased significantly compared to the amount before watching the screen (F=2.87, P=0.049), and was significantly greater than the amount after watching the TV screen (P=0.049). The AC/A value after watching the paper screen was lower than that after watching the TV screen (χ2 =2.99, P=0.03), but there was no significant difference from before and after watching the two screens. After watching the two screens, the positive relative accommodation ability (PRA) of the right eye, left eye and both eyes of the subjects increased compared with before viewing (F=11.01, 5.01, 10.00, P<0.05). The PRA of both eyes after watching paper-like screens at the same time was higher than watching TV screens (P=0.02). After watching a paper screen, the break point of the near-eye negative fusion (BI) and the recovery point of the far-eye positive fusion increased compared to before watching the screen (P=0.02, 0.04), but there was no obvious change in the functional parameters of fusion after watching the TV screen. Conclusions: Watching a VDT for a short time and at a medium distance can cause some visual fatigue-related index changes; different types of VDTs can have different effects on the visual function of the human eye. Watching a TV screen has less effect than watching a paper projection screen with low blue light and no flicker. The screen may be more likely to cause visual fatigue.
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		2021 Vol. 23 (8): 570-575 [Abstract] ( 501 ) [HTML 1KB] [ PDF 716KB] ( 14409 )

	576	Observations of Retinoschisis in a Young Myopic Population Using OCT
		Yue Gong, Yuhua Hao, Ning Shen, Ruijie Xi, Jinxin Shi, Ying Liu
		Objective: To investigate the spectral domain optical coherence tomography (SD-OCT) imaging characteristics of retinoschisis by observing the types, prevalence, composition, distribution and clinical features of retinoschisis in a young myopic population. Methods: This was a cross-sectional study. A total of 1 046 eyes of 523 myopia patients who were treated at the ophthalmological laser surgery outpatient department of the Second Hospital of Hebei Medical University from July 2020 to December 2020 were recruited. Of these, 227 eyes (21.7%) were diagnosed with low myopia (-3.00- 0 D), 405 eyes (38.7%) were diagnosed with moderate myopia (>-6.00- -3.00 D), and 414 eyes (39.6%) were diagnosed with high myopia (≤-6.00 D). The participants underwent a complete ophthalmologic examination, including best corrected visual acuity, axial length measurement, refractive error, color fundus photography and SD-OCT examinations. Multiple SD-OCT scans of each patient were made along the upper and lower arcades of the temporal and nasal quadrants of the retina and across the fovea. The distribution of retinoschisis in the four quadrants of the retina was observed. The types, prevalence, composition, distribution and clinical features of retinoschisis were analyzed. A Pearson Chi-square test was used for statistical analysis of the distribution of paravascular inner and outer retinoschisis. Fisher's exact test was used for statistical analysis of the distribution of middle retinoschisis. The Kruskal-Wallis rank sum test was used for statistical analysis of age and refractive error in the subgroups of paravascular retinoschisis. ANOVA was used for statistical analysis of axial length. Results: Of the 1 046 eyes with different degrees of myopia, paravascular retinoschisis was detected by SD-OCT in 30 eyes (2.9%). Myopic macular retinoschisis was never detected. Paravascular retinoschisis was classified into three different subtypes: Inner, middle and outer retinoschisis. The overall prevalence of the three subtypes of paravascular retinoschisis in the young myopic population was 2.9%, 0.8% and 1.5%, respectively. Of the 30 eyes with paravascular retinoschisis, inner retinoschisis was found in all 30 eyes, middle retinoschisis in 8 eyes, and outer retinoschisis in 16 eyes. All three subtypes of paravascular retinoschisis (inner: χ2 =13.468, P<0.001, middle: P=0.002, outer: χ2 =13.576, P<0.001) were observed more frequently along the temporal vascular arcades. Conclusions: All three subtypes of paravascular retinoschisis were more frequently observed along the temporal vascular arcades. Inner retinoschisis may be the predominant subtype of paravascular retinoschisis and is mainly related to the tangential traction of the posterior vitreous cortical and anterior traction of the retinal vessels in a young myopic population.
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		2021 Vol. 23 (8): 576-582 [Abstract] ( 438 ) [HTML 1KB] [ PDF 9031KB] ( 16470 )

	583	Influence of Base Curve Aspheric Orthokeratology on Objective Visual Quality
		Xuemei Fu1,Jiwen Yang1, 2, Bingcai Jiang3
		Objective: To analyze the influence of base curve aspheric orthokeratology on objective optical quality. Methods: This was a prospective study. Sixty patients (60 eyes) were recruited in Shenyang Aier Optometry Eye Hospital from August 2018 to March 2019. Patients were divided into two groups. The aspheric group (30 eyes) were treated with base curve aspheric orthokeratology and the spheric group (30 eyes) were treated with base curve spheric orthokeratology. Ocular and corneal higher-order aberrations (HOA), spherical aberrations (SA), coma, trefoil and modulation transfer function (MTF), and the Strehl ratio (SR) within a 5 mm pupil diameter were measured before and 6 months after orthokeratology. Only the left eye data were selected for analysis. Data were analyzed with paired t tests, an independent samples t test and Mann-Whitney U test. Results: At 6 months after wearing the lenses, the root mean squares (RMS) of the ocular HOA, SA, and coma aberrations had increased and MTF and SR had decreased in the two groups compared to before lens wear. The differences in these variables were statistically significant (P<0.001). The RMS of the corneal trefoil in the spheric group and aspheric group also increased compared to before lens wear and the differences were statistically significant (t=-3.69, P=0.001; t=-3.41, P=0.002). The comparison between the two groups showed statistically significant differences in ocular HOA, SA and coma (t=4.36, P<0.001; t=2.13, P=0.038; t=4.51, P<0.001), and corneal HOA and coma (t=2.84, P=0.006; t=2.69, P=0.009). There were no statistically significant differences in the other aberrations and MTF and SR between the two groups. Conclusions: The different designs of orthokeratology base curve lenses impact the patient's objective optical quality. Patients have a better objective optical quality after wearing base curve aspheric orthokeratology lenses compared to base curve spheric orthokeratology lenses.
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		2021 Vol. 23 (8): 583-588 [Abstract] ( 438 ) [HTML 1KB] [ PDF 731KB] ( 13775 )

	589	Clinical Analysis of 46 Cases Corneal Ulcer after Pterygium Excision
		Chunxiao Dong1, 2, Mengni Liu1, 2, Jingting Wang1, 2, Xin Wang1, 2, Weiyun Shi1, 2, Suxia Li1, 2
		Objective: To analyze the clinical features of corneal ulcer after pterygium surgery, and to explore therapeutic regimens. Methods: A retrospective analysis was conducted on 46 cases (46 eyes) that were diagnosed with corneal ulcer secondary to pterygium surgery in Shandong Eye Hospital from January 2004 to December 2020. Detailed records of the patient's preoperative systemic and local medical history, type of operation and postoperative complications management, and an assessment of the clinical characteristics of the corneal ulcer were analyzed. Different treatments were chosen based on the size of the corneal ulcer, depth of infiltration, limbal stem cell damage, symblepharon, etc. The prognosis of the above treatment regimens was explored. Data were analyzed by a Wilcoxon test and Chi-square test. Results: Retrospectively, 26 cases underwent the traditional pterygium excision, while 17 cases underwent pterygium excision combined with autoallergic limbus corneal stem cell transplants. Only 1 case underwent traditional the pterygium excision combined with mitomycin C. The pathogen results show that 26 cases (57%) had negative results. Twenty cases (43%) had infectious corneal ulcer and most ulcers were located at the attachment of the pterygium. Thirty-two cases involved the corneal and scleral limbus and 10 cases were complicated by severe scleral ischemia. Three patients were cured by systemic therapy, 36 patients underwent keratoplasty and 7 patients underwent other methods including amnion transplants, keratectomy, and conjunctival flap covering. Twenty patients with uninfected corneal ulcer underwent autoallergic limbus corneal stem cell transplantation and 11 cases of infected corneal ulcer were covered with conjunctiva. Best corrected visual acuity after ulcer healing was significantly higher than before (Z=-5.091, P<0.001). Conclusions: Corneal ulcer secondary to pterygium excision usually occurs at the attachment of the pterygium. It can be accompanied by symblepharon and scleral ischemia. Thoroughly clearing local lesions, ensuring corneal integrity and restoring limbal stem cell function are seen as the most effective treatments for corneal ulcer after pterygium excision.
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		2021 Vol. 23 (8): 589-596 [Abstract] ( 479 ) [HTML 1KB] [ PDF 10632KB] ( 16455 )

	597	Clinical Characteristics and Drug Resistance in 16 Cases of Moraxella Keratitis
		Yuanyuan Yang, Haiou Wang, Pengfei Chen, Yali Li, Meiqin Zheng
		Objective: To investigate the clinical characteristics of Moraxella keratitis and the drug resistance of isolated strains. Methods: Retrospective study. From December 2013 to June 2020, 16 patients diagnosed with Moraxella keratitis in the Eye Hospital, Wenzhou Medical University were recruited. The clinical characteristics, risk factors, treatment effect, distribution of pathogenic bacteria and drug resistance were analyzed in this study. The drug resistance trend was analyzed, and the Moraxella species were identified with the semi-automatic identification instrument ATB Reader and the mass spectrometer MBT. Results: The 16 cases of Moraxella keratitis studied were all confirmed cases after laboratory examination. According to the analysis of clinical characteristics, previous eye surgery and diabetes/hypertension were the most common local and systemic risk factors. The most common presenting complaint of patients was eye pain, and the most common examination result was corneal ulcer. Laboratory examination revealed that there were 7 cases of Moraxella lacunarum, 4 cases of Moraxella nonliquifaciens, 3 cases of Moraxella osloensis, 1 case of Moraxella catarrhalis, 1 case of Moraxella atalantae. The drug sensitivity test showed that the pathogenic bacteria isolated were rarely resistant to penicillin, cephalosporin, tetracycline, quinolones, aminoglycosides, etc. Conclusions: In this study of 16 cases of Moraxella keratitis patients, eye pain and corneal ulcers are the most common. The comparative analysis of different Moraxella bacteria suggests that in Moraxella keratitis cases, Moraxella lacunar and Moraxella nonliquefied are the two main infectious pathogens, and their isolates are highly sensitive to drugs.
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		2021 Vol. 23 (8): 597-603 [Abstract] ( 422 ) [HTML 1KB] [ PDF 3112KB] ( 15453 )

	604	Analysis of the Clinical Features of Adult Ocular Myasthenia Gravis
		Junjie Tang, Fangyuan Chen, Jian Chen, Yuanting Yang, Qing Zhou
		Objective: To analyze the clinical features and ophthalmoplegic characteristics of ocular myasthenia gravis (OMG) in adult patients. Methods: A retrospective case series study of the medical records of 40 adult patients diagnosed with OMG at the First Affiliated Hospital of Jinan University from June 2016 to October 2019 was performed to analyze the clinical features of OMG. The descriptive statistics included the duration of symptoms, gender distribution, ocular symptoms, diplopia features, ophthalmoplegic characteristics and the results of diagnostic tests. Results: Of the 40 adult OMG patients, 50% of the cases (20) were men. The median course of the disease among all patients was 6 months (range: 1 month to 10 years). At the first visit, 27 patients (68%) showed diplopia only, 9 patients (22%) showed ptosis only, 4 patients (10%) showed diplopia with ptosis. Among the patients with diplopia (n=31), 20 cases (64%) showed horizontal diplopia and 11 cases (35%) showed vertical diplopia. Multiple binocular extraocular muscles were affected in all diplopia patients. The most paralytic extraocular muscle was the lateral rectus (16 cases, 52%), and in descending order, the superior rectus (6 cases, 19%), medial rectus (4 cases, 13%), inferior rectus (3 cases, 10%), superior oblique (1 case, 3%), and inferior oblique (1 case, 3%). A neostigmine test was positive in 32 of 40 patients (80%), acetycholine receptor antibody assay was positive in 4 of 40 patients (10%), abnormal electromyography results were found in 2 of 40 patients (5%), thymus CT showed abnormal findings in 5 of 40 patients (13%), and 19 cases (48%) combined the thymus with thyroid disorders. Conclusions: Horizontal diplopia was the initial symptom in most adult OMG patients and the lateral rectus was the most susceptible muscle.
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		2021 Vol. 23 (8): 604-609 [Abstract] ( 435 ) [HTML 1KB] [ PDF 5483KB] ( 15913 )

	610	Changes in Vault after Implantable Collamer Lens Implantation with Different Posterior Chamber Positions
		Lin Yao1, 2, Haiqing Bai3
		Objective: To investigate the changes in lens vault after implantation of implantable collamer lenses (ICL) with different posterior chamber positions. Methods: This was a retrospective case series study. Fortyseven patients (94 eyes) who underwent ICL implantations and were followed up beyond 1 year were enrolled from Qingdao Xinshijie Eye Hospital between January 2018 and December 2019. Patients were divided into 2 groups, a horizontal group (48 eyes, 24 cases) and a vertical group (46 eyes, 23 cases), based on the posterior chamber position of the ICL. Lens vaults were measured by optical coherence tomography (OCT) at 1 week, 1 month, 3 months, 6 months and 1 year after the operation. The data were analyzed by a χ2 test, independent-samples t test and paired-samples t test. Results: There were no significant differences in the vault between the groups at any postoperative follow-up time. The vault in both groups continued to decrease until 1 year after the operation (P<0.001). From 1 week to 1 month after the operation, the vault decreased more significantly in the vertical group compared to the horizontal group (t=-2.692, P=0.008). There was no difference between the groups in the degree of decrease at any other follow-up time. Conclusions: Within 1 year after the operation, the vault continuously decreases and is unrelated to the horizontal or vertical position of the ICL. When the ICL is placed vertically, the vault decreases even more in the first month postoperative period.
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		2021 Vol. 23 (8): 610-614 [Abstract] ( 412 ) [HTML 1KB] [ PDF 803KB] ( 13789 )

	615	I and II wAMD-Aided Deep-Learning Grading Algorithm Based on OCT
		Junyong Shen1,Yan Gong2,Yan Hu1,Yanhong Liao2,Jianlong Yang3,Yitian Zhao3,Jiang Liu1, 3
		Objective: To investigate the application of a deep learning algorithm based on optical coherence tomography (OCT) images for the classification of wet age-related macular degeneration (wAMD) so as to assist in the diagnosis of ophthalmic diseases. Methods: Data of this study were collected from 39 patients (46 eyes) diagnosed with wAMD in the outpatient department of Ningbo Eye Hospital from June 2018 to June 2019. First, senior ophthalmologists provide the wAMD grade of each patient as the gold standard of the classification algorithm. Then, Resnet 34 was used to output the predicted results of the type of wAMD in order to compare these results with the gold standard. The parameters were fine-tuned continuously until the status of the loss was in convergence. Finally, the wAMD grade for patients was diagnosed automatically. Results: The accuracy of the algorithm is the proportion of the cases correctly predicted in all test cases. The experimental results showed that the accuracy rate of identifying the type of wAMD based on the deep learning network was 20% higher than for general ophthalmologists. Gradientweighted class activation mapping can visualize how the model can be used as a diagnostic reference for ophthalmologists. Conclusion: In the aspects of classifying wAMD by an adequately trained deep learning algorithm, its accuracy is significantly better than that of general ophthalmologists. Therefore, the classification results based on deep learning algorithms can be used for auxiliary diagnosis of diseases, so as to alleviate the scarcity of domestic ophthalmologists.
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		2021 Vol. 23 (8): 615-621 [Abstract] ( 443 ) [HTML 1KB] [ PDF 2316KB] ( 14905 )

Case Report

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		2021 Vol. 23 (8): 622-624 [Abstract] ( 391 ) [HTML 1KB] [ PDF 4960KB] ( 15885 )

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		2021 Vol. 23 (8): 625-627 [Abstract] ( 412 ) [HTML 1KB] [ PDF 12220KB] ( 16377 )

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		2021 Vol. 23 (8): 628-630 [Abstract] ( 406 ) [HTML 1KB] [ PDF 5036KB] ( 15630 )

Review

	631	Current State and Progress of Research on Virtual Reality Technology and Its Application for Ophthalmology
		Zhen Peng, Chengrun Wu, Xu Zhang
		Virtual reality (VR) is a hot-button technology topic well known to many research communities. Its technical progress is set to prompt advances in modern ophthalmology research. At present, many studies have shown VR has practical value for ophthalmologist training and eye disease research. This paper presents a systematic review of specific applications of VR in various fields of ophthalmology, analyzes the connection between VR and ophthalmology, and briefly summarizes the future direction of VR use in ophthalmology based on current results.
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		2021 Vol. 23 (8): 631-635 [Abstract] ( 421 ) [HTML 1KB] [ PDF 684KB] ( 13960 )

	636	Progress on Research of the Concentration Detection Method of Riboflavin in Corneal Collagen Cross-Linking
		Mengdi Yan, Jinhai Huang, Qinmei Wang, Rongrong Gao
		Corneal collagen cross-linking (CXL) can be used to treat progressive keratoconus, as well as infectious keratitis, keratolysis and corneal stroma edema. At present, riboflavin ultraviolet cross-linking is the commonly used clinical CXL scheme. The concentration and distribution of riboflavin in the cornea is one of the important factors affecting its efficacy and safety. Its main detection methods include fluorescence microscopy imaging, high performance liquid chromatography, spectrophotometry and noninvasive realtime detection of riboflavin concentration, observation of anterior segment slit lamp and imaging mass spectrometry by matrix-assisted laser desorption/ionization, etc. Different detection methods may lead to different results. This paper summarizes riboflavin concentration and its detection methods in current research.
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		2021 Vol. 23 (8): 636-640 [Abstract] ( 404 ) [HTML 1KB] [ PDF 801KB] ( 13784 )

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