Chinese Journal of Optometry Ophthalmology and Visual science

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Chinese Journal of Optometry Ophthalmology and Visual science

	2022 Vol.24 Issue.3 Published 2022-03-25

	Orignal Article Case Report Consensus Review

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		2022 Vol. 24 (3): 0- [Abstract] ( 212 ) [HTML 1KB] [ PDF 51005KB] ( 7717 )

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		2022 Vol. 24 (3): 0- [Abstract] ( 163 ) [HTML 1KB] [ PDF 578KB] ( 6171 )

Consensus

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		2022 Vol. 24 (3): 161-169 [Abstract] ( 204 ) [HTML 1KB] [ PDF 1063KB] ( 8846 )

	170	Boao Manifesto on Myopia Prevention and Control Version 3.0 (China Eye Valley)

		On December 1, 2017, the Chinese Optometric Association, Chinese Ophthalmological Society, Chinese Center for Disease Control and Prevention, and relevant experts together published the 2017 Boao Manifesto on Myopia Prevention and Control (hereafter referred to as "Boao Manifesto 2017"). It was the first recommendation to include myopia prevention and control into the chronic care management category where suggestions were proposed for visual health initiatives. These included increasing outdoor activities, easing the near-range workload of the eyes, standardizing the correction of myopia, scientifically controlling myopia, and attaching importance to the harm of high myopia. The Boao Manifesto 2017 has been well received ever since, pushing the release of the national Implementation Plan of Comprehensive Myopia Prevention and Control for Children and Adolescents and other measures. In 2018, President Xi Jinping gave a series of instructions on the issue of myopia among children and adolescents, proposing "together we should care for children' s eyes to give them a bright future". In August, the joint issuance of the Implementation Plan of Comprehensive Myopia Prevention and Control for Children and Adolescents by eight national ministries and commissions including the Ministry of Education elevated the undertaking to a national strategy In December 2019, the 2019 Boao Manifesto on Myopia Prevention and Control ("Boao Manifesto 2019") was formulated by a follow-up expert forum based on the progress made through the Implementation Plan of Comprehensive Myopia Prevention and Control for Children and Adolescents, the Boao Manifesto 2017, and an expert consensus from the Xiangshan Science Conference. The Boao Manifesto 2019 adhered to studies on the mechanisms of the cause and development of myopia and promoted "more outdoor activities and a reduced ocular workload" for myopia prevention and control. It also moved forward with a proposal for effective myopia screening for children and adolescents along with health management and safe correction, propelling the cultivation of special talents and the formulation of inspection standards for myopia prevention and control technologies, and recommending the dissemination of myopia knowledge. The Boao Manifesto 2019 also called for fully implementing assessment mechanisms from leading organizations, including the Ministry of Education and the National Health Commission, to ensure concrete results and deliver long-term benefits to keep myopia at bay or under control for youths in China Taken as a whole, the state's undertaking on myopia prevention and control for children and adolescents has yielded preliminary progress. To cope with the impact of COVID-19 and tackle the myopia problem of the young with tight and pragmatic efforts, in May 2021, fifteen departmental organizations, including the Ministry of Education, jointly compiled the "Bright Action Scheme for Myopia Prevention and Control for Children and Adolescents" (2021-2025) ("Bright Action Scheme"). To keep up with scientific progress on full myopia prevention and control and to update the prevention and treatment system for this eye problem among our youths therefore contributing to their vision health, the Boao Manifesto of Myopia Prevention and Control Version 3.0 (China Eye Valley) is issued as following. Since myopia is an issue concerning national strategy and people's well-being, closely related to national health, economic development, and social progress, the prevention and control of it becomes a systematic project involving basic theoretical research, practical transfer of clinical research, engineering technology development, and public policy formulation. In recent years, the Chinese government at all levels has issued a series of policies, systems, and implementation plans to enhance visual health. Professional research institutions have announced a number of standards, guidelines, and technical specifications for the prevention and control of myopia and schools, hospitals, families, and society have taken a range of actions to promote eye health. All sectors of society have jointly established a comprehensive prevention and control system for myopia among children and adolescents that has achieved remarkable results. However, tackling this issue for minors is an uphill battle, particularly due to the challenge of the COVID-19 outbreak. To ensure child and adolescent myopia prevention and control work to achieve results, the Bright Action Scheme is an opportunity to deepen various measures uninterruptedly to this end, and especially, in the study of the mechanisms of myopia, configure a featured, all-inclusive plan to make our efforts more targeted, science-based and long-lasting. Through in-depth discussions, all the involved experts reached the following consensus and suggestions: 1 Deepen the implementation of a national strategy to demonstrate the success of the Bright Action Scheme Given the new circumstances since the impact of the pandemic, the Ministry of Education and fourteen other departments and commissions put forward the Bright Action Scheme after the Implementation Plan issued in 2018, jointly conducting eight specific operations by focusing on key areas, core elements, and critical articulations of myopia prevention and control. In the process of advancing the Bright Action Scheme, it is proposed to: (1) implement a strict data reporting procedure to ensure the accuracy and thoroughness of the spring and autumn semester data collected for the Ministry of Education, providing scientific support for the prevention and control and accurate assessment of progress. (2) enhance the examination and approval mechanism with matching systems to safeguard the sustainability of the operation and a long-term mechanism to grapple with the myopia issue in youths. (3) recommend a national-level institution and commission to coordinate multiple departments and commissions. It is also suggested that the National Healthcare Security Administration, the Ministry of Industry and Information Technology, and other relevant organizations join this campaign. 2 Actively replicate the "double-reduction" policy to create a healthy ambience for eyes Uphold the Ministry of Education's "doublereduction" policy to reduce the burdens of homework and the eyes' workload with joint efforts made by home and school. Guidance should be given to families to specifically ease their children's academic burden by reducing indiscriminate extracurricular training and respecting their children's interests and hobbies, instead of cutting the burden at schools, which increases the stress at home. Improve lighting conditions in classrooms and homes, equip desks and chairs ergonomically for children and teenagers, and set up good indoor and outdoor environments for visual health; strengthen sports and improve sports facilities, especially for schools with after-class care and evening self-study, and make practical plans o ensure that students have two hours of outside activities per day. 3 Begin comprehensive screening and archiving data for an information-based prevention and control operation Launch scientific and efficient myopia screenings and eye health management for children and adolescents by establishing and improving standard procedures for their eye health archiving, myopia prevention and control, and health knowledge promotion. Make full use of big data, artificial intelligence, and the internet to make standardized and operable implementation plans. Optimize the information system for myopia prevention and control, support cohort studies on myopia among children and adolescents in order to achieve intelligent and personalized myopia solutions and early warning. It is suggested that a national big data management plan be established to standardize data storage, making the storage of big data from the nationwide screening for myopia safe and regulated, while analytically using the big data to guide the formulation and improvement of national myopia prevention and control policies. 4 Push prevention and control forward to curb the trend in the early onset of myopia Adopt vision screening as the starting point to push the prevention and control of myopia forward to achieve an annual coverage rate of eye health care and vision examinations of over 90% of children aged 0-6 years through early monitoring, early detection, early warning, and early intervention. The actual work should be conducted early and aimed at the young, taking precision measures for different school-age groups. Preschool is the critical period of refractive development when parents take the main responsibility for young children's eye health and should take the initiative to have vision screening included in newborn health examinations. For the 3-6 age group, the work is to control the time spent watching TV and playing on mobile phones. Since primary school is the golden period for the prevention and control of myopia, parents, children, and schoolteachers shall take principal responsibility by emphasizing efforts to develop healthy habits for eye use and to cultivate a wide range of sports hobbies. Middle school is a peak period for vision work, and youths themselves should be responsible for actively learning scientific knowledge about eye health, properly balancing work and rest and limiting electronic screen exposure. 5 Emphasize early intervention to avoid ocular damage resulting from high myopia (1) Further embrace vision screening to ensure the timely detection of risk factors and intervention as much as possible to avoid high myopia or even pathological myopia. (2) Deepen the public's scientific understanding of high myopia, raise awareness among high myopes to be alert, conduct routine follow-up examinations, avoid strenuous activities, and adapt certain medical strategies for timely intervention to prevent deterioration from the disease. 6 Advance appropriate technologies and make diagnosis and treatment standardized and safe (1) Enhance the management of myopia prevention and control in institutions by formulating basic clinical criteria for such institutions, including personnel qualification, site, equipment, and other requirements. (2) Enhance the training of ophthalmology professionals by promoting their professional education, improving the career development system for ophthalmologists, and establishing a series of development systems for professional titles in ophthalmology. (3) Improve an array of myopia prevention and control technical standards by developing and improving standards for tools in this regard, such as testing equipment, corrective instruments, lighting, desks, and chairs, to make these efforts effective and safe. Comprehensively optimize myopia prevention and control-related technical specifications, and help establish a number of institutions for ophthalmological standardization, testing, education, and training so that the entire industry can improve its development and quality. (4) Launch a national R&D strategy for myopia prevention and control by organizing joint efforts to research and develop medical devices, drugs and appropriate technologies with independent intellectual property rights to contain the myopia problem, breaking through existing bottlenecks to attain remarkable results. Meanwhile, by strengthening the industrial management of myopia prevention and control, to form a clear evaluation system, gradually taking devices and methods that control and mitigate myopia under the medical devices and clinical technologies management system, which should be at the disposal of medical institutions with prescription rights. 7 Enhance education outreach and improve the availability of the scientific knowledge of myopia prevention and control Promote the scientific knowledge of myopia prevention and control in the education system, guide relevant departments to identify substandard products for refractive correction and improper treatment methods, assist relevant market supervision and crack down on false marketing, inferior products and services so as to safeguard the scientific and authoritative reputation of anti-myopia knowledge. Formulate various models and efficient mechanisms conducive to the spread of knowledge on myopia prevention and control to make it more commonly accepted and easier to learn, building a strong atmosphere of national participation in this course. It is suggested to teach parents about myopia prevention and control in children, that regular popular science campaigns about eye care should be carried out, and that safety awareness in the battle against myopia should be raised, especially for standardized vision correction, which must be diagnosed and performed in qualified medical institutions, and that timely followup visits should be scheduled. 8 Strive for breakthroughs in scientific research and promote science-based prevention and control methods (1) Despite achievements made on the genetic and environmental mechanisms of myopia, further research, especially basic research, remains necessary for further breakthroughs. It is advised to conduct a large-scale (a magnitude of one million or more), multi-center research on the genetic mechanisms of myopia and environmental factors that affect myopia to identify the interaction between genetic and environmental risk factors, providing scientific guidance to battle myopia. (2) Formulate a proposal by exploring the mechanisms and operability of myopia prevention and control through outdoor sports and conducting largescale field studies to identify how outdoor activities can duly adjust eye development, then "prescribe" a practical guide for outdoor activities and suggest a timetable for it. (3) It is advised to conduct a large-scale investigation and research on the school classroom teaching environment (daylight, lamp light, desks, and chairs), learning situation, home eye vision workload, and living style (diet, sleep, etc.), to identify the impact of environments and postures on vision health as well as living habits, etc., on the cause of myopia, and quantify a criterion for eye use based on science. (4) Identify a more effective clinical prevention and control formula based on the latest myopia remedial medicine, optical methods and other realworld studies (RWS) as well as clinical intervention research. (5) Perform genealogical in-depth analysis of genomes in families with high myopia, guide early clinical intervention in susceptible populations, study effective medical methods and means of controlling high myopia, and establish a diagnostic model of early complications of high myopia based on multi-omics big data research and artificial intelligence to reduce the risk of inflicted blindness.
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		2022 Vol. 24 (3): 170-176 [Abstract] ( 225 ) [HTML 1KB] [ PDF 1101KB] ( 6350 )

Orignal Article

	177	Clinical Application of Multi-Mode Imaging Technology at Different Stages of Stargardt's Disease
		Lizhu Zhang, Hua Li, Yinyan Ma,et al
		Objective: To explore the imaging characteristics of a multi-mode imaging techniques at different stages of Stargardt's disease. Methods: This was a retrospective analysis of 28 cases (56 eyes) of patients with Stargardt's disease diagnosed in Affiliated Hospital of Yunnan University from May 2016 to August 2019. Fundus color photography, autofluorescence, fundus fluorescein angiography, optical coherence tomography (OCT), multicolor fundus imaging, OCT angiography (OCTA), and characteristics of various imaging examinations at different stages of the disease were summarized. Results: Color photography of the fundus showed that the atrophic lesions in the macular area gradually expand with the progression of the lesion, with color change at the posterior pole. Multicolor imaging combines multiple wavelengths to show the atrophy of cells and range with better contrast. The fundus autofluorescence showed the damage in the retinal pigment epithelium (RPE), and can clearly and visually show the size of the atrophy lesion in the macular area. Fundus fluorescein angiography can directly reflect the degree of damage in the retinal pigment epithelial layer and choroidal blood vessels in Stargardt's disease. With the development of Stargardt's disease, the atrophy of the RPE layer in the macular area was enlarged, and the retina and choroidal capillaries progressively atrophied. OCT provided image information of the fundus in different layers. As the lesion progressed, the peripheral nerve epithelial layer became thinner, the photoreceptors and RPE shrank and disappeared to varying degrees, and the choroidal capillary shrank from the depth and range of the layer. In the OCTA, we observed that as the lesion progressed, the vascular density at each level decreased. When the deep blood vessels of the retina were scanned, the choroidal blood vessels below were observed, and as the atrophy increased, the range of the exposed choroidal vessels increased.
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		2022 Vol. 24 (3): 177-185 [Abstract] ( 203 ) [HTML 1KB] [ PDF 27763KB] ( 7348 )

	186	Induced Pain Response in Patients with Diabetic Retinopathy during Panretinal Photocoagulation
		Chaojun Wang, Jintao Chen, Xiaobei Lyu
		Objective: To observe and evaluate the pain response in patients with diabetic retinopathy (DR) treated with panretinal laser photocoagulation (PRP). Methods: This was a retrospective case series study. Fifty-five patients aged 45-72 years (average age: 60.7±7.9 years old) with DR who were treated with PRP from July 2019 to December 2019 were recruited at Taizhou Municipal Hospital. After PRP, the numerical rating scale was used to evaluate the pain response, and the pain responses from peripheral retinal photocoagulation and posterior polar retinal photocoagulation were compared by Spearman correlation analysis. The pain score was statistically analyzed by the Fisher exact test. Results: In this study, age and gender had no effect on the patient's pain response (correlation coefficient r=-0.58, P=0.338; r=0.06, P=0.305). There was no significant difference in pain response between the four quadrants (upper, lower, nasal, temporal) for PRP (P=0.763), but the pain score of the posterior pole was lower than that of peripheral retina (P<0.001). Conclusions: The induced pain response of the posterior pole was milder than that of the peripheral retina in patients with diabetic retinopathy during PRP. The areas with no pain or relatively mild pain from laser photocoagulation should be preferentially considered by doctors.
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		2022 Vol. 24 (3): 186-190 [Abstract] ( 222 ) [HTML 1KB] [ PDF 1314KB] ( 6275 )

	191	The Impact of Diabetic Macular Edema on Vision-Related Quality of Life in Type 2 Diabetes
		Bo Zang, Liang Wen, Dong Li, et al
		Objective: To investigate the effect of diabetic macular edema (DME) on vision-related quality of life (VRQoL) in patients with type 2 diabetes. Methods: In this cross-sectional study, 187 patients with type 2 diabetes diagnosed with DME were included from June 2017 to May 2019. Questionnaires were completed to collect information about their sociodemographic and healthcare characteristics. VRQoL was assessed using the 25-Item National Eye Institute Visual Questionnaire (NEI-VFQ-25). NEI-VFQ-25 scores that were compared between groups using the Wilcoxon rank-sum test. The severity of DME in each eye was graded as mild, moderate, or severe. A generalized estimating equation model was used to assess the relationship between NEI-VFQ-25 scores and DME severity. Results: A total of 159 patients were recruited for the study eventually. Compared with patients without visual impairment (decimal visual acuity >0.3), those with visual impairment showed statistically significant compromises in terms of general vision, near activities, distance activities, social functioning, dependency, mental health, role difficulties, color vision, peripheral vision, and NEI-VFQ-25 composite scores (P<0.001). Compared with unilateral DME, bilateral DME was associated with greater dependency and role difficulties, compromised near and distance activities, and poorer general health, general vision, color vision, peripheral vision, mental health, and NEIVFQ- 25 composite scores (P<0.05). Scores for NEI-VFQ-25 on general health (Ptrend=0.013), general vision (Ptrend<0.001), near activities (Ptrend=0.001), distance activities (Ptrend=0.002), mental health (Ptrend=0.001), role difficulties (Ptrend=0.022), dependency (Ptrend=0.023), peripheral vision (Ptrend=0.041) and NEI-VFQ-25 composite (Ptrend=0.001) decreased gradually as DME severity increased. β coefficients were the largest for mental health (β=-15.01, 95%CI: -26.73- -3.30, P=0.012) and general vision (β=-13.66, 95%CI: -19.86- -7.47, P<0.001). Conclusions: DME severity significantly affects patients' VRQoL, particularly their general vision and mental health. NEI-VFQ-25 should be widely used to assess overall health in patients.
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		2022 Vol. 24 (3): 191-197 [Abstract] ( 229 ) [HTML 1KB] [ PDF 982KB] ( 6315 )

	198	Study on the Association between RASGRF1 Genetic Polymorphisms and Myopia Susceptibility in Gansu Province
		Xiangli Wang1, Liyuan Yang1, Yong Jin1, et al
		Objective: To analyze the association between the SNPs in the cis-regulatory elements of the RASGRF1 gene and myopia patients in Gansu province. Methods: In a prospective case-control study, 166 patients with high myopia (332 eyes), 92 patients with moderate and low myopia (184 eyes) and 77 people from a normal control population (154 eyes) were enrolled in the Optometry Center, Gansu Provincial Hospital from January 2018 to January 2019. Five SNPs were identified using ENCODE and GTEx, and candidate SNPs were genotyped using a multiple ligase detection reaction technique. A Chi-square test and unconditional logistic regression were used to analyze the differences in genotype frequency distribution between the myopia patients and the normal control population under different genetic patterns. Results:Rs8033417 T/C allele C significantly reduced the risk of myopia in the dominant mode (P=0.035). Rs8033417 had no significant correlation with the risk of moderate and low myopia in Gansu, but it significantly reduced the risk of high myopia (P=0.043, 0.032). Further bioinformatics analysis showed that rs8033417 T/C was correlated with the expression of RP11-16K12.1, the antisense long non-coding RNA of the RASGRF1 gene. Conclusion: Rs8033417 may be a genetic variation locus associated with myopia in Gansu province. It is speculated that rs8033417 may affect the risk of myopia, especially high myopia, by affecting the expression of the antisense long non-coding RNA gene RP11-16K12.1 and then regulating the expression of the RASGRF1 gene
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		2022 Vol. 24 (3): 198-207 [Abstract] ( 221 ) [HTML 1KB] [ PDF 1449KB] ( 6452 )

	208	Preliminary Screening and Analysis of Survival Prognostic lncRNA in Uveal Melanoma
		Huiping Shang1, Xiangxiang Lin2
		Objective: To construct a competing endogenous RNA (ceRNA) network of lncRNA-miRNA-mRNA, and to screen the long non-coding RNA (lncRNA) associated with the survival prognosis of uveal melanoma (UM). Methods: In this study, the expression data set of lncRNA was screened from the Tumor Genome Atlas Database through disease prognosis correlation analysis and a subcellular localization search of lncRNA using bioinformatics methods. Target microRNAs (miRNAs) corresponding to lncRNAs were found by the mircode database, targetscan database, and common miRNAs associated with UM prognosis were screened out by Venn analysis. The common miRNA-mRNA was screened from multiple databases simultaneously. Through KEGG enrichment and lncRNA-miRNA-mRNA network visualization, candidate lncRNAs related to the survival prognosis of UM were finally identified. Results: In the prediction of downstream target miRNAs and the functional genes of lncRNAs, 630 pairs of candidate miRNA-mRNA were identified. Based on the mechanism of gene expression regulation by ceRNAs, 9 lncRNAs that might play the role of ceRNAs were screened out. KEGG analysis showed that the downstream regulatory genes of lncRNAs were mainly enriched in the signaling pathways involved in the pathological process of tumors. SHNG6 may regulate miRNAs such as has-miR-214-5p, has-miR-214-3p, has-miR-let-7b-5p, and has-miR-let-7c-3p, the regulators of downstream functional genes BAX, IGF1R, KRAS, PIK3R1, PDGFD and so on. Conclusions: Through the mechanism of ceRNAs, lncRNAs regulate the expression of a series of oncogenes involved in tumor genesis and development, and affect the prognosis and treatment of UM. lncRNAs such as SHNG6 and LINC01278 may play an important role in its occurrence, development, migration and invasion.
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		2022 Vol. 24 (3): 208-215 [Abstract] ( 214 ) [HTML 1KB] [ PDF 1922KB] ( 6446 )

	216	The Influence of B/F Ratio and Central Corneal Thickness on the Consistency of SimK and TCRP
		Wanmin Wu, Feiyan Chai, Jiewei Liu
		Objective: To evaluate the effects of the back-front corneal radius ratio (B/F Ratio) and central corneal thickness (CCT) on the consistency of the simulated keratometry (SimK) and total corneal refractive power (TCRP) in normal corneal patients with cataract. Methods: This retrospective analysis focused on the clinical data of 202 patients with cataracts and a normal cornea who underwent phacoemulsification with intraocular lens implantation in Shanxi Eye Hospital from September 2019 to January 2020. Corresponding measurement results of preoperative Pentacam HR anterior segment analyzer were analyzed, including the corneal SimK, TCRP, B/F Ratio, CCT and △Km (△Km=SimK-TCRP), which is the difference between SimK and TCRP, in the central 4 mm area of the pupil. Only 1 eye from each patient was selected, and if the patient had binocular surgery, a random eye was chosen by tossing a coin. Then, a paired samples t-test on SimK and TCRP data was conducted on the measurement results of the Pentacam HR anterior segment analyzer. Pearson correlation analysis was applied to evaluate the correlation of CCT and B/F Ratio with △Km, followed by the establishment of the multiple linear regression equation. Results: The mean values of corneal SimK, TCRP, △Km, B/F Ratio and CCT in 202 patients were 44.45±1.51 D, 44.34±1.59 D, 0.11±0.30 D, 82.04%±1.52%, and 537±30 μm, respectively. △Km=0 D accounted for 12.4% of the difference between SimK and TCRP, which was significant (t=5.2, P<0.001). The B/F Ratio and CCT were negatively correlated with △Km (r=-0.22, P<0.001; r=-0.172, P=0.014). The linear regression equation of the B/F Ratio, CCT and △Km was △Km=6.882-6.549×B/F Ratio-0.003×CCT (R2=0.13; F=14.90, P<0.001). Conclusions: There is a divergence between SimK and TCRP, which is negatively correlated with the B/F Ratio and CCT. The SimK will exceed the TCRP which can cause the hyperopia shift based on △Km, if the B/F Ratio and CCT are too small.
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		2022 Vol. 24 (3): 216-220 [Abstract] ( 296 ) [HTML 1KB] [ PDF 0KB] ( 730 )

	221	Clinical Efficacy of Ab Externo Microcatheter-Assisted Trabeculotomy in Childhood Glaucoma
		Weiwei Liu1, Xiaoyuan Yang2, Conghui Ma2, et al
		Objective: To investigate the clinical efficacy of ab externo microcatheter-assisted trabeculotomy (MAT) in childhood glaucoma and the open range of the incised trabecular meshwork one year after surgery. Methods: This was a prospective clinical study. 21 patients (28 eyes) with childhood glaucoma, aged 4-16 years, were enrolled in the glaucoma center of Henan Eye Hospital from January 2018 to December 2019. All patients underwent ab externo MAT. Patients were followed up for one year after surgery. The best corrected visual acuity (BCVA), intraocular pressure (IOP), usage of anti-glaucoma medication, the condition of the anterior chamber angle and complications were observed and analyzed. A paired t test, Wilcoxon signed-rank test, Kruskal-Wallis H test, and Spearman rank correlation were used to analyze the data. Results: All patients underwent ab externo MAT successfully. Surgery on 16 patients (22 eyes) was performed with full incisions and surgery on 5 patients (6 eyes) was performed with a subtotal incision. Preoperative BCVA (median: 0.8, range: 0.00-2.00) was not significantly different from postoperative BCVA (median: 0.75, range: 0.00-1.60) (Z=-1.41, P=0.157). Preoperative and postoperative IOPs were 30.4±4.8 mmHg (1 mmHg=0.133 kPa) and 14.1±4.5 mmHg, respectively. The difference was statistically significant (t=14.11, P<0.001). The amount of the postoperative anti-glaucoma medication (median: 0, range: 0-3) was significantly lower than preoperative levels (median: 3, range: 1-4) (Z=-4.35, P<0.001). At the last follow-up, the open range of the incised trabecular meshwork median was 302.5° (range: 70°- 360°). Fifteen cases (21 eyes) and 4 cases (5 eyes) achieved complete and qualified success; 2 cases (2 eyes) failed. The open range medians of the incised trabecular meshwork of the 3 groups were 330°(210°- 360°), 205°(180°-225°), and 85°(70°-100°) at the last visit. The open ranges of the different groups were statistically significant (χ2=15.20, P=0.001). The open range of incised trabecular meshwork was negatively correlated with intraocular pressure (r=-0.82, P<0.001). Conclusions: Ab externo MAT is effective for treating childhood glaucoma,and the postoperative open range of the incised trabecular meshwork is an important factor affecting the prognosis for children.
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		2022 Vol. 24 (3): 221-226 [Abstract] ( 216 ) [HTML 1KB] [ PDF 0KB] ( 688 )

	227	Analysis and Countermeasures of the Current Status of Ethics Committees in Eye Hospitals
		Chenxiao Wang1, Dan Miao2, Peiqiu Gu1, et al
		Objective: To detect the main problems in the formation of ethics committees in eye hospitals in China and to provide relevant solutions for them by investigating the current status and understanding the establishment and operation at these hospitals. Methods: This was a crosssectional study. Convenience sampling combined with online distribution was adopted to investigate 33 ethics committees in eye hospitals all over the country from October 2018 to October 2019. The contents included the profile, formation, and operation of these ethics committees. Valid questionnaire data were selected and analyzed using descriptive statistical analysis. Results: A total of 21(64%) eye hospitals had established ethics committees, and the other 12(36%) had not. Of the 21 hospitals with ethics committees, 12 hospitals had independent ethics committees,9 hospitals had full-time secretaries or staff, 4 hospitals did not have outside committee members, 7 hospitals had not established the presiding censorship, 4 hospitals had not conducted annual or regular follow-up reviews, and 3 hospitals had not organized ethics-related training for their researchers. Conclusions: There are problems in ethics committees in eye hospitals, such as chaotic subordinate relationships, inappropriate membership, inadequate training of committee members, and a lack of the whole course of ethics censorship. Specialized eye hospitals still need to strengthen the establishment of ethics committee setup, personnel composition, effective guaranteed conditions, effective training mechanisms, and normalized ethical review procedures. Mean while, it is recommended to establish a collaborative ethics censor alliance in eye hospitals, to actively promote a more normalized formation of ethics committees in the alliance, and to revise and improve standard operating procedures. While increasing the efficiency of ethical reviews, there are benefits in promoting the development, normalization and high quality of these ethics committees in eye hospitals.
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		2022 Vol. 24 (3): 227-230 [Abstract] ( 218 ) [HTML 1KB] [ PDF 785KB] ( 6193 )

Case Report

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		2022 Vol. 24 (3): 231-234 [Abstract] ( 170 ) [HTML 1KB] [ PDF 14797KB] ( 7117 )

Review

	235	Research Progress on the Safety of the Clinical Application of Orthokeratology
		Wenchen Zhao, Xiangui He, Xun Xu
		At present, the effectiveness of orthokeratology lenses in controlling the progression of myopia has been preliminarily recognized, and it is one of the common clinical methods in the treatment of myopia. Orthokeratology is mainly used in children and adolescents, so there should be persistent concern about safety. This article reviews the information about orthokeratology's safety from related literature. Microbial keratitis is the most serious adverse reaction. Other common adverse reactions include corneal stromal infiltration, corneal epithelium damage, conjunctivitis, corneal pigment ring, in addition, changes in lacrimal film, endothelial cells, corneal thickness and corneal biomechanical properties may also bring potential safety concerns. There are few concordant conclusions on etiology, mechanism, incidence and long-term effects, which are needed to be confirmed by further studies. Currently, in view of the occurrence of myopia at a young age and the tendency of myopia to develop into high myopia, orthokeratology is an effective means of clinical myopia control, and has beneficial application values. But it is still important to pay attention to its application safety and evaluate its long-term effects.
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		2022 Vol. 24 (3): 235-240 [Abstract] ( 258 ) [HTML 1KB] [ PDF 875KB] ( 6959 )

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