Chinese Journal of Optometry Ophthalmology and Visual science

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Chinese Journal of Optometry Ophthalmology and Visual science

	2022 Vol.24 Issue.12 Published 2022-12-25

	Orignal Article Case Report Review Lecture

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		2022 Vol. 24 (12): 0- [Abstract] ( 169 ) [HTML 1KB] [ PDF 2379KB] ( 4274 )

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		2022 Vol. 24 (12): 0- [Abstract] ( 158 ) [HTML 1KB] [ PDF 83264KB] ( 4659 )

Lecture

	881	New Understanding of the Influence of Ocular Surface Microenvironment and Tear Film Homeostasis on Visual Quality
		Lin Lin1,Yun Feng2,Yao Fu3,et al
		The Chinese Dry Eye Expert Consensus released in 2020 added the concept of ocular surface microenvironment to the definition of dry eye for the first time. The tear film instability and ocular surface microenvironmental imbalance was emphasized to play a critical role in the pathogenesis of dry eye, and visual dysfunction was defined as one of the important outcomes of dry eye. In order to strengthen the understanding of the new consensus, promote the development and transformation of related basic and clinical research, and provide more detailed diagnosis and treatment recommendations for dry eye patients, many experts in the field of dry eye held a panel discussion in Ji'an on March 26, 2021 and analyzed the current research status and existing problems of the ocular surface microenvironment and tear film homeostasis. In that meeting, opinions and recommendations were put forward based on new understandings of the two key factors in the mechanism of dry eye, the relationship with visual quality, clinical methods of evaluation and treatment, and new directions for future development.
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		2022 Vol. 24 (12): 881-887 [Abstract] ( 203 ) [HTML 1KB] [ PDF 2283KB] ( 4500 )

Orignal Article

	888	Clinical Study of Photoshop Software Guided Femtosecond Laser Assisted DLK for the Treatment of Keratoconus
		Xiaolin Qi, Miaolin Wang, Xiao Lin,et al
		Objective: To observe the effectiveness and accuracy of femtosecond laser-assisted deep lamellar keratoplasty (DLK) for the treatment of keratoconus guided by Photoshop software personalized design.Methods: In this prospective, noncomparative and interventional study, patients with advanced keratoconus that were scheduled to undergo DLK at Eye Hospital of Shandong First Medical University from December 2016 to December 2018 were continuously enrolled and divided into the experimental group and the control group. For patients in the experimental group, the corneal diameter was measured with Photoshop software before surgery and then the diameter of the corneal implant bed/graft was designed individually, while in the control group, the diameter of the corneal implant bed/graft was uniformly set at 7.9/8.2 mm. Indicators including the best corrected visual acuity (BCVA), mean corneal curvature, spherical equivalent and average astigmatism were observed 12 months after surgery. Independent samples t-test was used for statistical analysis of the data. Results: A total of 72 patients (72 eyes) were included, including 40 cases in the experimental group and 32 patients in the control group. In the experimental group, 6 patients had a corneal implant bed/graft diameter of 7.9/8.2 mm, 18 patients had a diameter of 8.1/8.4 mm and 16 patients had a diameter of 8.3/8.6 mm. One week after the operation, the actual diameter of corneal graft measured by Photoshop software in the experimental group was 8.4±0.1 mm, with no significant difference compared with that personalized designed preoperatively (t=-0.47, P=0.710). Twelve months after the operation, the best corrected visual acuity (LogMAR) of the experimental group was 0.44卤0.24, which was better than that of the control group 0.58±0.30 (t=-2.19, P=0.030). The average astigmatism of the experimental group was 3.96±2.68 D, more stable than that of the control group 6.30±4.71 D (t=-2.65,P<0.001).Complications such as Descemet's membrane rupture, suture loosening, suture-induced corneal neovascularization and immune rejection did not occur in all the patients included. Conclusions: The method using Photoshop software to individually design the corneal bed/graft diameter achieves high accuracy and predictability and can significantly improve the refractive state of patients with keratoconus after DLK.
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		2022 Vol. 24 (12): 888-893 [Abstract] ( 121 ) [HTML 1KB] [ PDF 8905KB] ( 4615 )

	894	Evaluation of Optical Performance of IOL in Vitro by Optical Bench
		Guangliang Cao1,Xiaomin Liu2,Zheng Fan2, et al
		Objective: To evaluate the optical performance of intraocular lens in vitro by optical bench. Methods: In this experimental study, the intraocular lens (IOL) with different optical performance was tested in vitro by optical bench OptiSpheric? IOL PRO Ⅱ . The spectral transmittance of Vivinex, SN60WF and ZCB00 were compared. The modulation transfer function (MTF) under different degrees of decentration and tilt were compared for Vivinex, A1-UV, SN60WF and ZCB00. The USAF resolution test charts and MTF of AT LISA tri, Diff-aAY, SBL-3, Symfony and ZCB00 were compared at the best distance, intermediate and near focus. The data were analyzed by one-way ANOVA and independent sample t-test. Results: Compared with non-blue-light filtering IOL ZCB00, blue-light filtering IOL Vivinex and SN60WF could significantly reduce the blue light transmission at the wavelength of 400-500 nm. In the wavelength range around 400 nm, the spectral transmittance of Vivinex was less than SN60WF, the difference was statistically significant (t=-15.65, P<0.001); in the wavelength range around 480 nm affecting melatonin secretion, the spectral transmittance of Vivinex was greater than SN60WF, the difference was statistically significant (t=11.04, P<0.001). When the IOL was decentrated or tilt in the same extent, the MTF values at 100 lp/mm spatial frequency of Vivinex and A1-UV were better than ZCB00 and SN60WF, the difference was statistically significant (all P<0.05). The best distance focus, ZCB00 had the highest MTF value and the best USAF resolution; the best intermediate focus, Symfony had the highest MTF value and the best USAF resolution; the best near focus, Diff-aAy has the highest MTF value and the best USAF resolution. When the defocus degree of monofocal IOL exceeded 0.50 D, the visual quality of resolving object details would decline more than that of multifocus IOL without defocus. Conclusions: The spectral transmittance of Vivinex and SN60WF are different. Vivinex and A1-UV are more tolerant to decentration and tilt than ZCB00 and SN60WF. Different types of multifocal IOLs have different optical quality at the distance, intermediate and near focus.
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		2022 Vol. 24 (12): 894-901 [Abstract] ( 187 ) [HTML 1KB] [ PDF 9492KB] ( 4687 )

	902	Correlation between Functional Optical Zone and Corneal Epithelial Remodeling after Small Incision Lenticule Extraction for Correcting Myopia
		Zhe Yang, Likun Xia
		Objective: To explore the size of functional optical zone (FOZ) and the relationship between the FOZ and the change in corneal epithelial thickness and corneal shape after small incision lenticule extraction (SMILE). Methods: In this prospective clinical study. A total of 69 myopic patients (135 eyes) who underwent SMILE in Shengjing Hospital of China Medical University were selected consecutively from June 2021 to December 2021. According to the predicted spherical equivalent (SE), treated eyes were divided into two groups: a high myopic group (2-5 mm, >5-7 mm areas of the two groups increased and the corneal epithelial thickness in the 7-9 mm area was slightly decreased compared with preoperative ones. The change of corneal epithelial thickness in the 0-2 mm and >2-5 mm area of the high myopia group were larger than that of the moderate and low myopia group, and the difference between two groups was statistically significant (t=2.43, P=0.016; t=2.71, P=0.008). There was no significant difference in corneal curvature and corneal Q value between two groups before surgery (t=0.79, P=0.430; t=0.13, P=0.894). Three months after surgery, the corneal curvature of two groups was significantly decreased and the corneal Q value was significantly higher than that before surgery. The changes in the high myopia group were greater than those in the moderate and low myopia group, and the difference between two groups was statistically significant (t=-6.26, t=10.86; both P<0.001). Three months after the operation, the size of the FOZ was positively correlated with the expected SE by surgery (r=0.51, P<0.001), and was negatively correlated with the change of corneal curvature and corneal Q value (r=-0.48, r=-0.39; both P<0.001), and negative correlated with the change of corneal epithelial thickness (r0~2 mm=-0.37, r>2~5 mm=-0.32; both P<0.001). Three months after surgery, there were statistically significant differences in total high-order aberration, spherical aberration and vertical Coma between the two groups (t=6.46, t=5.04, t=-4.91; both P<0.001), and FOZ was significantly negatively correlated with ?HOA, ?SA, ?V-Coma (r=-0.59, r=-0.59, r=-0.59; both P<0.001). Conclusions: The FOZ after SMILE was lower than that expected before operation, the larger the preoperative SE, the more obvious postoperative corneal epithelial remodeling, and the smaller the postoperative FOZ, the more the increase of corneal high-order aberration. Corneal epithelial remodeling and changes in corneal aspheric morphology and curvature can affect the size of postoperative FOZ after SMILE.
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		2022 Vol. 24 (12): 902-909 [Abstract] ( 124 ) [HTML 1KB] [ PDF 2889KB] ( 4471 )

	910	Automatic Diagnosis of Stages 1-3 Retinopathy of Prematurity Based on Deep Convolutional Neural Network
		JiaLiu1,QinglanPu1,PengLi2, et al
		Objective: The aim of the system is to research the automatic diagnosis of stages 1-3 of retinopathy of prematurity(ROP) using Deep Convolutional Neural Networks(DCNN). Methods: In this retrospective study, using 12 219 retinal images of preterm infants, which collected from January 2019 to December 2020 at the Department of Ophthalmology, Jiaxing Maternity and Child Health Care Hospital, we constructed a retinal images dataset for Ophthalmology of Ophthalmology, preterm infants. Based on the segmented demarcation lines or ridge, the region of interest (ROI) were calculated, features from the ROI segmentated images were extracted and the classifier was trained using a five-fold cross-validation method to automatically diagnose stages 1-3 ROP. The performance of the DCNN and analyzed the consistency with clinical diagnosis results on the test data set was evaluated. Results: The trained system achieved an average accuracy of 98% for all the four categories. The sensitivity and specificity of the system reached 0.975 7 and 0.975 6, when diagnosing non-ROP images; 0.922 1 and 0.983 7, when diagnosing stage 1; 0.933 1 and 0.988 6, when diagnosing stage 2. At the same time, the sensitivity and specificity for the diagnosis of stage 3 ROP images were as high as 0.910 2 and 0.992 8. The Kappa value of the system for the diagnosis was 0.905 9, which was close to perfect agreement with the clinic diagnosis. Conclusion: The system based on DCNN, trained using features extracted for segmented ROI images, could diagnose automatically stages 1-3 ROP with a high accuracy.
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		2022 Vol. 24 (12): 910-916 [Abstract] ( 128 ) [HTML 1KB] [ PDF 7945KB] ( 4728 )

	917	A Bibliometric Visual Analysis of Atropine Delaying Myopia in the Past Ten Years
		Xixiang Wei, Hui Yang, Zheng Fu,et al
		Objective: Based on the collection of Web of Science database, using the method of bibliometrics to analysis the status and hot spots of atropine on the field of myopia prevention and control. Methods: In this literature research, articles about atropine in the field of myopia prevention and control collected from the core database of Web of Science (WOS) in recent ten years (2011—2021) were analyzed. By using CiteSpace software and bibliometric method, the visual analysis was performed from the perspectives of annual publication, sources of countries and institutions, distribution of published journals and keywords with the strongest citation bursts, and analysis of co-cited article. Results: A total of 290 articles were retrieved. The country publish the most of articles was China, followed by the United States. The research institutions publish the most articles were National Eye Center of Singapore, and then the National University of Singapore and Hong Kong Polytechnic University. The journals publish the most articles were《Ophthalmic and Physiological Optics》and《Investigative Ophthalmology and Visual Science》. The research trends range from early animal studies focusing on the pharmacology and safety of atropine, to clinical randomized controlled trials in mid-term and followed a series of meta-analysis based on these controlled trials. At present, the research focuses on the effect of atropine on choroidal thickness. Conclusions: CiteSpace is applied to analyze the related articles concerning the application of atropine on the field of myopia prevention and control, which reveals the main research results in this field as well as the countries and institutions cooperating with each other and the research trends in this field. Atropine has great application potential in myopia prevention and control, and it still has high research value.
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		2022 Vol. 24 (12): 917-925 [Abstract] ( 126 ) [HTML 1KB] [ PDF 4249KB] ( 4559 )

	926	Effects of Corneal Incision in Different Directions on Tear Film Stability and Corneal Nerve Repair after Cataract Surgery
		Xi Zou, Zhinan Liu, Dong Zhou, et al
		Objective: To investigate the effects of transparent corneal incision in different directions on tear film stability and corneal nerve injury repair in patients with age-related cataract (ARC) and diabetic cataract (DC). Method: In this prospective clinical study, 67 patients (80 eyes) of cataract underwent phacoemulsification combined with intraocular lens (IOL) implantation from September 2021 to December 2021 in the Third People's Hospital of Changzhou. Thirty-five patients (40 eyes) of ARC were randomly divided into groups Ⅰ , Ⅱ ; 18 patients (20 eyes) of ARC in group Ⅰ were treated with upper transparent corneal incision; 17 patients (20 eyes) in group Ⅱ were treated with temporal transparent corneal incision. Thirty-two patients (40 eyes) of DC were randomly divided into groups Ⅲ , Ⅳ ; 16 patients (Twenty eyes) of DC in group Ⅲ were treated with upper transparent corneal incision; 16 patients (20 eyes) of DC in group Ⅳ were treated with temporal transparent corneal incision. Tear film break-up time (BUT), tear meniscus height (TMH) and Schirmer I test (S Ⅰ T) were examined before operation, 1 week, 1 month and 3 months after operation; anterior segment optical coherence tomography (AS-OCT) was performed at 1 week, 1 month and 3 months after operation; corneal confocal microscopy (CCM) was performed at 1 and 3 months after operation. The t-test was used to test BUT, TMH and S Ⅰ T in each group after and before operation. One-way ANOVA was used to compare differences between age, corneal nerve fiber density (CNFD) and corneal nerve branch density (CNBD) of each group. Nonparametric Mann-Whitney test was used to compare corneal nerve fiber length (CNFL) and cornenl nerve fiber width (CNFW). Results: There were significant differences in BUT, TMH and S Ⅰ T at 1 week and 1 month after operation compare with before operation (P<0.05); The values of BUT, TMH and S Ⅰ T in group I were higher than those in group III, group II than those in group IV one week after operation (P<0.05), but the difference disappeared 1 month after operation. One month after operation, there were few integral long nerve fibers in all patients. Three months after operation, integral long nerve fibers and nerve fiber branch connection were seen in all four groups. Compared with 1 month after operation, CNFL, CNFD and CNBD increased in the four groups at 3 months after operation (P<0.05). One month after operation, CNFL, CNFD and CNBD in group IV were lower than those in group III (P<0.05). One month and three months after operation, the value of CNFL, CNFD and CNBD in group I were higher than those in group III, group II was higher than those in group IV, and the difference was significant (P<0.05). Conclusion: During cataract surgery, the corneal nerve injury of the upper corneal incision in DC patients was lighter than those of the temporal incision. The repair of tear film injury and corneal nerve injury in DC patients was slower than those in ARC patients.
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		2022 Vol. 24 (12): 926-932 [Abstract] ( 165 ) [HTML 1KB] [ PDF 3267KB] ( 4421 )

	933	Analysis on the Difference of Binocular Adjustment Parameters in Patients with Different Degrees of Myopic Anisometropia
		Pengcheng Yue, Qiuxuan Du, Ling Kong,et al
		Objective: To explore the relationship between the difference of accommodation between two eyes and the degree of anisometropia in patients with myopic anisometropia. Methods: In this cross-sectional study, a total of 123 myopic patients (246 eyes) who were admitted to the Qingdao Eye Hospital of Shandong First Medical University aged from 8 to 21 years old were collected from November 2019 to June 2021. According to the difference of equivalent spherical refraction (SE) between two eyes, there were 29 cases in ametropia group (SE difference ≤ 0.25 D), 62 cases in low anisometropia group (1.00 D ≤ SE<2.50 D) and 32 cases in high anisometropia group (SE difference ≥ 2.50 D). All patients meet the binocular best corrected visual acuity (BCVA) ≥ 0.8 and the original data were perfect. The monocular and binocular negative relative accommodation (NRA), accommodative reaction (AR), positive relative accommodation (PRA), accommodative facility (AF) and monocular accommodative amplitude (AMP) were measured by comprehensive optometry. The refraction between the two eyes was determined after optometry under cycloplegic. The differences of interocular accommodation related parameters and the difference of binocular accommodation parameters among the three groups (binocular accommodation parameter difference=myopia diopter higher eye accommodation value-myopia diopter lower eye accommodation value) were analyzed. One-way ANOVA was used to compare the accommodation parameters among the three groups, and Spearman correlation analysis was used to analyze the relationship between the degree of anisometropia and interocular accommodation parameters and the difference between binocular accommodation parameters. Results: There was no statistically significant difference between the three groups in the difference between the NRA, PRA, AR, AF values and the difference between the interocular NRA and AF values (all P>0.05). AR values were -0.03±0.25 in the ametropia group, 0.20±0.30 in the low anisometropia, and 0.26±0.36 in the high anisometropia groups respectively, with statistically significant differences (F=7.36, P<0.001). The PRA difference between the three groups was 0.04±0.27, 0.34±0.72, 0.66±0.63, with statistically significant differences (F=7.47, P<0.001). The difference in AMP was statistically significant (F=9.25, P<0.001) among the three groups (0.41±0.86, -1.07±1.53, and -1.02±2.18, respectively). Multiple comparison showed that there were significant differences in AR difference, PRA difference and AMP difference between anisometropia group and low anisometropia group and high anisometropia group (all P<0.05). In addition, SE differences were associated with lower intensity of AR and AMP differences (r=0.22, P=0.014; r=0.36, P<0.001). Conclusion: The value of accommodation parameters between the eyes of patients with different degrees of myopia refractive variance is different, and there is a correlation of the difference between the difference of AR and AMP with the degree of myopia refractive variance between the eyes.
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		2022 Vol. 24 (12): 933-937 [Abstract] ( 112 ) [HTML 1KB] [ PDF 2295KB] ( 4286 )

	938	Evaluation and Comparison of Visual Acuity and Dynamic Visual Acuity after Three Kinds of Intraocular Lens Implantation in Cataract Patients
		Shurui Ke, Can Li
		Objective: To evaluate and compare monocular visual acuity and dynamic visual acuity after implantation of trifocal intraocular lens, bifocal intraocular lens, or extended depth of focus intraocular lens in cataract patients. Methods: This was a prospective clinical study. Eight-one cataract eyes of 65 patients which had cataract surgery in the ophthalmology department of the First Affiliated Hospital of Chongqing Medical University from January 2020 to January 2021 were involved. Thirty-three eyes were implanted with ZMB00 IOL as the bifocal group, 20 eyes implanted with AT Lisatri. 839MPIOL as the trifocal group and 28 eyes implanted with ZXR00 IOL as the EDOF group. The uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), uncorrected distance dynamic visual acuity (UDDVA), uncorrected intermediate dynamic visual acuity(UIDVA), and uncorrected near dynamic visual acuity (UNDVA) (log MAR) were assessed 3 months postoperatively. Data were assessed with a Chi-square test, analysis of variance, and Kruskal-Wallis H test. Results: The UDVA and UNVA of the three groups were not significantly different; the UIVA of the three groups was significantly different (H=23.13, P<0.001). The EDOF group was significantly better than the bifocal group (P<0.001); the trifocal group was significantly better than the bifocal group (P=0.016); there was no significant difference between the EDOF group and the trifocal group. There was no significant difference in the UDDVA of the three groups at 4 and 8 fps, but at 12 and 24 fps (H=10.96, P=0.004; H=11.52, P=0.003). The bifocal group was better than the trifocal group (H=-16.21, P=0.003; H=-17.98, P=0.004), and the EDOF group significantly better than the trifocal group (H=12.67, P=0.030; H=-16.48, P=0.009). The difference between the bifocal group and the EDOF group was not statistically significant. There was no significant difference in the UIDVA of the three groups at 8 fps, but at 4, 12, and 24 fps (H=8.17-11.36, P<0.05): At 4, 12 fps, the EDOF group was better than the bifocal group (H=14.61, P=0.013; H=-14.52, P=0.009), and the difference was not statistically significant with the trifocal group; at 24 fps, the EDOF group was better than the bifocal group and the trifocal group (H=15.31, P=0.008; H=-16.60, P=0.027). The UNDVA of the three groups was significantly different at 4, 8, 12, and 24 fps (H=11.25-17.61, P<0.05): at these four speeds, the EDOF group was better than the bifocal group (H=12.71-17.87, P<0.05) and trifocal group (H=-23.04--15.87, P<0.05), but there was no significant difference between bifocal group and trifocal group. Conclusions: Patients implanted with trifocal IOL and EDOF IOL can obtain same UDVA, UIVA, UNVA, while bifocal IOL has relatively poor UIVA. The three IOLs can obtain same DVA at long distance and low speed; however, at medium or short distance, especially at high speed, the DVA of EDOF IOL is better than the other two.
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		2022 Vol. 24 (12): 938-944 [Abstract] ( 120 ) [HTML 1KB] [ PDF 2318KB] ( 4382 )

Case Report

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		2022 Vol. 24 (12): 945-946 [Abstract] ( 151 ) [HTML 1KB] [ PDF 13772KB] ( 4616 )

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		2022 Vol. 24 (12): 947-949 [Abstract] ( 167 ) [HTML 1KB] [ PDF 10233KB] ( 4645 )

Review

	950	Advances in Optical Coherence Tomography in Amblyopia
		Zhicheng Xu, Xuefeng Shi
		Amblyopia is a developmental visual impairment caused by abnormal visual experience during a critical period, which results in lower best corrected visual acuity of one or both eyes than that of normal children of the corresponding age, without obvious organic lesions in the eye. It is generally believed that the pathogenesis of amblyopia is mainly located in the visual cortex. In recent years, optical coherence tomography (OCT) as an advanced in vivo imaging technology has encouraged a great deal of research on the morphological structure of retina, and has also been applied to the research field of amblyopia. Different research groups have successively reported the findings of structural changes in the retina and choroid in the amblyopic eye by OCT technology. Here we will review these new progresses.
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		2022 Vol. 24 (12): 950-955 [Abstract] ( 143 ) [HTML 1KB] [ PDF 2225KB] ( 4293 )

	956	Research Progress of Low-Concentration Atropine for Myopia Control in Children
		Luling yang, Huibin Lyu, Yueguo Chen,et al
		With the increasing incidence of myopia in children and a younger age of myopia onset, myopia has become a global public health problem, which needs to be addressed immediately. Effective interventions for myopia control include bifocal glasses, multi-focal glasses, orthokeratology lens and pharmacologic, etc. Recently, atropine eye drops have obtained widespread concern for its effectiveness in suppressing the myopia progression. As low-dose atropine can effectively control myopia progression and axial growth, with significantly less adverse events such as photophobia and blurred near vision compared to higher concentration preparation, low-concentration atropine has become one of the important research areas for myopia prevention and control in children. This article summarizes the research progress of lowconcentration atropine in myopia control of children.
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		2022 Vol. 24 (12): 956-960 [Abstract] ( 144 ) [HTML 1KB] [ PDF 2250KB] ( 4825 )

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