The Myopia Control in Real Clinical Practice: The Results of an Expert Study

The article presents expert study results about myopia control. The study was conducted by Russian eye care practitioners in 2019.Purpose. to summarize the views of eye care practitioners on the problem of myopia control in Russia.Methods. The study was conducted by mailing (sending) questionnaires to practitioners. The questionnaire contained 9 questions. Base questionnaire was developed by British Contact Lens Association (BCLA) for global study, translated into Russian and updated with items of interest to Russian practitioners.Results. 356 questionnaires were received and processed. Concern increasing frequency of pediatric myopia was highest (9.0 ± 0.08 on a 10 point scale). Orthokeratology was perceived to be the most effective method of myopia control, followed by myopia control soft contact lenses and increased time outdoors. Perceived effectiveness rated as percentage was 50.7 ± 1.6 %, 44.9 ± 1.8 % и 42.9 ± 1.7 % respectively. Perifocal spectacles correction was perceived to be the most effective method in the Southern area of Russia (56.8 ± 11.1 %), atropine — in the Northwestern Federal District (39.5 ± 7.1 %), scleroplasty — in the Far East (55.1 ± 7.6 %). Under-correction was perceived to be the least effective method in all areas (11.6 ± 1.0 %). Increased time outdoors was a priority for most practitioners (on average 94.0 ± 7.8 prescriptions per month by one practitioner). Practitioners prescribed single vision spectacles as the primary mode of correction for myopic patients (47.2 ± 3.6 prescriptions per month by one practitioner). Phenylephrine instillation was used often (49.4 ± 3.6 prescriptions per month by one practitioner). This trend was in most areas. Vision therapy was used most frequent in Siberia and the Urals and in the Far East (70.4 ± 11.5 и 20.0 ± 5.2 prescriptions per month by one practitioner respectively). The most common reasons practitioners gave for not adopting myopia control strategies were: they were felt to be uneconomical (42.1 %); they considered there to be inadequate information about the modalities (22.2 %). 45 % practitioners from the Far East called the last reason the main one. 42.9 % practitioners from Northwestern Federal District did not believe that these are any more effective methods then single vision correction.Conclusion. The active promotion and introduction into everyday clinical practice of myopia control methods that have proven to be highly effective could help reduce the frequency of progressive and degenerative myopia

Prismatic correction in the presence of acutely acquired esotropia with diplopia

Purpose. To analyze changes in binocular vision functions in patients with acutely acquired esotropia after preoperative correction by prisms. Material and methods. The study included 16 patients with acutely acquired esotropia with diplopia. Depending on the tactics of preoperative case management, two groups were distinguished. Eight patients with acutely acquired esotropia of the Bielshowsky type at the age from 12 to 35 years old (mean age, M±sd – 17.5±1.9 years). This group underwent preoperative prismatic correction of diplopia and the deviation angle, as well as eight patients with acutely acquired esotropia of the Bielshowsky type at the age from 12 to 35 years (18.5±1.9 years). Patients in this group underwent surgery without prior prismatic correction. Fresnel prisms were used to select and assign prismatic correction. The patients were monitored dynamically. Results. In the course of treatment 1 group (prismatic correction followed by surgical correction) according to the indicator of Worth's four-dot test color test, revealed a statistically significant increase in the frequency of value of the binocular single vision (p=0.041), the frequency of the presence of stereovision according to the Fly-test (p=0.013), fusion amplitude in the distance by 1.11 times (p=0.033) and near fusion amplitude by 1.15 times (p=0.003). Significant differences between the groups were observed only in the frequency of stereovision presence according to the Fly-test after treatment, which was 2.0 times higher in group 1 (p=0.041). Conclusion. Prismatic correction in combination with surgical treatment had better curative benefits than surgery itself in improving both binocular and stereoscopic visual functions. Key words: acutely acquired esotropia, diplopia, binocular vision, stereoscopic vision, Fresnel prisms

Safety and efficacy of 0.02% and 0.01% atropine on controlling myopia progression: a 2-year clinical trial

Four hundred myopic children randomly received atropine 0.02% (n = 138) or 0.01% (n = 142) in both eyes once-nightly or only wore single-vision spectacles (control group) (n = 120) for 2 years. Spherical equivalent refractive error (SER), axial length (AL), pupil diameter (PD), and amplitude of accommodation (AMP) were measured every 4 months. After 2 years, the SER changes were − 0.80 (0.52) D, − 0.93 (0.59) D and − 1.33 (0.72) D and the AL changes were 0.62 (0.29) mm, 0.72 (0.31) mm and 0.88 (0.35) mm in the 0.02% and 0.01% atropine groups and control group, respectively. There were significant differences between changes in SER and AL in the three groups (all P < 0.001). The changes in SER and AL in the 2nd year were similar to the changes in the 1st year in the three groups (all P > 0.05). From baseline to 2 years, the overall decrease in AMP and increase in PD were not significantly different in the two atropine groups, whereas the AMP and PD in the control group remained stable (all P > 0.05). 0.02% atropine had a better effect on myopia control than 0.01% atropine, and its effects on PD and AMP were similar to 0.01% atropine. 0.02% or 0.01% atropine controlled myopia progression and AL elongation synchronously and had similar effects on myopia control each year.

Diplopia after Isolated Inferior Orbital Wall Fracture According to the Computed Tomography Findings

Purpose: To investigate the postoperative changes in diplopia and evaluate factors that affect diplopia after isolated inferior orbital wall fracture.Methods: A retrospective study was conducted on 200 patients who underwent reconstruction surgery for isolated inferior orbital wall fracture between March 2001 and December 2020. Diplopia was categorized into peripheral, central, and full-degree types based on the history and binocular single vision. The natural course of diplopia was analyzed pre-operatively and at 1 day, 6 weeks, and 6 months postoperatively. We analyzed the orbital computed tomography images to determine fracture size (small, medium, or large), fracture site (anterior, middle, posterior, or mixed), extraocular muscle (EOM) size (swelling or deformity), EOM site (incarcerated or prolapsed), and EOM tenting.Results: Diplopia was seen in 144 out of 200 patients (72.0%) before surgery; peripheral diplopia was seen in 57 patients (39.6%), central diplopia in 46 (24.3%), and full-degree diplopia in 20 (13.9%). Pre-operative diplopia differed according to the pre-operative limitation of range of motion (LOM) (p < 0.001) and EOM site (p = 0.022). Pre-operative diplopia type differed according to the LOM direction (p = 0.018) and EOM size (p = 0.020). Diplopia persisted in 33 patients (16.5%) 6 months after the surgery. Recovery was faster in patients with peripheral diplopia compared to those with central or full-degree diplopia.Conclusions: The presence of diplopia was associated with the pre-operative LOM and EOM site but the type of diplopia was associated with LOM direction and EOM size. These factors can be used to predict the progression of diplopia in patients with isolated inferior orbital wall fracture.