Xue Li

Background/Objectives: Estimate the prevalence of myopia among children aged 6–17 years in county and rural areas across seven geographically diverse provinces of China, and identify demographic, behavioral, and geographic factors associated with myopia, with particular focus on urban–rural and ethnic differences. Methods: A multi-stage stratified cluster sampling design was employed. Seven provinces were randomly selected, one from each of seven geographical regions of China (Southeast, North, Central, South, Southwest, Northwest, and Northeast). In each province, one rural county was randomly chosen. Within each county, one urban survey site (county town) and one rural survey site (village) were selected. From each site, one primary school and one junior high school were included. In each school, approximately 20 ± 2 students per grade (grades 1–9) were recruited. Uncorrected visual acuity and non-cycloplegic autorefraction were measured. Multivariable generalized linear mixed models (GLMM) with random intercepts at the class level were used to identify factors associated with myopia, accounting for the cluster sampling design. Results: The overall myopia prevalence was 42.9% (urban 49.6%, rural 36.0%). In the multivariable GLMM, educational stage was the strongest risk factor (grades 7–9 vs. 1–3: OR = 5.54). A significant district × ethnicity interaction was found only for Mongolian children: rural residence was strongly protective (OR = 0.19) compared to Han (OR = 0.65), and the ethnic advantage disappeared in county towns. Only 14.2% of myopic students had adequate correction. Conclusions: In conclusion, myopia is highly prevalent and severely under-corrected in rural China. Educational pressure is the main risk factor, and the rural protective effect is strongest in Mongolians but erodes with urbanization. Urgent public health actions, including vision screening, affordable spectacles, and lifestyle preservation, are needed to address this growing burden.

Introduction: This study investigated the effects of the short and long-term wearing of spectacle lenses with highly aspherical lenslets (HAL) on visual field sensitivity in children with myopia. Methods: This prospective case‒control study included 80 children with myopia aged 13–18 years, whose spherical equivalent refractive error (SER) ranged from ﹣1.00 D to -7.25 D. Forty children wore single vision lenses (SVL) habitually, while the remaining 40 children had been wearing HAL lenses for five years. Static visual field sensitivity was assessed using automatic static perimetry (Goldman III target) involving 76 white light points within a 30° radius visual field. After a practice round without the test lenses, measurements were taken while the participants wore either test HAL lenses or SVL in a randomized order. All assessments were conducted on the right eye while the left eye was occluded. Results: Statistical analysis using generalized estimating equations (GEEs) revealed no significant main effects of group ( p = 0.17) or lens ( p = 0.52), nor significant interaction effect between these factors ( p = 0.81). When the test SVL were used, the difference in mean sensitivity between the HAL and SVL groups (HAL group minus SVL group) was 0.7 ± 1.19 dB (ranging from ﹣ 2.5 dB to 4.8 dB). When the test HAL lenses were used, a mean difference of 0.7 ± 0.91 dB (ranging from ﹣ 0.6 dB to 3.3 dB) was observed between the two groups. Visual field reliability parameters (fixation, false-positive, and false-negative error ratios) were similar between conditions (all p > 0.05). Conclusion: Neither short nor long-term wearing of spectacles with HAL affected full-field static visual field sensitivity within the 30° radius visual field in children with myopia aged 13 to 18 years, supporting their safety profile in controlling myopia.

Purpose This study evaluated the efficacy of spectacle lenses with highly aspherical lenslets (HALs) for myopia control in clinical practice. Methods A retrospective cohort study with propensity score matching (PSM) was conducted using patients from the Eye Hospital, Wenzhou Medical University from July 1, 2020 to March 15, 2023. Participants wore either HALs or single-vision lenses (SVL). PSM was used to balance confounding factors between groups. Efficacy was assessed by comparing myopia progression (non-cycloplegic refractive error) and axial length (AL) elongation between the two groups. Result A total of 3419 HALs and 10,846 SVL users aged 3–18 years were included (mean SER: −2.92 ± 1.82 D, range +0.50 to −9.00 D). After PSM, 2050, 1524, 807 and 433 pairs were retained in the 0.5, 1, 1.5 and 2 year sub-datasets, respectively. Additionally, a sub-dataset containing AL measurement from 406 pairs at 1 year was analysed. In the matched dataset without AL, the HAL group exhibited significantly slower myopia progression both at 1 year (−0.33 vs. −0.63 D) and 2 years (−0.68 vs. −1.10 D) compared with the SVL group. Furthermore, in the 1-year matched dataset that included AL, the HAL group showed significantly less AL elongation (0.19 mm) and myopia progression (−0.37 D) than the SVL group (0.37 mm, 0.69 D). Subgroup analysis indicated that the reduction in myopia progression was evident amongst children aged 3–14 years with low and moderate myopia. However, no significant difference was observed in the 15–18 year-old subgroup with low-to-moderate myopia or in the high myopia subgroup (all p > 0.05). Conclusion This real-world study found that wearing HALs effectively reduced myopia progression and axial elongation in children aged 3–14 years with low-to-moderate myopia. However, the efficacy of HALs was inconclusive in children aged 15–18 years and limited in those with high myopia.

Background: To investigate visual cognitive functions, including visual attention, executive function, and visual working memory, in children with anisometropic amblyopia versus those with normal vision.Methods: Thirty‐five children with anisometropic amblyopia and 34 with normal vision participated. Visual acuity, stereoacuity, and contrast sensitivity were measured, followed by the Cambridge Neuropsychological Test Automated Battery's six subtests for cognitive evaluation. Visual attention was assessed using reaction time (RTI) and rapid visual information processing (RVP). Executive function was evaluated through the multitasking test (MTT). Visual working memory was assessed with spatial working memory (SWM), delayed matching to sample (DMS), and paired association learning (PAL), all under binocular conditions.Results: The amblyopia group exhibited longer reaction and movement times in the RTI than the control group (p < 0.01). A trend towards lower RVP A' scores, reflecting reduced ability to detect target sequences, appeared in the amblyopia group (p = 0.056). Amblyopic children demonstrated a lower multitasking cost in the MTT compared with the control group (p = 0.04). As difficulty increased in the SWM (from four to six boxes), amblyopic children revisited more (p = 0.01). In the DMS task, while no differences were observed across all delay times (p = 0.55), amblyopic children performed significantly worse than the control group under the 12‐second delay (p = 0.04). In the eight‐pattern PAL condition, the amblyopia group made more errors (p = 0.01).Conclusions: Children with anisometropic amblyopia performed poorly on neuropsychological tests, particularly visual attention and working memory, but outperformed the control group in multitasking. These findings highlight the broader cognitive impacts of anisometropic amblyopia beyond vision.

Purpose: To investigate changes in peripheral eye length (PEL) and peripheral refraction (PR) in myopic children after wearing spectacle lenses with highly or slightly aspherical lenslets (HAL or SAL) for 2 years. Methods: We recruited 170 children aged 8 to 13 years with myopia between −0.75 diopters (D) and −4.75 D. Participants were randomized to wear HAL, SAL, or single vision spectacle lenses (SVL). PEL and PR were measured at 0° central and 15° and 30° in the nasal and temporal retina every 6 months for 2 years. The relative PR (RPR) was calculated by subtracting central from peripheral values. Results: PELs significantly increased with time (all P < 0.001), with the greatest elongation in the SVL group and the least in the HAL group. In the SVL and SAL groups, axial length elongated faster than the periphery. Whereas in the HAL group, N30 elongated faster than other PELs, axial length elongated less than the periphery. With time, the PR became more negative (all P < 0.001), with the most negative changes in the SVL group and the least negative changes in the HAL group. RPR became more hyperopic in the SVL and SAL groups, but less hyperopic in the HAL group (all P < 0.001). Conclusions: Over the 2-year myopia progression, steeper retina and greater peripheral hyperopic defocus were found in the SVL group. In the SAL group, changes were attenuated. In the HAL group, the retina flattened and peripheral defocus became less hyperopic. Translational Relevance: HAL and SAL lenses had little impact on PEL elongation.

Purpose: The aim of this study was to evaluate the short‐term effects of peripheral gradient high‐addition multifocal soft contact lenses (MFSCLs) and orthokeratology (Ortho‐K lenses) on visual performance in myopic children. Methods: Thirty myopic children participated in this prospective study. Each participant wore different sets of lenses in the following sequence: single‐vision spectacles (SVSPs) as a control, MFSCLs and Ortho‐K lenses. Ocular aberrations, topography, high‐contrast visual acuity (HCVA), low‐contrast visual acuity (LCVA) and accommodation of the right eye were measured with each type of correction on a different day. Results: Compared with SVSPs, high‐addition MFSCLs and Ortho‐K lenses significantly increased all items of aberrations (all p < 0.05) except trefoil ( p = 0.17). MFSCLs induced less coma, root mean square of the third‐order aberration (RMS3) and higher order aberrations than Ortho‐K lenses (all p < 0.05). No significant difference in HCVA was found across the three correction types ( F = 1.19, p = 0.39). In terms of LCVA, MFSCLs performed significantly poorer than SVSPs (difference, 0.16 logMAR; p = 0.001) and slightly worse than Ortho‐K lenses (difference, 0.08 logMAR; p = 0.35). No significant difference in decentration was found between the two types of contact lenses, and no associations were observed between decentration and visual acuity at both high‐ and low‐contrast levels (all p > 0.05). For MFSCLs, decentration was positively related to coma ( r = 0.43, p = 0.02) and RMS3 ( r = 0.44, p = 0.02), which was not the case for Ortho‐K lenses. Accommodative facility was worse with MFSCLs than Ortho‐K lenses ( p = 0.001). Conclusion: Multifocal soft contact lenses differed from Ortho‐K lenses in aberration profile and LCVA, although decentration was similar. Decentration <1 mm had minimal influence on both HCVA and LCVA for either type of correction, but significantly increased third‐order aberrations for MFSCLs, but not Ortho‐K lenses.

Purpose. To evaluate the influence of spectacle lenses with highly aspherical lenslets (HAL) on binocular vision and accommodation in myopic children with intermittent exotropia (IXT) and compare the changes after wearing HAL in binocular vision and accommodation in myopic children with or without IXT. Method. Forty myopic subjects aged 8–12 years were recruited: 20 with IXT and 20 visually normal children. Stereoacuity, phoria, accommodative facility, fusional vergence, vergence facility, near point of convergence, amplitude of accommodation, and accommodative response (AR) were measured by wearing HAL or single vision spectacle lenses (SVL) in a random order after adapting for 20 minutes. Accommodative microfluctuation (AMF) was defined as the standard deviation of AR. Changes in binocular vision and accommodation after wearing HAL were compared between the two groups. Results. No significant differences were found in binocular vision after wearing HAL versus SVL in either group (all ). A greater AMF was found after wearing HAL than after wearing SVL in both groups (0.04 D, 95% confidence interval (CI), 0.03 to 0.05 D, for the IXT group; 0.05 D, 95% CI, 0.03 to 0.07 D, for the visually normal group); however, the other accommodation parameters did not change significantly (all ). There were no differences in the changes after wearing HAL in any parameter between the two groups (all ). Conclusion. HAL did not significantly change the binocular vision and accommodation for myopic children with or without IXT except for AMF in the short term.

Objectives: To investigate the short- and long-term effects of myopia control spectacle lenses with highly aspherical lenslets (HAL) and slightly aspherical lenslets (SAL) on visual function and visual quality using data obtained from a randomized controlled clinical trial. Methods: This was a prospective, randomized, controlled, and double-blinded study; 170 myopic children aged 8–13 years were randomly assigned to the HAL, SAL, or single-vision spectacle lenses (SVL) groups. Distance and near visual acuity (VA) at high (100%) and low (10%) contrast in photopic and scotopic conditions, near phoria, stereoacuity, and accommodative lag, microfluctuations (AMFs), amplitude (AA) were measured after wearing lenses for 10 min, 6 months, and 12 months. Results: In total, 161 subjects completed all follow-up in 12 months and were included in the analysis. After 10 min of wearing, the HAL and SAL groups had lower scotopic and low-contrast VA than the SVL group (decreased 0.03–0.08 logMAR and 0.01–0.04 logMAR in different VAs in the HAL and SAL groups, respectively, all P < 0.05). The reduction in VA was recovered at 12 months as the HAL and SAL groups exhibited significant VA improvements, and the VA was not different among the three groups (all P > 0.05). The HAL and SAL groups had significantly larger AMFs than the SVL group (HAL vs. SAL vs. SVL: 0.21 ± 0.08 D vs. 0.16 ± 0.05 D vs. 0.15 ± 0.06 D at baseline, 0.19 ± 0.07 D vs. 0.17 ± 0.05 D vs. 0.13 ± 0.07 D at 12 months, all P < 0.05). There were no significant differences in accommodative lag, AA, or phoria between the groups (all P > 0.05). The HAL and SAL groups had reduced stereoacuity compared to the SVL group at baseline (70’ vs. 60’ vs. 50’, P = 0.005), but no difference was observed at 12 months (70’ vs. 70’ vs. 70’, P = 0.11). Conclusions: HAL and SAL have no significant influence on accommodation and phoria except had larger AMF than SVL. Scotopic VA and low-contrast VA are reduced with short-term HAL and SAL use but recovered to be at same level with the SVL after 1 year of use. Trial registration Chinese Clinical Trial Registry: ChiCTR1800017683. Registered on 9 August 2018. http://www.chictr.org.cn/showproj.aspx?proj=29789

Purpose: To investigate whether the treatment zone (TZ) decentration in orthokeratology (OK) lenses affects retinal expansion in Chinese children with myopia. Methods: Children aged 8 to 13 years ( n = 30) were assessed over 13 months comprising 12 months of OK lens wear followed by discontinuation of lens wear for 1 month. Corneal topography was measured at 0, 1, 3, 6, 9, 12 and 13 months. TZ decentration of the OK lens was calculated, and subjects were subdivided into a small decentration group (group S) and a large decentration group (group L) based on the median value of the weighted average decentration (d _ave ). Central axial length (AL) and peripheral eye lengths (PELs) at the central retina, as well as 10°, 20° and 30° nasally and temporally were measured at 0 and 13 months under cycloplegia. Second‐order polynomial ( y = ax ² + bx + c) and linear fits ( y = Kx + B) were applied to the peripheral relative eye length (PREL), and the coefficients ‘a’ and ‘K’ were used to describe the shape of the eye. Results: Mean AL growth for one year was 0.28 ± 0.17 mm. In a multiple linear regression model, AL elongation was related to the baseline age ( β = −0.41, p = 0.01) and the d _ave ( β = −0.37, p = 0.03) ( R ² = 0.34, p = 0.002). When compared with smaller d _ave (0.45 ± 0.15 mm), a larger d _ave (0.89 ± 0.17 mm) was associated with slower ocular growth (central: 0.20 ± 0.13 mm vs. 0.35 ± 0.17 mm, p = 0.009; 10° nasal: 0.26 ± 0.18 mm vs. 0.45 ± 0.21 mm, p = 0.02; 10° temporal: 0.17 ± 0.14 mm vs. 0.32 ± 0.19 mm, p = 0.02) and more oblate retina shape (‘a’: −0.13 ± 0.02 vs. −0.14 ± 0.02, p = 0.02; K _nasal : 0.35 ± 0.11 vs. 0.39 ± 0.09, p = 0.02; K _temporal : −0.42 ± 0.08 vs. −0.46 ± 0.08, p = 0.004). Conclusions: Greater TZ decentration with the use of OK lenses was associated with slower axial growth and a more oblate retinal shape. TZ decentration caused local defocusing changes, which may inhibit myopic progression. These findings may have important implications for improving optical designs for myopia control.