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Purpose: Scleral perforation during strabismus surgery is considered a rare complication that usually results in no significant consequences. The true rate of such occurrences is difficult to evaluate due to the young age of most patients and the occult nature of most events. This study aimed to evaluate long-term retinal changes under the suture areas in patients post-strabismus surgery as presumed signs indicating past undiscovered scleral perforations. Methods: The study population consisted of patients with a follow-up of at least 10 years post-strabismus surgery at the [redacted for review] Eye Institute and with no known retinal conditions as well as with wide fundus visibility. We performed slit-lamp retinal periphery examinations in search of retinal scars or changes at the suture sites. Results: Seventy-one eyes from 43 patients were examined. The mean age (±standard deviation [SD]) at the time of examination was 27 years (±14), and the mean number of strabismus surgeries per patient was 1.8. Three of the examined eyes showed retinal changes at the suture sites, yielding an overall incidence rate of suspected perforation/penetration of 4.2% per eye and 3.6% per strabismus surgery. These three patients were all asymptomatic. Conclusion: Scleral perforations during strabismus surgeries could remain unnoticed since a comprehensive exam of the retinal periphery is challenging in young children, especially during the postoperative period. While retinal changes caused by inadvertent scleral perforations appear to have no clinical sequelae in a time frame of 10 years, such changes should be noted for future fundoscopic examinations.

To determine whether the COVID-19 pandemic restrictions among 5-year-old kindergarten children in Israel affected the prevalence of uncorrected myopia. A nationwide community-based study assessed and compared the prevalence of uncorrected myopia in 101,626 kindergarten children, aged 5 years, from 2013 to 2023. The photo-screening was conducted annually across Israeli kindergartens, utilizing PlusOptiX S12, to obtain refractive data. Among the 101,626 kindergarten children, the prevalence of uncorrected myopia increased approximately three-fold following COVID-19 confinement, rising from 3.7 to 12.6%. For over a decade, linear regression analyses consistently indicated that annual myopia odds increased by 1.2 (95% CI 1.19–1.22). In comparing the uncorrected myopia prevalence in the years before and after the COVID-19 pandemic (2018–2019 versus 2023), the risk of myopia in 2023 was 2.72 times higher (Prevalence Odds Ratio; 95% CI 2.47–2.99). The highest prevalence of uncorrected myopia was in 2023 (12.6%), of which 7.84% were mild myopia, 4.61% moderate myopia, and 0.14% severe myopia. The mean spherical equivalent declined from 0.58 D pre-pandemic to 0.26 D in 2023. This research identified an increase in uncorrected myopia prevalence after the COVID-19 pandemic, potentially driven by altered environmental factors and behavioral habits.

This study reports the 1-year results of a 2-year multicenter prospective randomized, controlled, double-masked trial aimed to determine whether Myoslow lenses (Crystal Optic Industries Ltd., Acre, Israel) based on the peripheral defocus mechanism of action can slow myopia progression. Children aged 6–12 years with myopia between − 1.00 D and − 5.00 D and astigmatism ≤ 1.50 D ( N  = 121) received either Myoslow (treatment) or single vision (control) spectacle lenses. The mean change in spherical equivalent refractive error from baseline was − 0.46 D in the treatment group and − 0.65 D in the control group ( p  = 0.015), with myopia progression slowed by 0.19 D (29.5%). The mean change in axial length was 0.27 mm in the treatment group and 0.36 mm in the control group ( p  = 0.002), with myopia progression slowed by 0.09 mm (23.6%). Younger age was the only covariate significantly associated with the treatment effect across both outcome measures, with a significant correlation between the treatment effects in the two measures ( R  = − 0.71, p  < 0.001). Treatment was well tolerated, with only one ocular complication: myopia progression (0.08%). Myoslow lenses effectively and safely slow myopia progression in children, with greater benefit in younger ages compared to single vision lenses.

Young children exhibit poorer visual performance than adults due to immaturity of the fovea and of the fundamental processing of visual functions such as masking and crowding. Recent studies suggest that masking and crowding are closely related to the size of the fundamental processing unit-the perceptive field (PF). However, while it is known that the retina and basic visual functions develop throughout childhood, it is not clear whether and how changes in the size of the PF affect masking and crowding. Furthermore, no retinal and perceptual development data have been collected from the same cohort and time. Here we explored the developmental process of the PF and the basic visual functions. Psychophysical and imaging methods were used to test visual functions and foveal changes in participants ranging from 3-17 years old. Lateral masking, crowding and contrast sensitivity were tested using computerized tasks. Foveal measurements were obtained from spectral-domain optical coherence tomography (OCT). The children patterns below 6 years exhibited high crowding, while the expected facilitation was found only at a larger target-flanker distance than required for children above 6 years, who exhibited the typical adult. Foveal thickness and macular volume for the children below 6 years were significantly lower than for the older group. Significant correlation was found for contrast sensitivity, foveal thickness and macular volume with age and between contrast sensitivity and foveal thickness. Our data suggest that the developmental processes at the retina and visual cortex occur in the same age range. Thus, in parallel to maturation of the PF, which enables reduction in crowding, foveal development contributes to increasing contrast sensitivity.

PurposeTo explore what the current worldwide preferred practice patterns of pediatric ophthalmologists are to decrease myopia progression among their patients.MethodsA questionnaire was sent to all members of supranational and national pediatric ophthalmology and strabismus societies.ResultsThe questionnaire was fully completed by most respondents 90.10% (847 of 940 responses). Fifty-seven percent (457) routinely treat to decrease myopia progression. The most common parameter to initiate treatment was a myopic increase of 1 diopter/year or more (74.8%, 246). Seventy percent (345) prescribed eye drops. Atropine 0.01% was the most popular (63.4%, 277) followed by atropine 1% (10.9%, 48) and atropine 0.5% (8.9%, 39). Eighty-six percent (394) of the respondents advised to spend more time outdoors, to reduce the amount of time viewing screens (60.2%, 277), and cutback the use of smart phones (63.9%, 294).ConclusionsMost pediatric ophthalmologists treat to decrease myopia. They employ a wide variety of means to decrease myopia progression. Atropine 0.01% is the most popular and safe modality used similarly to recent reports. However, there is no consensus when treatment should be initiated. Further prospective studies are needed to elucidate the best timing to start treatment and the applicability of recent studies in the Asian population to other ethnic groups. This will improve the ability to update pediatric ophthalmologist with evidenced-based treatment options to counter the myopia epidemic.

Purpose. To provide a bibliographical-historical perspective and main interest in the field of myopia. Methods. In this bibliographic study, the Web of Science Database was searched from 1999 to 2018. Recorded parameters included journal name, impact factor, year and language, number of authors, type and origin, methodology, number of subjects, funding, and topics. Results. Epidemiological assessments were the leading type of article (28%), and half of the papers were prospective studies. The number of citations for multicenter studies was significantly higher (P=0.034). The articles were published in 27 journals, with the majority in Investigative Ophthalmology, Vision Sciences (28%), and Ophthalmology (26%). Etiology, signs and symptoms, and treatment equally encompassed the topics. Papers addressing etiology, specifically genetic and environmental factors (P=0.029), signs and symptoms (P=0.001), and prevention, specifically public awareness (47%, P=0.005), received significantly more citations. Treatment to decrease myopia progression was a much more common topic (68%) than refractive surgery (32%). Optical treatment was the most popular modality (39%). Half of the publications came from 3 countries: the United States (US), Australia, and Singapore. The highest ranked and cited papers came from the US (P=0.028) and Singapore (P=0.028). Conclusions. To our knowledge, this is the first report of the top-cited articles on myopia. There is a predominance of epidemiological assessments and multicenter studies originating from the US, Australia, and Singapore, assessing etiology, signs and symptoms, and prevention. These are more frequently cited, emphasizing the great interest in mapping the increase in the incidence of myopia in different countries, public health awareness, and myopia control.

Background The ultra-Orthodox Jewish community has a unique lifestyle including minimal outdoor activity and intense, prolonged nearby work, beginning at a very young age. Their prevalence of myopia is extremely high. This paper provides a unique insight into the attitudes of this community towards myopia. Methods Ultra-Orthodox Jewish parents of children who came to the pediatric ophthalmology clinic in one tertiary care and two community centers in ultra-Orthodox-oriented cities were given a questionnaire. Demographic information, along with myopia prevalence in the family, was gathered. In addition, their attitudes and common knowledge regarding myopia were investigated. Results 161 questioners were collected, mostly completed by mothers ( n  = 110, 68%). The average number of children per family was 6 (range 1–16). In 148 families (92%) at least one of the parents has myopia. The average parent refraction was − 4.5 diopters (range − 0.5 to 15 diopters). Out of 935 children, 410 (44%) wore glasses. Twelve parents (7%) believe that myopia is a disease and 94 (58%) reported that they are concerned because their child wears glasses. Twenty-four (15%) believe that glasses are a sign of a high education level. Regarding treating myopia progression, 144 (89%) think that myopia progression should be treated, but only 36 (22%) are aware of the available treatments for it. Conclusion This study examines an insular community with a very high incidence of myopia. In this community most parents think that myopia progression should be treated but most of them are unaware of the currently available treatments.

Purpose: To summarize the characteristics and trends of interest in retinoblastoma (Rb) in the last 50 years. Methods: The Web of Science Database was used to find all studies focused on Rb published from 1970 to 2018. The term “retinoblastoma” was used to search for the 100 most cited records. Results: The mean number of citations was 153.55 ± 88.9. The majority were from the United States (US) (n = 68). Drs. Shields authored 38% of the papers. The number of citations per year was positively correlated with the number of authors, r = 0.26 (p = 0.008). The number of patients was significantly associated with the number of citations per year (p = 0.012). Although papers on radiotherapy were the most common, publications about intra-arterial chemotherapy (IAC) were associated with 88.3% more citations per year (p = 0.031) and papers on intravenous chemotherapy (IVC) were associated with 40.3% more citations per year (p= 0.04). Review and meta-analysis studies had a higher median of citations (10.5) than interventional (6.4) or observational (5.2) studies. Conclusions: This study compiles a comprehensive analysis of the most-cited articles on Rb. Studies with a higher number of citations per year were associated with IAC, which emphasizes the significance of the advances in Rb treatments that allow for the saving of eyes and vision as well as lives. Review studies had more citations than observational or interventional studies. More citations were associated with a larger number of authors or more reported patients per paper. These findings highlight the importance of collaborations to achieve relevant, high-quality research of Rb.