Purpose: Although there is a high prevalence of keratoconus in the Middle East including Israel, limited data is available describing first‐degree relatives of patients with sporadic keratoconus (KC) using Scheimpflug imaging. The purpose of this study is to accurately phenotype first‐degree relatives of patients with sporadic KC in Israel using corneal tomography, which may help determine the genetic aetiology of KC. Methods: First‐degree relatives ( N = 56) of 16 KC probands participated in this prospective case‐control study. Healthy controls ( N = 96) were from a previous study. Autorefraction, visual acuity, slit lamp biomicroscopy, retinoscopy, subjective refraction and Scheimpflug imaging (CSO Sirius Topographer) of keratoconus patients and their first‐degree relatives were evaluated. The worse eye was used for KC and KC suspects. The main outcome measure was prevalence of abnormal corneal topography and tomography parameters, which was compared between first‐degree relatives vs controls. p values < 0.05 were considered significant. Results: KC ( N = 2) or KC suspect ( N = 8) was diagnosed in 18% (95% CI 8‐28%) of the first‐degree relatives. At least one abnormal corneal parameter was evident in 34% of first‐degree relatives, while this was significantly lower for controls (14%, χ ² _{(1, N  = 152)} = 8.8, p = 0.01). Qualitative analysis showed KC first‐degree relatives had significantly more abnormal anterior corneal topography patterns than controls (34% vs 17%, χ ² _{(1, N  = 152)} = 5.9, p = 0.02). For first‐degree relatives, sex was not a factor influencing prevalence of corneal abnormalities (18% for both men and women, χ ² _{(1, N  = 56)} = 0.0, p = 1.0). A significant correlation was found for first‐degree relatives between age and most corneal parameters, while this was not evident for the control group. Conclusions and Relevance: Eye care practitioners should consider first‐degree relatives of patients with KC at moderate risk for the disease and/or corneal abnormalities.

Studies using questionnaires report that COVID-19 restrictions resulted in children spending significantly less time outdoors. This study used objective measures to assess the impact of pandemic-related restrictions on children’s behavior. A total of 19 healthy 8–12-year-old boys were observed before and during social restriction periods. Of these, 11 boys were reassessed after restrictions were lifted. For each session, Actiwatches were dispensed for measures of time outdoors, activity, and sleep. Changes overall and by school status were assessed using signed-rank test and Wilcoxon rank sum tests. During restrictions, children spent significantly less time outdoors (p = 0.001), were less active (p = 0.001), and spent less time engaged in moderate-to-vigorous physical activity (p = 0.004). Sleep duration was not significantly different between sessions (p > 0.99), but bedtime and wake time shifted to a later time during restrictions (p < 0.05 for both). Time outdoors and activity returned close to pre-pandemic levels after restrictions were lifted (p > 0.05 for both). Children’s behaviors significantly changed during the COVID-19 pandemic. The reduction in outdoor light exposure is of importance due to the role of light in the etiology of myopia and vitamin D production. The reduction in physical activity may have negative health effects in terms of obesity and depression, although further research is required to ascertain the long-term effects.

Supplemental digital content is available in the text. SIGNIFICANCE: Evidence supporting the contributions of near work in myopia is equivocal. Findings from this pilot study suggest that a high prevalence of myopia in ultra‐Orthodox boys may be attributed to intense near work at school and learning to read in preschool at an early age. PURPOSE: This study aimed to assess factors that may influence myopia in three groups of Jewish boys with different educational demands. METHODS: Healthy ultra‐Orthodox, religious, and secular Jewish boys (n = 36) aged 8 to 12 years participated. Refractive status, education, time spent reading and writing, and electronic device use were assessed using a questionnaire, and time outdoors and physical activity were assessed objectively using an Actiwatch. Data were analyzed with χ ² and Kruskal‐Wallis tests with Bonferroni post hoc comparisons. RESULTS: Ultra‐Orthodox (n = 14) and religious (n = 13) children had greater myopia prevalence compared with secular children (n = 9; P =. 01), despite no differences in parental myopia. Actigraph data showed that there were no differences in activity ( P =. 52) or time spent outdoors ( P =. 48) between groups. Ultra‐Orthodox children learned to read at a younger age and spent more hours at school ( P <. 001 for both). All groups engaged in a similar amount of near work while not in school ( P =. 52). However, ultra‐Orthodox boys had less electronic device use than did religious ( P =. 007) and secular children ( P <. 001). CONCLUSIONS: This pilot study demonstrates that ultra‐Orthodox, religious, and secular children have distinct educational demands but similar time outdoors, physical activity, and near work while not in school. The findings suggest that near work at school and/or learning to read in preschool at an early age may contribute to previously reported differences in refractive error between groups. However, conclusions should be confirmed in a larger sample size.

Preschool vision screening is essential for the early detection and treatment of eye and vision problems.The rate of parental adherence to referrals for comprehensive examination was assessed and f...

To determine the prevalence of refractive errors in Jewish and Arab college students in Israel and associations with ethnicity and sex. In this retrospective cross-sectional study, first-year college students underwent non-cycloplegic autorefraction and answered a questionnaire to assess age, sex, and self-identified ethnicity. Spherical equivalent refractive error (SER) was calculated, and the prevalence of hyperopia (>+0.50 Diopter, D), emmetropia (>-0.50 to +0.50 D), myopia (≤-0.50D, low ≤-0.50 to >-3.0D, moderate <-3.0 to >-6.0D, high ≤-6.0D), and astigmatism (>0.50D) were determined. Groups were compared using Chi-square or Fisher test. Univariate and multivariate analyses were conducted to identify factors associated with refractive errors. Participants (n = 807) had a mean age of 22.1 ± 2.6 years (range: 17–30 years) and SER of -1.7 ± 2.2D (range: -13.3 to +5.7D). The prevalence and 95% confidence internal of myopia was 66.3% (63.0–69.6). Jewish students had a higher prevalence than Arab students for myopia (69.2% vs 60.3%), moderate (18.5% vs 12.2%) and high myopia (5.9% vs 1.9%) and astigmatism (51.4% vs 43.9%, p<0.05 for all), but not low myopia or hyperopia. Females had a higher prevalence of myopia than males (68.1% vs 58.7%, p<0.03). Jewish ethnicity was associated with myopia (OR=1.48, p = 0.01) and moderate myopia (OR=1.72, p = 0.01), and studying optometry was associated with moderate myopia (OR=1.63, p = 0.02). Sex and age were not associated with myopia. Myopia prevalence in Israeli college students is high, showing associations with Jewish, but not Arab, ethnicity, suggesting that ethnic factors may play a role in the refractive differences between Arabs and Jews.

Background: There are many causes of visual impairment, and even blindness, which are treatable or at least preventable. Two such conditions are strabismus (crossed-eye, squint) and refractive error (visual image not focused on the most sensitive part of the retina). If these are not detected and corrected at an early age, they can lead to an irreversible impairment known as amblyopia (lazy eye). Pediatric vision screening and subsequent treatment for amblyopia and amblyogenic risk factors are thus key to preventing vision loss. Furthermore, vision screening can detect moderate to high hyperopia, which has been found to be associated with poor school readiness.Evidence-based recommendations call for screening children at 3–5 years of age; they are old enough to cooperate, but still within the window of effective intervention. However, these recommendations have yet to be universally implemented as the standard of care.Methods: This paper integrates a review of the literature and the international experience of preschool vision screening with the findings from a preliminary feasibility study of expanded screening in Israel to formulate a discussion of the current health policy challenge in Israel and the options for addressing it. The advantages and disadvantages of various venues for vision screening are discussed.Findings: Screening by optometrists in Mother and Child Health Centers, as implemented in a recent pilot project in the Jerusalem District, would allow the most comprehensive testing. Photo-screening in preschools would reach the most children, but at the cost of missing hyperopia (farsightedness). Either approach would probably constitute improvements over the current situation. The relative strengths of the two approaches depends in part on the ability to purchase automatic screening equipment (and the efficacy of that equipment) vs. the ongoing cost of paying trained personnel.Conclusions: Further research should be conducted in Israel to determine the prevalence of refractive errors, so that best practices can be established for Israel’s population and social needs. In the interim, the Ministry of Health should promptly implement the inclusion of preschool visions screening for children in the approved “basket of services” covered by the National Health Insurance Laws, using photo-screening, including collection of the clinical data.