Purpose: Experimental animal models of myopia demonstrate that higher melatonin (Mel) and lower dopamine ( DA ) concentrations actively promote axial elongation. This study explored the association between myopia and serum concentrations of DA and Mel in humans. Methods: Morning serum concentrations of DA and Mel were measured by solid phase extraction ‐ liquid chromatography ‐ tandem mass spectrometry from 54 participants (age 19.1 ± 0.81 years) in September/October 2014 (phase 1) and March/April 2016 (phase 2). Axial length ( AL ), corneal radii ( CR ) and spherical equivalent refraction ( SER ) were also recorded. Participants were defined as myopic if non‐cycloplegic spherical equivalent refractive error ≤−0.50 DS at phase 1. Results: Nine participants were lost to follow up. Mel concentrations were measurable for all myopes (phase 1 n = 25, phase 2 n = 22) and non‐myopes (phase 1 n = 29, phase 2 n = 23). SER did not change significantly between phases ( p = 0.51). DA concentrations were measurable for fewer myopes (phase 1 n = 13, phase 2 n = 12) and non‐myopes (phase 1 n = 23, phase 2 n = 16). Myopes exhibited significantly higher Mel concentrations than non‐myopes at phase 1 (Median difference: 10 pg mL ⁻¹ , p < 0.001) and at phase 2 (Median difference: 7.3 pg mL ⁻¹ , p < 0.001) and lower DA concentrations at phase 2 (Median difference: 4.7 pg mL ⁻¹ , p = 0.006). Mel concentrations were positively associated with more negative SER (all r ≥ −0.53, all p < 0.001), longer AL (all r ≥ 0.37, all p ≤ 0.008) and higher AL / CR ratio (all r ≥ 0.51, all p < 0.001). Conclusion: This study reports for the first time in humans that myopes exhibit higher serum Mel concentrations than non‐myopes. This may indicate a role for light exposure and circadian rhythm in the human myopic growth mechanism. Further research should focus on younger cohorts exhibiting more dynamic myopic progression and explore the profile of these neurochemicals alongside evaluation of sleep patterns in myopic and non‐myopic groups.

Body height and axial length (AL) increase during childhood with excessive axial elongation resulting in myopia. There is no consensus regarding the association between body growth and AL during refractive development. This study explored the association between change in body height, AL and refractive status over 4-years in children and young adults. Measures were collected biennially (timepoints: t1, t2, t3) (t1 n = 140, aged 5-20years). Non-cycloplegic autorefraction was obtained using the Shin-Nippon openfield autorefractor. AL, corneal curvature (CC) and anterior chamber depth (ACD) were measured by IOL Master. Body height (cm) was measured using a wall mounted tape measure. Refractive status was classified using spherical equivalent refraction (SER): persistent emmetropes (PE) (-0.50D to +1.00D), persistent myopes (PM) (≤-0.50D), progressing myopes (PrM) (increase of ≤-0.50D between timepoints), incident myopes (IM) (subsequent SER≤-0.50D) and persistent hyperopes (PH) (>+1.00D). Change in AL and change in height were correlated in the PE (all t:p ≤ 0.003) and the IM (t1-t2 p = 0.04). For every increase in body height of 1 cm: t1-t2: AL increased by 0.03 mm in the PE, 0.15 in the PM, 0.11 mm in the IM, 0.14 mm in the PrM, -0.006 mm in the PH. T2-t3: AL increased by 0.02 mm in the PE, 0.06 in the PM, 0.16 mm in the PrM, 0.12 mm in the IM and -0.03 mm in the PH. In emmetropia body growth and axial elongation are correlated. In participants with myopia, body growth appears to stabilise whilst axial elongation continues at a much faster rate indicating dysregulation of normal ocular growth.

Purpose: Conjunctival ultraviolet autofluorescence ( CUVAF ) has been used in previous Southern Hemisphere myopia research as a marker for time spent outdoors. The validity of CUVAF as an indicator of time spent outdoors is yet to be explored in the Northern Hemisphere. It is unclear if CUVAF represents damage attributed to UV exposure or dry eye. This cross‐sectional study investigated the association between CUVAF measures, self‐reported time spent outdoors and measures of dry eye. Methods: Participants were recruited from University staff and students ( n = 50, 19–64 years; mean 41). None were using topical ocular medications (with the exception of dry eye treatments). Sun exposure and dry eye questionnaires (Ocular Surface Disease Index and McMonnies) were completed by the participant. Dryness was also assessed using slit lamp biomicroscopy and invasive tear break up time. Images of the temporal and nasal conjunctiva from the right and left eye were captured using a bespoke photography system. The total CUVAF area, average CUVAF pixel intensity per mm ² and total CUVAF pixel intensity were analysed using MATLAB R2013a (The MathWorks Inc). Results: Of the 50 participants, 42% were classified as having dry eye. Self‐reported sunglasses use was negatively associated with all CUVAF measures (Kruskal Wallis total CUVAF area, p = 0.04, p _trend = 0.03, average CUVAF pixel intensity p = 0.02, p _trend = 0.02, total CUVAF pixel intensity: p = 0.04, p _trend = 0.02). Time spent outdoors was positively associated with all CUVAF measures (Spearman's correlation coefficients, total CUVAF area: r = 0.37, p = 0.01, average CUVAF pixel intensity: r = 0.36, p = 0.01, total CUVAF pixel intensity: r = 0.37, p = 0.01) and remained significant when sunglasses use was controlled for (partial correlation, total CUVAF area: r = 0.32, p = 0.03, average CUVAF pixel intensity: r = 0.39, p = 0.01, total CUVAF pixel intensity: r = 0.39, p = 0.03). Neither CUVAF area nor intensity measures were associated with any dry eye measure (Ocular Surface Disease Index: all p ≥ 0.41, corneal staining: all p ≥ 0.38, McMonnies: all r ≤ 0.09 all p ≥ 0.52, slit lamp biomicroscopy: all r ≤ 0.20 all p ≥ 0.17, invasive tear break up time: all r ≤ −0.07 all p ≥ 0.31). Conclusions: CUVAF area and intensity were not associated with clinical measures of dry eye. Greater CUVAF area and intensity were associated with wearing sunglasses less frequently and spending more time outdoors. If sunglass wear is accounted for, CUVAF may be a useful biomarker of time spent outdoors in future myopia studies.

Introduction: This work aimed to establish the largest UK and Ireland consensus on myopia management in children and young people (CYP). Methods: A modified Delphi consensus was conducted with a panel of 34 optometrists and ophthalmologists with expertise in myopia management. Results: Two rounds of voting took place and 131 statements were agreed, including that interventions should be discussed with parents/carers of all CYP who develop myopia before the age of 13 years, a recommendation for interventions to be publicly funded for those at risk of fast progression and high myopia, that intervention selection should take into account the CYP's hobbies and lifestyle and that additional training for eye care professionals should be available from non‐commercial sources. Topics for which published evidence is limited or lacking were areas of weaker or no consensus. Modern myopia management contact and spectacles are suitable first‐line treatments. The role and provision of low‐concentration atropine needs to be reviewed once marketing authorisations and funding decisions are in place. There is some evidence that a combination of low‐concentration atropine with an optical intervention can have an additive effect; further research is needed. Once an intervention is started, best practice is to monitor non‐cycloplegic axial length 6 monthly. Conclusion: Research is needed to identify those at risk of progression, the long‐term effectiveness of individual and combined interventions, and when to discontinue treatment when myopia has stabilised. As further evidence continues to emerge, this consensus work will be repeated to ensure it remains relevant.

Background/objectives: Adults living in more deprived areas are less likely to attend an eye examination, resulting in greater visual impairment from undiagnosed eye disease and a widening of health inequalities. It is unknown if the introduction of free NHS eye examinations and help with spectacle costs has benefited children in Scotland. This study aimed to explore factors associated with accessing NHS spectacles including level of deprivation, refractive error, urbanity and age. Subjects/methods: NHS-financed General Ophthalmic Services (GOS) 3 supplement the cost of spectacles for children under 16 years. Administrative data on the spectacle refraction dispensed were obtained from Information Services Division (ISD) for mainland Scotland, 2018, and categorised by: Emmetropes/low hyperopes (reference group), myopes and moderate/high hyperopes. Data were linked to the Scottish Index of Multiple Deprivation (SIMD) quintile. Results: Data included 108, 043 GOS 3 claims. Greater deprivation was associated with greater GOS 3 claims p = 0.041. This was most evident in emmetropic/low hyperopic children and in moderate/high hyperopic children. GOS 3 claims in the myopes group increased with age across all SIMD and decreased with age in the moderate/high hyperope group (all p < 0.001). GOS 3 claims were not associated with urbanity for all Health Boards (p = 0.13). Conclusions: Children in areas of greater deprivation and in more rural areas are not disadvantaged in accessing NHS spectacles. This did not vary by refractive error group. This suggests that health policy in Scotland is accessible to those from all deprivation levels and refractive errors.