Aim To evaluate and compare the efficacy of combination treatment using 0.025% atropine and Defocus Incorporated Multiple Segments (DIMS) spectacle lenses to 0.025% atropine and single vision (SV) spectacle lenses in slowing myopia progression in children with myopia. Methods Randomised controlled trial conducted on children aged 4–16 years with myopia between −1.00D and −6.00D and astigmatism ≤2.00D. Children were randomly allocated into two groups: 0.025% atropine and SV spectacle lenses treatment group (group A), and 0.025% atropine and DIMS spectacle lenses treatment group (group B). Cycloplegic spherical equivalent refraction (SER) and axial length were measured at baseline, 6 and 12 months. Results 102 patients completed the 12-month follow-up: n=49 in group A, mean age 9.50±2.78 years and n=53 in group B, mean age 9.90±2.47 years. At 12 months, the mean AL±SD change was 0.18±0.16 mm in group A and 0.07±0.16 mm in group B (mean difference: 0.11, 95% CI: 0.05 to 0.17; p≤0.001). Mean SER±SD progression at 12 months was −0.19±0.42D and −0.09±0.35D in groups A and B, respectively (p=0.13). 39.6% of children in group B had no axial elongation over 12 months compared with 12.2% of the children in group A (p=0.002). Conclusions Combination treatment with 0.025% atropine and DIMS spectacle lenses is more effective in controlling axial elongation than 0.025% atropine with SV lenses. Although not significant, SER differences between groups were lower in group B. These findings support a potential additive effect of the two treatments.

Background: Childhood myopia represents a global concern with increasing prevalence in recent decades. Lifestyle factors significantly impact myopia. Aim: To evaluate lifestyle factors in myopic children from a metropolitan area in Europe. Methods: This was a descriptive study including myopic subjects aged 4–18 years. Patient demographic and clinical data were collected, including cycloplegic refraction in spherical equivalent refraction (SER) and axial length (AL). In addition, a questionnaire on lifestyle factors was conducted between September 2022 and April 2023. Results: A total of 321 myopic children were included, aged 10.72 ± 3.05 years, of whom 51.4% were boys, with SER −2.25 ± 1.9 D and AL 24.54 ± 0.98 mm. The mean age of myopia onset was 7.69 ± 3.05 years. A total of 59.8% had family history of myopia. Those children who had 2 h/day, SER: −2.50 ±1.88 D (p = 0.009). Children who spent 2 h/day (SER: −1.75 ± 1.83 vs. SER: −2.75 ± 1.82, respectively, p = 0.03). However, no significant association was observed between SER and AL and time spent outdoors nor between SER and AL and academic performance (p > 0.05). Conclusions: Screen time and near-work time appear to be lifestyle factors related to myopia.

Introduction: While optical coherence tomography (OCT) measurements of the lower tear meniscus height (LTMH) have been reported in adults, here we obtained LTMH measurements through Fourier Domain OCT in healthy children and compared these with values obtained in healthy adults. Methods: Participants were children 7–17 years of age and a control group of adults 20–40 years of age. Inclusion criteria were no abnormal eye conditions or the use of contact lenses. Candidates who fulfilled the TFOS DEWS II criteria for dry eye disease (DED) were excluded. All subjects underwent LTMH measurement (OCT Spectralis) and tests for non‐invasive tear break‐up time and ocular surface staining. Participants also completed the ocular surface disease index questionnaire. Results: A total of 86 children and 27 adults were included. Mean LTMH values in the children and adult groups were 217.40 ± 71.40 μm and 225.0 ± 54.86 μm, respectively; p = 0.53. However, 59.3% of the children had an LTMH ≤210 μm suggestive of DED, compared with only 33.3% of adults ( p = 0.02). For the children, no significant differences in LTMH were observed with sex or for those more or less than 12 years of age. Conclusions: Optical coherence tomography‐derived LTMH measurements were obtained in healthy children. While values were similar in children and adults, a greater proportion of children had an LTMH compatible with a diagnosis of DED. More studies in different paediatric populations are required to establish a complete set of normative LTMH measurements.

PURPOSE: Torsional eye position by the disc-fovea angle (DFA) is a relevant objective parameter in vertical strabismus. DFA measurement with optical coherence tomography (OCT) has proven to be a good alternative to the gold standard measurement in fundus photography. Our study aims to analyze the validity and reliability of 2 undescribed Cirrus high-definition OCT (HD-OCT; Carl Zeiss Meditec) methods that offer clinical advantages for measuring objective cycloposition in normal patients compared with Spectralis spectral-domain OCT (Heidelberg Engineering) and the reference method. center dot DESIGN: Prospective validity and reliability analysis. center dot METHODS: Objective cycloposition by means of the DFA was measured in the right eyes of 59 binocularly normal individuals attending the ophthalmology service of a medical institution. DFA was obtained by fundus photography (gold standard), FoDi software of Spectralis spectral-domain OCT, HD 1 line scan of Cirrus HDOCT, and macular cube of Cirrus HD-OCT (fundus, FoDi, line, and cube methods, respectively). Measurements were performed 3 times for each method and the patient was repositioned and realigned between captures. Posterior manual quantification was made by 2 observers with external protractor software for the fundus and cube methods. center dot RESULTS: The 3 OCT methods showed and excellent agreement with fundus photography (ICC 0.83-0.84) with no significant differences comparing mean values (P = .36 for fundus-FoDi, P = .09 for fundus-line, and P = .09 for fundus-cube). Absolute differences between methods were 1.5 degrees. All methods showed excellent reliability (ICC 0.92 for FoDi, 0.91 for line, 0.92 for cube, and 0.91 for fundus). The minimal detectable change was lower than 3 degrees and the absolute difference between repeated measurements was 1 degrees for all methods. Interrater reliability was excellent for methods requiring manual quantification (ICC 0.98 for cube, ICC 0.94 for fundus). center dot CONCLUSIONS: Measurement of the DFA by Cirrus HD-OCT methods in normal patients was a valid and reliable alternative for the cycloposition assessment. Among the methods, the Cirrus OCT HD 1 line improved clinical performance due to the simplicity and speed of measurement, with no need to export the image for quantification.

Background/Objectives: Choroidal thickness (ChT) changes have been proposed as biomarkers of myopia-control response, but their regional pattern and relationship with axial elongation remain uncertain. We evaluated regional choroidal responses to adding. Defocus Incorporated Multiple Segments (DIMS) spectacles to 0.025% atropine, and asessed biomarker potential of regional and baseline ChT. Methods: This secondary analysis included ASPECT participants with enhanced-depth imaging OCT scans. In ASPECT, 111 myopic children aged 4–16 years were randomized to nightly 0.025% atropine plus DIMS or single-vision spectacles. ChT was measured subfoveally and 1000 µm nasally and temporally at baseline and 6, 12, 18, and 24 months using a validated automated segmentation pipeline. Linear mixed-effects models assessed longitudinal and between-group differences, associations with axial elongation, and effect modification by baseline ChT. Results: 101 children completed 24 months (53 atropine plus DIMS; 48 atropine plus single-vision). In the DIMS group, mean 24-month ChT increases were largest temporally (+22.2 µm), followed by nasally (+15.5 µm) and subfoveally (+10.6 µm). Between-group differences favored DIMS, significant temporally at all visits (p = 0.009–0.040) and nasally at 6, 12, and 24 months (p = 0.030–0.040); no significant subfoveal differences were found. Regional ChT changes were not significantly associated with axial elongation, and baseline ChT did not modify the treatment effect. Conclusions: Over 24 months, ChT showed a region-specific treatment response, most consistent temporally, less consistent nasally, and subfoveally. Regional ChT may offer an exploratory marker of treatment-related remodelling, but its predictive value for individualised treatment remains uncertain.

Background/Objectives: Long-term tear-film and symptom data for compounded 0.025% atropine remain limited in European children. We assessed changes in first non-invasive tear-film break-up time (fNIBUT) and Ocular Surface Disease Index (OSDI) scores over 24 months. Methods: This secondary analysis of the ASPECT trial included 101 children completing 24 months, all assigned nightly compounded 0.025% atropine with Defocus Incorporated Multiple Segments or single-vision spectacles. Available fNIBUT, OSDI, and corneal endothelial cell density (ECD) measurements at baseline, 12 months, and 24 months were analysed using longitudinal mixed-effects models. The six pairwise contrasts across the primary outcomes of this secondary analysis used Holm-adjusted p-values and simultaneous Bonferroni 95% confidence intervals (CIs). No untreated comparator was available. Results: fNIBUT was numerically higher at 24 months than at baseline (16.9 vs. 14.3 s; mean difference [MD], 2.60 s; 95% CI, −0.37 to 5.57; p = 0.103). OSDI decreased from 14.7 to 9.6 (MD, −5.15 points; 95% CI, −9.93 to −0.36; p = 0.028). This reduction was not statistically significant in all examined missing-not-at-random scenarios or in an analysis restricted to children aged ≥8 years. ECD showed no statistically significant longitudinal changes. The exploratory combined criterion of OSDI ≥ 13 and fNIBUT < 10 s decreased numerically from 13/98 (13.3%) to 5/86 (5.8%). Conclusions: No deterioration was detected in the measured parameters among 24-month completers. Selection of completers, differential missingness, limited paediatric symptom assessment, and absence of a concurrent untreated comparator preclude firm conclusions about long-term ocular surface tolerability.