Volume 61 · Issue 12 · 2025

This issue focuses on the research progress of myopia prevention and control. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Liu Longqian.

Against the backdrop of persistently high global prevalence of myopia as a public health challenge, the management of premyopia has emerged as a critical component in myopia prevention and control. This article establishes a theoretical framework for premyopia and systematically examines the importance of managing premyopia in children through six dimensions: necessity, urgency, scientific validity, strategic significance, economic implications, and forward-looking considerations. Specifically, it underscores the imperative of prioritizing premyopia management in pediatric populations to guide clinical practice, refine standardized protocols, and establish a theoretical foundation for constructing a full-cycle myopia prevention and control system encompassing the premyopia stage.

Myopia in China has become increasingly prevalent and is emerging at younger ages among children and adolescents. The early onset of myopia substantially raises the risk of developing high myopia and associated complications. An early intervention in children with premyopic conditions and insufficient hyperopic reserve is therefore crucial for advancing myopia prevention and control efforts. The Optometry Branch of China Ethnic Medicine Association, together with the Beijing Academy of Optometry, has integrated the latest domestic and international research findings, clinical experience, and expert insights. Through literature review, expert consultations, and multiple rounds of in-depth discussions, a consensus has been developed regarding the management of premyopia in children, including its criteria and intervention strategies. This document aims to offer clinical guidance to ophthalmologists and improve the effectiveness of myopia prevention and control.

To evaluate the accuracy, stability, and influencing factors of 14 intraocular lens (IOL) calculation formulas in calculating the IOL power for highly myopic cataract patients.

Retrospective case series. Clinical data were collected from patients with high myopia and cataract who underwent cataract extraction at Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University between January 2024 and January 2025. Participants were grouped according to the axial length (AL), keratometry, and anterior chamber depth (ACD). Nine modern IOL power calculation formulas, including Barrett Universal Ⅱ (Barrett UⅡ), Kane, Emmetropia Verifying Optical (EVO) 2.0, Pearl-Debellemanière Gauvin Saad (Pearl-DGS), Hoffer Q Savini Taroni (Hoffer QST), Cooke K6, Castrop, Zhu-lu, and the formula after plana vitrectomy (Lisa), and five traditional formulas, including SRK-T, Haigis, Holladay 1, Holladay 2, and Hoffer Q, were evaluated and compared. The outcome measures were prediction error, absolute error, intergroup difference, and the proportion of eyes with absolute errors within ≤0.25,≤0.50,≤0.75, and ≤1.00 D. Data were analyzed using the ANOVA, Friedman test, Kruskal-Wallis H test, and Dunn test.

A total of 293 patients (293 eyes) were included in this study, comprising 100 males and 193 females, with a mean age of (57.8±9.9) years. The absolute errors of the 14 IOL formulas showed statistically significant differences (P<0.05). The Hoffer QST formula demonstrated the lowest absolute error [0.32 (0.14, 0.54) D], followed by EVO 2.0 [0.35 (0.17, 0.58) D] and Barrett UⅡ [0.34 (0.17, 0.60) D], while the Hoffer Q formula exhibited the highest absolute error [0.74 (0.35, 1.14) D]. Among all formulas, only EVO 2.0 (β=0.106, 0.084, and -0.028) and Castrop (β=0.098, 0.078, and 0.026) showed no correlation between absolute error and AL, corneal curvature, or ACD (all P>0.05). In the subgroup comparisons, the differences in the absolute error of Barrett UⅡ, SRK-T, Hoffer Q, Haigis, Holladay 1, and Holladay 2 across different AL subgroups, as well as the differences in the absolute error of Barrett UⅡ across different keratometry subgroups, were statistically significant (P<0.05).

In highly myopic cataract patients, the modern IOL power calculation formulas can demonstrate superior accuracy compared to traditional formulas. AL is the predominant factor influencing the accuracy of IOL calculation formulas, while the impact of keratometry and ACD is relatively limited. EVO 2.0 and Castrop appear to exhibit relatively stable performance.

To evaluate the distribution characteristics of corneal curvature (CC) among populations with different axial lengths (AL).

This was a cross-sectional study. Data were collected from patients who underwent IOL Master biometer examination at 5 tertiary grade A hospitals in Hubei Province (Zhongnan Hospital of Wuhan University, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Yichang Central People′s Hospital, Jingzhou Central Hospital, and Xiaogan Central Hospital) from April 2012 to November 2023. Relevant data including axial length (AL), mean corneal curvature (CC), and corneal astigmatism were collected. Subjects aged>25 years were further divided into 5 subgroups based on AL: ≤22 mm, >22 to ≤24.5 mm, >24.5 to ≤26 mm, >26 to ≤28 mm, and >28 mm. One-way analysis of variance (ANOVA) with Tamhane′s method was used to compare CC among the subgroups of subjects aged >25 years. Piecewise multiple linear regression and linear trend test were applied to analyze the correlation between CC and AL. Partial correlation analysis and Kendall′s τc test were used to explore the relationship between corneal astigmatism (degree and type) and AL.

A total of 49 641 patients (75 529 eyes) were included, with 22 452 eyes from Zhongnan Hospital of Wuhan University, 8 438 eyes from Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, 19 040 eyes from Yichang Central People′s Hospital, 18 810 eyes from Jingzhou Central Hospital, and 6 789 eyes from Xiaogan Central Hospital. The median age of the patients was 53 years. The mean AL was (24.07±1.98) mm, the mean CC was (43.90±1.54) D, and the mean degree of corneal astigmatism was (1.13±0.72) D. The relationship between CC and AL exhibited different characteristics with changes in AL. For subjects aged >25 years, CC was negatively correlated with AL in the AL subgroups of ≤22 mm and >22 to ≤24.5 mm (β=-0.343, -1.062; both P<0.001), while the correlation turned positive in the AL subgroup of>24.5 to ≤26 mm (β= 0.500, P<0.001), and no correlation was observed in the AL subgroup of >26 mm (all P>0.05). Results of the linear trend test showed that when AL ≤24.5 mm, CC tended to decrease with increasing AL (β=-1.147, P<0.001); when AL >24.5 mm, CC tended to increase with increasing AL (β=0.126, P<0.001); and when AL >26 mm, the change in CC was minimal with increasing AL (β=0.045, P<0.001). Among all AL subgroups, CC was the steepest in the AL subgroup of ≤22 mm [(45.95±1.35) D] and the flattest in the AL subgroup of >24.5 to ≤26 mm [(43.45±1.56) D], with all differences in CC among different AL subgroups being statistically significant (P<0.001). For subjects aged ≤25 years, CC was weakly negatively correlated with AL (r=-0.342, P<0.001). The correlation between corneal astigmatism and AL was weak: (P<0.05).

For subjects aged ≤25 years, CC shows a decreasing distribution with increasing AL. For subjects aged >25 years, AL of 24.5 mm and 26 mm are the key turning points for the change of CC with AL. There is no significant correlation between corneal astigmatism and AL.

To explore the key influencing factors of hyperopia reserve level and its 4-year dynamic changes in school-aged children in Mojiang County, Yunnan Province, and to provide a basis for the protection of hyperopia reserve in myopia prevention and control for local children.

A cohort study design was adopted, with the baseline survey starting in 2016 and the final follow-up completed in 2020. Twelve primary schools were selected by simple random sampling (random number table) from 15 towns in Mojiang County, Yunnan Province. A total of 2 432 first-grade school-aged children who had lived in Mojiang County for at least 1 year and planned to continue living there for another 4 years were included as baseline subjects. For ocular parameters: after cycloplegia, an automatic refractor was used to measure the sphere equivalent refraction (SE), and an ocular biometer was applied to determine the axial length, lens thickness, anterior chamber depth, corneal curvature, and axial length/average corneal curvature radius (AL/CR ratio). For systemic development indicators: body mass index (BMI), blood pressure (including systolic and diastolic blood pressure), and waist circumference were measured. For behavioral factors: the myopia risk factor questionnaire developed by the World Health Organization (WHO) was used to collect information on children′s learning habits and eye-use behaviors, among which eye-use behaviors included lighting methods, eye use in dynamic scenarios, etc.

A total of 2 169 children (89.2%) completed the 4-year follow-up, including 1 192 boys and 977 girls, with a baseline age of (7.64±0.58) years. Among them, 1 520 children (70.11%) had hyperopia reserve; by the 4th year of follow-up, the number of children with hyperopia reserve decreased to 715 (32.98%), and the 4-year cumulative incidence of myopia was 43.17%. Among the 1 520 children with hyperopia reserve at baseline, there were differences in the proportion of "emmetropization/myopization" and the decrease in hyperopia reserve among different age groups: 42.48% of the 7-year-old group showed emmetropization/myopization, with a 4-year decrease of 0.75 D in hyperopia reserve (annual decrease of 0.19 D); 49.77% of the 8-year-old group showed emmetropization/myopization, with a 4-year decrease of 0.86 D in hyperopia reserve (annual decrease of 0.22 D); 64.71% of the 9-year-old group showed emmetropization/myopization, with a 4-year decrease of 1.00 D in hyperopia reserve (annual decrease of 0.25 D). For the 715 children who maintained hyperopia reserve throughout the follow-up, the 4-year decreases in hyperopia reserve in the 7-year-old, 8-year-old, and 9-year-old groups were 0.22 D, 0.15 D, and 0.33 D, respectively. The 4-year cumulative incidences of myopia in the groups with SE>+2.00 D,+1.50 D<SE≤+2.00 D,+1.00 D<SE≤+1.50 D, and +0.50 D<SE≤+1.00 D were 0, 1.71%, 3.95%, and 10.07%, respectively. None of the children with baseline SE≥+2.00 D developed myopia. Correlation analysis showed that the 4-year change in hyperopia reserve was significantly correlated with the 4-year changes in AL/CR ratio, steepest corneal curvature, axial length, anterior chamber depth, lens thickness, central corneal thickness, BMI, and diastolic blood pressure (all P<0.05). Among behavioral factors, "time spent reading/doing homework after school", "type of lamp used for reading/doing homework at night", "reading or using electronic devices while walking", and "reading or using electronic devices on vehicles/ships" were significantly associated with changes in hyperopia reserve (all P<0.05).

The annual decrease in hyperopia reserve increases with age in 7-9-year-old school-aged children in Mojiang County, Yunnan Province. For first-grade primary school children, a hyperopia reserve of ≥+1.50 D can meet the consumption needs during the primary school stage, and high natural light exposure and reasonable eye-use behaviors may help delay the consumption of hyperopia reserve.

To explore the application status and development trend of artificial intelligence (AI) in myopia research from 2017 to 2024.

A bibliometric study was conducted. Based on CNKI, Wanfang, and the Web of Science Core Collection, we retrieved Chinese and English literature published between 2017 and 2024 with the themes of "myopia" and "artificial intelligence". Bibliometric and visual analyses were performed using CiteSpace, covering dimensions such as annual publication volume, national/institutional collaboration, journal distribution, co-cited literature, and burst keywords. Meanwhile, a phased analytical approach was adopted by integrating the temporal dimension to reveal the evolutionary characteristics and developmental patterns of AI in myopia research across different periods.

A total of 211 English articles and 72 Chinese articles were included. China ranked first with a publication share of 48.35%, and the combined share of China, the United States, and Singapore exceeded 70%. The key research institutions included Capital Medical University, Sun Yat-sen University, and the National University of Singapore. Chinese Journal of Ocular Fundus Diseases and Translational Vision Science & Technology were the top journals in terms of publication volume in Chinese and English, respectively. Co-citation analysis showed that classic studies focused on the global myopia epidemiology, AI-based fundus recognition models, and myopic maculopathy grading systems. The burst keywords indicated that the research focus shifted from "prevention and control" and "screening" to "refractive surgery" and "high myopia". The research developed in two phases: (1) 2017-2021 as the "pathological recognition foundation period", during which AI mainly completed lesion recognition in fundus images, laying a technical foundation for the early screening of juvenile myopia and diagnosis of myopia-related complications in the elderly; (2) from 2022 onward, entering the "precision intervention expansion period", extending to the whole-life-cycle management—AI was applied to the behavioral intervention for pediatric myopia prevention, personalized calculation for adult refractive surgery, and postoperative outcome prediction.

The application of AI in myopia research has evolved from image recognition to whole-life-cycle precision management, forming a new prevention and control model characterized by "data-driven and whole-process collaboration". In the future, it is necessary to strengthen domestic institutional collaboration, integrate cross-cycle data, and promote global cooperation to advance the clinical implementation and policy translation of AI technology in the myopia prevention and control.

To explore the postoperative visual outcomes of in-the-bag implantation of monofocal and bifocal intraocular lenses (IOLs) in cataract patients with a history of laser-assisted corneal refractive surgery.

A prospective non-randomized controlled study was conducted. Cataract patients with a history of laser-assisted corneal refractive surgery, who were consecutively enrolled at Qingdao Eye Hospital affiliated to Shandong First Medical University between October 2022 and February 2024 and successfully received phacoemulsification cataract extraction combined with IOL implantation, were included in the study, with data of one eye per patient for analyses. They were divided into the monofocal IOL group and bifocal IOL group according to the type of the IOL chosen by the patients. Preoperatively, an optical biometer was used to measure ocular biological parameters. The Barrett True-K formula was applied to calculate the IOL power. Corneal topography was performed to assess corneal morphology (e.g., effective optical zone, corneal irregular astigmatism), and anterior segment optical coherence tomography was used to examine anterior segment structures. At 3 months postoperatively, uncorrected distance visual acuity, best-corrected distance visual acuity, distance-corrected near visual acuity, refractive prediction error, optical quality parameters, including objective scattering index, modulation transfer function, and Strehl ratio, and corneal and total ocular aberrations were measured. The Quality of Vision questionnaire was completed. Statistical comparisons of the above postoperative indicators at 3 months were performed between the two groups.

A total of 63 patients (63 eyes) were enrolled. The monofocal group comprised 32 patients (32 eyes) with a mean age of (46.00±5.27) years and a male-to-female ratio of 17:15. The bifocal group included 31 patients (31 eyes) with a mean age of (45.10 ± 5.83) years and a male-to-female ratio of 16:15. No loss to follow-up occurred in either group of patients during the 3-month follow-up period. There were no significant differences in baseline data between the two groups (all P>0.05). In the monofocal IOL group, the uncorrected distance visual acuity and objective scattering index were 0.126±0.137 logMAR and 2.275±0.888, respectively, while those in the bifocal IOL group were 0.087±0.077 logMAR and 2.436±0.791, with no significant differences between the two groups (both P>0.05). The distance-corrected near visual acuity in the bifocal IOL group (0.294±0.137 logMAR) was superior to that in the monofocal IOL group (0.582±0.120 logMAR), with a significant difference (P<0.05). Twenty-one eyes (65.63%) in the monofocal IOL group and 22 eyes (70.97%) in the bifocal IOL group had a refractive prediction error within±0.50 D, showing no significant difference (P>0.05). No significant difference was found in corneal aberration or total ocular aberration between the two groups (both P>0.05). Regarding the questionnaire scores, the monofocal IOL group had mean scores of 39.06±6.90 (frequency), 31.03±8.21 (severity), and 36.69±12.04 (distress), while the bifocal IOL group had mean scores of 44.99±10.71 (frequency), 34.73±8.03 (severity), and 37.98±16.51 (distress), respectively. Among these dimensions, there was a statistically significant difference in the frequency dimension between the two groups (P<0.05). The incidence of glare was 62.5% (20/32) in the monofocal IOL group and 22.58% (7/31) in the bifocal IOL group, and the incidence of halos was 6.25% (2/32) in the monofocal IOL group and 77.42% (24/31) in the bifocal IOL group, with significant differences (both P<0.05).

For cataract patients with a history of laser-assisted corneal refractive surgery, implantation of bifocal IOLs can achieve favorable distance and near visual outcomes, and the visual quality shows no significant decrease compared with that in patients implanted with monofocal IOLs.

A 50-year-old man was admitted to the Department of Ophthalmology at Xuanwu Hospital, Capital Medical University, with a 24-day history of transient binocular visual blurring, headache, and nausea. Ophthalmic examination revealed bilateral papilledema. Neuroimaging indicated cerebral venous sinus thrombosis. Due to the unclear etiology, the patient initially underwent bilateral optic nerve sheath decompression to preserve vision. After surgery, a further etiological evaluation was conducted. Although thrombophilia screening was negative, leukocytosis and persistent thrombocytosis were detected. Molecular analysis revealed a JAK2(V617F) mutation, raising suspicion for a myeloproliferative neoplasm. Bone marrow aspiration and biopsy subsequently confirmed primary myelofibrosis. The patient then received specialized management from neurology and hematology departments.

A 2-year-and-7-month-old male child presented to the Department of Ophthalmology, Shijiazhuang Fourth Hospital, with "binocular congenital cataracts combined with dental, facial, and neurological abnormalities for more than 2 years". The child mainly manifested as binocular congenital cataracts. He had previously undergone binocular phacoemulsification and aspiration at 3 months of age, and binocular intraocular lens implantation+posterior capsulotomy+anterior vitrectomy at 2 years of age. Physical examination revealed typical special facial features such as serrated incisors and large, anteverted auricles, along with rare neurological abnormalities including intellectual disability, speech and language developmental disorder, and autism spectrum disorder. The child′s mother was a female carrier, presenting with mild binocular cataracts and characteristic facial features such as serrated incisors, a long and narrow face, a high and prominent nasal bridge, and large, anteverted auricles. Whole-genome sequencing (WGS) of the family showed that the child had a hemizygous variant of c.3596delA (p.Asn1199Thrfs*6) in the NHS gene; further verification by Sanger sequencing confirmed that both the child′s mother and the pregnant fetus were heterozygous for this variant. According to relevant genetic guidelines, this variant was classified as a pathogenic variant (PM2+PP4+PVS1) because it was not recorded in the 1000 Genomes Project or gnomAD East Asian population databases (PM2), the carrier′s phenotype was highly consistent with a monogenic disease (PP4), and it caused premature protein termination and conformed to the haploinsufficiency mechanism (PVS1). This variant was the pathogenic cause of the family. Combining the child′s clinical manifestations and genetic testing results, the final diagnosis was Nance-Horan Syndrome (NHS). The child has been continuously given rehabilitation training to improve neurological development. During follow-up, cycloplegic refraction was performed, and he is currently given glasses and amblyopia training to improve visual acuity. The child′s younger sister was found to have punctate opacities in both crystalline lenses in early infancy; currently, the opacities have not progressed, and some teeth show slight abnormalities.

A 50-year-old male patient presented with "redness and blurred vision in the right eye for more than 1 year". He ran a farm. Three years ago, he sustained a branch injury to his right eye, which led to fungal corneal ulcer, and underwent penetrating keratoplasty at that time. Since March 2024, the right eye has had recurrent redness. Multiple follow-up visits showed that his visual acuity gradually decreased to hand movement in front of the eye. The cornea successively developed opacity, infiltration and ulceration. His intraocular pressure fluctuated, and a large number of inflammatory cells were observed under confocal microscopy. He had received antibacterial, antiviral and anti-inflammatory treatments, but his condition recurred repeatedly. In April 2025, he was admitted for penetrating keratoplasty due to aggravated corneal ulcer with descemetocele. Postoperative corneal scraping with Giemsa staining revealed oval spores, and metagenomic testing confirmed Vittaforma corneae infection. He was diagnosed with severe ulcerative microsporidial stromal keratitis. After the operation, the cornea remained transparent with no recurrence during follow-up.

The patient was a 46-year-old female. Due to abnormal glucose tolerance, the fundus was examined, and he was seen in the Department of Ophthalmology of Peking Union Medical College Hospital. Previous good health, denied family history of medical and other eye diseases. Eye examination: the best corrected visual acuity of both eyes was 1.0, and the intraocular pressure of both eyes was normal; Anterior segment examination of both eyes showed no obvious abnormalities; The right fundus is shown in the essence picture 1. The optic disc has a clear boundary and a positive color. A flat flaky pigmentation area can be seen in the middle and superior temporal periphery, with a diameter of about 10 times the diameter of the optic disc. There are patchy atrophic foci in it and the retina is in place. Left fundus normal. Fundus autofluorescence: low autofluorescence in the supratemporal lesion area of the right eye. optical coherence tomography (OCT) examination showed that the thickness of the retinal pigment epithelial layer in the supratemporal lesion area of the right eye was uneven and local discontinuity, and the corresponding neuroepithelial layer in the lesion area was thinned (A in Quintessential Picture 2). Coherence optical tomography angiography examination: the corresponding choroidal capillary layer at the supratemporal lesion of the right eye was atrophied and thinned, and the blood flow signal was weakened (B in Quintessential Picture 2). Fluorescein fundus fluorescence angiography (FFA) and indocyanine green angiography (ICGA) examination: the early supratemporal lesion area of the right eye was hypofluorescent with clear boundaries, and dendritic hyperfluorescence (through choroidal vessels) was visible in it (A and B in essence picture 3); Late FFA dendritic hyperfluorescence enhanced staining, no obvious leakage was observed, ICGA corresponding fluorescence was weakened, and no obvious leakage was observed in the peripheral blood vessels of both eyes (C and D in Essence Picture 3). Clinical diagnosis: congenital retinal pigment epithelial hypertrophy in the right eye.

Current treatments for refractory eye diseases such as ocular neovascular diseases, dry eye, and uveitis have limited efficacy, and there is an urgent clinical need for better therapeutic options. Tyrosine kinase inhibitors (TKIs), as multi-target tyrosine kinase inhibitors with strong targeting and high safety, have shown remarkable efficacy in the treatment of malignant tumors, and their potential in the treatment of ocular diseases has gradually emerged in recent years. This article reviews the preclinical mechanisms and efficacy of TKIs such as upadacitinib and sunitinib, relying on novel formulation technologies like micelles and nanoparticles, in corneal neovascularization, posterior segment neovascular diseases, dry eye, uveitis, and conjunctivitis, providing references for the clinical expansion of their application in ocular diseases.

Behavioral assessment of visual function can dynamically and quantitatively capture the full-chain functional state from visual perception to behavioral output in ophthalmic disease animal models, serving as a crucial tool for linking neural circuit mechanisms with clinical phenotypes. In recent years, advances in stimulus control, automated recognition, and multimodal integration have markedly improved the sensitivity, data consistency, and inter-laboratory reproducibility of these methods. Based on response characteristics, visual behavioral assessments can be broadly categorized into spontaneous response paradigms and operant task paradigms. The former include optomotor response, optokinetic reflex, light/dark transition test, and looming visual stimuli, which rely on innate reflexes or instinctive behaviors and are suitable for early functional screening and disease monitoring. The latter include the Morris water maze, visual water task, two-alternative forced choice task, touchscreen-based discrimination systems, and virtual reality navigation platforms, which, under strictly controlled stimulus and feedback conditions, enable detailed analysis of higher-order functions such as pattern recognition, contrast sensitivity, spatial navigation, and perceptual decision-making. Numerous studies have demonstrated that functional indicators derived from these methods correlate well with retinal structure, electrophysiological parameters, and therapeutic outcomes, and these functional indicators have been validated in gene therapy, stem cell transplantation, and pharmacological intervention studies. Current challenges include insufficient reproducibility across laboratories, susceptibility of results to nonspecific confounding factors, and the lack of standardized task parameters. Future directions should focus on standardizing task protocols and stimulus parameters, promoting multimodal integration with in vivo imaging and electrophysiology, achieving causal inference from stimulus input through neural circuit processing to behavioral output, and aligning task design with clinical functional assessment constructs. Establishing cross-species, cross-stage comparative frameworks will further enhance the mechanistic interpretability and translational value of preclinical research.

The article "Clinical Study of Glucocorticoid Combined with Amniotic Membrane Transplantation in the Treatment of Severe Marginal Ulcerative Keratitis" by Jia Yanni, Wang Jingting and Wang Xin in the "Short Essays" column of Volume 61, Issue 2, 2025 should be supplemented with the Fund projects: "Fund Program: Key R&D Program of Shandong Province (2022CXGC010505); Natural Science Foundation of Shandong Province (ZR2023MH187)" [Fund Program: Key R&D Program of Shandong Province (2022CXGC010505); Shandong Provincial Natural Science Foundation (ZR2023MH187)], Corrections are hereby made.