Ian Flitcroft

CHI at Temple Street

Purpose: The Myopia Outcome Study of Atropine in Children (MOSAIC) is an investigator-led, double-masked, randomized controlled trial investigating the efficacy and safety of 0.01% atropine eye drops for managing myopia progression in a predominantly White, European population. Methods: Children aged 6-16 years with myopia were randomly allocate...

Significance: The spatial frequency spectrum of the environment has been proposed as a risk factor for myopia development. However, this hypothesis has not yet been directly tested in humans. Purpose: This study aims to investigate the impact on childhood myopia of classrooms with spatial properties of classrooms resembling those of outdoor envi...

Importance: The global prevalence of myopia is predicted to approach 50% by 2050, increasing the risk of visual impairment later in life. No pharmacologic therapy is approved for treating childhood myopia progression. Objective: To assess the safety and efficacy of NVK002 (Vyluma), a novel, preservative-free, 0.01% and 0.02% low-dose atropine fo...

Purpose: The purpose of this study was to evaluate the epidemiology, etiology, clinical assessment, investigation, management, and visual consequences of high myopia (≤-6 diopters [D]) in infants and young children. Findings: High myopia is rare in pre-school children with a prevalence less than 1%. The etiology of myopia in such children is dif...

Purpose: To describe nonpathological myopia-related characteristics of the human eye. Methods: Based on histomorphometric and clinical studies, qualitative and quantitative findings associated with myopic axial elongation are presented. Results: In axial myopia, the eye changes from a spherical shape to a prolate ellipsoid, photoreceptor, and...

Myopia is a dynamic and rapidly moving field, with ongoing research providing a better understanding of the etiology leading to novel myopia control strategies. In 2019, the International Myopia Institute (IMI) assembled and published a series of white papers across relevant topics and updated the evidence with a digest in 2021. Here, we summarize...

In the field of myopia control, effective optical or pharmaceutical therapies are now available to patients in many markets. This creates challenges for the conduct of placebo‐controlled, randomised clinical trials, including ethics, recruitment, retention, selective loss of faster progressors and non‐protocol treatments: Ethics: It is valid to que...

Purpose: To evaluate the impact of clinical protocol change via active minimisation on the number of general anaesthetic (GA)/sedation episodes for diagnostic ophthalmic purposes at Children's Health Ireland at Temple Street (CHI-TS), Dublin, Ireland, from 2016 to 2019, inclusive. Change was implemented following published cautionary principles in...

Purpose: This retrospective analysis of electronic medical record (EMR) data investigated the prescribing patterns of soft myopia control contact lens (MCCL) treatments since their introduction in Ireland in 2017. Methods: Anonymised EMR data were sourced from 33 optometry practices in Ireland from 2017 to 2021 to determine the number of practic...

Significance: This study addresses the lack of choroidal thickness (ChT) profile information available in European children and provides a baseline for further evaluation of longitudinal changes in ChT profiles in myopic children as a potential biomarker for myopia treatment and identifying children at risk of myopic progression. Purpose: This s...

Objective To establish the baseline distribution of refractive errors and associated factors amongst a population that attended primary care optometry clinics. Design Retrospective cross sectional cohort study of electronic medical records (EMR). Methods Electronic medical record data was extracted from forty optometry clinics, representing a mix...

Purpose: To provide contemporary and future estimates of childhood myopia prevalence in Africa. Methods: A systematic online literature search was conducted for articles on childhood (≤18 years) myopia (spherical equivalent [SE] ≤ -0.50D; high myopia: SE ≤ -6.00D) in Africa. Population- or school-based cross-sectional studies published from 1 Ja...

At birth, the patient was noted to have microphthalmia and optic atrophy in her left eye with no apparent cause. In early childhood, the vision in that eye began to deteriorate. A few years later, disc swelling was noted in the contralateral right eye. Neuroimaging was normal and a subsequent lumbar puncture found borderline high opening pressure....

Background: To test the hypothesis that 0.01% atropine eyedrops are a safe and effective myopia-control approach in Australian children. Methods: Children (6-16 years; 49% Europeans, 18% East Asian, 22% South Asian, and 12% other/mixed ancestry) with documented myopia progression were enrolled into this single-centre randomised, parallel, double...

Purpose: Treatments for myopia progression are now available, but implementing these into clinical practice will place a burden on the eye care workforce. This study estimated the full-time equivalent (FTE) workforce required to implement myopia control treatments in the UK and Ireland. Methods: To estimate the number of 6- to 21-year-olds with...

The objective of this paper is to provide an overview of the World Health Organization - International Telecommunication Union MyopiaEd programme - a digital message programme targeting education on myopia and its prevention. The development of the MyopiaEd programme included 4 key steps: (1) Conceptualization and consultation with experts in the f...

Inherited retinal degenerations (IRDs) account for over one third of the underlying causes of blindness in the paediatric population. Patients with IRDs often experience long delays prior to reaching a definitive diagnosis. Children attending a tertiary care paediatric ophthalmology department with phenotypic (i.e., clinical and/or electrophysiolog...

Purpose: Visual acuity assessment is the most commonly performed vision screening method for drivers. The standards and repeat assessment intervals used, however, are arbitrary, lack an evidence base and are highly variable across different countries. This study utilises the power of Big Data to provide evidence-based recommendations for standardi...

Objective To investigate whether spectacle lens sales data can be used to estimate the population distribution of refractive error amongst ametropes and hence estimate the current and future risk of vision impairment. Design Cross Sectional Study Subjects A total 141,547,436 spectacle lens sales records from an international European lens manufac...

To the Editor Chen and colleagues’ article¹ on overminus lens therapy for intermittent exotropia (IXT) raises many questions regarding this condition but has implications for the management of childhood myopia. To our knowledge, this study is also the first randomized clinical trial of the so-called lens-paradigm, where rearing nonmyopic animals wi...

Choroidal thickness (CT) variations are significant contributory mechanisms to the development of chorioretinal pathologies in myopic patients. Baseline CT profiles may provide important information on the longitudinal choroidal changes associated with myopic progression in children. The purpose of this study was to investigate CT profiles in myopi...

Purpose: Rapid urbanisation and lifestyle changes have been associated with a huge increase in myopia across many parts of the world. There is strong evidence that environmental factors including time outdoors and urbanisation can influence the development of myopia, particularly in school-aged children. The aim of this study is to determine wheth...

Myopia has been associated with structural changes such as axial elongation and thinning of the retina and choroid. The relationship between choroidal thickness (CT), axial length (AL) and myopia has been studied in adult populations, yet there is little evidence available in children. Baseline data of 248 myopic children aged 6-16 years and enroll...

Objective: To investigate whether spectacle lens sales data can be used to estimate the population distribution of refractive error amongst ametropes and hence estimate the current and future risk of vision impairment. Design: Cross Sectional Study Subjects: A total 141,547,436 spectacle lens sales records from an international European lens manufa...

Objective The prevalence of myopia is increasing around the world, stimulating interest in methods to slow its progression. The primary justification for slowing myopia progression is to reduce the risk of vision loss through sight-threatening ocular pathology in later life. The paper analyzes whether the potential benefits of slowing myopia progre...

Purpose: The International Myopia Institute (IMI) Yearly Digest highlights new research considered to be of importance since the publication of the first series of IMI white papers. Methods: A literature search was conducted for articles on myopia between 2019 and mid-2020 to inform definitions and classifications, experimental models, genetics,...

Purpose: To examine whether data sourced from electronic medical records (EMR) and a large industrial spectacle lens manufacturing database can estimate refractive error distribution within large populations as an alternative to typical population surveys of refractive error. Subjects: A total of 555,528 patient visits from 28 Irish primary care...

In this paper we propose a convolution estimator for estimating the density of a response variable that employs an underlying multiple regression framework to enhance the accuracy of the estimates through the incorporation of auxiliary information. Suppose we have a sample of $N$ observations of a response variable and an associated set of covariat...

Shortsightedness is caused by the eye growing too long, which results in faraway objects, such as the board in school, appearing blurry. People who are shortsighted wear glasses or contact lenses to see better. But would not it be incredible to figure out and avoid whatever causes shortsightedness, so we could wave goodbye to our never-clean, alway...

The prevalence of myopia is increasing extensively worldwide. The number of people with myopia in 2020 is predicted to be 2.6 billion globally, which is expected to rise up to 4.9 billion by 2050, unless preventive actions and interventions are taken. The number of individuals with high myopia is also increasing substantially and pathological myopi...

Myopia is caused by an eye which has grown too long. The prevalence of myopia has increased drastically in recent years and half of the world's population is expected to be myopic by 2050.(Reference Holden, Fricke and Wilson1) Consequently, a significant increase in sight threatening diseases will follow.(Reference Holden, Fricke and Wilson1) Myopi...

Purpose: To examine the hypothesis that the spatial frequency spectra of urban and indoor environments differ from the natural environment in ways that may promote the development of myopia. Methods: A total of 814 images were analyzed from three datasets; University of California Berkeley (UCB), University of Texas (UT), and Botswana (UPenn). I...

Background/Aims Both eyes of one individual share the same environment and genes. We examined interocular differences in biometry to determine the potential role of other factors in refractive development. Methods 362 subjects (6–7 years) from the Northern Ireland Childhood Errors of Refraction study were studied. Cycloplegic autorefraction was me...

Purpose of the study Macular pigment (MP), comprising the dietary carotenoids lutein, zeaxanthin and meso-zeaxanthin, is believed to benefit eye health and vision. Numerous clinical and research devices and techniques are currently available to facilitate MP optical density (MPOD) measurement. One of those techniques, dual-wavelength fundus autoflu...

Myopia is one of the leading causes of preventable blindness in the world. Its prevalence has risen drastically over recent decades, and it is estimated that close to half the world population will be myopic by 2050.The rise in myopia is lifestyle related. Myopia occurs as a consequence of excessive eye growth, which may be related to general growt...

Clinical relevance This study demonstrates an association between myopia and smartphone data usage. Youths now spend more time participating in near tasks as a result of smartphone usage. This poses an additional risk factor for myopia development/progression and is an important research question in relation to potential myopia management strategie...

Background: With the increasing prevalence of myopia there is growing interest in active myopia control. However, the majority of progressive myopes are still prescribed single vision spectacles. This prospective study aims to elucidate the knowledge and attitudes of optometrists toward myopia control, and thereby identify perceived barriers to the...

Clinical significance Nutritional status influences growth and development, including that of the eye. However, little attention has been given to possible dietary influences in myopia. This study demonstrates that serum zinc has no relationship with myopia development. Background Myopia is inherently associated with eye growth and thereby possibl...

Importance: Atropine eyedrops are a promising treatment for slowing myopia progression in East Asian children. However, its effects on children in Australia, including those of non-Asian background, have not been well-studied. Background: The Western Australia Atropine for the Treatment of Myopia (WA-ATOM) study aims to determine the efficacy an...

Background: With the increasing prevalence of myopia there is growing interest in active myopia control. However, the majority of progressive myopes are still prescribed single vision spectacles. This prospective study aims to elucidate the knowledge and attitudes of optometrists toward myopia control, and thereby identify perceived barriers to the...

Background/aims To report the protocol of a trial designed to evaluate the efficacy, safety and mechanism of action of low-dose atropine (0.01%) eye-drops for reducing progression of myopia in UK children. Methods Multicentre, double-masked, superiority, placebo-controlled, randomised trial. We will enrol children aged 6–12 years with myopia of −0...

Background: The Myopia Outcome Study of Atropine in Children (MOSAIC) aims to explore the efficacy, safety, acceptability and mechanisms of action of 0.01% unpreserved atropine for myopia control in a European population. Methods: MOSAIC is an investigator-led, double-masked, placebo-controlled, randomised clinical trial (RCT) investigating the eff...

Significance: This present study advances our knowledge on the role of lifestyle factors in myopia (short-sightedness), specifically dietary factors. It has been suggested in previous studies that lower zinc status is associated with myopia; however, this article shows no relationship between dietary zinc intake and myopia in U.S. adolescents. Pu...

The Relationship between Serum Zinc Levels and Myopia (short-sightedness) in Korean Adolescents - Volume 78 Issue OCE2 - Niamh Burke, John S Butler, Ian Flitcroft, James Loughman

Background: The Myopia Outcome Study of Atropine in Children (MOSAIC) aims to explore the efficacy, safety, acceptability and mechanisms of action of 0.01% unpreserved atropine for myopia control in a European population. Methods: MOSAIC is an investigator-led, double-masked, placebo-controlled, randomised clinical trial (RCT) investigating the eff...

Background: Studies suggest that lutein and zeaxanthin may be important for cognitive development in children, but a comprehensive evidence synthesis is lacking. The purpose of this evidence synthesis was to analyse the available data regarding the role of lutein and zeaxanthin for cognition in children and propose a theoretical basis for future st...

Background Myopia is becoming increasingly prevalent throughout the world. It is an overlooked but leading cause of blindness, particularly among the working aged population. Myopia is often considered benign because it is easily corrected with glasses, contact lenses or refractive surgery. Traditionally myopia has been classified into physiologica...

With the growing prevalence of myopia, already at epidemic levels in some countries, there is an urgent need for new management approaches. However, with the increasing number of research publications on the topic of myopia control, there is also a clear necessity for agreement and guidance on key issues, including on how myopia should be defined a...

Purpose: We provide a standardized set of terminology, definitions, and thresholds of myopia and its main ocular complications. Methods: Critical review of current terminology and choice of myopia thresholds was done to ensure that the proposed standards are appropriate for clinical research purposes, relevant to the underlying biology of myopia...

Purpose: To systematically compare the efficacy, predictability, safety, postoperative haze, pain scores, and epithelial healing time of four corneal surface ablation procedures. Methods: PubMed, Embase, Cochrane Library, and the U.S. trial registry were searched up to June 2018. Randomized controlled trials were selected. Efficacy (uncorrected...

Purpose With the increasing prevalence in myopia there is growing interest in active myopia prevention. This study aims to increase our understanding of parental attitudes to myopia development and control, as a means to inform future health planning and policy. It evaluates, for the first time, the attitude of parents to myopia and its associated...

Purpose: To test the hypothesis that genes known to cause clinical syndromes featuring myopia also harbor polymorphisms contributing to nonsyndromic refractive errors. Methods: Clinical phenotypes and syndromes that have refractive errors as a recognized feature were identified using the Online Mendelian Inheritance in Man (OMIM) database. One h...

Purpose Foveal aplasia, or hypoplasia, refers to the lack of foveal depression with continuity of all neurosensory layers in the presumed location of the fovea. Whilst it is has been reported in cases of aniridia, albinism, microphthalmia and achromatopsia, foveal hypoplasia as an isolated entity is a rare phenomenon. We describe the presentation o...

Paraneoplastic retinopathy is a rare cause of painless vision loss, associated with an underlying (and often occult) systemic malignancy. Ocular examination findings are subtle, and the diagnosis is often made on the basis of electrophysiology findings. This report describes the case of a 48-year-old Caucasian man with paraneoplastic retinopathy pr...

Background: Myopia is a condition of enormous public health concern, affecting up to 2.5 billion people worldwide. The most effective treatment to prevent myopia progression is atropine but at the cost of accommodative paresis and mydriasis, necessitating the use of bifocal glasses. Low-dose atropine (0.01%) has been found to be almost as effectiv...

Purpose: To determine the effectiveness of different interventions to slow down the progression of myopia in children. Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov from inception to August 2014. We selected r...

Purpose To examine factors necessitating pupil dilation to achieve gradable diabetic screening photographs using a digital non-mydriatic camera and to establish techniques to predict the need for dilation and to validate them. Methods Prospective clinic-based cross-sectional study with follow-up validation study. The participants' involved consecut...

Two siblings, an 11-year-old boy and a 7-year-old girl presented with bilateral symmetrical ptosis and limited eye movements. Having already been reviewed on a number of occasions by a variety of specialists in multiple hospital settings a diagnosis of their ocular motility disorder had remained elusive. We describe their cases, outline the differe...

The discloses method and apparatus (“system”) enables users to: generate a map of computer servers visited while browsing, calculate the total distance travelled on the web, earn “Goosemiles” or travel points for the distance surfed on the web, earn bonus points for being the first member to access a specific site or web-page, leave an electronic f...

The distribution of human refractive errors displays features that are not commonly seen in other biological variables. Compared with the more typical Gaussian distribution, adult refraction within a population typically has a negative skew and increased kurtosis (ie is leptokurtotic). This distribution arises from two apparently conflicting tenden...

Controlled Payment Numbers (CPNs) which issue as a unique payment number for each transaction uniquely identify the transaction for matching the purchase and payment information. The issuance of the CPN is controlled by business rules which are designed to and effectively restrict the use of the CPN, such that if a user exceeds his authorization, a...

In the following point-counterpoint article, internationally-acclaimed myopia researchers were challenged to defend the two opposing sides of the topic defined by the title; their contributions, which appear in the order, Point followed by Counterpoint, were peer-reviewed by both the editorial team and an external reviewer. Independently of the inv...

To validate a novel ultrasonic sensor for logging reading distances. In addition, this device was used to compare the habitual reading distances between low and high myopes. First, the stability and sensitivity of the ultrasonic device were determined by repeated measures using artificial targets. Then, thirty Hong Kong Chinese (20-30 years) were r...

Heavy eye phenomenon can be cosmetically unaccepted due to significant pseudoproptosis and hypotropia. We highlight the salient features of this condition, and report successful cosmetic outcome following a staged procedure comprising orbital decompression and horizontal recti surgery.

To examine factors necessitating pupil dilation to achieve gradable diabetic screening photographs using a digital non-mydriatic camera and to establish techniques to predict the need for dilation and to validate them. Prospective clinic-based cross-sectional study with follow-up validation study. The participants' involved consecutive patients att...

Destruction and degeneration of preganglionic or postganglionic autonomic axons is followed by greatly increased sensitivity of the denervated autonomic effectors to their specific neurotransmitters and to pharmacological agonists.1 Because of this principle of denervation sensitivity, Horner syndrome produced by a lesion interrupting the postgangl...

The Pulfrich effect (named after Carl Pulfrich) is a well described visual stereoillusion observed when a swinging pendulum bob is viewed through a neutral density filter in front of one eye. The Pulfrich effect can be demonstrated spontaneously (ie, without a neutral density filter) in patients with multiple sclerosis because of the delayed optic...

The authors applied partial coherence interferometry (PCI) to estimate the thickness of the human choroid in vivo and to learn whether it fluctuates during the day. By applying signal processing techniques to existing PCI tracings of human ocular axial length measurements, a signal modeling algorithm was developed and validated to determine the pos...

Damage to the nerve fiber layer or visual pathway might be expected to reduce the efficiency with which the visual system performs analysis of the ever-changing field of vision. The purpose of this article is to provide a further analysis of previously reported data (Loughman J, Davison P, Flitcroft I, Br J Ophthalmol 2007;91:1493-98.) to: (i) dete...

Background The evidenceBifocal glassesMultifocal/progressive spectacle lensesPrisms with bifocalsContact lenses: conventional and orthokeratologySummary of optical interventionsPharmacological interventionsBetablockersImplications for practiceImplications for researchReferences

Preattentive visual search (PAVS) describes rapid and efficient retinal and neural processing capable of immediate target detection in the visual field. Damage to the nerve fibre layer or visual pathway might reduce the efficiency with which the visual system performs such analysis. The purpose of this study was to test the hypothesis that patients...

The Pulfrich effect (named after Carl Pulfrich) is a well described visual stereoillusion observed when a swinging pendulum bob is viewed through a neutral density filter in front of one eye.1 Although the bob is moving in a frontal plane, the path seems elliptical. The effect arises from the fact that dimming a stimulus with a neutral density filt...

To evaluate the relation between refractive error and electrophysiological retinal abnormalities in children referred for investigation of reduced vision. The study group comprised 123 consecutive patients referred over a 14 month period from the paediatric service of Moorfields Eye Hospital for electrophysiological investigation of reduced vision....

To learn if eye shape might be a useful parameter in refractive research. Laboratory research on eye growth mechanisms is summarised. The available clinical literature relating refraction to eye shape and peripheral refraction is critically assessed in the context of the laboratory research on refractive development. Almost all refraction research...